A 22-Year-Old Woman Comes to the Emergency Department Due to Continuous

question 170

Multiple Choice

A 22-year-old woman comes to the emergency department due to continuous gum bleeding after a mouth injury a few hours ago.  She was playing doubles tennis and was accidentally struck on her bottom lip by her partner's racquet.  The patient has a history of bruising with minor trauma and of heavy menstruation with crampy pain.  She has no other medical conditions and takes no medications other than occasional ibuprofen.  The patient does not use tobacco, alcohol, or illicit drugs; she eats a balanced diet.  Her mother also had a history of "bleeding issues."  Blood pressure is 120/70 mm Hg and pulse is 80/min.  Oropharyngeal examination shows blood oozing from a gum abrasion.  A fading ecchymosis is present on the right calf, but there are no other skin abnormalities.  The remainder of the physical examination is normal.  Laboratory results are as follows: Which of the following is the most likely cause of this patient's bleeding problem?

• A)Abnormal activation of coagulation and fibrinolysis
• B)Decreased factor VIII production
• C)Factor VIII inhibitor production
• D)Immune-mediated platelet destruction
• E)Impaired platelet-endothelial binding
• F)Reduced gamma-carboxylation of vitamin K-dependent clotting factors

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Definitions:

Placenta Previa

A pregnancy complication where the placenta partially or completely covers the cervix, leading to bleeding during the third trimester.

Preeclampsia

A pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the liver or kidneys.

Striae Gravidarum

Stretch marks that occur on the abdomen, thighs, and breasts during pregnancy due to rapid stretching of the skin.

Postpartum Psychosis

A severe mental illness that can occur in the first few weeks after childbirth, characterized by hallucinations, delusions, and irrational behavior.