Haematology Flashcards
The most important cell in the initiation of normal haemostasis.
A. Erythrocyte B. Fibrin C. Megakaryocyte D. Protein C E. Endothelial cell F. Thromboxane A2 G. a2 macroglobulin H. Cycloxygenase I. Platelet J. Plasmin K. Fibrinogen L. Tissue plasminogen-activator (t-PA) M. Antithrombin III
E. Endothelial cell
Damage to the endothelial cells causes the release of substances that INITIATE the process of haemostasis, including platelet activation.
The main component involved in stabilising the primary haemostatic plug.
A. Erythrocyte B. Fibrin C. Megakaryocyte D. Protein C E. Endothelial cell F. Thromboxane A2 G. a2 macroglobulin H. Cycloxygenase I. Platelet J. Plasmin K. Fibrinogen L. Tissue plasminogen-activator (t-PA) M. Antithrombin III
B. Fibrin
A serine protease which assists in the break down of blood clots by binding to the clot and localising agents which break it down.
A. Erythrocyte B. Fibrin C. Megakaryocyte D. Protein C E. Endothelial cell F. Thromboxane A2 G. a2 macroglobulin H. Cycloxygenase I. Platelet J. Plasmin K. Fibrinogen L. Tissue plasminogen-activator (t-PA) M. Antithrombin III
L. Tissue plasminogen-activator (t-PA)
A single chain glycoprotein, synthesised by the liver and endothelium, which has strongly anticoagulant action and is important in the mode of action of heparin.
A. Erythrocyte B. Fibrin C. Megakaryocyte D. Protein C E. Endothelial cell F. Thromboxane A2 G. a2 macroglobulin H. Cycloxygenase I. Platelet J. Plasmin K. Fibrinogen L. Tissue plasminogen-activator (t-PA) M. Antithrombin III
M. Antithrombin III
A potent inhibitor of plasmin in the blood.
A. Erythrocyte B. Fibrin C. Megakaryocyte D. Protein C E. Endothelial cell F. Thromboxane A2 G. a2 macroglobulin H. Cycloxygenase I. Platelet J. Plasmin K. Fibrinogen L. Tissue plasminogen-activator (t-PA) M. Antithrombin III
G. a2 macroglobulin
This product of the cyclic endoperoxides induces platelet aggregation
A. Autoimmune thrombocytopenic purpura B. Sensitised platelet C. Christmas disease D. Vitamin K deficiency E. Thromboxane A2 F. Haemophilia G. Megakaryocyte H. von Willebrand deficiency I. Factor VIII deficiency J. Factor XII deficiency K. Ehlers-Danlos syndrome L. Prostacyclin PGI2 M. Marfan syndrome
E. Thromboxane A2
A 6 foot 7 inch rower presents to his GP complaining of easy skin bruising. On further examination he is found to have pectus excavatum, lax joints and a high-arched palate.
A. Autoimmune thrombocytopenic purpura B. Sensitised platelet C. Christmas disease D. Vitamin K deficiency E. Thromboxane A2 F. Haemophilia G. Megakaryocyte H. von Willebrand deficiency I. Factor VIII deficiency J. Factor XII deficiency K. Ehlers-Danlos syndrome L. Prostacyclin PGI2 M. Marfan syndrome
K. Ehlers-Danlos syndrome
A 62 year old overweight woman presents to the Emergency Department following a Road Traffic Accident. A full set of investigations is carried out – which shows an increased Activated Partial Thromboplastin Time (APTT) and Prothrombin Time (PT)
A. Autoimmune thrombocytopenic purpura B. Sensitised platelet C. Christmas disease D. Vitamin K deficiency E. Thromboxane A2 F. Haemophilia G. Megakaryocyte H. von Willebrand deficiency I. Factor VIII deficiency J. Factor XII deficiency K. Ehlers-Danlos syndrome L. Prostacyclin PGI2 M. Marfan syndrome
D. Vitamin K deficiency
A 25 year old man presents to the Emergency Department a day after attending his dentist for a routine check-up. After treatment at the dentists the previous day, his gums had not stopped bleeding. On investigation, his APTT and bleeding time are prolonged but a normal PT.
