HEMA 2 FINALS Flashcards
A 6 year old girl requiring a adenoidectomy undergoes preoperative laboratory testing by her surgeon revealing a prolonged activated partial thromboplastin time (PTT) of 150 seconds (normal range 22-36 seconds). Her prothrombin time (PT) is normal. She had previously had 2 dental extractions that were uneventful.
She otherwise has no personal or family history of bleeding. Which of the
following is most likely:
a. Factor VIII activity of 2%
b. Factor IX activity of 2%
c. Factor VII activity of 2%
d. Factor XI activity of 2%
e. Factor XII activity of 2%
e. Factor XII activity of 2%
Singer Method of Alkaline Denaturation is a test to measure increased Level of:
a. Hgb S
b. Hgb F
c. Hgb A
b. Hgb F
In case of Hemophilia B, which of the following tests would be prolonged?
I. Clotting Time
II. APTT
III. PT
IV. Reptilase Time
a. I and II
b. II and IV
c. I, II and III
d. I and IV
a. I and II
ANTIPLATELET DRUGS except:
a. FONDAPARINUX
b. CLOPIDOGREL
c. None
a. FONDAPARINUX
Acute Disseminated intravascular coagulation is characterized by:
a. Hypofibrinoginemia
b. Negative D-Dimer
c. Thrombocytosis
d. Shortened Prothrombin Time
a. Hypofibrinoginemia
A 5-year-old boy contracts fulminant hepatitis A from contaminated vegetables.
He is hospitalized in the intensive care unit with hepatic failure and hepato-renal syndrome necessitating dialysis. The intensive care physician is planning on
placing a dialysis catheter and orders a PT and aPTT. The PT is 56 seconds (normal range 9–12 seconds) and the aPTT is 99 seconds (normal range is 22–33 seconds). Which combination of factor deficiencies is most likely in this scenario?
a. Factors II, V, VIII, and X
b. Factors II, VII, VIII, and IX
c. Factors II, VII, IX, and X
d. Factors VII, VIII, IX, and XI
e. Factors VII, VIII, IX, and von Willebrand factor
c. Factors II, VII, IX, and X
An 11 year old female with recurrent tonsillitis is referred for a tonsillectomy. Her surgeon orders pre-operative laboratory tests and the results demonstrate a PT
of 10.2 seconds (normal 9.7- 11.2 seconds) and a PTT of 58 seconds (normal 22-36 seconds). The most appropriate next test to order is:
a. Factor VIII activity.
b. Factor IX activity.
c. Factor XI activity.
d. Factor XII activity.
e. A mixing study.
e. A mixing study.
Which of the following is true regarding the bleeding time?
a. It is a highly reliable and reproducible test
b. The sample is evaluated using an optical densitometer
c. It evaluates platelet function in vivo
d. It is a commonly ordered test
e. It evaluates the coagulation system
c. It evaluates platelet function in vivo
In cellulose Acetate Electrophoresis, which of the following HGB variants will
migrate with Hgb A2?
a. Hgb S
b. Hgb F
c. Hgb C
c. Hgb C
A 10 day old male is being seen in the emergency room due lethargy and poor feeding. Her anterior fontanel is full. A CT scan demonstrates an intraparenchymal hemorrhage. Coagulation tests are ordered with the following
results: PT—37 seconds (normal 9.7-11.2 seconds) and a PTT of 66 seconds (normal 22- 36 seconds). This child may have which of the following factor
deficiencies:
a. Factor VII.
b. Factor VIII.
c. Factor IX.
d. Factor X.
e. Factor XI.
d. Factor X.
