Mod.2 Ppt And Chap 35,37,38 - REVIEW QUESTIONS 39,40,41 Flashcards
The clinical presentation of platelet-related bleeding can include all of the ff. except
A. Bruising
B. Nosebleeds
C. Gastrointestinal bleeding
D. Bleeding into the joints (hemarthoses)
D. Bleeding into the joints (hemarthoses)
A defect in GP IIb/IIIa causes:
A. Glanzmann thrombasthenia
B. Bernard-Soulier Syndrome
C. Gray platelet syndrome
D. Storage pool disease
A. Glanzmann thrombasthenia
Patients with Bernard-Soulier Syndrome have which of the ff. laboratory test findings?
A. Abnormal platelet response to arachidonic acid
B. Abnormal platelet response to ristocetin
C. Abnormal platelet response to collagen
D. Thrombocytosis
B. Abnormal platelet response to ristocetin
Which of the ff is the most common hereditary platelet function defects?
A. Glanzmann thrombasthenia
B. Bernard-Soulier syndrome
C. Storage pool disease
D. Multiple myeloma
C. Storage pool disease
A reduction in thrombin generation in patients with Scott Syndrome results from
A. Defective granule secretion
B. Altered platelet aggregation
C. Altered expression of phospholipids on the platelet membrane
D. Deficiency of vit.K-dependent clotting factors
C. Altered expression of phospholipids on the platelet membrane
The impaired platelet function in myeloproliferative neoplasms results from:
A. Abnormally shaped platelets
B. Extended platelet lifespan
C. Increased procoagulant activity
D. Decreased numbers of a-granules and dense granules
D. Decreased numbers of a-granules and dense granules
The platelet defect associated with increased paraproteins is:
A. Impaired membrane activation, owing to protein coating
B. Hypercoagulability, owing to antibody binding and membrane activation
C. Impaired aggregation, because the hyperviscous plasma prevents platelet-endothelium interaction
D. Hypercoagulability, because the increased proteins bring platelets closer together, which leads to inappropriate aggregation
A. Impaired membrane activation, owing to protein coating
In uremia, platelet function is impaired by higher than normal levels of:
A. Urea
B. Uric acid
C. Creatinine
D. NO
D. NO
Thrombocytopenia associated with the use of cardiopulmonary bypass is not caused by:
A. Anti-GP IIb/IIIa antibodies
B. Hemodilution
C. Platelet binding to bypass circuitry
D. Platelet consumption associated with normal post surgical hemostatic activity
A. Anti-GP IIb/IIIa antibodies
Aspirin ingestion blocks the synthesis of:
A. Thromboxane A2
B. Ionized calcium
C. Collagen
D. ADP
A. Thromboxane A2
A mechanism of anti platelet drugs targeting GP IIb/IIIa function is:
A. Interference with platelet adhesion to the subendothelium by blocking of the collagen binding site
B. Inhibition of transcription of the GP IIb/IIIa gene
C. Direct binding to GP IIb/IIIa
D. Interference with platelet secretion
C. Direct binding to GP IIb/IIIa
Which is a congenital qualitative platelet disorder?
A. Senile purpura
B. Ehlers-Danlos syndrome
C. Henoch-Schönlein purpura
D. Waldenström macroglobulinemia
B. Ehlers-Danlos syndrome
The autosomal dominant disorder associated with decreased platelet production is:
A. Fanconi anemia
B. TAR syndrome
C. May-Hegglin anomaly
D. Wiskott-aldrich anomaly
C. May-Hegglin anomaly
Which of the following is not a hallmark of ITP?
A. Petechiae
B. Thrombocytopenia
C. Large overactive platelets
D. Megakaryocyte hypoplasia
C. Large overactive platelets
The specific antigen most commonly responsible for the development of NAIT is:
A. Bak
B. HPA-1a
C. GPIB
D. Lewis antigen a
B. HPA-1a
A 2-year-old child with an unexpected platelet count of 15,000/ul and a recent history of a viral infection most likely has:
A. HIT
B. NAIT
C. Acute ITP
D. Chronic ITP
C. Acute ITP
Which drug causes a reduction in platelet count by inhibiting megakaryocyte maturation?
