⏳ Case-based MCQ | #Case_439
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A 19-year-old female presents to your department with a complaint of absence of menses for the last four months. She reports that her menarche was at the age of 13 and even though the first two years the menses were irregular, she has had normal menstruation every 30 days after that initial period. She has normal secondary sexual development. Past medical history reveals elective abortion, two years ago.
Pregnancy test is negative. TSH and prolactin are within normal limits. Progesterone withdrawal test results in the absence of bleeding. The estrogen-progesterone challenge test is administered, but again there is no withdrawal bleeding.
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A 19-year-old female presents to your department with a complaint of absence of menses for the last four months. She reports that her menarche was at the age of 13 and even though the first two years the menses were irregular, she has had normal menstruation every 30 days after that initial period. She has normal secondary sexual development. Past medical history reveals elective abortion, two years ago.
Pregnancy test is negative. TSH and prolactin are within normal limits. Progesterone withdrawal test results in the absence of bleeding. The estrogen-progesterone challenge test is administered, but again there is no withdrawal bleeding.
👍3
After treatment, which of the following would be most helpful to reduce the risk of recurrence?
Anonymous Poll
25%
A. Clomiphene
24%
B. Hyaluronic acid gel
23%
C. Maudsley method family-based therapy
17%
D. Bromocriptine
11%
E. Follitropin alfa
❤7👍3
⏳ Case-based MCQ | #Case_439 | #answer
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✅ B
This patient presents with a history of absent menses for 4 months; however, she reports that she has had regular menses for several years, which makes her condition secondary amenorrhea. This differs from primary amenorrhea, which is generally defined as the absence of menstruation by the age of 16 in a female with complete secondary sexual development or by the age of 14 in a female without secondary sexual development. Secondary amenorrhea is defined as the absence of menstruation for > 3 months in a patient who had regular menstruation previously or absence of menstruation for 9 months in a patient who had oligomenorrhea.
Major causes of amenorrhea are shown in the table below.
Since pregnancy is the most common cause of secondary amenorrhea, the initial step is to order a pregnancy test as described in the opening stem. In this patient, the test was negative. The following step is usually a pelvic ultrasound if primary amenorrhea is suspected to confirm the presence or absence of a uterus, in this patient's case, this is unnecessary because if she had menses previously, she obviously has a uterus. In patients with a previously well functioning uterus TSH and prolactin are ordered next, if both are normal, the progesterone challenge test follows as this allows evaluation whether amenorrhea is due to progesterone deficiency in a patient with normal estrogen levels. If this is the case, withdrawal bleeding is observed within 7 days. If this does not occur, the estrogen-progesterone challenge test is done. In a patient who has deficiency of both hormones, withdrawal bleeding is observed. The absence of withdrawal bleeding after both hormones are given, suggests outflow tract obstruction as the most likely cause of amenorrhea. In patients with secondary amenorrhea, Asherman disease is the most common cause of outflow tract obstruction. This is usually caused by intrauterine synechiae due to postpartum endometritis, an operative procedure involving the uterus, particularly curettage, elective abortion, or a missed abortion.
Treatment of intrauterine adhesions is focused on two areas: first is the actual management of the adhesions, and second is preventing adhesion re-formation. Hysteroscopy is the treatment of choice with lysis of the adhesions under direct vision. Rigid hysteroscope is preferred for this procedure with operating channel of 3 to 7 Fr diameter. This allows for the use of flexible or semirigid scissors to lyse the adhesion usually at the junction of the adhesion with the endometrium and excise the tissue. Potential complications include uterine perforation, especially when there are lateral adhesions or they are very dense, making it difficult to dissect.
After hysteroscopic adhesions lysis, management goal should be the prevention of adhesions re-formation as recurrence rate has been estimated to be between 16% and 42%. The most preferred options are using a balloon catheter or adhesion barriers such as modifications of hyaluronic acid (choice B).
At the conclusion of the procedure, a Foley-type catheter is placed in the uterine cavity and left in place. The length of time varies between 3 days and 14 days. It reduces the risk of reagglutination of the walls of the uterus. Similarly, the hyaluronic acid gel is beneficial in keeping the walls of the uterine cavity separated. Either option can be used to reduce the risk of recurrence.
⚠ Clomiphene (choice A) is known to induce ovulation in various secondary amenorrhea conditions such as polycystic ovarian syndrome, but it would be of no benefit after adhesion lysis treatment in Asherman's syndrome.
