USMLE Forums banner

1 - 6 of 6 Posts

·
Registered
Joined
·
414 Posts
Discussion Starter · #1 ·
A 32-y-o man is brought to the emergency department 20 minutes after having a generalized tonic-clonic seizure. He has a 24-hour history of fever, headache, and intolerance of light. He is alert. His temperature is 40C (104F), pulse is 140/min, respirations are 24/min, and BP is 90/55 mm Hg. He appears acutely ill. Neurologic examination shows no focal findings. Intravenous fluids are administered, and there is persistent bleeding around the intravenous site.
Laboratory studies show:

PT 16 sec (INR=1.1)
PTT 33 sec
FDP increased
D-dimer increased

Which of the following changes is most likely in the blood coagulation process of this patient?

A) Decreased fibrinolysis
B) Decreased microvascular thrombus formation
C) Decreased thrombin production
D) Increased circulating clotting factors
E) Increased plasmin generation
F) Increased platelet count
 

·
Registered
Joined
·
487 Posts
DIC is consuptive coagulopathy...as a result of wide spread injury to endothelial cells e.g. in septic shock...there is increased exposure of tissue factor leading to stimulation of extrinsic system which inturn stimulate intrinsic system too....resulting in coagulation in micro as well as macro vasculature...so..B) Decreased microvascular thrombus formation can not be choice...
during this massive coagulation clotting factors r used...ruls out D) Increased circulating clotting factors...
during cascade prothrombin is converted to thrombin....C) Decreased thrombin production can't be choice...n during this massive coagulation lots of platelets r also being used...decreasing their level...ruls out F) Increased platelet count....
thrombin that is formed during cascade n also activated factor 12 stimulate plasminogen coverting it to plasmin....E) Increased plasmin generation is correct choice...
 

·
Registered
Joined
·
414 Posts
Discussion Starter · #5 ·
what factor in the question help you decide that its DIC?thx :sorry:
DIC is consuptive coagulopathy...as a result of wide spread injury to endothelial cells e.g. in septic shock...there is increased exposure of tissue factor leading to stimulation of extrinsic system which inturn stimulate intrinsic system too....resulting in coagulation in micro as well as macro vasculature...so..B) Decreased microvascular thrombus formation can not be choice...
during this massive coagulation clotting factors r used...ruls out D) Increased circulating clotting factors...
during cascade prothrombin is converted to thrombin....C) Decreased thrombin production can't be choice...n during this massive coagulation lots of platelets r also being used...decreasing their level...ruls out F) Increased platelet count....
thrombin that is formed during cascade n also activated factor 12 stimulate plasminogen coverting it to plasmin....E) Increased plasmin generation is correct choice...
 

·
Registered
Joined
·
487 Posts
Key word here is persistant bleeding at iv site..n also hypotension, its due to blood loss...Neurological signs here is due to ischemia from occlusive thrombi..
There may be patachiae n ecchymosis from thrombocytopenia....
 
1 - 6 of 6 Posts
Top