A 32-Year-Old Woman, Gravida 1 Para 0, Comes to the Office

question 705

Multiple Choice

A 32-year-old woman, gravida 1 para 0, comes to the office at 30 weeks gestation for thrombocytopenia evaluation.  The patient was found to have a platelet count of 110,000/mm³ during routine blood tests performed at 28 weeks gestation.  She reports no history of blood disorders and has had no easy bruising, epistaxis, gingival bleeding, or blood in the urine or stool.  Her pregnancy has been uneventful, and her only medication is a prenatal vitamin.  The patient drank alcohol occasionally but stopped after conceiving.  She does not use tobacco or illicit drugs.
Vital signs are within normal limits.  There is no scleral icterus or lymphadenopathy.  Skin examination shows no petechiae or ecchymosis.  The uterus is appropriate in size for gestational age.  Bilateral lower extremity 1+ pitting edema is present.
Laboratory testing performed today reveals the following:
Peripheral smear shows no platelet clumping.  Urinalysis reveals 1+ proteinuria.  An anatomy ultrasound reveals normal fetal development, and the first trimester HIV screening was negative.
Which of the following is the most appropriate next step in management of this patient?

• A)Antiplatelet antibody assay
• B)Bone marrow biopsy
• C)Continue regular prenatal care
• D)Corticosteroid therapy
• E)Thrombopoietin-receptor agonists

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Definitions:

Resource Allocation

The process of distributing available resources among different uses identified in an economy.

Taxing Polluters

A policy approach that imposes taxes on companies or individuals who produce pollution as a means to internalize environmental externalities and encourage pollution reduction.

Positive Externalities

Benefits that affect a third party not directly involved in a transaction or activity, resulting in a positive effect on society.

Principal-Agent Problem

A dilemma in economics where one party (the agent), acting on behalf of another party (the principal), may have different goals or incentives, potentially leading to inefficiencies.