⚠ Maudsley method family-based therapy (choice C) is recommended for patients with anorexia nervosa for remission maintenance but would be of no benefit to this patient.
⚠ Bromocriptine (choice D) is used to treat pituitary microadenomas. It would be of no benefit to this patient.
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✅ B
This patient presents with a history of absent menses for 4 months; however, she reports that she has had regular menses for several years, which makes her condition secondary amenorrhea. This differs from primary amenorrhea, which is generally defined as the absence of menstruation by the age of 16 in a female with complete secondary sexual development or by the age of 14 in a female without secondary sexual development. Secondary amenorrhea is defined as the absence of menstruation for > 3 months in a patient who had regular menstruation previously or absence of menstruation for 9 months in a patient who had oligomenorrhea.
Major causes of amenorrhea are shown in the table below.
Since pregnancy is the most common cause of secondary amenorrhea, the initial step is to order a pregnancy test as described in the opening stem. In this patient, the test was negative. The following step is usually a pelvic ultrasound if primary amenorrhea is suspected to confirm the presence or absence of a uterus, in this patient's case, this is unnecessary because if she had menses previously, she obviously has a uterus. In patients with a previously well functioning uterus TSH and prolactin are ordered next, if both are normal, the progesterone challenge test follows as this allows evaluation whether amenorrhea is due to progesterone deficiency in a patient with normal estrogen levels. If this is the case, withdrawal bleeding is observed within 7 days. If this does not occur, the estrogen-progesterone challenge test is done. In a patient who has deficiency of both hormones, withdrawal bleeding is observed. The absence of withdrawal bleeding after both hormones are given, suggests outflow tract obstruction as the most likely cause of amenorrhea. In patients with secondary amenorrhea, Asherman disease is the most common cause of outflow tract obstruction. This is usually caused by intrauterine synechiae due to postpartum endometritis, an operative procedure involving the uterus, particularly curettage, elective abortion, or a missed abortion.
Treatment of intrauterine adhesions is focused on two areas: first is the actual management of the adhesions, and second is preventing adhesion re-formation. Hysteroscopy is the treatment of choice with lysis of the adhesions under direct vision. Rigid hysteroscope is preferred for this procedure with operating channel of 3 to 7 Fr diameter. This allows for the use of flexible or semirigid scissors to lyse the adhesion usually at the junction of the adhesion with the endometrium and excise the tissue. Potential complications include uterine perforation, especially when there are lateral adhesions or they are very dense, making it difficult to dissect.
After hysteroscopic adhesions lysis, management goal should be the prevention of adhesions re-formation as recurrence rate has been estimated to be between 16% and 42%. The most preferred options are using a balloon catheter or adhesion barriers such as modifications of hyaluronic acid (choice B).
At the conclusion of the procedure, a Foley-type catheter is placed in the uterine cavity and left in place. The length of time varies between 3 days and 14 days. It reduces the risk of reagglutination of the walls of the uterus. Similarly, the hyaluronic acid gel is beneficial in keeping the walls of the uterine cavity separated. Either option can be used to reduce the risk of recurrence.
⚠ Clomiphene (choice A) is known to induce ovulation in various secondary amenorrhea conditions such as polycystic ovarian syndrome, but it would be of no benefit after adhesion lysis treatment in Asherman's syndrome.
⚠ Maudsley method family-based therapy (choice C) is recommended for patients with anorexia nervosa for remission maintenance but would be of no benefit to this patient.
⚠ Bromocriptine (choice D) is used to treat pituitary microadenomas. It would be of no benefit to this patient.
👍9
⚠ Follitropin alfa (choice E) is a recombinant gonadotropin preparation used as a fertility medication to induce ovulation; it would be of no benefit to this patient because most likely cause of amenorrhea is outflow tract obstruction.
🔖 Key point:
In patients with intrauterine adhesions, the management goal, post adhesions lysis, should be the prevention of adhesions reformation as recurrence rate has been estimated to be between 16% and 42%. The most preferred options are using a balloon catheter or adhesion barriers such as modifications of hyaluronic acid.
🔖 Key point:
In patients with intrauterine adhesions, the management goal, post adhesions lysis, should be the prevention of adhesions reformation as recurrence rate has been estimated to be between 16% and 42%. The most preferred options are using a balloon catheter or adhesion barriers such as modifications of hyaluronic acid.
❤1👍1
⏳ Case-based MCQ | #Case_440
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An 18-month-old child is brought to your department by his parents because they noticed some blood in his stool for the last four days. They describe the color as bright red and the stool as having normal consistency. The frequency of passing stool is not increased. They report that he does not seem to fuss more than usual and they did not observe any fever. He eats a variety of foods, drinks apple juice, and milk.