A. Autoimmune thrombocytopenic purpura B. Sensitised platelet C. Christmas disease D. Vitamin K deficiency E. Thromboxane A2 F. Haemophilia G. Megakaryocyte H. von Willebrand deficiency I. Factor VIII deficiency J. Factor XII deficiency K. Ehlers-Danlos syndrome L. Prostacyclin PGI2 M. Marfan syndrome
H. von Willebrand deficiency
A 16 year old girl presents to the Haematology Outpatients clinic describing a fluctuating history of easy bruising, epistaxis and menorrhagia. On investigation there is a thrombocytopaenia with increased megakaryocytes on BM examination.
A. Autoimmune thrombocytopenic purpura B. Sensitised platelet C. Christmas disease D. Vitamin K deficiency E. Thromboxane A2 F. Haemophilia G. Megakaryocyte H. von Willebrand deficiency I. Factor VIII deficiency J. Factor XII deficiency K. Ehlers-Danlos syndrome L. Prostacyclin PGI2 M. Marfan syndrome
A. Autoimmune thrombocytopenic purpura
Which protein, important in haemostasis, is vitamin K dependent but is not a serine protease?
A. Thrombin B. Activated factor X C. Vascular subendothelium D. Protein C E. Protein S F. Cyclooxygenase G. Factor VII H. Tissue factor pathway inhibitor I. Arichidonic acid J. Platelets K. Vascular endothelium L. Tissue factor
E. Protein S
Which option is required as a cofactor for protein C activity?
A. Thrombin B. Activated factor X C. Vascular subendothelium D. Protein C E. Protein S F. Cyclooxygenase G. Factor VII H. Tissue factor pathway inhibitor I. Arichidonic acid J. Platelets K. Vascular endothelium L. Tissue factor
E. Protein S
Which option synthesises tissue factor, vWF, prostacyclin, plasminogen activator, antithrombin III and thrombomodulin?
A. Thrombin B. Activated factor X C. Vascular subendothelium D. Protein C E. Protein S F. Cyclooxygenase G. Factor VII H. Tissue factor pathway inhibitor I. Arichidonic acid J. Platelets K. Vascular endothelium L. Tissue factor
K. Vascular endothelium
Which enzyme, important for platelet aggregation, is irreversibly inhibited by aspirin?
A. Thrombin B. Activated factor X C. Vascular subendothelium D. Protein C E. Protein S F. Cyclooxygenase G. Factor VII H. Tissue factor pathway inhibitor I. Arichidonic acid J. Platelets K. Vascular endothelium L. Tissue factor
F. Cyclooxygenase
Which key clotting factor activates both factors V and VIII, and also activates protein C?
A. Thrombin B. Activated factor X C. Vascular subendothelium D. Protein C E. Protein S F. Cyclooxygenase G. Factor VII H. Tissue factor pathway inhibitor I. Arichidonic acid J. Platelets K. Vascular endothelium L. Tissue factor
A. Thrombin
A 37 year old mother of 4 children, presents to her GP because of recurrent nose bleeds and feeling tired all the time and heavy periods.
A. Warfarin overdose B. Christmas Disease C. Vitamin K Deficiency D. B-Thalassaemia E. Antiphospholipid antibody syndrome F. Disseminated intravascular coagulation G. Von Willebrand’s Disease H. Osler-Weber-Rendu Syndrome I. Factor V Leiden J. Bile acid malabsorption K. Haemophilia A L. Malignancy M. Henoch – Schönlein Purpura N. Sickle cell anaemia
H. Osler-Weber-Rendu Syndrome
A rare autosomal dominant disorder. Alternative name = hereditary haemorrhagic telangiectasia. There is a structural abnormality of the blood vessels, resulting in telangiectases, which are thin walled so are likely to bleed. This leads to haemorrhage and anaemia. It is more common in females, and may not present until later in life. Epistaxis is the commonest presenting symptom. This patient is feeling tired, not just because of her 4 children, but because she also has iron deficiency anaemia.
A 3 year old boy is brought to see his GP by his mother. A fortnight ago he had been brought along because of cold-like symptoms, unsurprising since it was the middle of winter and he attends nursery. He was therefore sent home with some Calpol, and as expected his symptoms soon resolved. However this morning his mother noticed a rash on his bottom, and he said his tummy ached.
