A 25-Year-Old Woman Comes to the Office Due to Heavy

question 1305

Multiple Choice

A 25-year-old woman comes to the office due to heavy menses.  Over the past few months, the patient's menstrual periods have lasted 7 days rather than the usual 3 days.  In addition, her menstruation has been unusually heavy and has, at times, bled through her clothing while at work.  The patient is an active volleyball player but has not been able to play recently due to increasing fatigue; frequent, diffuse myalgias; and bilateral pain in her wrists that requires icing after practice.  She has also noticed that her forearms become easily bruised in areas where the ball hits.  The patient takes no medications and does not use tobacco, alcohol, or illicit drugs.  Temperature is 37 C (98.6 F) , blood pressure is 116/76 mm Hg, pulse is 76/min, and respirations are 16/min.  There are scattered petechiae across the body with a few large ecchymoses on the forearms.  The remainder of the physical examination is normal.  Laboratory results are as follows: Peripheral blood smear shows normal and large platelets.  Which of the following is the best next step in evaluation of this patient?

• A)Antinuclear antibody screen
• B)Ascorbic acid level test
• C)Factor VIII assay
• D)Hemoglobin electrophoresis
• E)Platelet aggregation test
• F)Von Willebrand antigen level test

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Definitions:

Credit Sales

Sales made by a business where payment is delayed as per agreed terms.

Inferior Merchandise

Goods that are of lower quality than the standard expected by consumers, often resulting in reduced customer satisfaction.

Sales Invoice

A document that supports each credit sale.

Credit Sales

Sales in which the customer is allowed to pay at a later date.