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USMLE (United States Medical Licensing Examination) Practice Exam 36

Practice exam for USMLE (United States Medical Licensing Examination).

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Question 1 of 1000%
Time remaining120:00
Attempts allowedUnlimited
Difficulty mixE • M • H
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Question 1

MEDIUM

A 24-year-old woman presents with 2 days of dysuria and urinary frequency. She has no flank pain. Temperature is 37.2°C (99.0°F), blood pressure is 112/70 mm Hg, and pulse is 84/min. Urinalysis shows positive leukocyte esterase and nitrites. She is prescribed trimethoprim-sulfamethoxazole. Two days later, she returns with fatigue and shortness of breath. Laboratory studies show: hemoglobin 8.1 g/dL, reticulocyte count 8%, total bilirubin 3.2 mg/dL (0.2–1.2), LDH elevated, and haptoglobin low. Which of the following is the most likely underlying mechanism of her anemia?

Sulfonamides can precipitate hemolysis in G6PD deficiency by increasing oxidative stress; deficient NADPH impairs glutathione regeneration, leading to hemolysis (often intravascular with low haptoglobin). Warm autoimmune hemolysis (A) is IgG-mediated and not classically triggered by TMP-SMX in this way; microangiopathic hemolysis (E) would show schistocytes and thrombocytopenia.

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