Coagulation Disorders USMLE Step 1 Practice Question
A 52-year-old man with a 10-year history of alcohol use disorder and biopsy-proven cirrhosis presents to the emergency department with hematemesis. Physical examination reveals jaundice, ascites, and spider angiomas. Vital signs: BP 98/62, HR 112, RR 22, temperature 37.2°C, SpO2 98% on room air. He denies recent aspirin or anticoagulant use. Laboratory studies show: PT: 18 seconds (normal 12-14)
aPTT: 42 seconds (normal 25-35)
Platelet count: 85,000/µL
Fibrinogen: 120 mg/dL (normal 200-400)
INR: 1.8
Total bilirubin: 4.2 mg/dL
Albumin: 2.1 g/dL Which of the following best explains this patient's coagulation abnormalities?
Answer choices
- ASelective deficiency of vitamin K-dependent factors due to cholestasis
- BThrombotic thrombocytopenic purpura with secondary coagulopathy
- CDisseminated intravascular coagulation secondary to bacterial translocation
- DDecreased hepatic synthesis of clotting factors and impaired fibrinogen productionCorrect answer
- EHeparin-induced thrombocytopenia with consumptive coagulopathy
- FVon Willebrand disease with portal hypertension-related thrombocytopenia
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