A. Gold salts
B. Abciximab
C. Anagrelide
D. Quinidine
C. Anagrelide
A defect in primary hemostasis (platelet response to an injury) often results in:
A. Musculoskeletal bleeding
B. Mucosal bleeding
C. Hemarthroses
D. None of the above
B. Mucosal bleeding
When a drug acts as a hapten to induce thrombocytopenia, an antibody forms against which of the ff?
A. Typically unexposed, new platelet antigens
B. The combination of the drug and the platelet membrane protein to which it is bound
C. The drug alone in plasma, but the immune complex then binds to the platelet membrane
D. The drug alone, but only when it is bound to the platelet membrane
B. The combination of the drug and the platelet membrane protein to which it is bound
TAR refers to:
A. Abnormal platelet morphology in which the radial striations of the platelet are missing
B. Abnormal appearance of the iris of the eye in which radial striations are absent
C. Abnormal bone formation, including hypoplasia of the forearms
D. Neurologic defects affecting root (radix) of the spinal nerves
C. Abnormal bone formation, including hypoplasia of the forearms
Neonatal autoimmune thrombocytopenia occurs when:
A. The mother lacks a platelet antigen that the infant possesses, and she builds antibodies to that antigen, which cross the placenta
B. The mother has an autoimmune antibody to her own platelets, which crosses the placenta and reacts with the infant’s platelets
C. The infant develops an autoimmune disease such as lupus erythematosus before birth
D. The infant develops an autoimmune process such as ITP secondary to in utero infection
B. The mother has an autoimmune antibody to her own platelets, which crosses the placenta and reacts with the infant’s platelets
HUS in children is associated with:
A. Diarrhea caused by shigella species
B. Meningitis caused by haemophilus species
C. Pneumonia caused by mycoplasma species
A. Diarrhea caused by shigella species
Treatment with an anticomplement agent such as eculizumab is first-line therapy for:
A. Hereditary TTP
B. HUS
C. ITP
D. Atypical HUS
D. Atypical HUS
Which of the ff statements regarding thrombocytosis is not true?
A. Thrombosis can be associated with hemorrhage and thrombosis
B. Thrombocytosis is self-correcting
C. Thrombocytopenia can be congenital or acquired
B. Thrombocytosis is self-correcting
_____ is a complex physiologic process that keeps circulating blood in a fluid state and then, when an injury occurs, produces a lot of clot to stop the bleeding, confines the clot to the site of injury, and finally dissolves the clot as the wound heals
Hemostasis
_____ involves the interaction of vasoconstriction, platelet adhesion and aggregation, and coagulation enzyme activation to stop bleeding
Hemostasis
______ refers to the role of blood vessels and platelets in the initial response to a vascular injury
Primary hemostasis
_____ describes the activation of a series of coagulation proteins in the plasma, mostly serine protease, to form a fibrin clot
Secondary hemostasis
_____ is an enzyme that converts fibrinogen to a localized fibrin clot
Thrombin
_____ is the gradual digestion and removal of the fibrin clot as healing occurs
Fibrinolysis
The innermost lining of blood vessels is a monolayer of metabolically active _______
Endothelial cells
_____ play essential roles in immune response, vascular permeability, proliferation, and, of course, hemostasis
Endothelial cells
______ is a platelet inhibitor and a vasodilator, is synthesized through the eicosanoid pathway and prevents unnecessary or undesirable platelet activation in intact vessels
Prostacyclin
______ induces smooth muscle relaxation and subsequent vasodilation, inhibits platelet activation, and promotes angiogenesis and healthy arterioles
Nitric oxide
_____ is an important EC-produced anticoagulant
Tissue factor pathway inhibitor (TFPI)
____ is a glycosaminoglycan that enhances the activity of antithrombin, a blood plasma serine protease inhibitor
Heparan sulfate
T or F: Connective tissue degeneration occurs naturally in aging, which leads to an increased bruising tendency in the elderly
True
______ is an adhesion molecule that promotes platelet and leukocyte binding
P-selectin
_____ are produced from the cytoplasm of bone marrow megakaryocytes
Platelets
_____ serves as the body’s first line of defense against blood loss
Platelets
_____ is the property by which platelets bind non-platelet surfaces such as subendothelial collagen
Adhesion
