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  #1  
Old 11-28-2012
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Default HIT : NBME 2 Concept

A 57-year-old man has been hospitalized for 2 days for treatment
of unstable angina pectoris. He is currently receiving intravenous
heparin and undergoing evaluation for coronary artery
bypass grafting.
His blood pressure is 160/90 mm Hg, pulse is 88/min,
and respirations are
16/min. Laboratory studies show:

Platelet count 90,000/mm3
Prothrombin time 12 sec (INR=1.1)
Partial thromboplastin time 35 sec

Which of the following is the most likely cause of
these findings?

A) Excessive platelet destruction

B) Factor VIII deficiency

C) Inadequate platelet production

D) Uncontrolled activation of coagulation and
fibrinolytic cascades

E) Vitamin K deficiency

I choose A but the correct answer in the key is D
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  #2  
Old 11-29-2012
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ans is D, not A. some weird pathophys cncept

btw, this site does not allow nbme discussion.
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Old 11-29-2012
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HIT is caused by the formation of abnormal antibodies that activate platelets.

Quote:
The IgG antibodies form a complex with heparin and PF4 in the bloodstream. The tail of the antibody then binds to theFcγIIa receptor, a protein on the surface of the platelet. This results in platelet activation and the formation of platelet microparticles, which initiate the formation of blood clots; the platelet count falls as a result, leading to thrombocytopenia.
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  #4  
Old 11-29-2012
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but how does it explain fibrinolysis
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