A. Warfarin overdose B. Christmas Disease C. Vitamin K Deficiency D. B-Thalassaemia E. Antiphospholipid antibody syndrome F. Disseminated intravascular coagulation G. Von Willebrand’s Disease H. Osler-Weber-Rendu Syndrome I. Factor V Leiden J. Bile acid malabsorption K. Haemophilia A L. Malignancy M. Henoch – Schönlein Purpura N. Sickle cell anaemia
M. Henoch – Schönlein Purpura
Affects children between 2-8yrs old. More common in winter. Usually presents following an upper respiratory tract infection. Rapid onset, with a palpable purpuric rash over the buttocks and legs, as well as symmetrical urticarial plaques, and haemorrhagic bullae. Arthritis of the knee and ankle. Abdominal pain – perhaps due to mesenteric vasculitis.
Can have renal involvement – with haematuria/proteinuria. (not idiopathic thrombocytopenic purpura – because it’s not an option here
22 year old Saharawi refugee presents with anaemia, weight loss, loose stools and blood tests reveal an increased PT and slightly increased APTT, with normal thrombin time and platelet count.
A. Warfarin overdose B. Christmas Disease C. Vitamin K Deficiency D. B-Thalassaemia E. Antiphospholipid antibody syndrome F. Disseminated intravascular coagulation G. Von Willebrand’s Disease H. Osler-Weber-Rendu Syndrome I. Factor V Leiden J. Bile acid malabsorption K. Haemophilia A L. Malignancy M. Henoch – Schönlein Purpura N. Sickle cell anaemia
C. Vitamin K Deficiency
Prevalence of coeliac disease is highest in Saharawi refugees. This patient has coeliac disease, and as a result of malabsorption is losing weight and has loose stools (steatorrhoea), and vitamin K deficiency. The blood results related to vitamin K deficiency.
A 5 year old boy has the following blood results: normal PT, increased APTT, normal platelet count, decreased VIII:C and decreased vWF.
A. Warfarin overdose B. Christmas Disease C. Vitamin K Deficiency D. B-Thalassaemia E. Antiphospholipid antibody syndrome F. Disseminated intravascular coagulation G. Von Willebrand’s Disease H. Osler-Weber-Rendu Syndrome I. Factor V Leiden J. Bile acid malabsorption K. Haemophilia A L. Malignancy M. Henoch – Schönlein Purpura N. Sickle cell anaemia
G. Von Willebrand’s Disease
The most common hereditary bleeding disorder, affect 1% of the population. vWF is a carrier protein for factor VIII and stabilises it. Mutation is in chromosome 12.
A 32 week pregnant lady who has gestational diabetes and is epileptic has a caesarean section while on holiday in rural China. Her newborn baby is suffering from bleeding from the umbilical stump, as well as nose and gums. What is wrong with the baby?
A. Warfarin overdose B. Christmas Disease C. Vitamin K Deficiency D. B-Thalassaemia E. Antiphospholipid antibody syndrome F. Disseminated intravascular coagulation G. Von Willebrand’s Disease H. Osler-Weber-Rendu Syndrome I. Factor V Leiden J. Bile acid malabsorption K. Haemophilia A L. Malignancy M. Henoch – Schönlein Purpura N. Sickle cell anaemia
C. Vitamin K Deficiency
Drugs, such as anticonvulsants, which the mother is likely to be taking as she suffers from epilepsy, as well as isoniazid, rifampicin and anticoagulants, are risk factors for haemorrhagic disease of the newborn – which is what this baby has. This is due to vitamin K deficiency – although rare now in the UK as prophylactic vitamin K is given to newborns.
A fit 48-year-old investment banker presents to A&E with a painful R arm that was present when he woke up that morning. He is otherwise well and there is no history of trauma or abnormalities of any system. On examination there is marked tenderness and mild erythema along the anterolateral aspect of the forearm and cubital fossa, with no abnormality of the upper arm or axilla.
A. Deep vein thrombosis B. Superior vena caval obstruction C. Postphlebitic syndrome D. Thrombophlebitis E. Inferior vena caval obstruction F. Axillary vein thrombosis G. Superficial venous thrombosis H. Varicose veins I. DIC J. Pulmonary embolism
G. Superficial venous thrombosis
Superfical venous thrombosis is what it says on the tin - thrombosis of a superficial vein.
A 45-year-old lady, known heavy smoker with chronic respiratory problems, presents to her GP with increasing dyspnoea and swelling of her R arm and face. On examination of her chest there is no asymmetry or tracheal deviation, but there are added sounds over the R upper lobe and on bending forward her face becomes congested.