VWF binds platelets through their ______ membrane receptor
GP Ib/IX/V
_____ is the property by which platelets bind to one another
Aggregation
_____ is inherited as an autosomal recessive disorder in which GP IIb/IIIa is missing or defective
Glanzmann thrombasthenia
______ is inherited as an autosomal recessive disorder in which GP Ib/IX/V is missing
Bernard-soulier syndrome
_____ is inherited as an autosomal dominant disorder and has dohle-body like neutrophil inclusion as their clinical characteristics
May-Hegglin anomaly
______ is inherited as an autosomal dominant disorder in which platelets are spherical and have a prominent surface-connected cannicular system
Epstein syndrome
_____ is the most common of the hereditary platelet function defects
Storage pool disease
______ is a rare x-linked disease caused by mutations in the WAS gene
Wiskott-aldrich syndrome
_____ serves to form thrombin that initiates the proteolysis of fibrinogen, leading to fibrin clot formation
Coagulation system (clot forming)
______ functions to lyse the clot formed by thrombin
Fibrinolytic system (clot lysing)
_____ regulates all enzymes of the coagulation and fibrinolytic systems, so that no inappropriate excess of clotting or bleeding occurs
Anticoagulation system (regulating)
_____ is a short-lived reflex reaction of the smooth muscle in the vessel wall produced by the sympathetic branches of the autonomic nervous system
Vasoconstriction
____ increases the adhesiveness of platelets
ADP
____ is the most abundant platelet membrane protein and is specific for platelets
GP IIb/IIIa
_____ is the gold standard test to determine platelet function
Platelet aggregation
_____ provides basis for platelet consolidation and stabilization
Fibrinogen
_____ is the in vivo measurement of platelet adhesion and aggregation on locally injured vascular subendothelium
Bleeding time with and without aspirin
____ provides an estimate of the integrity of the platelet plug and thereby measures the interaction between the capillaries and platelets
Bleeding time with or without aspirin
_____ reflects the number and quality of platelets, fibrinogen concentration, fibrinolytic activity and packed red cell volume
Clot retraction
______ disorder that exhibits giant platelets and thrombocytopenia
Alport syndrome
_____ demonstrates the smallest platelets seen
Wiskott-Aldrich syndrome
___ is characterized by the presence of large platelets and dohle-like bodies in the granulocytic leukocytes
May-Hegglin anomaly
_______ a disease that demonstrate the largest platelets
Bernard-Soulier syndrome
What are the 4 types of platelet dysfunction
Acquired
Drug-Induced
Platelet membrane receptors
Hereditary
What is the prevalence of venous thrombosis in the United states?
a. 0.01
b. 1 in 1000
c. 10% to 15%
d. 500,000 cases per year
b. 1 in 1000
What is thrombophilia?
A. Predisposition to thrombosis secondary to a congenital or acquired disorder
B. Inappropriate triggering of the plasma coagulation system
C. A condition in which clots form uncontrollably
D. Inadequate fibrinolysis
A. Predisposition to thrombosis secondary to a congenital or acquired disorder
What acquired thrombosis risk factor is assessed in the hemostasis laboratory?
A. Smoking
B. Immobilization
C. Obeisty
D. Lupus anticoagulant
Lupus anticoagulant
Trousseau syndrome, a low grade chronic DIC, is often associated with what type of disorder?
A. Renal disease
B. Hepatic disease
C. Adenocarcinoma
D. Chronic inflammation
Adenocarcinoma
What is the most common heritable thrombosis risk factor in Caucasians?
A. APC resistance (factor V leiden mutation)
B. Prothrombin G20210A
C. Antithrombin deficiency
D. Protein S deficiency
APC resistance (factor V leiden mutation)
In most LA profiles, what screening test is primary because it detects LA with the fewest interferences?
A. Low-phospholipid PTT
B. DRVVT
C. KCT
D. PT
DRVVT
A patient with venous thrombosis is tested for protein S deficiency. The protein S activity, antigen, and free antigen all are less than 65%, and the C4bBP level is normal. What type of deficiency is likely?
A. Type I
B. Type II
C. Type III
D. No deficiency is indicated, because the reference range includes 65%
Type 1
An elevated level of what fibrinolytic system assay is associated with arterial thrombotic risk?
A. PAI-1
B. TPA
C. Factor VIIa
D. Factor XII
PAI-1
How does lipoprotein (a) cause thrombosis?