Vital signs are normal, and on physical examination, the abdomen does not appear distended. On palpation, there is no mass or any particularly tender point. You suspect Meckel's diverticulum.
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An 18-month-old child is brought to your department by his parents because they noticed some blood in his stool for the last four days. They describe the color as bright red and the stool as having normal consistency. The frequency of passing stool is not increased. They report that he does not seem to fuss more than usual and they did not observe any fever. He eats a variety of foods, drinks apple juice, and milk.
Vital signs are normal, and on physical examination, the abdomen does not appear distended. On palpation, there is no mass or any particularly tender point. You suspect Meckel's diverticulum.
👍1
Which of the following study would be most appropriate to confirm this diagnosis?
Anonymous Poll
5%
A. Nasogastric tube
39%
B. Barium contrast study
38%
C. Tc-99m pertechnetate
5%
D. Angiography
13%
E. Doppler ultrasonography
👍2
⏳ Case-based MCQ | #Case_440 | #answer
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✅ C
This patient is an 18-month-old male presenting with bloody stools. The absence of fever and diarrhea generally makes infection low on our diagnosis differential, and the fact the child is not fussing suggests that this is painless hematochezia. In this age group, the most common causes of painless hematochezia are Meckel’s diverticulum and polyps.
Meckel's diverticulum is a remnant of the prenatal vitellointestinal tract. The yolk sac of the developing embryo is connected to the primitive gut by the omphalomesenteric duct. This structure normally regresses between the fifth and seventh weeks of fetal life. If this process of regression fails, various anomalies can occur, the most common of those anomalies is Meckel's diverticulum. Ectopic gastric mucosa is found in the majority of symptomatic Meckel’s diverticuli.
Lower gastrointestinal hemorrhage is the most common presentation in children with Meckel's diverticulum. The incidence rate is about 50%. Besides bleeding, the second most common complication is intestinal obstruction, and for those who have Meckel’s diverticulum in their adult years, it is the most common presenting complication. In pediatric patients, the incidence rate is 25% to 30%. There are various mechanisms by which it can cause intestinal obstruction: volvulus, intussusception, and Littre’s hernia are some of the most common.
A technetium-99m pertechnetate scan (choice C), also called Meckel scan, is the investigation of choice to diagnose Meckel's diverticula in children. It is a non-invasive study that uses a radionuclide to bind plasma protein and accumulate in functional gastric mucosa. Meckel’s diverticulum is identified on the scan by a focus of increased activity often mid-abdomen or in the right lower quadrant.
⚠ Nasogastric tube (choice A) is used in children with a history that suggests upper gastrointestinal bleeding. If bloody stools are noted from an upper gastrointestinal source, they are usually dark, also known as melena, and not bright red as seen in this child.
⚠ Barium contrast study (choice B) is used in intestinal malrotation. Patient's history is usually suggestive of the presence of foreign bodies, esophagitis, and polyps.
⚠ Angiography (choice D) is an invasive study that is less preferable than a technetium-99m pertechnetate scan. It is also more useful if the blood loss is in large quantity, which does not appear to be the case here.
⚠ Doppler ultrasonography (choice E) is very sensitive and specific for diagnosis intussusception, but the success rate is operator-dependent.
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✅ C
This patient is an 18-month-old male presenting with bloody stools. The absence of fever and diarrhea generally makes infection low on our diagnosis differential, and the fact the child is not fussing suggests that this is painless hematochezia. In this age group, the most common causes of painless hematochezia are Meckel’s diverticulum and polyps.
Meckel's diverticulum is a remnant of the prenatal vitellointestinal tract. The yolk sac of the developing embryo is connected to the primitive gut by the omphalomesenteric duct. This structure normally regresses between the fifth and seventh weeks of fetal life. If this process of regression fails, various anomalies can occur, the most common of those anomalies is Meckel's diverticulum. Ectopic gastric mucosa is found in the majority of symptomatic Meckel’s diverticuli.
Lower gastrointestinal hemorrhage is the most common presentation in children with Meckel's diverticulum. The incidence rate is about 50%. Besides bleeding, the second most common complication is intestinal obstruction, and for those who have Meckel’s diverticulum in their adult years, it is the most common presenting complication. In pediatric patients, the incidence rate is 25% to 30%. There are various mechanisms by which it can cause intestinal obstruction: volvulus, intussusception, and Littre’s hernia are some of the most common.
