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NBME 22 Answers

nbme22/Block 4/Question#44 (reveal difficulty score)
A 10-year-old boy has bruised easily since ...
Prolonged prothrombin time๐Ÿ”,๐Ÿ“บ
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 +10 
submitted by adong(103),
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ociDumral is in eth uraoimnc yimlaf cwhhi ilunedsc rwan.aifr tI lphes fi yuo nktih uotba fnsrrawai' rdban maen aCiodnm.u nuimaoCd, raum,nico ucaam.i.rlllod. hte eohtr sevtarediiv veha UOCM ti in osem hsfoina




 +7 
submitted by azibird(200),

In what century is this question taking place?? Dicoumarol was replaced by warfarin in the mid-1950s! It's on the FDA's list of discontinued drug products!

From wikipedia: "Identified in 1940, dicoumarol became the prototype of the 4-hydroxycoumarin anticoagulant drug class. Dicoumarol itself, for a short time, was employed as a medicinal anticoagulant drug, but since the mid-1950s has been replaced by its simpler derivative warfarin, and other 4-hydroxycoumarin drugs."

Did the grandpa have some leftover dicoumarol in the cabinet from his DVT in the summer of 1949?? This question is absolutely ridiculous.

https://en.wikipedia.org/wiki/Dicoumarol https://pubchem.ncbi.nlm.nih.gov/compound/Dicumarol#section=Uses




 +6 
submitted by seagull(1688),
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fI yuo 'ndto kown hawt iDoalcrum eods lkei nay mralno .naumh Teh oucsf on twha irainps 'todsen o,d ylaemn st'i esntod' fetfca TP tmei dna omts plils n'tdo sreiance lttncigo cle(yapeisl itwh )ni.sarpi Thsi is how I ilocg ot teh ritgh a.wrsne

usmleuser007  If that's then thinking, then how would you differentiate between PT & PTT? +28  
ls3076  Why isn't "Decreased platelet count" correct? Aspirin does not decrease the platelet count, only inactivates platelets. +5  
drmohandes  Because dicumarol does not decrease platelet count either. +1  
krewfoo99  @usmleuser007 Because the answer choice says decrease in PTT. If you take a heparin like drug then the PTT will increase. Drugs wont increase PTT (that would be procoagulant) +5  
pg32  I think usmleuser007 and is3076 were working form the perspective of not knowing what dicumerol was. If you were unsure what dicumarol was, there really wasn't a way to get this correct, contrary to @seagull's comment. You can't really rule out any of these as possible options because aspirin doesn't do any of them. +5  
snripper  yeah, it wouldn't work. We'll need to know with Dicumarol is. +5  
jackie_chan  Not true, the logic works. You gotta know what aspirin does at least, it interferes with COX1 irreversibly and inhibits platelet aggregation (kinda like an induced Glanzzman), all it does. PT, aPTT are functions of the coagulation cascade and the test itself is not an assessment of platelet function. Bleeding time/clotting time is an assessment of platelet function. A- decreased plasma fibrinogen concentration- not impacted B- decreased aPTT/partial- DECREASED, indicates you are hypercoaguable, not the case C- decreased platelet count- aspirin does not destroy platelets D- normal clotting time- no we established aspirin impacts clotting/bleeding time by preventing aggregation E- prolonged PT- answer, aspirin does not impact the coagulation factor cascades in the test +5  
teepot123  di'coumarin'ol +1  



 +6 
submitted by mattnatomy(43),
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You can lciaayslb ihktn of Docmrailu sa Ariwan: f.rMOa tesepeDl atimvin K ior snectSse iVmitan K si lnveodvi in ammga alxotinoabcyr of osatfcr 2, 7, ,9 ma;&p 10, ouy can sue teh rhonbPiotmr iemT to urmeeas eth srsnoee.p tborhrPimno meit sreeuams the tcxirnise ahytwap of atilouongac, whihc is mlynai idadetme iva caFtro 7.




 +1 
submitted by shutch94(1),

I get that bleeding time is a measurement of platelet function. Is clotting time a measurement of the coagulation cascade (PTT/PT)?

drdoom  yes, that's correct. +1  



 +1 
submitted by fukprometric(2),

we need to know like 400 drugs in FA, and they choose the one that's not in there. thanks NBME




 +0 
submitted by zpatel(26),
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aCn noneay ellt eth eftefc of rpinisa no a lobod lab vauel i(e. rTbPnTF,iP,iT cp)rto?ud

paperbackwriter  Aspirin only increases platelet aggregation (blocks COX1/2 --> decreased production of Thromboxane A2 --> decreased aggregation). That's why it only increases bleeding time and has no effect on PT, PTT, and fibrin products. PT and PTT are only affected if something messes the coagulation cascade. +