A patient presents with petechiae, purpura, and mucosal bleeding. Laboratory tests reveal thrombocytopenia, elevated serum creatinine, and schistocytes on peripheral blood smear. Which of the following conditions is most likely to cause these findings?

Correct Answer: A

Rationale: Thrombotic thrombocytopenic purpura (TTP) is a rare but serious condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological abnormalities, fever, and renal dysfunction. The classic pentad of symptoms includes fever, neurologic changes, renal impairment, thrombocytopenia, and microangiopathic hemolytic anemia. The presence of petechiae, purpura, and mucosal bleeding along with thrombocytopenia, elevated serum creatinine, and schistocytes on peripheral blood smear are consistent with TTP. In TTP, there is usually a deficiency of ADAMTS13 (a von Willebrand factor-cleaving protease) leading to excessive platelet adhesion, aggregation, and microthrombi formation within small blood vessels. Treatment typically

Correct Answer: C

Rationale: The patient is presenting with sudden onset weakness and numbness on one side of the body, along with difficulty speaking and understanding speech, which are typical symptoms of a stroke. Imaging revealing an acute infarction involving the left middle cerebral artery territory is consistent with an ischemic stroke. Ischemic stroke occurs when there is a blockage in a blood vessel supplying blood to the brain, leading to a lack of oxygen and nutrients to the affected area, resulting in neurological deficits. This is in contrast to an intracerebral hemorrhage, which is caused by bleeding into the brain tissue, or a subarachnoid hemorrhage, which involves bleeding into the space surrounding the brain. A transient ischemic attack (TIA) is a temporary episode of neurological dysfunction caused by a brief blockage of blood flow to a part of the brain, usually resolving within 24 hours. In this case, the presentation and imaging findings are most

Correct Answer: D

Rationale: A subarachnoid hemorrhage is characterized by bleeding within the subarachnoid space, the area between the arachnoid mater and the pia mater surrounding the brain. Patients typically present with a sudden-onset severe headache, altered mental status, and focal neurological deficits due to the mass effect of the blood in the subarachnoid space. Imaging, such as a CT scan, can confirm the presence of the hemorrhagic lesion. Ischemic stroke results from a blockage in the blood vessels supplying the brain, leading to tissue infarction and neurological deficits. Subdural hematoma is a collection of blood between the dura mater and the arachnoid mater, commonly seen following head trauma. Intracerebral hemorrhage involves bleeding within the brain tissue itself, often leading to focal neurological deficits.

Correct Answer: D

Rationale: The presentation described in the question – sudden-onset unilateral headache along with ipsilateral ptosis, miosis, and anhidrosis – is characteristic of Horner syndrome. Horner syndrome is caused by disruption of the sympathetic nerve pathway and can occur in trigeminal neuralgia. Trigeminal neuralgia is a painful condition affecting the trigeminal nerve commonly characterized by sudden and severe facial pain that can be triggered by various stimuli. The involvement of the sympathetic pathway in trigeminal neuralgia can lead to Horner syndrome symptoms such as ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face. Cluster headaches usually involve severe unilateral pain around the eye, but they do not typically present with Horner syndrome symptoms. Migraine and tension-type headaches also do not typically present with Horner syndrome symptoms.

Correct Answer: C

Rationale: When providing health education to a patient, using clear and simple language is an essential aspect of effective communication. Medical terminology can be confusing and overwhelming for individuals without a medical background. By using language that the patient can easily understand, you improve their comprehension of the information being conveyed. Speaking quickly or using complex terms can actually hinder communication and may lead to misunderstanding. Clear and simple language helps ensure that the patient fully grasps the information and can make informed decisions about their health.