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BOC study (harr book) > heme externship - coag 2.3-2.4 > Flashcards

heme externship - coag 2.3-2.4 Flashcards

1
Q

the APTT is sensitive to a deficeincy of which clotting factor
A. FVII
B. FX
C. PF3
D. calcium

A

B. FX

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2
Q

which test result would be normal in a patient with dysfibrinogenemia
A. TT
B. APTT
C. PT
D. immunologic fibrinogen level

A

D. immunologic fibrinogen
- measures total fibrinogen

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3
Q

a patient with prolonged PT is given intravenous vitamin K. OT is corrected to normal after 24 hours. which clinical condition most likely caused these results
A. nectortic liver disease
B. FX deficiency
C. fibrinogen deficiency
D. obstructive jaundice

A

B. FX deficiency

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4
Q

which factor deficiency is associated with prolonged PT and APTT
A. FX
B. FVIII
C. FIX
D. FXI

A

A. FX

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5
Q

prolonged APTT is corrected with FVIII deficient plasma but not with FIX deficient plasma. which factor is deficient
A. FV
B. FVIII
C. FIX
D. FX

A

C. FIX

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6
Q

which of the following is a characteristic of classic hemophilia A
A. abnormal PLT aggregation
B. autosomal recessive inheritance
C. mild to severe bleeding episodes
D. prolonged PT

A

C. mild to severe bleeding episodes
- FVIII deficiency

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7
Q

which disorder may be indicated with the following results:
- PT: prolonged
- APTT: prolonged
- PLT count: decreased

A. FVIII deficiency
B. vWF disease
C. DIC
D. FIX deficiency

A

C. DIC

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8
Q

which of the following is a predisposing condition for the development of DIC
A. adenocarcinoma
B. ITP
C. PTP
D. HIT

A

A. adenocarcinoma
- releases thromboplastic substances

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9
Q

FXII deficiency is associated with:
A. bleeding
B. epistaxis
C. decreased risk of thrombosis
D. increased risk of thrombosis

A

D. increased risk of thrombosis

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10
Q

the following results were obtained on a patient:
- PLT count and function: normal
- PT: normal
- APTT: prolonged
which of the following disorders is most consistent with these results
A. hemophilia A
B. bernard-soulier syndrome
C. vWF disease
D. glanzmanns thrombathenia

A

A. hemophilia A
- FVIII deficiency

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11
Q

the following lab results were obtained from a 40 year old woman:
- PT: 20 seconds
- APTT: 50 seconds
- TT: 18 seconds
what is the most probably diagnosis
A. FVII deficiency
B. FVIII deficiency
C. FX deficiency
D. hypofibrinogenemia

A

D. hypofibrinogenemia
- PT RR: 13-16
- TT RR; 14-20 (harr says lower)
- CTT RR: 16-22
- APTT RR: 26-36

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12
Q

when performing a FVIII activity assay, a patients plasma is mixed with
A. normal patient plasma
B. FVIII deficient plasma
C. plasma with high concentration of FVIII
D. normal control plasma

A

B. FVIII deficient plasma

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13
Q

the most suitable product for treatment of a FVIII deficiency is
A. FFP
B. FVIII concentrate
C. prothromin complex concentrate
D. FV Leiden

A

B. FVIII concentrate
- if the deficiency is known it is best to treat it ith its corresponding concentrate
- if unknown then FFP is used

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14
Q

which of the following is associated with an abnormal PLT aggregation test result
A. FVIII deficient
B. FVIII inhibitor
C. lupus anticoagulant
D. afibrinogenemia

A

D. afibrinogenamia

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15
Q

which of the following disorders is indicated by the results:
- PT: Normal
- APTT: prolonged
- PLT count: normal
- PLT aggregation to ristocetin: abnormal

A. FVIII deficiency
B. DIC
C. vWF disease
D. FIX deficiency

A

C. vWF disease
- missing vWF = missing FVIII = prolonged APTT
- abnoraml ristocetin = no vWF agglutination

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16
Q

which results are associated with hemophilia A
A. prolonged APTT, normal PT
B. prolonged PT and PATT
C. prolonged PT and normal APTT
D. normal PT and APTT