The cell series most readily identified by a positive Sudan Black B is:
a. Erythrocytic
b. Lymphocytic
c. Myelocytic
d. Megakaryocytic
c. Myelocytic
Which of the following tests can be useful in differentiating leukemoid reactions
from chronic granulocytic leukemias?
a. Peroxidase stain
b. Specific esterase Stain
c. Sudan Black B stain
d. Leukocyte Alkaline Phosphatase
d. Leukocyte Alkaline Phosphatase
Mode of Administration for Heparin:
a. Intramuscular
b. Intradermal
c. Intravenous
d. All of the above
c. Intravenous
Rosenthal Syndrome will result to a prolonged result in:
a. Clot Retraction
b. APTT
c. Prothrombin Time
d. Both A and C
b. APTT
A patient has a white blood count of 50 x 103/uL. To distinguish between
bacterial infection and chronic granulocytic leukemia, the most useful test is?
a. NBT Reduction
b. PAS
c. TRAP
d. LAP
d. LAP
Which of the following factor will be decreased in cases of Vitamin K deficiency?
I. Christmas Factor
II. Proconvertin
III. Stuart Factor
IV. Hageman Factor
a. II and III
b. I, II and III
c. I and IV
d. I, II and IV
b. I, II and III
In the positive pressure method for Capillary Fragility Test, which is being
increased?
a. Oncotic Pressure
b. Hydrostatic Pressure
c. Osmotic pressure
d. Both B and C
b. Hydrostatic Pressure
What occurs during platelet Adhesion?
a. Binding of GP IIb/ IIIa with Fibrinogen
b. Shape change of Platelet
c. Binding of GP ib with vWf
d. Release of Thromboxane A2
c. Binding of GP ib with vWf
Which of the following INCREASE ANTICOAGULANT EFFICACY?
a. Hyperlipidemia
b. Edema
c. Hyperthyroidism
d. Hypothyroidism
c. Hyperthyroidism
The positive Color for Non-Specific Esterase staining is:
a. Gold
b. Blue
c. Red
d. Purple
c. Red
DIPYRIDAMOLE Mechanism of Action:
a. Inhibiting the binding of fibrinogen to activated platelets
b. Inhibiting cyclic nucleotide phosphodiesterase
c. Blocking glycoprotein IIb/IIIa receptor
d. Inhibiting cyclooxygenase
b. Inhibiting cyclic nucleotide phosphodiesterase
kidney enzyme that directly converts plasminogen to active plasmin:
a. Streptokinase
b. Alteplase
c. Urokinase
d. Tenecteplase
c. Urokinase
Which of the following is a characteristic of a normal inactive platelet?
a. Appears gray in wright stained smears
b. Multi nucleated
c. Granular
d. Spherical in shape
c. Granular
Which of the following is secreted by the Alpha granules of the platelets?
I. ADP
II. Fibrinogen
III. Serotonin
IV. VWf
a. I and III
b. I and II
c. II and III
d. II and IV
d. II and IV
“prevent progression of thrombosis” is the function of:
a. Anticoagulatants
b. Fibrinolytics
c. Antiplatelets
d. All of the above
a. Anticoagulatants
Transient thrombocytopenia (HIT) is side effect of:
a. Protamine sulfate
b. Heparin
c. Warfarin
d. Aspirin
b. Heparin
Abnormal Increased activity of Inhibitors will result to which of the following?
a. Bleeding
b. Clotting
c. Fibrinolysis
d. All
a. Bleeding
Which of the following my be used to stain neutral fats, phospholipids and
sterols?
a. Peroxidase
b. PAS
c. Sudan Black B
d. Prussian Blue
c. Sudan Black B
Which of the following factors is not found in the serum?
a. V
b. X
c. XI
d. A and C
a. V
A 3-year-old girl presents with prolonged oozing from her tongue after apparently biting it. Her platelet count is normal. Her PT is 68 seconds (normal range is 9–12
seconds), her aPTT is 123 seconds (normal range is 22–33 seconds) and her thrombin time is 58 seconds (normal range is 12–18 seconds). Which of the following tests should be ordered next?
a. Factor XIII level
b. Fibrinogen level
c. Factor X level
d. Ristocetin cofactor activity
e. Prekallikrein level
b. Fibrinogen level
Which of the following Organisms is a VIT K Producer?
