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NBME 23 Answers

nbme23/Block 3/Question#17

A 24-year-old woman comes to the physician because ...

Accessory spleen

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submitted by yogi(9),

ITP - Platelet + Ab goes to spleen - Lysed - Low plt count.After splenectomy - usually plt count improve and Peripheral blood smear show - HJ bodies as a sign of asplenia ( nuclear remnants in RBC usually removed by spleen). If there was an accessory spleen (which was not functional when the main spleen was working) will take over the function gradually - HJ bodies will disappear and Plt starts to lyse - which has happened in this case scenario.

sympathetikey  Makes total sense looking back. Just didn't know that was a thing :) +3  
sugaplum  Fun fact: Meredith from Grey's anatomy got her idea for Mini livers from a patient who presented with an accessory spleen.... and who said watching TV doesn't count as studying +7