Question 1

What are the physiological processes involved in hypercoagulability?

Accepted Answer

Hypercoagulability occurs when there is an imbalance between procoagulants (increase) or anticoagulants (decrease).
The chief thrombogenic agents that are altered in hypercoagulable conditions are the vascular endothelium, platelets, and coagulation proteins.

Question 2

Patients with a DVT are at risk for developing which of the following?

Accepted Answer

A) Transient ischemic attacks 
B) Peripheral artery disease 
C) Myocardial infarction 
D) Pulmonary emboli 
A) Transient ischemic attacks 
B) Peripheral artery disease 
C) Myocardial infarction 
D) Pulmonary emboli D

Question 3

How does a thrombus become a thromboembolus?

Accepted Answer

A thrombus is an initial formation of a clot. When a piece of thrombotic material breaks off, it becomes an embolus. The clot (embolus) can travel through the circulatory system, deposit anywhere in the body, and obstruct blood flow. This is called a thromboembolus.

Question 4

Which laboratory test is considered to have a reliable negative predictive value in the diagnosis of DVT?

Accepted Answer

A) Factor VLeiden 
B) PT 
C) tPA 
D) D-dimer 
A) Factor VLeiden 
B) PT 
C) tPA 
D) D-dimer

Question 5

A patient has been diagnosed with a coagulopathy and has been given Coumadin as a mode of treatment.What screening test(s)should be performed to monitor this treatment,and what effect will this therapy have on the coagulation pathway?

Accepted Answer

A) APTT;initial decrease in the vitamin K-dependent factors of the intrinsic pathway 
B) PT-INR;initial decrease in the vitamin K-dependent factors of the extrinsic pathway 
C) PT-INR and APTT;initial decrease in the vitamin K-dependent factors of all pathways 
D) PT-INR;initial decrease in all vitamin K-dependent serine proteases 
A) APTT;initial decrease in the vitamin K-dependent factors of the intrinsic pathway 
B) PT-INR;initial decrease in the vitamin K-dependent factors of the extrinsic pathway 
C) PT-INR and APTT;initial decrease in the vitamin K-dependent factors of all pathways 
D) PT-INR;initial decrease in all vitamin K-dependent serine proteases

Question 6

How do red thrombi differ from white thrombi?

Accepted Answer

A) Their location 
B) Their composition 
C) Their location and composition 
D) Their degree of severity 
A) Their location 
B) Their composition 
C) Their location and composition 
D) Their degree of severity

Question 7

A postoperative heart transplant patient has been given unfractionated heparin.Five days postoperative,he develops petechiae and needs multiple dressing changes over his wound site.What tests should be used to assess the patient's clinical status?

Accepted Answer

A) Platelet count and HIT antibody assay 
B) APTT and PT 
C) PT and FDP 
D) D-dimer and fibrogen 
A) Platelet count and HIT antibody assay 
B) APTT and PT 
C) PT and FDP 
D) D-dimer and fibrogen

Question 8

Heparin inhibits coagulation by

Accepted Answer

A) Chelating calcium release from platelet granules 
B) Catalyzing antithrombin activity 
C) Neutralizing labile factors V and VIII 
D) Neutralizing the tenase complex 
A) Chelating calcium release from platelet granules 
B) Catalyzing antithrombin activity 
C) Neutralizing labile factors V and VIII 
D) Neutralizing the tenase complex

Question 9

Which of the following is thought to be a traditional risk factor associated with the formation of arterial thrombi?

Accepted Answer

A) von Willebrand's disease 
B) Hemophilia 
C) Dysfibrinogenemia 
D) Diabetes 
A) von Willebrand's disease 
B) Hemophilia 
C) Dysfibrinogenemia 
D) Diabetes

Question 10

Why does a patient who had a thrombotic incident receive both heparin and Coumadin for 4-5 days before heparin is discontinued?

Accepted Answer

A) Heparin is not effective as an anticoagulant without Coumadin. 
B) Coumadin requires heparin for its full anticoagulant effect. 
C) Coumadin and heparin have a synergistic effect 
D) Coumadin 's full effect is not achieved for 4- days after initiation because of the half-life of the vitamin K coagulation factors. 
A) Heparin is not effective as an anticoagulant without Coumadin. 
B) Coumadin requires heparin for its full anticoagulant effect. 
C) Coumadin and heparin have a synergistic effect 
D) Coumadin 's full effect is not achieved for 4- days after initiation because of the half-life of the vitamin K coagulation factors.

