Anemia: Clinical (To be retired)


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Anemia: Clinical (To be retired)

Medicine and surgery

Allergy and immunology

Antihistamines for allergies


Cardiology, cardiac surgery and vascular surgery

Coronary artery disease: Clinical (To be retired)

Heart failure: Clinical (To be retired)

Syncope: Clinical (To be retired)

Hypertension: Clinical (To be retired)

Hypercholesterolemia: Clinical (To be retired)

Peripheral vascular disease: Clinical (To be retired)

Leg ulcers: Clinical (To be retired)

Adrenergic antagonists: Alpha blockers

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

Thiazide and thiazide-like diuretics

Calcium channel blockers

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Antiplatelet medications

Dermatology and plastic surgery

Hypersensitivity skin reactions: Clinical (To be retired)

Eczematous rashes: Clinical (To be retired)

Papulosquamous skin disorders: Clinical (To be retired)

Alopecia: Clinical (To be retired)

Hypopigmentation skin disorders: Clinical (To be retired)

Benign hyperpigmented skin lesions: Clinical (To be retired)

Skin cancer: Clinical (To be retired)

Endocrinology and ENT (Otolaryngology)

Diabetes mellitus: Clinical (To be retired)

Hyperthyroidism: Clinical (To be retired)

Hypothyroidism and thyroiditis: Clinical (To be retired)

Dizziness and vertigo: Clinical (To be retired)

Hyperthyroidism medications

Hypothyroidism medications


Hypoglycemics: Insulin secretagogues

Miscellaneous hypoglycemics

Gastroenterology and general surgery

Gastroesophageal reflux disease (GERD): Clinical (To be retired)

Peptic ulcers and stomach cancer: Clinical (To be retired)

Diarrhea: Clinical (To be retired)

Malabsorption: Clinical (To be retired)

Colorectal cancer: Clinical (To be retired)

Diverticular disease: Clinical (To be retired)

Anal conditions: Clinical (To be retired)

Cirrhosis: Clinical (To be retired)

Breast cancer: Clinical (To be retired)

Laxatives and cathartics


Acid reducing medications

Hematology and oncology

Anemia: Clinical (To be retired)

Anticoagulants: Warfarin

Anticoagulants: Direct factor inhibitors

Antiplatelet medications

Infectious diseases

Pneumonia: Clinical (To be retired)

Urinary tract infections: Clinical (To be retired)

Skin and soft tissue infections: Clinical (To be retired)

Protein synthesis inhibitors: Aminoglycosides

Antimetabolites: Sulfonamides and trimethoprim

Miscellaneous cell wall synthesis inhibitors

Protein synthesis inhibitors: Tetracyclines

Cell wall synthesis inhibitors: Penicillins

Miscellaneous protein synthesis inhibitors

Cell wall synthesis inhibitors: Cephalosporins

DNA synthesis inhibitors: Metronidazole

DNA synthesis inhibitors: Fluoroquinolones

Herpesvirus medications



Miscellaneous antifungal medications

Anti-mite and louse medications

Nephrology and urology

Chronic kidney disease: Clinical (To be retired)

Kidney stones: Clinical (To be retired)

Urinary incontinence: Pathology review

ACE inhibitors, ARBs and direct renin inhibitors

PDE5 inhibitors

Adrenergic antagonists: Alpha blockers

Neurology and neurosurgery

Stroke: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Headaches: Clinical (To be retired)

Migraine medications

Pulmonology and thoracic surgery

Asthma: Clinical (To be retired)

Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)

Lung cancer: Clinical (To be retired)

Antihistamines for allergies

Bronchodilators: Beta 2-agonists and muscarinic antagonists

Bronchodilators: Leukotriene antagonists and methylxanthines

Pulmonary corticosteroids and mast cell inhibitors

Rheumatology and orthopedic surgery

Joint pain: Clinical (To be retired)

