A 32-year-old G1P0 reports to your office for a routine OB visit at 14 weeks gestational age. Labs drawn at her first prenatal visit 4 weeks ago reveal a platelet count of 60,000. All her other labs were within normal limits. During the present visit, the patient has a blood pressure of 120/70. Her urine dip reveals the presence of trace protein. The patient denies any complaints. The only medication she is currently taking is a prenatal vitamin. On taking a more in-depth history you learn that, prior to pregnancy, your patient had a history of occasional nose and gum bleeds, but no serious bleeding episodes. She has considered herself to be a person who just bruises easily. Which of the following is the most likely diagnosis?
a. Alloimmune thrombocytopenia
b. Gestational thrombocytopenia
c. Immune thrombocytopenic purpura
d. HELLP syndrome
e. Pregnancy-induced hypertension
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Immune thrombocytopenic purpura.
Immune thrombocytopenic purpura (ITP) typically occurs in the second or third decade of life and is more common in women than in men. The diagnosis of ITP is one of exclusion, because there are no pathognomonic signs, symptoms, or diagnostic tests. Traditionally, ITP is associated with a persistent platelet count of less than 100,000 in the absence of splenomegaly. Most women have a history of easy bruising and nose and gum bleeds that precede pregnancy. If the platelet count is maintained above 20,000, hemorrhagic episodes rarely occur. In cases of ITP, the patient produces IgG antiplatelet antibodies that increase platelet consumption in the spleen and in other sites. Gestational thrombocytopenia occurs in up to 8% of pregnancies. Affected women are usually asymptomatic, have no prior history of bleeding, and usually maintain platelet counts above 70,000. In gestational thrombocytopenia, platelet counts usually return to normal in about 3 months. The cause of gestational thrombocytopenia has not been clearly elucidated. HELLP syndrome of severe preeclampsia is associated with thrombocytopenia, but this condition occurs in the third trimester and is associated with hypertension. In neonatal alloimmune thrombocytopenia, there is a maternal alloimmunization to fetal platelet antigens. The mother is healthy and has a normal platelet count, but produces antibodies that cross the placenta and destroy fetal/neonatal platelets.