This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'Which of the following is generally not seen in idiopathic thrombocytopenic purpura (ITP) – \nSelect and explain. \nA. More common in females, B. Petechiae, ecchymosis and bleeding, C. Palpable splenomegaly, D. Increased megakaryocytes in bone marrow', 'role': 'user'}, {'content': 'Answer: C \nExplanation: Idiopathic thrombocytopenic purpura\n\nThere are two clinical subtypes of primary I.T.P, acute and chronic both are autoimmune disorders in which platelet destruction results from the formation of antiplatelet antibodies.\n\nPathology\n\nThe principal morphologic lesions of thrombocytopenic purpura are found in the spleen and bone marrow but they are not diagnostic.\nThe point to stress is that despite the increased destruction of platelets in spleen the spleen size remains normal.\xa0 \n\nBone Marrow\n\nBone marrow reveals a modestly increased number of megakaryocytes.\nThese findings are not specific for autoimmune thrombocytopenic purpura but merely reflect accelerated thrombopoiesis, being found in most forms of thrombocytopenia resulting from increased platelet destruction.\nThe importance of bone marrow examination is to rule out thrombocytopenias resulting from bone marrow failure.\nA decrease in the number of megakaryocytes goes against the diagnosis of I.T.P.\n\nClinical Features\n\nChronic ITP occurs most commonly in adult women, younger than age 40 years.\nFemale to male ratio is 4: 1.\nThe clinical signs and symptoms associated with I.T.P are non-specific for this condition but they are rather reflective of thrombocytopenia.\nThe disease is often insidious in onset and is characterized by bleeding into the skin and mucosal surfaces.\nCutaneous bleeding occurs in the form of pinpoint haemorrhages, petechiae or ecchymoses. Often there will be a history of easy bruising, nosebleeds, bleeding from the gums and haemorrhages into soft tissues from relatively minor trauma.\nSometimes disease may first manifest with melena, hematuria or excessive menstrual flow.\nSubarachnoid haemorrhage and intracerebral haemorrhage are serious consequences of thrombocytopenic purpura but fortunately are rare in treated patients.', 'role': 'assistant'}]