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Question streamHealthcare & Medical ExamsMedical Licensing

USMLE (United States Medical Licensing Examination): Step 1: Basic Sciences Assessment practice questions

Practice exams for USMLE (United States Medical Licensing Examination): Step 1: Basic sciences assessment.

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Question 1 of 2041

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Multisystem Processes & Disorders

A 41-year-old man presents to the emergency department with fever, diffuse muscle pain, and dark urine for 1 day. Two days ago, he began taking trimethoprim-sulfamethoxazole for a skin infection. He has a history of "anemia after certain medicines" but does not recall details. Temperature is 38.9 C (102.0 F), blood pressure is 124/76 mm Hg, pulse is 112/min. Physical examination shows scleral icterus. Laboratory studies show:

Hemoglobin: 7.9 g/dL (reference: 13.5-17.5 g/dL) Reticulocyte count: 6.5% (reference: 0.5-2.5%) Total bilirubin: 4.2 mg/dL (reference: 0.2-1.2 mg/dL) LDH: increased Haptoglobin: decreased Direct antiglobulin (Coombs) test: negative

A peripheral blood smear shows red blood cells with semicircular defects along the membrane. Which of the following is the most likely underlying biochemical abnormality in this patient?

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