NBME BLEEDING

Prep for USMLE Forum

» Log in | Register

Forum

Step 1

Match

Prep4USMLE Forum » USMLE Step 2 CK Forum » Pediatrics Forum

NBME BLEEDING

Author

11 Posts

dr_jojo

03/22/07 - 06:06 AM

A 7-day-old newborn is brought for a well-child examination. He was born at home. His mother has taken acetaminophen for perineal discomfort. The newborn is breast-feeding well. He is at the 75th percentile for length and weight. Examination shows no abnormalities. After vaccination with hepatitis B, he has prolonged bleeding at the injection site. There is no family history of excessive bleeding. Laboratory studies show:

Hemoglobin 16 g/dL
Leukocyte count 6800/mm3
Segmented neutrophils 48%
Bands 2%
Lymphocytes 50%
Platelet count 280,000/mm3
Prothrombin time 20 sec (INR=1.6)
Partial thromboplastin time 60 sec

Which of the following is the most likely mechanism for these findings?

A
) Autoimmunization

B
) Bacterial toxic effect

C
) Factor VIII deficiency

D
) Factor IX deficiency

E
) Immunoglobulin deficiency

F
) Iron deficiency

G
) Pharmacologic effect

H
) Viral toxic effect

I
) Vitamin deficiency

J
) Zinc deficiency

Aashi
Forum Moderator
avatar

Topics: 112
Posts: 918

03/22/07 - 06:11 AM

I) Vitamin deficiency

___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."

rongg
Forum Newbie

Topics: 0
Posts: 4

04/07/07 - 11:37 AM

rongg
Forum Newbie

Topics: 0
Posts: 4

04/07/07 - 11:40 AM

The answer should be G. nod

Justice
Forum Fanatic
avatar

Topics: 100
Posts: 1,885

04/07/07 - 01:33 PM

Vitamin K deficiency

___________________
Don't live in a town where there are no doctors

neuroblastoma
Forum Guru
avatar

Topics: 99
Posts: 1,011

04/13/07 - 12:27 PM

I

___________________
yahoo mesenger and skype ID asdvsd2003

sprint123
Forum Guru

Topics: 129
Posts: 870

04/13/07 - 01:46 PM

Please explain the anaemia in this child....?!

Dr.Luck
Forum Senior

Topics: 12
Posts: 225

04/13/07 - 02:23 PM

as far as i can tell this kid doesn't have anemia

snowdrops
Forum Senior
avatar

Topics: 5
Posts: 135

04/13/07 - 02:39 PM

I choose G, the bleeding due to acetaminophen effect on baby's liver because both PT and PTT prolonged. If Vitamin K deficiency, it should be only PT prolonged, not PTT.

vradojc1
Forum Elite
avatar

Topics: 21
Posts: 309

04/14/07 - 02:53 PM

#10

Vitamin K deficiency. aPTT measures everything but XIII and VII. So if the kid is missing II, IX and X in addition to VII (Vitamin K dependent), it would also be altered.

Justice
Forum Fanatic
avatar

Topics: 100
Posts: 1,885

04/16/07 - 10:56 AM

#11

vradojc1 wrote:
Vitamin K deficiency. aPTT measures everything but XIII and VII. So if the kid is missing II, IX and X in addition to VII (Vitamin K dependent), it would also be altered.

OK,
I initially answered vit K deficiency...
After reading other comments, I asked a ped hematology/oncology fellow sitting in my office about his opinion, and he said that the Pt most likely has Vit K deficiency, since he was born at home and didn't get a shot in the hospital (usually occurs within first 20' of the life, after all vitals are documented)... aPTT is increased, BUT in case of hemophilias it should be over 120'...
Hope this helps...
grin

___________________
Don't live in a town where there are no doctors

You don't have permission to post.