Rheumatoid arthritis: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Anatomy clinical correlates: Clavicle and shoulder

Anatomy clinical correlates: Arm, elbow and forearm

Anatomy clinical correlates: Wrist and hand

Anatomy clinical correlates: Median, ulnar and radial nerves

Anatomy clinical correlates: Bones, joints and muscles of the back

Anatomy clinical correlates: Hip, gluteal region and thigh

Anatomy clinical correlates: Knee

Anatomy clinical correlates: Leg and ankle

Anatomy clinical correlates: Foot

Acetaminophen (Paracetamol)

Non-steroidal anti-inflammatory drugs


Opioid agonists, mixed agonist-antagonists and partial agonists

Antigout medications

Non-biologic disease modifying anti-rheumatic drugs (DMARDs)

Osteoporosis medications


Anemia: Clinical (To be retired)

USMLE® Step 2 questions

0 / 37 complete


USMLE® Step 2 style questions USMLE

of complete

A 55-year-old woman comes to the clinic with generalized fatigue, unsteady gait, and numbness in her lower limbs for the past 2 months. She states that she often experiences a “tingling” sensation in her legs and feet. Her other medical conditions include hypertension and hypercholesterolemia, which are managed with hydrochlorothiazide and atorvastatin, respectively. She had a gastric bypass surgery one year ago. Temperature is 37.0°C (98.6°F), pulse is 96/min, respirations are 18/min, and blood pressure is 136/95 mmHg. She is oriented to time, place and person but is slow to respond to questions. Motor strength is 4/5 in bilateral lower limbs, and deep tendon reflexes are diminished at the ankles. Sensory loss is noted in the bilateral feet with diminished perception to touch and vibration. The patient’s gait is ataxic. Romberg test is positive. Bilateral plantar reflexes are upgoing. Complete blood count reveals a hemoglobin of 10 g/dL. Peripheral smear is shown below:

Reproduced from Wikipedia

Which of the following is the next best step in evaluation?


Content Reviewers

Rishi Desai, MD, MPH


Antonella Melani, MD

Tanner Marshall, MS

Anemia is a blood disorder where the body doesn’t have enough healthy red blood cells or hemoglobin, resulting in poorly oxygenated tissues throughout the body. This condition takes many forms, ranging from mild to severe depending on the cause.

Anemia in males is a hemoglobin below 13.5 g/dL or a hematocrit less than 41%, and in females it’s a hemoglobin below 12.0 g/dL or a hematocrit less than 36%, but those numbers can differ based on which guidelines you’re using. Also, people with chronic respiratory diseases like emphysema or medical problems like malnutrition may have symptoms of anemia even at normal levels of hemoglobin and hematocrit. In addition, those living at altitude can have high levels of hemoglobin and hematocrit to help deal with the lower oxygen levels. So it’s good to keep in mind that these guidelines aren’t appropriate for everyone. Now, the most common signs and symptoms of anemia are dyspnea with exertion and at rest, fatigue, pallor, and a hyperdynamic state like bounding pulses and palpitations.

If someone is anemic, the first thing to look at is the mean corpuscular volume or MCV. An MCV of less than 80 femtoliters is low, so microcytic, between 80 and 100 femtoliters is normal, so normocytic, and above 100 femtoliters is high, so macrocytic. Of course, some individuals might have a few types or causes of anemia mixed together, and that’s where things get more complicated. Most microcytic and macrocytic anemias are caused by a problem in producing either red blood cells or hemoglobin, and in those situations we can measure the reticulocyte production index (RPI) or corrected reticulocyte count (CRC). This number is the percentage of red blood cells that are reticulocytes, or immature, and is normally between 0.5 and 2.5%. A person with anemia and less than 2% RPI means that their body is not capable of producing enough red blood cells. In certain normocytic anemias that are caused by the loss or destruction of red blood cells, the RPI is above 2% because the body increases red blood cell production to replace the ones that were lost.


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