Question 11

Which of the following conditions is not associated with an increased tendency for thrombosis?

Accepted Answer

A) Antiphospholipid antibody syndrome 
B) Pregnancy 
C) Malignancy 
D) Factor VIII deficiency 
A) Antiphospholipid antibody syndrome 
B) Pregnancy 
C) Malignancy 
D) Factor VIII deficiency

Question 12

Explain why many patients with an inherited thrombophilia are misdiagnosed.

Accepted Answer

Thrombophilia depends on the p

Question 13

Which of the following test results would help differentiate between type I and II protein C deficiencies?

Accepted Answer

A) PT and APTT 
B) Protein C antigen assay 
C) Protein C functional activity assay 
D) Protein S assay 
A) PT and APTT 
B) Protein C antigen assay 
C) Protein C functional activity assay 
D) Protein S assay

Question 14

Mutations in which of the following gene(s)lead to hyperhomocysteinemia?

Accepted Answer

A) HFE and MTHFR genes 
B) CBS and MTHFR genes 
C) Prothrombin gene 
D) Factor V gene 
A) HFE and MTHFR genes 
B) CBS and MTHFR genes 
C) Prothrombin gene 
D) Factor V gene

Question 15

Name the genetic mutation that induces increased concentration of prothrombin in the circulation that leads to increased risk of venous thrombosis.

Accepted Answer

A) G → A substitution on nucleotide 20210 of the prothrombin gene 
B) Lysine to glutamic acid substitution on the sixth position on the beta globin chain 
C) Arginine to glutamine substitution at the 506 position of prothrombin 
D) Translocation of chromosome 22 onto the long arm of chromosome 9 
A) G → A substitution on nucleotide 20210 of the prothrombin gene 
B) Lysine to glutamic acid substitution on the sixth position on the beta globin chain 
C) Arginine to glutamine substitution at the 506 position of prothrombin 
D) Translocation of chromosome 22 onto the long arm of chromosome 9

Question 16

During coumadin-induced anticoagulation,which factor's activity disappears most rapidly?

Accepted Answer

A) FIX 
B) FVII 
C) FVIII 
D) FV 
A) FIX 
B) FVII 
C) FVIII 
D) FV

Question 17

A patient is admitted to the local hospital with a pulmonary embolus.He was unconscious when admitted to the emergency department.Ultrasound revealed a large clot in the patient's saphenous vein.Thrombolytic therapy is administered,and eventually the patient's condition stabilizes.Laboratory tests are performed at hospital admission;their results follow: PT: 15.5 sec
INR: 2.85
APTT: 76 sec
Protein C antigen: 14%
Protein C functional activity: 18%
Molecular studies: FV-R506Q present
Based on this information,what is the most probable diagnosis for this patient?

Accepted Answer

A) PC deficiency and factor V deficiency 
B) PS deficiency and factor V deficiency 
C) APCR and PC deficiency 
D) HC-II deficiency 
A) PC deficiency and factor V deficiency 
B) PS deficiency and factor V deficiency 
C) APCR and PC deficiency 
D) HC-II deficiency

Question 18

Which of the following alterations would most likely be associated with a hypercoagulable state?

Accepted Answer

A) Excess plasma coagulation proteins 
B) Decreased fibrinolytic inhibitors 
C) Excess coagulation inhibitors 
D) Decreased platelets 
A) Excess plasma coagulation proteins 
B) Decreased fibrinolytic inhibitors 
C) Excess coagulation inhibitors 
D) Decreased platelets

Question 19

Which of the following mechanisms can lead to an increased risk of thrombosis?

