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NBME 21 Answers

nbme21/Block 4/Question#14 (48.5 difficulty score)
A 25-year-old woman has a 3-week history of ...
Autoantibodies against platelet glycoproteins🔍
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ergogenic22  isolated thrombocytopenia (low platelets) should be highly suggestive of ITP https://www.aafp.org/afp/2012/0315/p612.html +2  
pg32  I agree that in ITP you will see an increase in megakaryocytes, but where did you see that in the stem? Platelets being, "rare but large" doesn't mean megakaryocytes, does it? Also... can anyone explain why she was anxious but alert and had petechiae distal to the blood pressure cuff? +  
meryen13  @pg32, I'm not too sure about the "anxious but alert" but I think they might wanted to mention she is oriented so in case there was no lab values, you would guess that she is not extremely anemic or something. and about the petechia with the cuff and the tooth brushing bleeds, that is a sign of platelet problems because its a superficial bleed. if you saw deep bleeds like joint bleedings, think about coagulation pathway problems (like hemophilia) +1  
zevvyt  "rare" means thrombocytopenia. "Large" means there are megakaryocytes to make up for the thrombocytopenia +  



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 +3  upvote downvote
submitted by sahusema(118),
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cienfuegos  Same, except in my case I was the person who was tricked and who did the tricking though. Thx for the link. +  



 -14  upvote downvote
submitted by yotsubato(806),
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sympathetikey  That's a genetic deficiency of GP1b -- not antibody related +4  
alexandramda  In Berard Soulierd you have a Defect in adhesion. decreases GpIb and decreased platelet-to-vWF adhesion. Labs: abnormal ristocetin test, large platelets. +