a. Orientia tsutsugamushi
b. Proteus mirabillis
c. Bacteroides fragilis
d. B and C
c. Bacteroides fragilis
Kasabach Merritt Syndrome Is characterized by:
a. Vasculitis caused by allergy with Complement containing IgA
b. Collagen degradation due to Old age
c. Hemangioma
d. Missing Elastin
c. Hemangioma
A 4-year-old male is in the intensive care unit and has been intubated and sedated. You are asked to consult because of the presence of numerous generalized petechiae and some large ecchymosis on the abdomen and trunk. Laboratory evaluation demonstrates a platelet count of 45 × 109/L, a PT of 15.4
seconds (normal 9.7–11.2 seconds), a PTT of 48 seconds (normal 22–36
seconds), and a fibrinogen level of 0.87 g/L (normal 2–4 g/L). Which of the following most likely led to these clinical findings?
a. Immune thrombocytopenic purpura (ITP)
b. Systemic lupus erythematosus (SLE)
c. Congenital hypofibrinogenemia
d. Acute promyelocytic leukemia
e. Vitamin K deficiency
d. Acute promyelocytic leukemia
You are seeing a 10 year boy old with easy bruising and recurrent epistaxis as a
second opinion. He is active in a variety of sports, however his mother feels that
his bruising is excessive. His pediatrician sent the following laboratory tests all of which are normal: WBC, Hemoglobin, platelet count, PT, PTT. Another
hematologist ordered the following all of which were normal: VWF Ag, ristocetin cofactor activity, factor VIII activity, factor XIII activity, and platelet aggregation studies. Which of the following physical exam findings would be most informative:
a. Petechiae where the blood pressure cuff was placed.
b. Hypermobility of the finger joints.
c. Palpable bruises over the tibial surface.
d. A conjunctival hemorrhage
e. Albinism
b. Hypermobility of the finger joints
Glanzmann Thrombasthenia will show a normal in vitro aggregation test result in
which of the following stimulating agents?
a. ADP
b. Ristocetin
c. Collagen
d. Both A and B
b. Ristocetin
Scurvy is a vascular disorder characterized by inefficient collagen synthesis due
to deficiency of which of the following?
a. Folic Acid
b. Collagen synthetase
c. Ascorbic Acid
d. Hyaluronic Acid
c. Ascorbic Acid
Deficiency of Decay Accelerating Factor (DAF) on the cell membrane can cause
a hemolytic Disorder that can be confirmed using which special Hematology
Test?
a. Kyurem Denaturation Test
b. Sucrose Hemolysis Test
c. RivaltasTest
d. A and C Test
b. Sucrose Hemolysis Test
A 44-year-old man in acute distress is noted to have multiple ecchymoses of the
skin that have developed over the past 48 hours. His prothrombin time (PT) is 38 seconds and partial thromboplastin time (PTT) 55 seconds. A CBC shows a WBC count of 5300/microliter, hemoglobin 8.1 g/dL, hematocrit 24.9%, MCV 99
fL, and platelet count 16,300/microliter. His DDimer test is very high. Which of the following is the most likely diagnosis?
a. Hemophilia A
b. Afibrinogenemia
c. Vitamin K deficiency
d. vonWillebrand disease
e. Disseminated intravascular coagulopathy
e. Disseminated intravascular coagulopathy
MOA of Warfarin Except:
a. inhibit epoxide hydrase
b. interfere with the synthesis of vitamin K and thus inhibits activation of
vitamin K-dependent clotting factors (II, VII, IX, X)
c. also decreases the activity of protein S (activated by thrombin) –
responsible for some side effect
d. None
c. also decreases the activity of protein S (activated by thrombin) –
responsible for some side effect
Bernard Soulier Syndrome will result to a defect in which platelet function?
a. Platelet Adhesion
b. Platelet aggregation
c. Platelet Secretion
d. None
a. Platelet Adhesion
The Active Enzyme Necessary for Fibrinolysis:
a. A. Plasminogen
b. B. TPA
c. C. Urokinase
d. D. Plasmin
d. D. Plasmin
Which drug promotes Fibrinolysis?