A. It causes elevated factor VIII levels
B. It coats the endothelial lining of the arteries
C. It substitutes for plasminogen or TPA in the forming clot
D. It contributes additional phospholipid in vivo for formation of the tense complex
It substitutes for plasminogen or TPA in the forming clot
What test may be used to confirm the presence of LA?
A. PT
B. Bethesda titer
C. Antinuclear antibody
D. DRVVT using high-phospholipid reagent
DRVVT using high-phospholipid reagent
What molecular test may be used to confirm APC resistance?
A. Prothrombin G20210A
B. MTHFR 1298
C. MTHFR 677
D. Factor V Leiden
Factor V Leiden
What therapeutic agent may occasionally cause DIC?
A. Factor VIII
B. Factor VIIa
C. Antithrombin concentrate
D. Activated prothrombin complex concentrate
Activated prothrombin complex concentrate
Which is not a fibrinolysis control protein?
A. Thrombin activatable fibrinolysis inhibitor
B. Plasminogen activator inhibitor 1
C. Alpha2 antiplasmin
D. D-dimer
D-dimer
What is the most important application of the quantitative D-dimer test?
A. Diagnose primary fibrinolysis
B. Diagnose liver and renal disease
C. Rule out deep venous thrombosis
D. Diagnose acute myocardial infarction
Rule out deep venous thrombosis
What is the first laboratory assay necessary to detect heparin-induced thrombocytopenia?
A. Platelet count
B. H:PF4 immunoassay
C. Quick turnaround test
D. Serotonin release assay
Platelet count
What is the PT/INR therapeutic range for Coumadin therapy when a patient has a mechanical heart valve?
A. 1 to 2
B. 2 to 3
C. 2.5 to 3.5
D. Coumadin is not indicated for a patient with mechanical heart valves
2.5 to 3.5
Monitoring of a patient taking Coumadin showed that her anticoagulation results remained stable over a period of about 7 months. The frequency of her visits to the laboratory began to decrease, so the period between testing averaged 6 weeks. This new testing interval is:
a. Acceptable for a patient with stable anticoagulation results after 6 months
b. Unnecessary, because monitoring for patients taking oral anticoagulants can be discontinued entirely after 4 months of stable test results
c. Too long even for a patient with previously stable test results; 4 weeks is the standard
d. Acceptable as long as the patient performs self-monitoring daily using an approved home testing instrument and reports unacceptable results promptly to her physician
Acceptable for a patient with stable anticoagulation results after 6 months
What is the greatest advantage of point-of-care PT testing?
a. It permits self-dosing of Coumadin
b. It is inexpensive
c. It is convenient
d. It is precise
It is convenient
You collect a citrated whole-blood specimen to monitor UFH therapy. What is the longest it may stand before the plasma must be separated from the cells?
a. 1 hour
b. 4 hours
c. 24 hours
d. Indefinitely
1 hour
What test is used to monitor high-dose UFH therapy in the cardiac catheterization lab?
a. PT
b. PTT
c. Bleeding time
d. ACT
ACT
Leave the first rating
What test is used most often to monitor UFH therapy in the central laboratory?
a. PT
b. PTT
c. ACT
d. Chromogenic anti-factor Xa heparin assay
PTT
What test is used most often to monitor LMWH therapy in the central laboratory?
a. PT
b. PTT
c. ACT
d. Chromogenic anti-factor Xa heparin assay
Chromogenic anti-factor Xa heparin assay
What is an advantage of LMWH therapy over UFH therapy?
a. It is cheaper
b. It causes no bleeding
c. It has a stable dose response
d. There is no risk of HIT
It has a stable dose response
In what situation is an intravenous DTI used?
a. DVT
b. HIT
c. Any situation in which Coumadin could be used
d. Uncomplicated AMI
HIT
What laboratory test may be used to monitor intravenous DTI therapy when PTT results are unreliable?
a. PT
b. ECT
c. Reptilase clotting time
d. Chromogenic anti-factor Xa heparin assay
ECT
What is the reference method for detecting aspirin or clopidogrel resistance?
a. Platelet aggregometry
b. AspirinWorks
c. VerifyNow
d. PFA-100
Platelet aggregometry
What is the name of the measurable platelet activation metabolite used in the AspirinWorks assay to monitor aspirin resistance?