A technetium-99m pertechnetate scan (choice C), also called Meckel scan, is the investigation of choice to diagnose Meckel's diverticula in children. It is a non-invasive study that uses a radionuclide to bind plasma protein and accumulate in functional gastric mucosa. Meckel’s diverticulum is identified on the scan by a focus of increased activity often mid-abdomen or in the right lower quadrant.
⚠ Nasogastric tube (choice A) is used in children with a history that suggests upper gastrointestinal bleeding. If bloody stools are noted from an upper gastrointestinal source, they are usually dark, also known as melena, and not bright red as seen in this child.
⚠ Barium contrast study (choice B) is used in intestinal malrotation. Patient's history is usually suggestive of the presence of foreign bodies, esophagitis, and polyps.
⚠ Angiography (choice D) is an invasive study that is less preferable than a technetium-99m pertechnetate scan. It is also more useful if the blood loss is in large quantity, which does not appear to be the case here.
⚠ Doppler ultrasonography (choice E) is very sensitive and specific for diagnosis intussusception, but the success rate is operator-dependent.
👍11❤2
⏳ Case-based MCQ | #Case_441
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 55-year-old Hispanic male presents with right shoulder pain for the last three days. The pain started shortly after he caught himself when he fell coming down his front steps. Plain radiographs of the shoulder are normal.
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A 55-year-old Hispanic male presents with right shoulder pain for the last three days. The pain started shortly after he caught himself when he fell coming down his front steps. Plain radiographs of the shoulder are normal.
❤1
Which one of the following, if present, would be most suggestive of a rotator cuff tear?
Anonymous Poll
8%
A. Inability to flex at the elbow against resistance
36%
B. Pain with passive forward flexion to 90°, elbow at 90° and internal rotation
7%
C. Signs of reduced arterial perfusion of the hand
9%
D. Swelling of the acromioclavicular joint
40%
E. Weakness in external rotation of the shoulder
👍18
⏳ Case-based MCQ | #Case_441 | #answer
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✅ E
Shoulder pain following a fall may be caused by a strained muscle and/or ligament, an exacerbation of smouldering subacromial bursitis or tendinitis, or a rotator cuff tear. Frequently there is a combination of two or three of these conditions. If the rotator cuff tear is small, treatment is similar to that recommended for the other conditions. However, if a rupture has occurred, immobilization and/or surgical consultation is required.
On physical examination, a painful arc of abduction above 90°, inability to lower affected arm from a fully abducted position, and weakness in external rotation would be expected with a torn rotator cuff. Of these three, weakness in external rotation (choice E) is much more specific.
⚠ Inability to flex at the elbow against resistance (choice A) is associated with, for instance, biceps (bicipital) tendonitis.
⚠ Pain with passive forward flexion to 90°, elbow at 90° and internal rotation (choice B) is considered a positive Hawkins sign, which is 90% sensitive for the diagnosis of shoulder impingement syndrome.
⚠ Signs of reduced arterial perfusion of the hand (choice C) would be seen in patients with arterial injury (e.g., trauma, thenar hammer syndrome).
⚠ Swelling of the acromioclavicular joint (choice D) may be associated with osteoarthritis, gout, post-traumatic osteolysis of the clavicle, etc.
🔖 Key point:
¹Positive active painful arc test, ²positive drop arm test, and ³weakness in external rotation suggest a significant rotator cuff tear
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✅ E
Shoulder pain following a fall may be caused by a strained muscle and/or ligament, an exacerbation of smouldering subacromial bursitis or tendinitis, or a rotator cuff tear. Frequently there is a combination of two or three of these conditions. If the rotator cuff tear is small, treatment is similar to that recommended for the other conditions. However, if a rupture has occurred, immobilization and/or surgical consultation is required.
On physical examination, a painful arc of abduction above 90°, inability to lower affected arm from a fully abducted position, and weakness in external rotation would be expected with a torn rotator cuff. Of these three, weakness in external rotation (choice E) is much more specific.
⚠ Inability to flex at the elbow against resistance (choice A) is associated with, for instance, biceps (bicipital) tendonitis.
⚠ Pain with passive forward flexion to 90°, elbow at 90° and internal rotation (choice B) is considered a positive Hawkins sign, which is 90% sensitive for the diagnosis of shoulder impingement syndrome.
⚠ Signs of reduced arterial perfusion of the hand (choice C) would be seen in patients with arterial injury (e.g., trauma, thenar hammer syndrome).
