Chronic Kidney Disease USMLE Step 1 Practice Question
A 61 year old woman with longstanding chronic kidney disease presents with fatigue and recurrent epistaxis. She has no family history of bleeding disorders. Laboratory studies show hemoglobin 8.9 g/dL, BUN 92 mg/dL, creatinine 6.4 mg/dL, normal platelet count, normal PT, and normal PTT. Which of the following best explains her bleeding tendency?
Answer choices
- AImpaired platelet adhesion and aggregation due to uremic toxinsCorrect answer
- BAutoimmune destruction of platelets in the spleen
- CVitamin K deficiency leading to low clotting factors
- DFactor VIII deficiency from defective hepatic synthesis
- EDisseminated intravascular coagulation with consumption of clotting proteins
- FAcquired von Willebrand factor dysfunction from uremia impairing vWF multimer binding to platelet GPIb
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