a. 11-dehydrothromboxane B2
b. Arachidonic acid
c. Thromboxane A2
d. Cyclooxygenase
11-dehydrothromboxane B2
Which of the following is an intravenous antiplatelet drug used in the cardiac catheterization laboratory?
a. Abciximab
b. Ticagrelor
c. Prasugrel
d. Clopidogrel
Abciximab
Which of the following is a newly developed oral anticoagulant?
a. Argatroban
b. Lepirudin
c. Bivalirudin
d. Rivaroxaban
Rivaroxaban
Which of the following is not a point-of-care instrument for the measurement of PT?
a. CoaguChek XS PT
b. Gem PCL Plus
c. Cascade POC
d. Multiplate
Multiplate
What happens if a coagulation specimen collection tube is underfilled?
a. The specimen clots and is useless
b. The specimen is hemolyzed and is useless
c. Clot-based test results are falsely prolonged
d. Chromogenic test results are falsely decreased
Clot-based test results are falsely prolonged
If you collect blood into a series of tubes, when in the sequence should the hemostasis (blue stopper) tube be filled?
a. After a lavender-topped or green-topped tube
b. First, or after a nonadditive tube
c. After a serum separator tube
d. Last
First, or after a nonadditive tube
What is the effect of hemolysis on a hemostasis specimen?
a. In vitro platelet and coagulation activation occur
b. The specimen is icteric or lipemic
c. Hemolysis has no effect
d. The specimen is clotted
In vitro platelet and coagulation activation occur
Most coagulation testing must be performed on PPP, which is plasma with a platelet count less than:
a. 1000/uL
b. 10,000/uL
c. 100,000/uL
d. 1,000,000/uL
10,000/uL
You wish to obtain a 5-mL specimen of whole-blood/ anticoagulant mixture. The patient’s hematocrit is 65%. What volume of anticoagulant should you use?
a. 0.32 mL
b. 0.5 mL
c. 0.64 mL
d. 0.68 mL
0.32 mL
You perform whole-blood lumiaggregometry on a specimen from a patient who complains of easy bruising. Aggregation and secretion are diminished when the agonists, thrombin, ADP, arachidonic acid, and collagen are used. What is the most likely platelet abnormality?
a. Storage pool disorder
b. Aspirin-like syndrome
c. ADP receptor anomaly
d. Glanzmann thrombasthenia
Glanzmann thrombasthenia
What is the reference assay for HIT?
a. Enzyme immunoassay
b. Serotonin release assay
c. Platelet lumiaggregometry
d. Washed platelet aggregation
Serotonin release assay
What agonist is used in platelet aggregometry to detect VWD?
a. Arachidonic acid
b. Ristocetin
c. Collagen
d. ADP
Ristocetin
Deficiency of which single factor is likely when the PT result is prolonged and the PTT result is normal?
a. Factor V
b. Factor VII
c. Factor VIII
d. Prothrombin
Factor VII
A prolonged PT, a low factor VII level, but a normal factor V level are characteristic of an acquired coagulopathy associated with which of the following?
a. Hemophilia
b. Liver disease
c. Thrombocytopenia
d. Vitamin K deficiency
Vitamin K deficiency
The patient has deep vein thrombosis. The PTT is prolonged and is not corrected in an immediate mix of patient plasma with an equal part of normal plasma. What is the presumed condition?
a. Factor VIII inhibitor
b. Lupus anticoagulant
c. Factor VIII deficiency
d. Factor V Leiden mutation
Lupus anticoagulant
What condition causes the most pronounced elevation in the result of the quantitative D-dimer assay?
a. Deep vein thrombosis
b. Fibrinogen deficiency
c. Paraproteinemia
d. DIC
DIC
What is the name given to the type of assay that uses a synthetic polypeptide substrate that releases a chromophore on digestion by its serine protease?
a. Clot-based assay
b. Molecular diagnostic assay
c. Fluorescence immunoassay
d. Chromogenic substrate assay
Chromogenic substrate assay
What component of the fibrinolytic process binds and neutralizes free plasmin?
a. PAI-1
b. TPA
c. a2-Antiplasmin
d. Urokinase
a2-Antiplasmin
What type of high-throughput genomic sequencing is likely to become a standard clinical assay?
A. Human genotypic ontogeny
B. Whole-genome sequencing
C. Whole-exome sequencing
D. Gene-targeted sequencing
Whole-genome sequencing
