Missing piece

it all comes down to this

Now all the year's Luna had dreamt of taking her boards or thinking about it she never knew she'd wake up hungover in a bed with the guy she was desperately in love with. But she wasn't going to let that ruin her day or chances at passing.

"Hii" Luna said rolling over and looking at Jackson quietly asleep.

She knew she didn't want to stay because she had to get ready but didn't want to just leave. Noticing the note pad she knew she had to write a note so she could leave without making him upset or question their relationship anymore.

hi Jackson,

I didn't sneak out don't worry, but I also didn't want to wake you up as you know I'm a morning person and need to do things before our boards. we both know that we are going to be fine. and I know you will always be there for me. so good luck today not that you need it and we can talk afterwards.

lots of love,

your luna

Luna had spent the last few years preparing for this and knew that nothing could mess it up for her even if it was a boy.

Luna had gone from Jackson's room to her own and just got into her zone. Not talking to anyone or anything just simply going over the basics again and getting ready.

"Luna Shepherd" The woman called out. The moment her name was called her stomach sank.

It all comes down to this.

Luna walked into that room knowing that when she exited two people would've decided her future.

"A previously healthy 3-year-old male presents to your primary care clinic with acute onset of generalized petechiae. He is otherwise well and the review of symptoms is negative for weight loss, fatigue, recurrent fevers, and change in activity. On physical examination, the patient is a well-appearing toddler in no apparent distress with generalized petechiae. The remainder of his examination is normal. There is no history of a preceding viral illness. He does not take any medications. A family history of bleeding disorders is non-contributory. CBC is significant for severe thrombocytopenia with platelets of 12,000. WBC and haemoglobin are normal. Which of the following is the most likely diagnosis in this patient?" A youngish-looking man asked. And all Luna could think of was how she looked older than him so how could he be the one interviewing her?

Luna thought very hard before speaking but not leaving it too long.

"Idiopathic thrombocytopenic purpura, a Splenectomy is curative for most patients but is indicated only for life-threatening emergencies and/or refractory disease because of the risks associated with asplenia. Watchful waiting may be considered in mild cases with platelets 20 K/L." Luna said smiling.

There was silence between her answer because the examiners looked at each other before proceeding to ask another question.

"A 10-year-old girl presents with restlessness, irritability, and chorea of the face, hands, and arms bilaterally. MRI revealed enlargement of the basal ganglia. Symptoms improved with valproic acid and resolved in approximately 6 months. The disorder was most likely related to autoantibodies that cross-react between antigens in basal ganglia and antigens in the membrane of:" The man asked again, this question was so easy Luna thought to herself.

"Group A streptococcus, The patient likely presented with Sydenham's chorea as a manifestation of rheumatic fever, which develops months after Group A streptococcal infections. It is the most common acquired chorea of childhood." Luna again said not even having to think about the answers.

"Luna you switched specialities so last minute how did you manage to keep up with the revision and knowing so much" The examiner who wasn't asking questions asked.