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* ck question need explanation
  jaguar12345 - 06/20/20 22:39
  A 52-year-old woman comes to the emergency department because of a 1-day history of bleeding gums and
moderate pain in her knees. She first noticed the gum bleeding while brushing her teeth this morning; she has been
unable to stop the bleeding. She has systemic lupus erythematosus with inflammatory arthritis and Raynaud disease.
Medications are tramadol and hydroxychloroquine. Vital signs are within normal limits. Examination shows
bleeding, friable gums. There are multiple ecchymoses and petechiae over the upper extremities. Cardiac and
abdominal examinations show no abnormalities. The knees are cool to the touch; there are effusions, and range of
motion is limited by pain. Neurologic examination shows no focal findings. Laboratory studies show:
Hemoglobin 11 g/dL
Hematocrit 33%
Erythrocyte count 4.2 1012/L
Mean corpuscular volume 90 μm3
Leukocyte count 9000/mm3
Segmented neutrophils 60%
Bands 3%
Eosinophils 2%
Basophils 1%
Lymphocytes 30%
Monocytes 4%
Platelet count 20,000/mm3
Creatinine 0.9 mg/dL
Ferritin 10 ng/mL
Which of the following is the most appropriate next step in management?
(A) Factor replacement therapy
(B) Methotrexate therapy
(C) Plasmapheresis
(D) Prednisone therapy
(E) Splenectomy

answer is d
what is the cause ITP or lupus?
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* Re:ck question need explanation
  23abc23 - 06/21/20 18:27
  ITP sec to Lupus.

Pl correct me if I am wrong.
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* Re:ck question need explanation
  jaguar12345 - 06/21/20 20:18
but what about hemarthrosis :/ does it happen with thrombocytopenia?
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* Re:ck question need explanation
  23abc23 - 06/21/20 22:41
@ jaguar12345

hemarthrosis - common causes- hemophilia,pt on not in ITP.U r correct.

Lupus can cause low platelets.

One guess-the painful knee effusion- suggestive of lupus arthritis. It might not be a hemarthrosis.

what do u think?

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* Re:ck question need explanation
  jaguar12345 - 06/22/20 23:21
I agree
lupus is the cause of the arthritis
itp bleeding causing the anemia
and the timefreme correspond with ITP one day of bleeding
lupus thrombocytopenia would take more time
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