A. Deep vein thrombosis B. Superior vena caval obstruction C. Postphlebitic syndrome D. Thrombophlebitis E. Inferior vena caval obstruction F. Axillary vein thrombosis G. Superficial venous thrombosis H. Varicose veins I. DIC J. Pulmonary embolism
B. Superior vena caval obstruction
A 56-year-old woman returns to the Vascular Clinic with recurrence of her L leg ulcer after the area has been knocked by a shopping trolley. On examination the ulcer is situated above the medial malleolus, its dimensions being 6cm x 5cm. The base is filled with yellowish slough and the surrounding area is erythematous, with prominent oedema.
A. Deep vein thrombosis B. Superior vena caval obstruction C. Postphlebitic syndrome D. Thrombophlebitis E. Inferior vena caval obstruction F. Axillary vein thrombosis G. Superficial venous thrombosis H. Varicose veins I. DIC J. Pulmonary embolism
C. Postphlebitic syndrome
A 48-year-old man develops R-sided pleuritic chest pain and coughs up a trace of bloodstained sputum 8 days after a R hemicolectomy. He has mild dyspnoea but chest examination and chest radiography are normal.
A. Deep vein thrombosis B. Superior vena caval obstruction C. Postphlebitic syndrome D. Thrombophlebitis E. Inferior vena caval obstruction F. Axillary vein thrombosis G. Superficial venous thrombosis H. Varicose veins I. DIC J. Pulmonary embolism
J. Pulmonary embolism
A 32-year-old lady develops acute swelling of her L leg 2 days post-partum. She had bilateral leg swelling during the pregnancy but the delivery was normal. On examination there is tense swelling of the leg and thigh and some deep tenderness over the calf and medial aspect of the thigh.
A. Deep vein thrombosis B. Superior vena caval obstruction C. Postphlebitic syndrome D. Thrombophlebitis E. Inferior vena caval obstruction F. Axillary vein thrombosis G. Superficial venous thrombosis H. Varicose veins I. DIC J. Pulmonary embolism
A. Deep vein thrombosis
A drug that is administered intravenously and has a rapid effect by potentiating the action of antithrombin. Action can be reversed quickly which is of relevance in myocardial infarction patients who may require early invasive treatment (ie PTCA).
A. Warfarin B. Dipyridamole modified release (MR) and aspirin C. 10mg, 10mg, 5mg, measure on 4th day then every 2 days D. LMWH and aspirin E. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days F. APTT G. Calciparone H. Unfractionated heparin (UFH) I. Aspirin J. Pentapolysaccharide K. Clopidogrel and aspirin L. Streptokinase M. Thrombin time (TT) N. Dalteparin (LMWH) O. Clopidogrel P. Prothrombin time (PT)
H. Unfractionated heparin (UFH)
Potentiates antithrombin III. Usually given subcutaneously. Can cause osteoporosis and hyperkalaemia.
A. Warfarin B. Dipyridamole modified release (MR) and aspirin C. 10mg, 10mg, 5mg, measure on 4th day then every 2 days D. LMWH and aspirin E. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days F. APTT G. Calciparone H. Unfractionated heparin (UFH) I. Aspirin J. Pentapolysaccharide K. Clopidogrel and aspirin L. Streptokinase M. Thrombin time (TT) N. Dalteparin (LMWH) O. Clopidogrel P. Prothrombin time (PT)
N. Dalteparin (LMWH)
Used to monitor patients undergoing warfarin therapy.
A. Warfarin B. Dipyridamole modified release (MR) and aspirin C. 10mg, 10mg, 5mg, measure on 4th day then every 2 days D. LMWH and aspirin E. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days F. APTT G. Calciparone H. Unfractionated heparin (UFH) I. Aspirin J. Pentapolysaccharide K. Clopidogrel and aspirin L. Streptokinase M. Thrombin time (TT) N. Dalteparin (LMWH) O. Clopidogrel P. Prothrombin time (PT)
P. Prothrombin time (PT)
Used to monitor patients undergoing unfractionated heparin therapy.
A. Warfarin B. Dipyridamole modified release (MR) and aspirin C. 10mg, 10mg, 5mg, measure on 4th day then every 2 days D. LMWH and aspirin E. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days F. APTT G. Calciparone H. Unfractionated heparin (UFH) I. Aspirin J. Pentapolysaccharide K. Clopidogrel and aspirin L. Streptokinase M. Thrombin time (TT) N. Dalteparin (LMWH) O. Clopidogrel P. Prothrombin time (PT)
F. APTT
