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NBME 21 Answers

nbme21/Block 4/Question#14 (58.1 difficulty score)
A 25-year-old woman has a 3-week history of ...
Autoantibodies against platelet glycoproteins🔍,📺

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submitted by cellgamesgojan(41),
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hTe nttpiae ereusdff orfm emmInu pToocoy.ainehrmbt beuitoansdotia giansat het isnreolgtcypo G/A2.3PB

On labs, ’luloy ee:s rnaisece in sat;cyegmkeayor on the esoiqtun semt hrt’eye dsrdieebc as rae“r utb r”lea.g ragykyeMacseot ear nto re.usppedss

ergogenic22  isolated thrombocytopenia (low platelets) should be highly suggestive of ITP +2  
pg32  I agree that in ITP you will see an increase in megakaryocytes, but where did you see that in the stem? Platelets being, "rare but large" doesn't mean megakaryocytes, does it? Also... can anyone explain why she was anxious but alert and had petechiae distal to the blood pressure cuff? +  
meryen13  @pg32, I'm not too sure about the "anxious but alert" but I think they might wanted to mention she is oriented so in case there was no lab values, you would guess that she is not extremely anemic or something. and about the petechia with the cuff and the tooth brushing bleeds, that is a sign of platelet problems because its a superficial bleed. if you saw deep bleeds like joint bleedings, think about coagulation pathway problems (like hemophilia) +2  
zevvyt  "rare" means thrombocytopenia. "Large" means there are megakaryocytes to make up for the thrombocytopenia +2  
lovebug  FA2019, page419 +1  

submitted by krazyglue5(6),
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She hsa imeuPT/nmI cp,nttbroyooheiam so hse sha ntoistoeubidaa natsiag rhe es,elptlat lcflcpeiisay IaI/.IPGbII hSe ahs eht agrel mtaesrkgaecyyo ucbeeas ehr bnoe aworrm si gynitr ot ncruh otu lttslepea. ’Sshe a woman fo bge-arclinhdi eag wthi aidsnecer lgnedieb etmi btu no oerth ruoeiglocn riltnasnoale/bmeair fis/veeue,srs so tnkhi T.IP

submitted by sahusema(153),
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I tgo dekictr noti inckpgi het eqci"udra sdebtinaio aintsga "P11.A Hmuna elapltet gA letatepl enagtin Pa1,1- tloaecd on eigitnrn ,3β is eth aimn ategrt ofr pbessroneil rfo leantaon /p/satytochmthiotbron:.pewne1m/l.5tu9ro/2i7j151/tgm/wcwnoo4n.

cienfuegos  Same, except in my case I was the person who was tricked and who did the tricking though. Thx for the link. +1  

submitted by amy(1),

I got stuck on the no organomegaly...I had thought that immune thrombocytopenia would have splenomegaly since it is the destruction of platelet in the spleen, like many extravascular anemias that present with splenomegaly due to the overworking of this organ. But I learned my lesson, splenomegaly would NOT be present when destructing platelet.

submitted by yotsubato(1088),
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Seh sah renaBrd lioeurS ieDasse apge 914 of stfri adi 2091

sympathetikey  That's a genetic deficiency of GP1b -- not antibody related +10  
alexandramda  In Berard Soulierd you have a Defect in adhesion. decreases GpIb and decreased platelet-to-vWF adhesion. Labs: abnormal ristocetin test, large platelets. +1