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Retired NBME 25 Answers

nbme25/Block 2/Question#47 (reveal difficulty score)
A 45-year-old woman with chronic Hepatitis C ...
Cryoglobulin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(20)
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See here in FA 2020 for a list of extrahepatic manifestations in HepC and HepB. Importantly HepC can induce essential mixed cryoglobulinemia. It presents with palpable purpura in association with arthralgia and peripheral neuropathies caused by immune-complex type III hypersensitivity mediated vasculitis.

The triad is weakness, arthralgia, and palpable purpura. Keep in mind peripheral neuropathy, hematuria, and hepatosplenomegaly and most importantly, Hepatitis C.

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