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NBME 22 Answers

nbme22/Block 3/Question#16

A 27-year-old woman comes to the physician because ...

Antiphospholipid antibodies

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submitted by hayayah(399),

Pregnancy + Hx of thrombosis --> think antiphospholipid syndrome

The PT and PTT are prolonged d/t interference from the antibodies to phospholipids. Thrombin time normal.

Had to find research articles about it so take it from here and don't waste your time...

monoloco  yeah, i’ve never heard of antiphospholipids increasing PT time ... +3  
goldenwakosu  Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis) +1  
johnthurtjr  I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies. +1  
link981  No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it +3  
yb_26  UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +1  




 +0  upvote downvote
submitted by amphotericin(0),

how would you rule out C) dysfibrinogenemia? I first guessed APS but switched it because of the PT/PTT thing