American Board of Internal Medicine (ABIM) Certification Practice Exam

Which bleeding type is primarily associated with von Willebrand disease?

1. Hemarthroses

2. Internal bleeding

3. Mucocutaneous bleeding

4. Intracranial hemorrhage

The correct answer is: Mucocutaneous bleeding

Von Willebrand disease (vWD) is a genetic bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor (vWF), which plays a crucial role in platelet adhesion and aggregation during blood clotting. The primary type of bleeding associated with vWD is mucocutaneous bleeding. Mucocutaneous bleeding refers to bleeding that occurs from mucous membranes, typically involving the skin, nose, gums, and gastrointestinal tract. Patients with von Willebrand disease often experience easy bruising, frequent nosebleeds (epistaxis), heavy menstrual bleeding (menorrhagia), and bleeding after dental procedures due to the impaired ability of platelets to adhere to the site of injury. This type of bleeding is a hallmark of vWD, making it distinguishable from other bleeding types. For instance, hemarthroses, which involves bleeding into joints, is more commonly seen in hemophilia rather than vWD. Internal bleeding and intracranial hemorrhage can occur in various bleeding disorders but are less characteristic of von Willebrand disease.