A

A. prolonged APTT, normal PT

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17
Q

fibrin monomers are increased in which of the following conditions
A. primary fibrinolysis
B. DIC
C. FVIII deficiency
D. fibrinogen deficiency

A

B. DIC
- nor primary fibrinogenolysis because that would be fibrinogen monomers, fibrin monomers are formed after coagulation

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18
Q

which of the following is associated with multiple factor deficiencies
A. an inherited disorder of coagulation
B. severe liver disease
C. dysfinrinogenemia
D. lupus anticoagulant

A

B. severe liver disease
- most coag factors are made in the liver so no liver no coag factors

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19
Q

normal PT and APTT results in a patient with poor wound healing may be associated with
A. FVII def
B. FCIII def
C. FXII def
D. FXIII def

A

D. FXIII def
- normal in vitro but no clot stabilization in the body

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20
Q

Fletcher factor (prekallikrein) deficiency may be associated with
A. bleeding
B, thrombosis
C. thrombocytopenia
D. thromobocytosis

A

B. thrombosis
- part of clot degredation in plasminogen activation

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21
Q

one of the complications associated with severe hemophilia A is
A. hemarthrosis
B. mucous membrane bleeding
C. mild bleeding during surgery
D. immune mediated thrombocytopenia

A

A. hemarthrosis
- bleeding in the joints

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22
Q

the most common subtype of classic vWF disease is
A. type 1
B. type 2a
C. type 2b
D. type 3

A

A. type 1
- universal decrease of all monomers

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23
Q

prolonged APTT and PT are corrected when mied with normal plasma. which factor is most likely deficient
A. FVIII
B. FV
C. FXI
D. FIX

A

B. FV
- common pathway

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24
Q

which characteristic describes antithrombin (AT)
A. synthesized by megakaryocytes
B. activated by protein C
C. cofactor of heparin
D. pathological inhibitor of coagulation

A

C. cofactor for heparin

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25
Q

which lab test is affected by heparin therapy
A. thrombin time
B. fibrinogen assay
C, protein C assay
D. protein S assay

A

A. thrombin time

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26
Q

abnormal APTT caused by a pathological circulating anticoagulant is:
A. corrected with FVIII deficient plasma
B. correct with FIX deficient plasma
C. corrected with normal plasma
D. not corrected with normal plasma

A

D. not corrected with normal plasma

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27
Q

the lupus anticoagulant affects which of the following tests
A. FVIII assay
B. FIX assay
C. vWF assay
D. phospholipid-dependent assay

A

D. phospholipid-dependent assays

28
Q

which statement about warfarin is accurate
A. it is a vitamin B antagonist
B. it is not recommended for pregnant and lactating women
C. it needs AT as a cofactor
D. APTT test is used to monitor its dosage

A

B.
- it can cross the placenta
- monitored with INR

29
Q

which statement regarding protein C is correct
A. it is a vitamin K-independent zymogen
B. it is activated by fibrinogen
C. it activates cofactors V and VIII
D. its activity is enhanced by protein S

A

D. its activity is enhanced by protein S

30
Q

which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant
A. thrombin time
B. dilute russell viper venom time
C. D dimer test
D. fibrinogen assay

A

B. DRVVT
- will remain prolonged due to lupus anticoagulant activity

31
Q

which of the following is most commonly associated with activated protein C resistance (APRC)
A. bleeding
B. thrombosis
C. epistaxis
D. menorrhagia

A

B. thrombosis
- most common cause of inherited thrombosis issues

32
Q

a 50 year old man has been on heparin for the past 7 days. Which combination of tests is expected to be abnormal
A. PT and APTT only
B. APTT, TT only
C. APTT, TT, firbinogen assay
D. PT, APTT, TT

A

D. PT, APTT, and TT

33
Q

which of the following drugs inhibits ADP mediated PLT aggregation
A. heparin
B. warfarin
C. aspirin
D. prasugrel

