Clotting cascade etc

Question 1

This is a protein that catalyses plasminogen –> plasmin conversion

Answer 1

Tissue plasminogen activator tPA

Question 2

Antidote for tissue plasminogen activator toxicity?

Answer 2

aminocaproic acid

Question 3

This serine protease dissolves fibrin blood clots

Answer 3

Plasmin

Question 4

Proteins that inhibit plasmin?

Answer 4

alpha2-macroglobulin

alpha2-antiplasmin

Question 5

What effect does heparin have on antithrombin?

Answer 5

Heparin increases AT binding of factor II and X

Question 6

Produced by activated platelets and has prothrombotic effects by increasing expression of GPIIb/IIIa on platelets

Answer 6

Thromboxane A2

Question 7

This enzyme is important for platelet aggregation and is irreversibly inhibited by aspirin.

Answer 7

Cyclooxygenase

Question 8

It works by irreversibly inactivating Factor Va and VIII. It is activated itself by thrombomodulin.

Answer 8

Protein C

Question 9

What is the other name for Prostaglandin-endoperoxide synthase 2?

Answer 9

Cyclooxygenase-2

Question 10

BM - increased megakaryocytes on a background of fluctuating history of easy bruising, epistaxis and menorrhagia.

Answer 10

Immune thrombocytopenic purpura

Question 11

Which components of the coagulation cascade are dependent on Vitamin K?

Answer 11

Factors II, VII, IX and X

Protein C, S and Z

Question 12

Vascular endothelium or subendothelium … which one synthesises tissue factor, vWF, prostacyclin, plasminogen activator, antithrombin III and thrombomodulin?

Answer 12

Endothelium

Question 13

Pain, tenderness, indurated cord along a palpable superficial vein. Skin is warm and erythematous.

Answer 13

Superficial venous thrombosis

Question 14

Peripheral oedema, tachycardia, supine hypotensive syndrome.

Answer 14

IVC syndrome

Question 15

Shortness of breath
Facial and arm swelling
Distended veins in the upper chest/arms

Answer 15

SVC syndrome (obstruction)

Question 16

Past medical history of DVT
Brownish discolouration of skin
Ulcer
Worsens after walking or standing for a long time

Answer 16

Post-thrombotic syndrome

Question 17

Antithrombin potentiator
Administered IV
Can be reversed quickly

Answer 17

Unfractionated heparin

Question 18

Potentiates antithrombin III
Usually subcut.
Risk of osteoporosis/hyperkalaemia

Answer 18

Dalteparin (LMWH)

Question 19

This is used to monitor warfarin therapy

Answer 19

INR (the patient’s PT divided by a normal PT)

Question 20

This prodrug goes on to inhibit P2Y receptors found on platelets - inhibiting their function
Primary prevention of stroke in aspirin allergic patients
Used in acute MI along with aspirin

Answer 20

Clopidogrel

Question 21

In patients with metallic heart valves, this drug is the most effective anticoagulant

Answer 21

Warfarin

Question 22

In patients with cancer and acute venous thromboembolism, the most effective drug at reducing the risk of recurrent VTE is __?

Answer 22

Dalteparin (LMWH)

Question 23

This drug when given alone initially increases the clotting risk

Answer 23

Warfarin

Question 24

Side effects include cutaneous necrosis

Answer 24

Warfarin

Question 25

The drug most likely to cause thrombocytopaenia with paradoxical thrombosis

Answer 25

Unfractionated heparin (UFH)

Question 26

Heparin mechanism of action?

Answer 26

Activates Antithrombin III --> inactivates Thrombin and FXa

Question 27

When is streptokinase contraindicated?

Answer 27

Contra-indicated if recent sore throat, if ever used before, or in the presence of proliferative retinopathy.

Question 28

Peripheral cytopenia | Greater than 20% blast cells in bone marrow

Answer 28

AML

Question 29

Macrocytic anaemia Megakaryocyte hyperplasia with nuclear hypolobation Moderate thrombocytosis

Answer 29

5q syndrome

Question 30

Pelger-Huet anomaly

Answer 30

Hyposegmented neutrophils

Question 31

A myelodysplastic syndrome with a marrow blast percentage of 5 to 19%

Answer 31

Refractory anaemia with excess of blasts

Question 32

A myelodysplastic syndrome in which two of the three blood cell types are abnormal and less than 1% of peripheral cells are blasts

Answer 32

Refractory cytopenia with multilineage dysplasia

Question 33

A myelodysplastic syndrome with low red cells and ringed sideroblasts

Answer 33

Refractory anaemia with ringed sideroblasts

Question 34

Imatinib used for what?

Answer 34

Treatment of CML - it's a tyrosine kinase inhibitor

Question 35

Two conditions in which you might see dacrocytes (teardrop cell)

Answer 35

Beta thalassemia major | Myelofibrosis

Question 36

Patient with CLL | Biopsy shows anaplastic, large cell lymphoma

Answer 36

Richter's syndrome CLL or hairy cell leukaemia --> diffuse large B cell lymphoma (a type of NHL)

Question 37

Patient with ALL has bone marrow infiltration of blasts or lymphocytes?

Answer 37

Blasts

Question 38

The commonest adult leukaemia

Answer 38

CLL | 'C' for common!

Question 39

Neutrophil alkaline phosphatase is low

Answer 39

CML

Question 40

Neutrophil alkaline phosphatase is raised

Answer 40

myeloproliferative disorders | Infections