05-31-2009, 09:28 AM
A 36-year-old mother brings her 1-year old son in for evaluation of an abnormal mass that she first noticed 2 days ago. She was bathing her son when she noticed that he had an unusual œlump in his abdomen. She reports that the child has not had any medical problems up to this point and does not have any symptoms. The mother has no medical problems of her own, and both her parents are alive and healthy. She has become very concerned about the mass and would like to know what it is. Physical examination of the child shows an active, happy, smiling baby. Palpation of the child™s stomach reveals a solid mass located in the right lower quadrant. It appears to be nontender and the physician decides to do further work-up.
he appropriate studies are performed and a 3 cm mass is identified in the right kidney. Homovanillic acid and vanillylmandelic acid levels return at 2 mg per 24 hours (0-10 mg/24h) and 4 mg per 24 hours (2-10 mg/24h) respectively. Blood chemistries were also taken at the time of diagnosis and results are shown below. What is the most likely cause of the elevated coagulation studies?
Whole blood count (WBC):
5500/mm3
Hemoglobin (Hb):
14g/dL
Hematocrit (Hct):
31%
Platelets:
250,000/mm3
Sodium:
140 mEq/L
Potassium:
4.3 mEq/L
Chloride:
102 mEq/L
Bicarbonate:
28 mEq/L
Blood urea nitrogen (BUN):
15 mg/dL
Creatinine:
0.6 mg/dL
Alanine aminotransferase (ALT):
20 U/L
Aspartate aminotransferase (AST):
48 U/L
Prothrombin Time (PT):
12 secs
Partial Prothrombin Time (PTT):
48 secs
Bleeding time:
15 mins
A. Antiphospholipid syndrome
B. Bernard Soulier Syndrome
C. Glanzmann thrombasthenia
D. Hemophilia A
E. Von Willebrand Disease (vWD
he appropriate studies are performed and a 3 cm mass is identified in the right kidney. Homovanillic acid and vanillylmandelic acid levels return at 2 mg per 24 hours (0-10 mg/24h) and 4 mg per 24 hours (2-10 mg/24h) respectively. Blood chemistries were also taken at the time of diagnosis and results are shown below. What is the most likely cause of the elevated coagulation studies?
Whole blood count (WBC):
5500/mm3
Hemoglobin (Hb):
14g/dL
Hematocrit (Hct):
31%
Platelets:
250,000/mm3
Sodium:
140 mEq/L
Potassium:
4.3 mEq/L
Chloride:
102 mEq/L
Bicarbonate:
28 mEq/L
Blood urea nitrogen (BUN):
15 mg/dL
Creatinine:
0.6 mg/dL
Alanine aminotransferase (ALT):
20 U/L
Aspartate aminotransferase (AST):
48 U/L
Prothrombin Time (PT):
12 secs
Partial Prothrombin Time (PTT):
48 secs
Bleeding time:
15 mins
A. Antiphospholipid syndrome
B. Bernard Soulier Syndrome
C. Glanzmann thrombasthenia
D. Hemophilia A
E. Von Willebrand Disease (vWD