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NBME Answers

free120/Block 1/Question#32 (20.4 difficulty score)
A 20-year-old woman comes to the physician ...
von Willebrand disease🔍

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shiT si a dab otsi.quen lealtePt nioaggeargt teim gnbei namlor, ok nefi I anc ees t.tah uBt FVW lbszseiita fatcor 8 adn o'dyu ees an snercaie in TPT is(tfr ilen tnex ot WVF ni tsrFi .iA)d yWh is itehr TTP ?lomrna

a1_antitrypsin  Totally agree, and they give you a slight increase in PT instead +  
mambaforstep  yeah but if they gave you an increase in PTT then Hemophilia A could have been a valid answer choice. so they prob showed a nl PTT to differentiate vWF dz from hemophlia A +  
drpee  VWD only sometimes presents with a slightly increased PTT. Don't let those anki facts steer you wrong... Plus all the other answers make no sense. Afibrinogenemia? That means literally no fibrinogin (PT and PTT would be infinitely increased). Hemophelia? Or vitamin K deficiency? Those are coagulation factor disorders so they would present with deep bleeding and large bruising. (Unlike platelet disorders, including VWD, which present with mucosal bleeding, petechiae, and heavy menses). VWD is actually the ONLY one that makes sense. +  

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vno naldelbiWr eiasesd is yb arf the tosm mmonoc ederthiin lngieebd ha.dstsiie Fultneyreq, eth oyln aartyorbol noltmabryai is scneirdea inbleged temi ye(lillatr ouy rickp eht ttpiean dan ees hwo ongl ti kaets mhet ot sopt g) nO t,peS ediglenb nmweo ahve .VWD gBdeelni osby have oil.emphaih

winelover777  Agree. PTT does not have to be elevated to be VWD. +3  
tulsigabbard  Welp. +  

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yhw is teh alletetp eoigtaanrgg tste si lnomar in ?VDW ym premolb is atht b1Gp nad WftcVoar heva to aenitcrt ot duenic a onoairinfcamlt ahgecn ni tselapetl to reseeal PAD ;–tg& DPA sidbn ot aorpectp-der dan euidncs G2ap/b3 which salneeb nieoggtgara iav irbofengni. whchi udlow elad to alarbmno rae?gngigoat adn is eth cntorsteii ssaya nto a lapleett aotegrinagg ?tste or anc ti eotseismm eb nalrmo nad smsomteei ?not

benwhite_dotcom  It can be abnormal as well, depends on the subtype and severity (the wikipedia page does a decent job explaining). The most common subtype of VWD is a quantitative defect, which is often mild/nearly clinically occult and can have essentially normal laboratory testing. This is one of those questions where the labs are really there to exclude the other choices. +3