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Review of Clinical Signs Review Questions

Easy Bruising and Bleeding in the Adult Patient

Author: Bernard Karnath, MD

1. A 50-year-old woman presents with a 3-week history of easy bruising, epistaxis, gingival bleeding and fatigue. Laboratory examination reveals a leukocyte count of 200 × 103/mm3, hemoglobin concentration of 9 g/dL, and a platelet count of 20 × 103/mm3. A peripheral blood smear shows numerous blasts. What is the most likely diagnosis?
  1. Hemophilia A
  2. Hemophilia B
  3. Acute leukemia
  4. Non-Hodgkin’s lymphoma
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2. A 70-year-old man presents with a 2-week history of hematuria, melena, easy bruising, epistaxis, and gingival bleeding. His past medical history and family history are unremarkable. Complete blood count reveals a normal platelet count, hemoglobin concentration of of 8 g/dL, prothrombin time (PT) of 10 seconds, and an activated partial thromboplastin time (aPTT) of 84 seconds. Coagulation studies performed 1 year ago were normal. What is the most likely diagnosis?

  1. Vitamin K deficiency
  2. Liver failure
  3. Factor VII deficiency
  4. Factor VIII inhibitor
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3. A 40-year-old man with a past medical history of chronic hepatitis C and alcohol abuse presents with complaints of epistaxis and gingival bleeding. Physical examination reveals splenomegaly. The liver span measures 10 cm on the right midclavicular line. Laboratory examination reveals a PT of 22 seconds and aPTT of 40 seconds. Complete blood count reveals a hemoglobin level of 10 g/dL and a platelet count of 40 × 103/mm3. What is the most likely diagnosis?
  1. Hemophilia A
  2. Hemophilia B
  3. Liver failure
  4. Von Willebrand’s disease
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4. A 50-year-old woman presents with complaints of epistaxis and gingival bleeding. Physical examination reveals petechiae and purpura of the lower extremities. Laboratory examination reveals a platelet count of 8 × 103/mm3 and normal leukocyte count, hemoglobin, PT, and aPTT. The patient recently started taking quinine for leg cramps. What is the most likely diagnosis?

  1. Immune thrombocytopenic purpura
  2. Thrombotic thrombocytopenic purpura
  3. Disseminated intravascular coagulation
  4. Hemolytic uremic syndrome
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