A

D. prasugrel
- blocks P2Y12 receptors which relates to ADP activation (apparently)

34
Q

thrombin - TM complex is necessary for activation of:
A. protein C
B. AT
C. Protien S
D. factors V and VIII

A

A. protein C

35
Q

which is used to monitor heparin therapy
A. INR
B. chromogenic anti-factor Xa assay
C. TT
D. PT

A

B. chromogenic anti-factor Xa assay

36
Q

which test is commonly used to monitor warfarin therapy
A. INR
B. APTT
C. TT
D. exarin time

A

A. INR

37
Q

which clotting factors (cofactors) are inhibited by protein S
A. Factors V and X
B. factors Va and VIIIa
C. factors VIII and IX
D. factors VIII and X

A

B. Va and VIIIa
- inactivated by CS complex

38
Q

which drug promotes fibrinolysis
A. warfarin
B. heparin
C. urokinase
D. aspirin

A

C. urokinase
- activates plasminogen to plasmin to break down clots

39
Q

diagnosis of lupus anticoagulant is confirmed by which of the following criteria
A. decreased APTT
B. correction of APTT by mixing studies
C. neutralization of the antibody by high concentration of phospholipids
D. confirmation that abnormal coagulation tests are related to factor deficiencies

A

C. neutralization of the antibody by high concentration of phospholipids

40
Q

which of the following abnormalities is consistent with the presence of lupus anticoagulant
A. decreased APTT/bleeding complications
B. prolonged APTT/thrombosis
C. prolonged APTT/thrombocytosis
D. thrombocytosis/thrombosis

A

B. prolonged APTT/thrombosis
- lupus anticoagulants inhibit prostacyclin which allows platelet adhesion to noninjured endothelial cells and thrombosis

41
Q

which of the following is a characteristic of LMWH
A. generally requires monitoring
B. specifically acts on factor Va
C. has a longer half life compared to UFH
D. can be used as a fibrinolytic agent

A

C.
- due to lower affinity for plasma proteins and endothelial cells it has a longer half life

42
Q

which of the following tests is most likely to be abnormal in patients taking aspirin (blood thinners ;))
A. PLT morphology
B. PLT count
C. PLT aggregatin
D. PT

A

C. PLT aggregation

43
Q

which of the following is associated with AT deficiency
A. thrombocytosis
B. thrombosis
C. thrombocytopenia
D. bleeding

A

B. thrombosis

44
Q

which of the following may be associated with thrombotic events
A. decreased protein C
B. increased fibrinolysis
C. afibrinogenemia
D. idiopathic thrombocytopenic purpura

A

A. decreased protein C

45
Q

aspirin resistance may be associated with:
A. bleeding
B. factor VIII deficiency
C. thrombosis
D. thrombocytosis

A

C. thrombosis

46
Q

prolonged TT is indicative of which of the following antithrombotic agents
A. prasugrel
B. clopidogrel
C. aspirin
D. heparin

A

D. heparin
- all others are platelet drugs

47
Q

screening tests for thrombophilia should be performed on:
A. all pregnant women because of thrombosis
B. patients with a negative family history
C. patients with thrombotic events occurring at a young age
D. patients who are receiving anticoagulant therapy

A

C. patients with thrombotic events occurring at a young age

48
Q

prothrombin G20210A is characterized by which of the following causes and conditions
A. single mutation of prothrombin molecule/bleeding
B. single mutation of prothrombin molecule/ thrombosis
C. decreased levels of prothrombin in plasma/thrombosis
D. increased levels of prothrombin in plasma/ bleeding

A

B.
mutation leads to increased amounts of prothrombin and increasing risk of thrombosis

49
Q

factor V Leiden promotes thrombosis by preventing:
A. inactivation of factor Va
B. activation of factor V
C. activation of protein C
D. activation of protein S

A

A. inactivation of factor Va

50
Q

what is the approximate incidence of antiphospholipid antibodies in the general population
A. less than 1%
B. 1-2%
C. 3-8%
D. 10-155

