American Board of Internal Medicine (ABIM) Certification Practice Exam

What is one of the symptoms included in the TTP pentad?

1. Neck pain

2. Hemolysis

3. Coughing

4. Skin rash

The correct answer is: Hemolysis

Thrombotic Thrombocytopenic Purpura (TTP) is characterized by a specific pentad of clinical features, of which hemolysis is one of the key components. TTP is a microangiopathic hemolytic anemia, which means that the destruction of red blood cells occurs in the microcirculation, leading to hemolysis. This results in elevated levels of lactate dehydrogenase (LDH) and indirect bilirubin, along with a low haptoglobin level. The symptoms included in the TTP pentad are microangiopathic hemolytic anemia, thrombocytopenic purpura (low platelet count leading to bleeding), neurologic symptoms (such as confusion or seizures), renal dysfunction, and fever. Hemolysis, as part of the anemia, manifests with signs and symptoms that can easily relate to severe fatigue, pallor, and shortness of breath. In contrast, the other options—neck pain, coughing, and skin rash—are not classic features of TTP. While a skin rash can occur due to microangiopathic disease, it is not a defining feature of TTP specifically. Instead, hemolysis plays a vital role in the diagnosis and understanding of TTP