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NBME 22 Answers

nbme22/Block 4/Question#21 (17.4 difficulty score)
A previously healthy 45-year-old woman has ...
Thrombotic thrombocytopenic purpuraπŸ”

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submitted by pg32(139),

NBME's love to test on the pentad of TTP, which can be remembered by the mnemonic FAT RN (fever, anemia, thrombocytopenia, renal involvement, neuro symptoms). This pt has fever, confusion (neuro sx), decreased urine production (renal involvement), anemia and thrombocytopenia. Boom. TTP.

submitted by waterloo(71),
  • Can't be aplastic anemia if the pt is able to produce other cells evident in the labs.
  • Not DIC bc PT and PTT are normal and not increased.
  • If pt has fulminant liver failure I would imagine they would not be able to produce their coag factors so again, not probably it.
  • Vit B12 Def leads to macrocytic anemia and here they were nice enough to give us MCV which is between 80 and 100.

TTP makes sense with what others said. You can also spot some schistocytes in the blood smear.

kevin  yeah I'm pretty sure schistocytes alone could give you ttp as answer +  
kevin  well that and pt/ptt being normal +  

submitted by jboud86(10),
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