Bleeding/Clotting Flashcards
For the past six months, a 35-year-old woman has experienced an excessively heavy menstrual flow each month. She also has noticed increasing numbers of pinpoint haemorrhages on her lower extremities in the past month. Physical examination shows no organomegaly or lymphadenopathy. CBC shows haemoglobin of 142 g/L, MCV of 91 fL, platelet count of 19 x 10(9)/L, and WBC count of 6.9 x 10(9)/L. On admission to the hospital, she has melena and is given a transfusion of platelets, but her platelet count does not increase. She is given high dose steroids, and her platelet count increases over the next few days. Which of the following describes the most likely basis for her bleeding tendency?
A.
Excessive loss of platelets in menstrual blood
b.
Destruction of antibody-coated platelets by the spleen
c.
Abnormalities in production of platelets by megakaryocytes
d.
Suppression of pluripotent stem cells
e.
Defective platelet-endothelial interactions
Destruction of antibody-coated platelets by the spleen
A 60-year-old man has developed widespread ecchymoses over the skin in the past month. His medical history includes a diagnosis of mucinous adenocarcinoma of the rectum. On physical examination, he appears cachectic and pale. An abdominal CT scan shows multiple hepatic masses. Laboratory studies show prothrombin time of 30 seconds, partial thromboplastin time of 55 seconds, platelet count of 15/um 3, and fibrinogen level of 75 mg/dL, and fibrin split product levels (D dimer) that are very elevated. Which of the following morphologic findings is most likely to be present on examination of his peripheral blood smear?
a.
Target cells
b.
Schistocytes
c.
Howell-Jolly bodies
d.
Macro-ovalocytes
e.
Teardrop cells
Schistocytes
RBC fragments, sign of haemolytic anaemia
A 23-year-old woman is bleeding heavily (per vagina) after a traumatic delivery of a term infant. There is bleeding from an IV insertion site. This patient has defects in her haemostatic system. Select the most likely diagnosis:
Hb 82g/L (120 - 155)
MCV 92fL (78 - 100)
WBC 14.2 x 109/L (4 - 11)
Neutrophils 11.4 x 109/L (2 - 7.5)
Platelets 31 x 109/L (150 - 400)
PT (INR) 2.1 (0.8 - 1.2)
aPTT 72 sec (25 - 41)
Fibrinogen 0.7g/L (2 - 4)
Select one:
a.
Immune thrombocytopenic purpura
b.
Acquired factor VIII inhibition
c.
Vitamin K deficiency
d.
Haemophilia B
e.
Warfarin overdose
f.
Simple easy bruisability
g.
Von Willibrand’s disease
h.
Haemophilia A
i.
Aspirin therapy
j.
Inherited platelet function defect
k.
Essential thrombocythaemia
l.
Acute leukaemia
m.
Aplastic anaemia
n.
Normal
o.
Inherited thrombophilia eg antithrombin III deficiency
p.
Factor XII deficiency
q.
Disseminated intravascular coagulation
Disseminated Intravascular Coagulation
caused by sustained severe shock/hypoxic tissue injury
An 18-year-old male has been fit and well and with no provocation develops a painful swollen left calf. Doppler ultrasonograph demonstrates a proximal vein deep venous thrombosis. This patient has defects in his haemostatic system. Select the most likely diagnosis:
Hb 140g/L (130 - 180)
MCV 87fL (78 - 100)
WBC 8.4 x 109/L (4 - 11)
Differential Normal
Platelets 310 x 109/L (150 - 400)
PT (INR) 1.1 (0.8 - 1.2)
aPTT 30 sec (25 - 41)
Fibrinogen 3.1g/L (2 - 4)
PFA 100 (bleeding time) 120 sec (100-150)
Select one:
a.
Acquired factor VIII inhibition
b.
Haemophilia B
c.
Aplastic anaemia
d.
Inherited platelet function defect
e.
Vitamin K deficiency
f.
Disseminated intravascular coagulation
g.
Von Willibrand’s disease
h.
Inherited thrombophilia eg antithrombin III deficiency
i.
Haemophilia A
j.
Warfarin overdose
k.
Simple easy bruisability
l.
Normal
m.
Immune thrombocytopenic purpura
n.
Aspirin therapy
o.
Factor XII deficiency
p.
Acute leukaemia
q.
Essential thrombocythaemia
Inherited thrombophilia eg antithrombin III deficiency
Even tho everything is normal (within ref ranges), he shouldn’t be getting DVT.
A 48-year-old man presented with a left sided transient ischaemic attack (now fully resolved). The spleen is palpable 2cm below the left costal margin.
Select the most likely diagnosis.
Hb 140 g/L (130 - 180)
MCV 90fL (78 - 100)
WBC 13.2 x 109/L (4 - 11)
Neutrophils 9.8 x 109/L (2 - 7.5)
Lymphocytes 3.1 x 109/L (0.9 - 3.6)
Platelets 1620 x 109/L (150 - 400)
Select one:
a.
Myelofibrosis
b.
Myelodysplasia
c.