Accepted Answer

A) Increased concentration of plasminogen activator 
B) Deficiency of plasminogen 
C) Deficiency of plasminogen activator inhibitor 
D) Increased concentration of plasminogen 
A) Increased concentration of plasminogen activator 
B) Deficiency of plasminogen 
C) Deficiency of plasminogen activator inhibitor 
D) Increased concentration of plasminogen

Question 20

A patient has been taking Coumadin for a recent thrombophilic episode.He follows up with his physician two weeks after starting this treatment.The physician sees evidence of skin necrosis on the patient.What should the physician do next to investigate this finding?

Accepted Answer

A) Request and have a PT and an APTT drawn 
B) Request and have a Protein C antigen assay drawn 
C) Request and have a HC-II antigen assay drawn 
D) Request and have a Protein S antigen assay drawn 
A) Request and have a PT and an APTT drawn 
B) Request and have a Protein C antigen assay drawn 
C) Request and have a HC-II antigen assay drawn 
D) Request and have a Protein S antigen assay drawn

Exam 35: Thrombophilia

What are the physiological processes involved in hypercoagulability?

Patients with a DVT are at risk for developing which of the following?

How does a thrombus become a thromboembolus?

Which laboratory test is considered to have a reliable negative predictive value in the diagnosis of DVT?

A patient has been diagnosed with a coagulopathy and has been given Coumadin as a mode of treatment.What screening test(s)should be performed to monitor this treatment,and what effect will this therapy have on the coagulation pathway?

How do red thrombi differ from white thrombi?

A postoperative heart transplant patient has been given unfractionated heparin.Five days postoperative,he develops petechiae and needs multiple dressing changes over his wound site.What tests should be used to assess the patient's clinical status?

Heparin inhibits coagulation by

Which of the following is thought to be a traditional risk factor associated with the formation of arterial thrombi?

Why does a patient who had a thrombotic incident receive both heparin and Coumadin for 4-5 days before heparin is discontinued?

Which of the following conditions is not associated with an increased tendency for thrombosis?

Explain why many patients with an inherited thrombophilia are misdiagnosed.

Which of the following test results would help differentiate between type I and II protein C deficiencies?

Mutations in which of the following gene(s)lead to hyperhomocysteinemia?

Name the genetic mutation that induces increased concentration of prothrombin in the circulation that leads to increased risk of venous thrombosis.

During coumadin-induced anticoagulation,which factor's activity disappears most rapidly?

Which of the following alterations would most likely be associated with a hypercoagulable state?

Which of the following mechanisms can lead to an increased risk of thrombosis?

A patient has been taking Coumadin for a recent thrombophilic episode.He follows up with his physician two weeks after starting this treatment.The physician sees evidence of skin necrosis on the patient.What should the physician do next to investigate this finding?

Introduction

Cellular Homeostasis

Structure and Function of Hematopoietic Organs

Hematopoiesis

The Erythrocyte

Hemoglobin

Granulocytes and Monocytes

Lymphocytes

The Platelet

The Complete Blood Count and Peripheral Blood Smear Evaluation

Introduction to Anemia

Anemias of Disordered Iron Metabolism and Heme Synthesis

Hemoglobinopathies: Qualitative Defects

Thalassemia

Megaloblastic and Nonmegaloblastic Macrocytic Anemias

Hypoproliferative Anemias

Hemolytic Anemia: Membrane Defects

Hemolytic Anemia: Enzyme Deficiencies

Hemolytic Anemia: Immune Anemias

Hemolytic Anemia: Nonimmune Defects

Nonmalignant Disorders of Leukocytes: Granulocytes and Monocytes

Nonmalignant Lymphocyte Disorders

Introduction to Hematopoietic Neoplasms

Myeloproliferative Neoplasms

Myelodysplastic Syndromes

Acute Myeloid Leukemias

Precursor Lymphoid Neoplasms

Mature Lymphoid Neoplasms

Hematopoietic Stem Cell Transplantation

Morphologic Analysis of Body Fluids in the Hematology Laboratory

Primary Hemostasis

Secondary Hemostasis and Fibrinolysis

Disorders of Primary Hemostasis

Disorders of Secondary Hemostasis

Hemostasis: Laboratory Testing and Instrumentation

Hematology Procedures

Bone Marrow Examination

Automation in Hematology

Flow Cytometry

Chromosome Analysis of Hematopoietic and Lymphoid Disorders

Molecular Analysis of Hematologic Diseases

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