Nephrology and electrolytes: uraemic platelet dysfunction: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology and electrolytes: uraemic platelet dysfunction

Sample item

A man with end-stage kidney disease has prolonged bleeding from a fistula puncture site and recurrent epistaxis. Platelet count, PT and aPTT are normal, but bleeding time is prolonged. Which agent can acutely improve haemostasis before a planned procedure?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Desmopressin

Uraemia impairs platelet adhesion and aggregation, so the platelet count is normal but function is poor. Desmopressin releases von Willebrand factor from endothelium and shortens the bleeding time within hours. Dialysis, correcting anaemia and conjugated oestrogens also help.

Option by option

  • A. Vitamin K

    Vitamin K corrects deficiency of clotting factors, which are normal here.

  • B. Platelet transfusion

    Transfused platelets are rapidly impaired by the uraemic milieu and the count is already normal.

  • C. Desmopressin (correct)

    Correct. Desmopressin releases von Willebrand factor and improves platelet adhesion in uraemia.

  • D. Fresh frozen plasma

    Plasma replaces clotting factors, but the PT and aPTT are normal.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Desmopressin. Uraemia impairs platelet adhesion and aggregation, so the platelet count is normal but function is poor.

Why is "Vitamin K" not the answer?

Vitamin K corrects deficiency of clotting factors, which are normal here.

Why is "Platelet transfusion" not the answer?

Transfused platelets are rapidly impaired by the uraemic milieu and the count is already normal.

Why is "Fresh frozen plasma" not the answer?

Plasma replaces clotting factors, but the PT and aPTT are normal.

What concept does this question test?

It tests Nephrology and electrolytes: uraemic platelet dysfunction in General Medicine. Desmopressin releases von Willebrand factor from endothelium and shortens the bleeding time within hours. Dialysis, correcting anaemia and conjugated oestrogens also help.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology and electrolytes: uraemic platelet dysfunction?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.