A

b. 1-2%

51
Q

which of the following laboratory tests is helpful in the diagnosis of aspirin resistance
A. APTT
B. PT
C. PLT count and morphology
D. PLT aggregation

A

D. PLT aggreagtion

52
Q

which of the following complications may occur as a result of decreased tissue factor pathway inhibitor (TFPI)
A. increased episodes of hemorrhage
B. increased risk of thrombosis
C. impaired PLT plug formation
D. immune thrombocytopenia

A

B. increased risk of thrombosis

53
Q

Factor VIII inhibitors occur in _____ of patients with FVIII deficiency
A. 40-50%
B. 30-50%
C. 25-30%
D. 20-25%

A

D. 20-25%
- alloantibody formation

54
Q

which therapy and resulting mode of action are appropriate for the treatment of a patient with high titer of FVIII inhibitors
A. FVIII concentrate to neutralize the antibodies
B. recombinant FVIIa to activate FX
C. FX concentrate to activate the common pathway
D. FFP to replace FVIII

A

B. recombinant FVIIIa

55
Q

the Bethesda assay is used for which determination
A. lupus anticoagulant titer
B. FVII inhibitor titer
C. FV leiden titer
D. Protein S deficiency

A

B. FVII inhibitor

56
Q

hyperhomocysteinemia may be a risk factor for:
A. bleeding
B. thrombocythemia
C. thrombosis
D. thrombocytopenia

A

C. thrombosis

57
Q

which drug may be associated with DVT
A. aspirin
B. tPA
C. oral contraceptive
D. plavix

A

C. oral contraceptives
- because women can’t have nice things apparently

58
Q

Argatroban may be used as an anticoagulant drug in patients with
A. DVT
B. hemorrhage
C. TTP
D. thrombocytosis

A

A. DVT
- direct thrombin inhibiting drug can be used to patients with HIT to prevent thrombosis

59
Q

heparin induced thrombocytopenia (HIT) results from
A. antibodies to heparin
B. antibodies to PLTs
C. antibodies to PF4
D. antibodies to heparin - PF4 complex

A

D. antibodies to heparin - PF4 complex

60
Q

which laboratory test is used to screen for APCR
A. mixing studies with normal plasma
B. mixin studies with factor deficient plasma
C. modified APTT with and without APC
D. modified PT with and without APC

A

C. modified APTT with and without APC
- the normal ratio between the two is 2:5 with APCR patients having a lower ratio

61
Q

ecarin clotting time may be used to monitor
A. heparin therapy
B. warfarin therapy
C. fibrinolytic therapy
D. bivalirudin

A

D. bivalirudin
- snake venom based clotting assay

62
Q

which of the following may interfere with the APCR screening tests
A. lupus anticoagulant
B. protein C deficiency
C. AT defieicny
D. protein S deficiency

A

A. lupus anticoagulant
- due to the test modelling an APTT

63
Q

thrombophilia may be associated with which of the following disorders
A. afribinogenemia
B. hypofibrinogenonemia
C. FVIII inhibitor
D. hyperfibrinogenemia

A

D. hyperfibrinogemia

64
Q

which of the following anticoagulant drugs can be used in patients with HIT
A. warfarin
B. heparin
C. aspirin
D. argatroban

A

D. argatroban
- direct thrombin inhibitor drug

65
Q

which of the following is the preferred method to monitor heparin therapy at the point of care during cardiac surgery
A. APTT
B. ACT
C. PT
D. TT

A

B. ACT

66
Q

Mrs. Smith has the following lab results and no history of bleeding
- APTT: prolonged
- preincubation mix APTT: prolonged
- 2 hour incubation mix APTT: prolonged
these results are consistent with
A. FVIII deficiency
B. FVIII inhibitor
C. lupus anticoagulant
D. protein C deficiency

A

C. lupus anticoagulant

67
Q

which test may be used to monitor LMWH therapy
A. APTT
B. INR
C. anti-factor Xa heparin assay
D. ACT

A

C. anti-Fx heparin assay

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