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Cervical cancer follow-up abnormal screen — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Cervical cancer follow-up abnormal screenUSMLE Step 3

A 36-year-old has confusion, petechiae, hemoglobin 7.8 g/dL, platelets 12,000/mm³, schistocytes, elevated LDH, normal coagulation studies, and creatinine 1.4 mg/dL. The PLASMIC score is high and ADAMTS13 activity is pending. Which treatment should begin now?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Begin plasma exchange plus glucocorticoids plus caplacizumab

The best answer is “Begin plasma exchange plus glucocorticoids plus caplacizumab”. This is high-probability immune TTP, a fatal emergency. Plasma exchange and immunosuppression begin immediately; caplacizumab rapidly blocks platelet-von Willebrand factor interaction. Platelets are avoided without life-threatening bleeding, eculizumab treats a different thrombotic microangiopathy, and confirmation cannot delay care. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: ISTH Guideline for Treatment of Thrombotic Thrombocytopenic Purpura: https://pubmed.ncbi.nlm.nih.gov/32914526/