⚠ Swelling of the acromioclavicular joint (choice D) may be associated with osteoarthritis, gout, post-traumatic osteolysis of the clavicle, etc.
🔖 Key point:
¹Positive active painful arc test, ²positive drop arm test, and ³weakness in external rotation suggest a significant rotator cuff tear
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👍9❤2
⏳ Case-based MCQ | #Case_442
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A 60-year-old black male complains of a one-week history of weakness of the lower left leg, giving away of the knee, and discomfort in the anterior thigh. He has no history of recent trauma. His past medical history is significant for DM2, diagnosed 15 years ago.
A physical examination reveals reduced sensation to pinprick and light touch over the left anterior thigh, reduced motor strength on hip flexion and knee extension, and normal straight leg raising test.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 60-year-old black male complains of a one-week history of weakness of the lower left leg, giving away of the knee, and discomfort in the anterior thigh. He has no history of recent trauma. His past medical history is significant for DM2, diagnosed 15 years ago.
A physical examination reveals reduced sensation to pinprick and light touch over the left anterior thigh, reduced motor strength on hip flexion and knee extension, and normal straight leg raising test.
👍4
What is the most likely cause of this patient's presenting condition?
Anonymous Poll
35%
A. Femoral neuropathy
42%
B. Diabetic polyneuropathy
8%
C. Meralgia paresthetica
8%
D. Spinal stenosis
6%
E. Iliofemoral atherosclerosis
👍4❤1
⏳ Case-based MCQ | #Case_442 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
This patient most likely presents with femoral neuropathy (choice A), a mononeuropathy commonly associated with direct trauma, compression, stretch injury, or ischemia. Patients with diabetes have an unusual predisposition for femoral and proximal mononeuropathies.
⚠ Diabetic polyneuropathy (choice B) is marked by symmetric and distal limb sensory and motor deficits.
⚠ Meralgia paresthetica (choice C), or lateral femoral cutaneous neuropathy is characterized by numbness and paresthesia over the anterolateral thigh with no motor dysfunction.
⚠ Spinal stenosis (choice D) causes pain in the legs but is not associated with the neurologic signs seen in this patient, nor with knee problems.
⚠ Iliofemoral atherosclerosis (choice E), a relatively common complication of diabetes mellitus, may produce intermittent claudication involving one or both calf muscles but would not produce the motor weakness noted in this patient.
🔖 Key point:
Patients with femoral neuropathy complain of difficulty with stairs, knee buckling, weakness of the quadriceps muscle, and medial leg and calf numbness.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
This patient most likely presents with femoral neuropathy (choice A), a mononeuropathy commonly associated with direct trauma, compression, stretch injury, or ischemia. Patients with diabetes have an unusual predisposition for femoral and proximal mononeuropathies.
⚠ Diabetic polyneuropathy (choice B) is marked by symmetric and distal limb sensory and motor deficits.
⚠ Meralgia paresthetica (choice C), or lateral femoral cutaneous neuropathy is characterized by numbness and paresthesia over the anterolateral thigh with no motor dysfunction.
⚠ Spinal stenosis (choice D) causes pain in the legs but is not associated with the neurologic signs seen in this patient, nor with knee problems.
⚠ Iliofemoral atherosclerosis (choice E), a relatively common complication of diabetes mellitus, may produce intermittent claudication involving one or both calf muscles but would not produce the motor weakness noted in this patient.
🔖 Key point:
Patients with femoral neuropathy complain of difficulty with stairs, knee buckling, weakness of the quadriceps muscle, and medial leg and calf numbness.
👍9❤4👏1
⏳ Case-based MCQ | #Case_443
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 4-year-old girl has a history of nosebleeds and easy bruising. There is a similar history among female and male family members. Laboratory investigations show prolonged aPTT and normal INR.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 4-year-old girl has a history of nosebleeds and easy bruising. There is a similar history among female and male family members. Laboratory investigations show prolonged aPTT and normal INR.
❤1
Which one of the following is the most likely cause of this patient's symptoms?
Anonymous Poll
27%
A. Hemophilia A
8%
B. Christmas disease
14%
C. Factor XIII deficiency
48%
D. Von Willebrand's disease
4%
E. Wiskott-Aldrich syndrome
👍9❤3🔥2😁2
⏳ Case-based MCQ | #Case_443 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ D
Von Willebrand's disease (choice D) is a hereditary deficiency of von Willebrand's factor (VWF), which causes platelet dysfunction. Bleeding tendency is usually mild. Screening tests show a prolonged bleeding time, normal platelet count, and, possibly, a slightly prolonged PTT. Diagnosis is based on low levels of VWF antigen and abnormal ristocetin cofactor activity. Treatment involves control of bleeding with replacement therapy (cryoprecipitate or pasteurized intermediate-purity factor VIII concentrate) or desmopressin.