Essential thrombocythaemia
d.
Non-Hodgkin’s lymphoma
e.
Acute myeloblastic leukaemia
f.
Chronic granulocytic leukaemia
g.
Chronic lymphocytic leukaemia
h.
Acute lymphoblastic leukaemia
i.
Polycythaemia vera
j.
Metastatic carcinoma to bone marrow
k.
Aplastic anaemia
l.
Glandular fever (infectious mononucleosis)
m.
Hodgkin’s disease
Essential thrombocythaemia (a type of bone marrow cancer)
A 63-year-old woman experiences a burning sensation in her hands and feet. Two months ago, she had an episode of swelling with tenderness in the right leg, followed by dyspnoea and right-sided chest pain. On physical examination, the spleen and liver are not enlarged. CBC shows haemoglobin, 133 g/L; MCV, 91 fL; platelet count, 957 x 19(9)/L; and neutrophil count, 8.4 x 10(9)/L. The peripheral blood smear shows abnormally large platelets. Which of the following is the most likely diagnosis?
Select one:
a.
Acute myeloid leukaemia
b.
Polycythaemia vera
c.
Essential thrombocythaemia
d.
Chronic myeloid leukaemia
e.
Primary myelofibrosis
Essential thrombocythaemia
A 32-year-old man had an upper respiratory tract, viral type illness two weeks before developing bruising and nose bleeds. This patient has defects in his haemostatic system. Select the most likely diagnosis:
Hb 138g/L (130 - 180)
MCV 92fL (78 - 100)
WBC 9.3 x 109/L (4 - 11)
Differential Normal
Platelets 6 x 109/L (150 - 400)
PT (INR) 1.0 (0.8 - 1.2)
aPTT 36 sec (25 - 41)
Fibrinogen 3.1g/L (2 - 4)
Select one:
a.
Von Willibrand’s disease
b.
Haemophilia A
c.
Aspirin therapy
d.
Acute leukaemia
e.
Disseminated intravascular coagulation
f.
Normal
g.
Inherited thrombophilia eg antithrombin III deficiency
h.
Aplastic anaemia
i.
Acquired factor VIII inhibition
j.
Warfarin overdose
k.
Essential thrombocythaemia
l.
Simple easy bruisability
m.
Vitamin K deficiency
n.
Immune thrombocytopenic purpura
o.
Haemophilia B
p.
Inherited platelet function defect
q.
Factor XII deficiency
Immune thrombocytopenic purpura
(platelets are down after a URTI)
A 45-year-old woman has experienced malaise with nausea and vomiting for three months. On physical examination, she has scleral icterus and a yellowish hue to her skin. She has difficulty remembering three objects after three minutes. There are no neurologic deficits. Laboratory studies show a positive serologic test result for hepatitis C, a serum ALT of 310 U/L, AST of 275 U/L, total bilirubin of 76 g/l, direct bilirubin of 58 g/l, alkaline phosphatase of 75 U/L, and ammonia of 55 µmol/L. An abnormal result of which of the following laboratory studies of haemostatic function is most likely to be reported?
Select one:
a. Fibrin split products
b. Platelet count
c. Platelet aggregation
d. Prothrombin time
e. Immunoassay for plasma von Willebrand factor
Prothrombin time (note APTT will be prolonged as well)
A 76-year-old woman notices that small, pinpoint-to-blotchy areas of superficial haemorrhage have appeared on her gums and on the skin of her arms and legs over the past three weeks. On physical examination, she is afebrile and has no organomegaly. Laboratory studies show a normal prothrombin time and partial thromboplastin time. FBC shows haemoglobin of 127 g/L, haematocrit of 37.2%, MCV of 80 µm 3, platelet count of 276/um 3, and WBC count of 5.6/mm 3. Platelet function studies and fibrinogen level are normal, and no fibrin split products are detectable. Which of the following conditions best explains these findings?
Select one:
a.Macronodular cirrhosis
b.Metastatic carcinoma
c.Meningococcemia
d.Vitamin C deficiency
e.Chronic renal failure
Vitamin C deficiency
Bleeding gums = scurvy
A 65-year-old man has an enlarged spleen and complains of headache and skin itch.
Hb 198g/L (130 - 180)
MCV 74fL (78 - 100)
WBC 12 x 109/L (4 - 11)
Differential Mild neutrophilia
Platelets 450 x 109/L (150 - 400)
What is the most likely diagnosis?
Select one:
a.
Acute myeloblastic leukaemia
b.
Myelodysplasia
c.
Multiple myeloma
d.
Aplastic anaemia
e.
Hodgkin’s disease
f.
Chronic granulocytic leukaemia
g.
Essential thrombocythaemia
h.
Chronic lymphocytic leukaemia
i.
Myelofibrosis
j.
Acute lymphoblastic leukaemia
k.
Polycythaemia vera
l.
Metastatic carcinoma to bone marrow
m.
Glandular fever (infectious mononucleosis)
n.
