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NBME 22 Answers

nbme22/Block 1/Question#42 (23.2 difficulty score)
An 18-year-old woman develops sepsis after an ...
Decreased plasma fibrinogen concentrationπŸ”
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 +4 
submitted by dr.xx(143),
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 +2 
submitted by syoung07(21),

Anytime I see a post-partum chica bleeding from an IV site i think DIC. You would see dec fibrinogen bc DIC is essentially this super hypercoaguable state that uses up all the factors for coagulation. Once you've used up all the coag factors ya start to bleed like a stuck pig ya feel me? In case you forgot, fibrinogen connects platelet-platelet during primary hemostasis.




 +1 
submitted by abhishek021196(50),

Disseminated intravascular coagulation (DIC) involves abnormal, excessive generation of thrombin and fibrin in the circulating blood. During the process, increased platelet aggregation and coagulation factor consumption occur. DIC that evolves slowly (over weeks or months) causes primarily venous thrombotic and embolic manifestations; DIC that evolves rapidly (over hours or days) causes primarily bleeding. Severe, rapidly evolving DIC is diagnosed by demonstrating thrombocytopenia, an elevated partial thromboplastin time and prothrombin time, increased levels of plasma D-dimers (or serum fibrin degradation products), and a decreasing plasma fibrinogen level. Treatment includes correction of the cause and replacement of platelets, coagulation factors (in fresh frozen plasma), and fibrinogen (in cryoprecipitate) to control severe bleeding. Heparin is used as therapy (or prophylaxis) in patients with slowly evolving DIC who have (or are at risk of) venous thromboembolism.




 -2 
submitted by asharm10(22),

Acute phase reactants Upregulated: More FFiSH in the C Ferritin Fibrinogen Serum Amyloid A Hepcidin C-Reactive protein