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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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submitted by dr.xx(125),
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eTh lahrmlka of IPT si doaliest natrmi.pyhootecbo


jboud86  Refer to page 419 in FA2019. +1  
hello  @dr.xx Compared to what? +  

  • 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. +  

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