Here's a recent case from the wards to inspire you to become the best doctor that you can be.  You will save lives and change the world for the better!!   Can you make the diagnosis?

Hey John:

I'm one of your Kaplan students whom you taught in Newark NJ back in 2010.  Currently I'm in my final year in internal medicine and will do hepatology next.  The reason I'm sending you this message is to thank you for your valuable lectures. They were so awesome that not only helped me in Step 1 , 2, 3 but also helped me save a life...

I was in the MICU,  on call,  when I had this patient sent from the floor with severe altered mental status and she had been intubated so history out of the equation.  I examined her and found asymmetric reflexes in the knees on the physical. During the rounds, the intern read the labs which were significant for a low platelet count and elevated creatinine. I was sitting beside the attending who was emphasizing on some point about the platelet count and the need for transfusion. She then asked the intern and me what do we think is the diagnosis?

As she spoke, I suddenly noticed 3 things of the pentad of TTP.   I couldn't help myself but to interrupt her and I said "TTP... The patient has TTP!"  She was surprised about my reaction, honestly so was I, and she was also unconvinced. I told her let's talk to hematologist and get ADAMTS 13.   I called the hematologist who also agreed with me and we called for a plasma exchange. The patient did have a stroke because of her TTP and she fully recovered. And few month later she came to the out patient clinic. You are a partner on saving this women. Thank you!Best,

M. A.  03/19/2015

I am so proud of my students.  Remember to learn your craft as best as you can and you will change the world for the better. Your destiny is greatness!!! - John Barone MD

Category: Pathology Mnemonics

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