NBME 20 Atrophy of dermal collagen (NBME Answers)

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NBME 20 Answers

nbme20/Block 3/Question#49 (reveal difficulty score)
A 92-year-old woman who was recently admitted ...
Atrophy of dermal collagen 🔍 / 📺 / 🌳 / 📖
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+24 upvote downvote
submitted by ∗medbitch94(56)

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Actinic purpura results from extravasation of blood into the dermis. This phenomenon is due to the skin atrophy and the fragility of the blood vessels in elderly individuals, which is exacerbated by chronic sun exposure. Actinic purpura lesions are located on sun-exposed areas, like the arms, face, and neck.

Skin atrophy in dermatoporosis is due to an alteration of collagen, similar to that which is seen in osteoporosis. This pronounced skin atrophy caused by the photo-aging makes the dermal vascular network very sensitive to the slightest trauma or shearing force.

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md_caffeiner Google actinic purpura, look through 5-10 images, and you get the idea. +12

athenathefirst How can you rule out answer choice (C) autoimmune disease? +

drbravojose maybe plt is normal +

+4 upvote downvote
submitted by ∗medbitch94(56)

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Full article: https://www.ncbi.nlm.nih.gov/books/NBK448130/

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+1 upvote downvote
submitted by vivarin(12)

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in hereditary hemorrhagic telangiectasia would you have normal or low platelets?

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andro You would have normal platelets : It is a a problem with the structure of the vessels that leads to the sequela ( vasculopathy) +2

sandysandy HHT findings = recurrent epistaxis, skin discoloration, AV malformations, GI bleeding, bloody stool, hematuria +

+1 upvote downvote
submitted by ∗rockodude(39)

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why couldn't this be platelet dysfunction, option E, like a qualitative platelet disorder even though the quanitative amount of platelets are normal

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kevin She's in her 90s, she would've likely presented with a platelet disorder decades ago. Given the vignette a normal aging process was most likely +3

abhishek021196 But the stem says that she's had similar lesions on and off for years. So why can't it be Platelet Dysfunction (Qualitative)? +2

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