NBME 22 Answers : Block 1 : #47 = A 25-year-old woman comes to the physician ...

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NBME 22 Answers ↦

nbme22/Block 1/Question#47 (23.7 difficulty score)
A 25-year-old woman comes to the physician ...
Immune thrombocytopenic purpura🔍
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+2 upvote downvote
submitted by dr.xx(125),

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eTh lahrmlka of IPT si doaliest natrmi.pyhootecbo

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jboud86 Refer to page 419 in FA2019. +1

hello @dr.xx Compared to what? +

+2 upvote downvote
submitted by drmohandes(72),

DIC, unlikely: PT/PTT normal; wouldn't just see gum bleeding
hypersplenism: would cause anemia
iron deficiency: anemia
vitamin C deficiency: wouldn't cause thrombocytopenia
von Willebrand disease: mixed platelet/coagulation disorder → would cause deep joint bleeding instead of mucosal membrane bleeding. Inherited (Autosomal Dominant), would see symptoms before. PTT can be normal/high.

beto Bleeding symptoms in von Willebrand disease tend to occur in mucous membranes. deep joint bleeding is rare +1

castlblack New onset bleeding? Immediately rule out vWD! +

waterloo Vit C def I thought was super tricky. My knee jerk reaction was oh easy bruising, bleeding from gums that's what it has to be. But yeah, I think low platelet is key here. +

nafilnaf Platelet count would be normal in vWD because there's nothing wrong with the platelets themselves. +

-3 upvote downvote
submitted by makinallkindzofgainz(175),

Pentad of TTP = FAT RN

Fever
Anemia (MAHA)
Thrombocytopenia
Renal failure
Neurologic symptoms

This is TTP not ITP

makinallkindzofgainz I seem to have commented on the wrong question, sorry! I wish I was able to delete my comment, but I can't. +3