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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


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  #1  
Old 10-26-2011
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Default mcq

A 21-year-old man with no significant past medical history presents to office with complaints of blood in his urine and mucosal bleeding while brushing his teeth. The patient complains of intermittent "ringing in the ears." He denies any drug or alcohol use. He has no family history of bleeding disorders. Petechiae are noted in the oral cavity, as is dried blood
in the nostrils.
Laboratory studies show the following:
Hematocrit 32%; white blood cell count 8,000/mm3 with 60% neutrophils;
platelet count 13,000; PT 13 seconds; PTT 28 seconds; LDH 1,200 U/L;
elevated indirect bilirubin.
Coombs' test is positive; abdominal examination is normal; and the peripheral smear shows spherocytes.
What is the most likely diagnosis?
a.alport syndrome
b.bernaud soulier syndrome
c.felty syndrome
d.thrombotic thrombocytopenic purpura
e.evan syndrome
f.idiopathic thrombocytopenic purpura
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  #2  
Old 10-26-2011
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Default TTP

TTP ?
because increase LDH
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  #3  
Old 10-26-2011
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A -On seeing hematuria and tinnitis i thought Alport but this is a collagen problem not a autoimmue problem and doesnt explain the thrombocytopenia and anemia.


B- that is platelet beelding disorder has nothing to do with tinnitus or a coombs positive anemia

C- That arthritus with spleenomegaly and nuetropenia

D- TTP we see schistocyes

F - It looks like thrombocytopenia but not the low hematocrit ( i doubt he bled out that much)

leaving E - Evans syndrome which is combo of autoimmune hemolytic anemia as well as a thrombocytopenia. still have no idea about the tinnitus though how that factors in.
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  #4  
Old 10-26-2011
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ans. is evan syndrome associated with autoimmune hemolysis and autoimmune thrombocytopenia
treatment initially steroid , splenectomy may b done to control the disease.
i don't like syndroms so i shared the question!!!dont knw hw much frequently they ask them.
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bassatom (10-26-2011), donofitaly (10-27-2011), pass7 (10-27-2011)
  #5  
Old 10-26-2011
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Good q
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