Non-Hodgkin’s lymphoma
Polycythaemia vera
A 25-year-old woman presents with a history of losing four pregnancies in the past five years. She also has a history of recurrent pains in her legs secondary to recurrent thrombosis. Her symptoms are most likely due to a deficiency of which one of the following substances?
Select one:
a.
C1 inactivator
b.
Plasmin
c.
Thrombin
d.
PA inhibitors
e.
Protein C
Protein C (an anticoagulant agent)
A 23-year-old woman is bleeding heavily (per vagina) after a traumatic delivery of a term infant. There is bleeding from an IV insertion site. Hb 82g/L (120 - 155) MCV 92fL (78 - 100) WBC 14.2 x 109/L (4 - 11) Neutrophils 11.4 x 109/L (2 - 7.5) Platelets 31 x 109/L (150 - 400) PT (INR) 2.1 (0.8 - 1.2) aPTT 72 sec (25 - 41) Fibrinogen 0.7g/L (2 - 4)
What is the most likely diagnosis?
Select one:
a.
Acute leukaemia
b.
Inherited platelet function defect
c.
Aplastic anaemia
d.
Factor XII deficiency
e.
Haemophilia A
f.
Aspirin therapy
g.
Essential thrombocythaemia
h.
Normal
i.
Inherited thrombophilia eg antithrombin III deficiency
j.
Simple easy bruisability
k.
Warfarin overdose
l.
Disseminated intravascular coagulation
m.
Immune thrombocytopenic purpura
n.
Haemophilia B
o.
Von Willibrand’s disease
p.
Acquired factor VIII inhibition
q.
Vitamin K deficiency
DIC
A 60-year-old man is admitted for coronary artery bypass surgery. Hb 138g/L (130 - 180) MCV 92fL (78 - 100) WBC 7.6 x 109/L (4 - 11) Differential: normal Platelets 320 x 109/L (150 – 400) PFA 100 190 sec (100 - 150)
What is the most likely cause of the abnormality?
Select one:
a.
Inherited platelet function defect
b.
Aplastic anaemia
c.
Disseminated intravascular coagulation
d.
Aspirin therapy
e.
Normal
f.
Von Willibrand’s disease
g.
Acute leukaemia
h.
Essential thrombocythaemia
i.
Haemophilia A
j.
Haemophilia B
k.
Simple easy bruisability
l.
Factor XII deficiency
m.
Acquired factor VIII inhibition
n.
Vitamin K deficiency
o.
Warfarin overdose
p.
Immune thrombocytopenic purpura
q.
Inherited thrombophilia eg antithrombin III deficiency
Aspirin therapy (PFA-100 is a platelet function analysis, aspirin is a platelet inhibitor. his count is normal tho so we know its like from a drug)
A 20-year-old female is referred from the gynaecologists (who find no abnormality) with menorrhagia. Hb 102g/L (120 - 155) MCV 71fL (78 - 100) WBC 6.2 x 109/L (4 - 11) Differential Normal Platelets 430 x 109/L (150 - 400) PT (INR) 1.1 (0.8 - 1.2) aPTT 53 sec (25 - 41) Fibrinogen 3.4g/L (2 - 4) PFA 100 (bleeding time) 240 sec (100 - 150)
What is the most likely cause of the abnormality?
Select one:
a.
Factor XII deficiency
b.
Inherited thrombophilia eg antithrombin III deficiency
c.
Warfarin overdose
d.
Acute leukaemia
e.
Essential thrombocythaemia
f.
Vitamin K deficiency
g.
Haemophilia A
h.
Disseminated intravascular coagulation
i.
Aplastic anaemia
j.
Haemophilia B
k.
Von Willibrand’s disease
l.
Inherited platelet function defect
m.
Normal
n.
Acquired factor VIII inhibition
o.
Immune thrombocytopenic purpura
p.
Aspirin therapy
q.
Simple easy bruisability
Von Willebrand’s disease (VW is a factor which helps to form the platelet plug, we know he got normal platelet count but PFA-100 - platelet function assay - is fucked)
A 32-year-old man had an upper respiratory tract, viral type, illness two weeks before developing bruising and nose bleeds. Hb 138 g/L (130 -180) MCV 92fL (80 - 198) neutrophils 6.3 x 10(9)/L (1.9-7.5) Platelets 6 x 10(9)/L (150 - 400) PT (INR) 1.0 (0.8 - 1.2) aPTT 36 sec (25 - 41) Fibrinogen 3.1 g/L (2 - 4)
What is the most likely cause of the abnormality?
Select one:
a.
Von Willebrand disease
b.
Simple easy bruisability
c.
Warfarin overdose
d.
Inherited thrombophilia; eg, antithrombin deficiency
e.
Inherited platelet function defect
f.
Essential thrombocythaemia
g.
Disseminated intravascular coagulation
h.
Factor XII deficiency
i.
Aspirin therapy
j.
Vitamin K deficiency
k.
Aplastic anaemia
l.
Immune thrombocytopenia
m.
Normal
n.
Acquired factor VIII inhibitor
o.
Haemophilia B
p.
Acute leukaemia
q.
Haemophilia A
Immune thrombocytopenia