⚠ Hemophilia A (choice A) and hemophilia B (Christmas disease) (choice B) are X-linked congenital bleeding disorders affecting male infants, usually diagnosed through family history and prolonged PTT. Undiagnosed hemophilia may cause severe bleeding with circumcision. It can also result in significant ecchymosis with minimal trauma or joint and muscle bleeding, usually by the end of infancy or in early childhood. These children have a significantly prolonged PTT and normal PT. Diagnosis is made through measurement of Factor VIII activity for Hemophilia A and Factor IX activity for Hemophilia B.
⚠ Activated partial thromboplastin time (aPTT) and international normalized ratio (INR) assessments are normal in factor XIII deficiency (choice C).
Wiskott-Aldrich syndrome (choice E) is an X-linked recessive disorder, which is characterized by immunodeficiency, severely dysfunctional platelets, and thrombocytopenia with microthrombocytes. INR and PTT are normal.
🔖 Key point:
Von Willebrand's disease is a hereditary deficiency of von Willebrand's factor (VWF), which causes platelet dysfunction. Bleeding tendency is usually mild. Screening tests show a prolonged bleeding time, normal platelet count, and, possibly, a slightly prolonged PTT
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ D
Von Willebrand's disease (choice D) is a hereditary deficiency of von Willebrand's factor (VWF), which causes platelet dysfunction. Bleeding tendency is usually mild. Screening tests show a prolonged bleeding time, normal platelet count, and, possibly, a slightly prolonged PTT. Diagnosis is based on low levels of VWF antigen and abnormal ristocetin cofactor activity. Treatment involves control of bleeding with replacement therapy (cryoprecipitate or pasteurized intermediate-purity factor VIII concentrate) or desmopressin.
⚠ Hemophilia A (choice A) and hemophilia B (Christmas disease) (choice B) are X-linked congenital bleeding disorders affecting male infants, usually diagnosed through family history and prolonged PTT. Undiagnosed hemophilia may cause severe bleeding with circumcision. It can also result in significant ecchymosis with minimal trauma or joint and muscle bleeding, usually by the end of infancy or in early childhood. These children have a significantly prolonged PTT and normal PT. Diagnosis is made through measurement of Factor VIII activity for Hemophilia A and Factor IX activity for Hemophilia B.
⚠ Activated partial thromboplastin time (aPTT) and international normalized ratio (INR) assessments are normal in factor XIII deficiency (choice C).
Wiskott-Aldrich syndrome (choice E) is an X-linked recessive disorder, which is characterized by immunodeficiency, severely dysfunctional platelets, and thrombocytopenia with microthrombocytes. INR and PTT are normal.
🔖 Key point:
Von Willebrand's disease is a hereditary deficiency of von Willebrand's factor (VWF), which causes platelet dysfunction. Bleeding tendency is usually mild. Screening tests show a prolonged bleeding time, normal platelet count, and, possibly, a slightly prolonged PTT
👍7❤6
Forwarded from Medical Mnemonics
🧩 Medical Mnemonics
♂️ When you have a male patient with infertility, you should think of SPERM COUNT!
💻 Join us on the official Instagram page: Online Medical School
#urology
〰〰〰〰〰〰〰〰〰〰〰
©Medical Mnemonics
♂️ When you have a male patient with infertility, you should think of SPERM COUNT!
💻 Join us on the official Instagram page: Online Medical School
#urology
〰〰〰〰〰〰〰〰〰〰〰
©Medical Mnemonics
👍4
⏳ Case-based MCQ | #Case_444
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A woman presents with hair loss. See the picture above 👆
She denies any family history of premature balding. She does state that she has been under severe stress and she has been taking medications for obsessive compulsive disorder.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A woman presents with hair loss. See the picture above 👆
She denies any family history of premature balding. She does state that she has been under severe stress and she has been taking medications for obsessive compulsive disorder.
👍3
Which of the following is the most likely explanation of this patient's presentation?
Anonymous Poll
10%
A. Telogen effluvium
34%
B. Trichotillomania
38%
C. Alopecia areata
9%
D. Tinea capitus
9%
E. Traction alopecia
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