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1. Surgery FIRST PART > Hemostasis, Surgical Bleeding, Transfusion > Flashcards

Hemostasis, Surgical Bleeding, Transfusion Flashcards

1
Q

Which of the following is NOT one of the four major physiologic events of hemostasis?

A. Fibrinolysis
B. Vasodilatation
C. Platelet plug formation
D. Fibrin production

A

B. Vasodilatation

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2
Q

Which is required for platelet adherence to injured endothelium?

A. Thromboxane A2
B. Glycoprotein (GP) IIb/IIIa
C. Adenosine diphosphate (ADP)
D. Von Willebrand factor (vWF)

A

D. Von Willebrand factor (vWF)

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3
Q

Which of the following clotting factors is the first factor common to both intrinsic and extrinsic pathways?

A. Factor I (Fibrinogen)
B. Factor IX (Christmas factor)
C. Factor X (Stuart-Prower factor)
D. Factor XI (plasma thromboplasma antecedent)

A

C. Factor X (Stuart-Prower factor)

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4
Q

Which congenital factor defiency is associated with delayed bleeding after initial hemostasis?

A. Factor VII
B. Factor IX
C. Factor XI
D. Factor XIII

A

D. Factor XIII

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5
Q 
In a previously unexposed patient, when does the platelet count fall in heparin-induced thrombocytopenia (HIY)?
A. <24 hours
B. 24–28 hours
C. 3–4 days
D. 5–7 days
A

D. 5–7 days

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6
Q

Which is NOT an acquired platelet hemostatic defect?

A. Massive blood transfusion following trauma
B. Acute renal failure
C. Disseminated intravascular coagulation (DIC)
D. Polycythemia vera

A

C. Disseminated intravascular coagulation (DIC)

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7
Q

What is true about coagulopathy related to trauma?

A. Acute coagulopathy of trauma is mechanistically similar to DIC.
B. Coagulopathy can develop in trauma patients following acidosis, hypothermia, and dilution of coagulation factors, though coagulation is normal upon admission.
C. Acute coagulopathy of trauma is caused by shock and tissue injury.
D. Acute coagulopathy of trauma is mainly a dilutional coagulopathy.

A

C. Acute coagulopathy of trauma is caused by shock and tissue injury.

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8
Q

What is the best laboratory test for determine degree of anticoagulation with dabigatran and rivaroxaban?

A. Prothrombin time/international normalized ratio (PT/INR)
B. partial thromboplastin time (PTT)
C. Bleeding time
D. None of the above

A

D. None of the above

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9
Q

A fully heparinized patient develops a condition requiring emergency surgery. After stopping the heparin, what else should be done to prepare the patient?

A. Nothing, if the surgery can be delayed for 2 to 3 hours.
B. Immediate administration of protamine 5 mg for every 100 units of heparin most recently administered.
C. Immediate administration of FFP.
D. Transfusion of 10 units of platelets.

A

A. Nothing, if the surgery can be delayed for 2 to 3 hours.

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10
Q

Primary ITP

A. Occurs more often in children than adults, but has a similar clinical course.
B. Includes HIT as a subtype of drug-induced ITP.
C. Is also known as thrombotic thrombocytopenic purpura (TTP).
D. Is a disease of impaired platelet production, unknown cause.

A

B. Includes HIT as a subtype of drug-induced ITP.

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11
Q

Which of the following is the most common intrinsic platelet defect?

A. Thrombasthenia
B. Bernard-Soulier syndrome
C. Cyclooxygenase deficiency
D. Storage pool disease

A

D. Storage pool disease

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12
Q

Which finding is not consistent with TTP?

A. Microangiopathic hemolytic anemia
B. Schistocytes on peripheral blood smear
C. Fever
D. Splenomegaly

A

D. Splenomegaly

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13
Q

What is FALSE regarding coagulation during cardiopulmonary bypass (CPB)?

A. Contact with circuit tubing and membranes activates infammatory cascades, and causes abnormal platelet and clotting factor function.
B. Coagulopathy is compounded by sheer stress.
C. Following bypass, platelets’ morphology and ability to aggregate are irreversibly altered.
D. Coagulopathy is compounded by hypothermia and hemodilution.

A

C. Following bypass, platelets’ morphology and ability to aggregate are irreversibly altered.

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14
Q

Following a recent abdominal surgery, your patient is in the ICU with septic shock. Below what level of hemoglobin would a blood transfusion be indicated?

A. <12 g/dL
B. <10 g/dL
C. <8 g/dL
D. <7 g/dL

A

D. <7 g/dL

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15
Q

Less than 0.5% of transfusions result in a serious transffusion-related complication. What is the leading cause of transfusion-related deaths?

A. Transfusion-related acute lung injury
B. ABO hemolytic transfusion reactions
C. Bacterial contamination of platelets
D. Iatrogenic hepatitis C infection

A

A. Transfusion-related acute lung injury

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16
Q

Allergic reactions do not occur with

A. Packed RBCs
B. FFP
C. Cryoprecipitate
D. None of the above

A

D. None of the above

17
Q

What is the risk of Hepatitis C and HIV-1 transmission with blood transfusion?

A. 1:10,000,000
B. 1:1,000,000
C. 1:500,000
D. 1:100,000

A

B. 1:1,000,000

18
Q

What is NOT a cause of bleeding due to massive transfusion?

A. Dilutional coagulopathy
B. Hypofibrinogenemia
C. Hypothermia
D. 2,3-DPG toxicity

A

D. 2,3-DPG toxicity

19
Q

The most common cause or a transfusion reaction is

A. Air embolism
B. Contaminated blood
C. Human error
D. Unusual circulating antibodies

A

C. Human error

20
Q

Frozen plasma prepared from freshly donated blood is necessary when a patient requires

A. Fibrinogen
B. Prothrombin
C. Antihemophilic factor
D. Christmas factor
E. Hageman  actor
A

C. Antihemophilic factor

21
Q

The most common clinical manifestation of a hemolytic transfusion reaction is

A. Flank pain
B. Jaundice
C. Oliguria
D. A shaking chill

A

C. Oliguria

22
Q

What type of bacterial sepsis can lead to thrombocytopenia and hemorrhagic disorder?

A. Gram-negative
B. Gram-positive
C. A & B
D. Encapsulated bacteria

A

A. Gram-negative

23
Q

After tissue injury, the first step in coagulation is

A. Binding of factor XII to subendothelial collagen
B. Cleavage of factor XI to active factor IX
C. Complexing of factor IX with factor VIII in the presence of ionized calcium conversion of prothrombin to thrombin
D. Formation of fibrin from fibrinogen

A

A. Binding of factor XII to subendothelial collagen

24
Q

What are the uses of thromboelastography (TEG)?

A. Predicting need for lifesaving interventions after arrival for trauma
B. Predicting 24-hour and 30-day mortality following trauma
C. Predicting early transfusion of RBC, plasma, platelets, and cryoprecipitate
D. All of the above

A

D. All of the above

25
Q 
Bank blood is  appropriate for replacing each of the following EXCEPT 
A. Factor I (fibrinogen) 
B. Factor II (prothrombin) 
C. Factor VII (proconvertin
D. Factor VIII (antihemophilic factor)
A

D. Factor VIII (antihemophilic factor)

1. Surgery FIRST PART (7 decks)

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