NBME 7-block 1/q18 Any one please answer, help. - greenboat

[ArchivalUser]

A previously healthy 40 year old woman is brought to the emergency department by her husband because of a 2 day history of fever, lethary and confusion. Her temperature is 38C, pulse is 80/m, respirations are 18/min and BP is 140/90mmHg. Physical examination shows scattered petechiae and ecchymoses over the lower extremities. Neurologic examination shows moderate generalized motor weaknes. She is oriented to person but not to place or time. Lab shows.
Hemoglobin - 9g/dl
Hct - 27%
Leukocyte count - 8000/mm3 with a normal differentiation.
Platelet count - 15,000/mm3
prothrombin time - 12 sec ( INR-1.1)
PTT = 30sec

serum Urea nitrogen - 25mg/dl
haptoglobin - less than 10 mg/dl ( N=40-180)
LDH = 1000 U/L
A direct antiglobulin test result is negative. A chest X-ray shows no abnormalities. The patient is admitted o the hospital, and IV plasma exchange twice daily is started. three days laer the patient is fully oriented. her hemoglobin concentration is 11g/dl, hct - 33%, and platelet count is 85,000/mm3. A peripheral blood smear at the time of admission most likely showed which of the following erythrocyte abnormalities.?

A. cabot rings.
B. hypochromic microcytes
C. pappenheimer bodies.
D.schistocytes
E. teardrop forms.

[ArchivalUser]

I think its a case of TTP and the answer could be DD.schistocyes

[ArchivalUser]

D... case of TTP with neurologic signs due to thrombotic complications, thrombocytopenia, and plasma exchange makes it better...peripheral smear shows schistocytes.

[ArchivalUser]

normal pt,ptt+decrease platelets(thrombocytopenia(purpura)+incr bleeding time)+hemolytic aneamia(schistocytes)+neurological signs)===ttp
of course ddd is right

[ArchivalUser]

yup, dic->schistocytes

[ArchivalUser]

dd