a. Warfarin
b. Heparin
c. Urokinase
d. Aspirin
c. Urokinase
Contraindicated during pregnancy:
a. Heparin
b. Warfarin
c. Hirudin
d. All of the Above
b. Warfarin
Plavix is an example of:
a. Antiplatelet
b. Fibrinolytic
c. Anticoagulant
d. None
a. Antiplatelet
Blocking glycoprotein IIb/IIIa receptor is the mechanism of:
a. EPTIFIBATIDE
b. DIPYRIDAMOLE
c. CLOPIDOGREL
d. Both A and B
a. EPTIFIBATIDE
Rifampin is a potent:
a. CYP Inhibitor
b. CYP Inducer
c. Both
d. None
b. CYP Inducer
Mode of Action of Warfarin:
a. Interfere with the synthesis of vitamin K
b. Increase the activity of protein C
c. Both
d. None
a. Interfere with the synthesis of vitamin K
inhibiting fibrin binding to thrombin is a mechanism of which of the following?
a. Hirudin
b. Argatroban
c. Both
d. None
c. Both
cutaneous necrosis is due to the decrease in:
a. Protein C
b. Streptokinase
c. Plasminogen
d. All of the above
a. Protein C
DECREASE ANTICOAGULANT EFFICACY is noted in all except:
a. Grave’s Disease
b. Hashimoto’s Thyroiditis
c. Hyperlipidemia
d. Renal Failure
a. Grave’s Disease
Decreased in platelet function is associated with:
a. Cephalosporin
b. Aspirin
c. Thromboxane A2
d. All of the Above
d. All of the Above
True of Warfarin:
a. S is metabolized primarily CYP3A4
b. Administered Intravenously
c. readily crosses placenta
d. None of The above
c. readily crosses placenta
Which characteristic describes Antithrombin?
a. Synthesized by Megakaryocytes
b. Activated by Protein C
c. Both
d. Neither
d. Neither
The most frequent bleeding disorder of childhood, which can lead to life
a. Scurvy
b. Hemophila A
c. Vitamin K deficiency
d. Both A and C
c. Vitamin K deficiency
What role does vitamin K play in the Prothrombin group?
a. Provides surface on which the proteolytic reaction occurs
b. Carboxylates the factors to allow calcium binding
c. Protects them from inappropriate activation by compounds such as
thrombin
d. Accelerates the binding of the serine protease and their cofactors
b. Carboxylates the factors to allow calcium binding
Patients Results: PT:20 sec, APTT:50 sec, Thrombin Time:18 sec. What is the
most probable diagnosis?
a. Hyperfibrinogenemia
b. Warfarin Therapy
c. Von Willebrand Disease
d. All of the above
e. None of the Above
e. None of the Above
A prolonged APTT and PT are corrected when mixed with normal plasma. Which
factor is most likely deficient?
a. V
b. X
c. VIII
d. IX
e. Both
f. Neither
a. V
Consumable factor in coagulation is:
a. XIII
b. VII
c. IX
d. all of the above
e. None of the above
a. XIII
APTT and PT are prolonged. Substitution studies was done by mixing patient
sample with the correction reagents. Results are as follows: APTT with Adsorbed
Plasma: C; APTT with Aged Serum: NC; PT with Adsorbed Plasma: C; PT with
Aged Serum: NC. Identify the factor deficiency.
a. II
b. XIII
c. IV
d. all of the above
e. None of the above
e. None of the above
APTT and PT are prolonged. Substitution studies was done by mixing patient
sample with the correction reagents. Results are as follows: APTT with Adsorbed
Plasma: C; APTT with Aged Serum: NC; PT
a. II
b. XIII
c. Both/Either
d. Neither
d. Neither
A prolonged APTT is corrected with Aged serum but not with adsorbed plasma.
What factor is deficient?
a. V
b. VIII
c. IX
d. X
e. 2 of the choices
f. all of the above
a. V
