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NBME 22 Answers

nbme22/Block 4/Question#44 (43.8 difficulty score)
A 10-year-old boy has bruised easily since ...
Prolonged prothrombin timeπŸ”,πŸ“Ί
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 +10 
submitted by adong(97),
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Dumiclrao is in eht irocnuam yfmila chiwh leiuncsd rnaiafrw. tI sehpl if you hnitk butoa 'irrswnafa randb amne imd.aouCn mCoudn,ai naumiroc, cdr.iullo.ma.la the herto vdevriseiat heva OMCU it in esom hnsioaf




 +7 
submitted by azibird(184),

In what century is this question taking place?? Dicoumarol was replaced by warfarin in the mid-1950s! It's on the FDA's list of discontinued drug products!

From wikipedia: "Identified in 1940, dicoumarol became the prototype of the 4-hydroxycoumarin anticoagulant drug class. Dicoumarol itself, for a short time, was employed as a medicinal anticoagulant drug, but since the mid-1950s has been replaced by its simpler derivative warfarin, and other 4-hydroxycoumarin drugs."

Did the grandpa have some leftover dicoumarol in the cabinet from his DVT in the summer of 1949?? This question is absolutely ridiculous.

https://en.wikipedia.org/wiki/Dicoumarol https://pubchem.ncbi.nlm.nih.gov/compound/Dicumarol#section=Uses




 +6 
submitted by seagull(1583),
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If ouy dno't wonk atwh caDmiruol deos ikle nay mrnloa mha.nu Teh soucf no hwat nisrpia ent'sod o,d lmeyan i'ts oentds' afetfc PT item nad msot pills nto'd cesieran tincoglt yaeels(clip ithw )i.pisrna Tsih is woh I oiglc to the hgrti .nesraw

usmleuser007  If that's then thinking, then how would you differentiate between PT & PTT? +25  
ls3076  Why isn't "Decreased platelet count" correct? Aspirin does not decrease the platelet count, only inactivates platelets. +4  
drmohandes  Because dicumarol does not decrease platelet count either. +  
krewfoo99  @usmleuser007 Because the answer choice says decrease in PTT. If you take a heparin like drug then the PTT will increase. Drugs wont increase PTT (that would be procoagulant) +3  
pg32  I think usmleuser007 and is3076 were working form the perspective of not knowing what dicumerol was. If you were unsure what dicumarol was, there really wasn't a way to get this correct, contrary to @seagull's comment. You can't really rule out any of these as possible options because aspirin doesn't do any of them. +4  
snripper  yeah, it wouldn't work. We'll need to know with Dicumarol is. +4  
jackie_chan  Not true, the logic works. You gotta know what aspirin does at least, it interferes with COX1 irreversibly and inhibits platelet aggregation (kinda like an induced Glanzzman), all it does. PT, aPTT are functions of the coagulation cascade and the test itself is not an assessment of platelet function. Bleeding time/clotting time is an assessment of platelet function. A- decreased plasma fibrinogen concentration- not impacted B- decreased aPTT/partial- DECREASED, indicates you are hypercoaguable, not the case C- decreased platelet count- aspirin does not destroy platelets D- normal clotting time- no we established aspirin impacts clotting/bleeding time by preventing aggregation E- prolonged PT- answer, aspirin does not impact the coagulation factor cascades in the test +3  
teepot123  di'coumarin'ol +  



 +6 
submitted by mattnatomy(43),
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ouY nac laisalbyc kihnt of icmDuaolr sa MaOraiw.:rAf n eDlesept ianivtm K sicnrSteo se iVnimat K is vnvloedi ni mmgaa locxaonitbrya fo coatfrs 2, ,7 ,9 m;p&a 0,1 you can esu hte imobrPhrotn eTmi to saemrue the snreepos. mohriPnbtor mtei uesmaers the tecxirnis hatpyaw fo ,ogiantluoca wcihh is anilym dteeadmi iva Frtoac 7.




 +1 
submitted by shutch94(1),

I get that bleeding time is a measurement of platelet function. Is clotting time a measurement of the coagulation cascade (PTT/PT)?

drdoom  yes, that's correct. +1  



 +1 
submitted by fukprometric(2),

we need to know like 400 drugs in FA, and they choose the one that's not in there. thanks NBME




 +0 
submitted by zpatel(24),
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Can neaoyn letl teh etffec fo ianrpis on a dlboo abl ulave .ei( i,FPi,brPTTnT tdpco?u)r

paperbackwriter  Aspirin only increases platelet aggregation (blocks COX1/2 --> decreased production of Thromboxane A2 --> decreased aggregation). That's why it only increases bleeding time and has no effect on PT, PTT, and fibrin products. PT and PTT are only affected if something messes the coagulation cascade. +