A 10-year-old girl has had fatigue and pallor for 3 weeks

Discussion in 'USMLE STEP 2 CS' started by Shabir., Jul 29, 2008.

  1. Shabir.

    Shabir. Guest

    A 10-year-old girl has had fatigue and pallor for 3 weeks. Six weeks ago, she underwent aortic valve replacement with a mechanical prosthesis. She is receiving digoxin therapy. Her temperature is 37°C (98.6°F), blood pressure is 100160 mmHg, pulse is 1151min, and respirations are 241min. A grade 216, systolic ejection murmur is heard along the left sternal border, and a grade 2/6, decrescendo diastolic murmur is heard along the left sternal border to the cardiac apex. The liver and spleen are palpable. Her hemoglobin level is 4.6 gldL. A blood smear shows schistocytes. Which of the following is the most likely cause of the anemia?

    A) Autoimmune hemolytic anemia
    B) Digoxin-induced hemolytic anemia
    C) Glucose 6-phosphate dehydrogenase deficiency
    D) Hemolytic-uremic syndrome
    E) Periprosthetic valve leak
  2. Guest

    Guest Guest

    E. prosthetic valve--- RBC bumping--schistocytes---intravasc. microangiopathic hemo. anemia----BM cann't keep up--- extramed. hemopoesis ( hepato-splenomegaly )

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