Deck 30: Disorders of Primary Hemostasis

Question 1

All of the following are conditions associated with reactive thrombocytosis except:

A)Acute hemorrhage.
B)Post splenectomy.
C)Chronic idiopathic myelofibrosis.
D)Iron deficiency anemia.

Answer 1

Chronic idiopathic myelofibrosis.

Question 2

When petechiae and ecchymoses are found in a higher-than-normal number with less-than-usual trauma, the condition is called which of the following?

A)Hematoma
B)Purpura
C)Easy bruisability
D)Excess bleeding

Answer 2

Easy bruisability

Question 3

Minimum screening tests that should be considered in the evaluation of abnormal bleeding is/are which of the following?

A)Thrombin time
B)Fibrinogen level
C)Factor studies
D)Platelet count, PT, APTT

Answer 3

Platelet count, PT, APTT

Question 4

Splenomegaly can cause thrombocytopenia by which of the following mechanisms?

A)Impaired production
B)Platelet sequestration
C)Immune-mediated
D)Mechanical destruction

Question 5

An instrument report has a platelet count of 850 x 109/L.This would be interpreted as:

A)A normal platelet count.
B)Thrombocytosis.
C)Thrombocytopenia.
D)It cannot be defined.

Question 6

Which hemostatic disorder usually is represented by a decreased platelet count, normal PT, normal APTT, and abnormal bleeding time?

A)Thrombocytosis
B)Thrombocytopenia
C)Vascular disorders
D)Platelet dysfunction

Question 7

A patient visits his physician because of unexplained bruising and prolonged bleeding from a recent tooth extraction.The physician orders a prothrombin time (PT) and an APTT.Results are within normal reference ranges.What other tests could the physician order to investigate his patient's symptoms?

A)Platelet count and platelet function assays
B)Platelet function assays
C)Platelet count only
D)Repeat the PT and the APTT after the beginning of treatment.

Question 8

Which of the following is a mechanism of inducing thrombocytopenia in a patient?

A)Antibody-mediated platelet destruction
B)Inherited platelet membrane defect
C)Increased splenic sequestration
D)All of the above

Question 9

Acquired disorders of the vascular system including senile purpura, Cushing's syndrome, corticosteroid therapy, and scurvy have one condition in common.Which of the following best describes this condition?

A)Decreased amount of supportive connective tissue in the blood vessel walls
B)Presence of abnormal proteins in the vascular system
C)Inflammation of the small blood vessels
D)Increased pressure within the lumen of capillaries after intense exercise

Question 10

Thrombocytosis is associated with which of the following?

A)Acute leukemia
B)ITP
C)HUS
D)Myeloproliferative disorder

Question 11

Scurvy can lead to vascular defects by which of the following mechanisms?

A)Degeneration of ECM
B)Excessive breakdown of collagen
C)Insufficient collagen synthesis
D)Presence of paraproteins directed against collagen

Question 12

A patient has a platelet count of 80 x 109/L and a bleeding time of 15 min.From what is the patient most likely suffering?

A)A platelet function disorder
B)A quantitative platelet disorder
C)A combined platelet disorder
D)von Willebrand Disease

Question 13

A peripheral blood smear of a patient reveals many giant platelets.Platelet function tests all show normal aggregation with the exception of ristocetin.From what is the patient most likely suffering?

A)Glanzmann's thrombasthenia
B)Bernard-Soulier syndrome
C)Storage pool disease
D)Wiskott-Aldrich syndrome

Question 14

A patient is exhibiting multiple pinpoint hemorrhages on his upper torso.This would be described as:

A)Hematomas.
B)Ecchymoses.
C)Purpura.
D)Petechiae.

Question 15

Which of the following best describes the effect of aspirin on platelets, and for how long does the effect last?

A)ADP receptor blockade; 5 days
B)Thrombocytosis; 7 days
C)Inactivation of cyclooxygenase; 7 days
D)Thrombocytopenia; 7 days

Question 16

Which of the following physical symptoms are associated with scurvy?

A)Hemangiomas
B)Ecchymoses
C)Bleeding into joints and muscles
D)Purpura fulminans

Question 17

A patient has a splitting headache prior to his blood draw.He takes two aspirin, and his blood is drawn.Platelet aggregation studies are performed, and one comes back abnormal.Based on this information, which agonist will show an abnormal aggregation pattern?

A)Arachidonic acid
B)Epinephrine
C)Collagen
D)All of the above

Question 18

Predict the typical expected results of clot-based PT in a patient with a platelet defect.

A)Prolonged
B)Normal
C)Shortened
D)Cannot be determined

Question 19

A 35-year-old female is hospitalized for knee replacement surgery.Preoperative blood tests reveal a platelet count of 64 x 109/L.The surgery is postponed, and the platelet count is repeated two days later.It is 48 x 109/L.All other labs appear normal.Based on this information, from what is the patient most likely suffering?

A)Acute ITP
B)Chronic ITP
C)TTP
D)HUS

Question 20

Increased risk of bleeding into the central nervous system occurs with a platelet count of:

A)800 x 109/L.
B)200 x 109/L.
C)150 x 109/L.
D)30 x 109/L.

Question 21

How do hematologic disorders contribute to the pathogenesis of thrombocytopenia?

Question 22

A patient has a splitting headache shortly before getting her blood tested.She takes a couple of aspirin, and is scheduled for platelet aggregation studies.What effect will this have on the platelet aggregation studies?

A)Patient platelets will show diminished activity with selected agonists.
B)Patient platelets will show normal activity with all agonists.
C)Patient platelets will show increased activity with selected agonists.
D)Patient platelets will show variable activity with all agonists.

Question 23

Which of the following contributes to the pathogenesis of Bernard-Soulier syndrome?

A)Abnormal glycoprotein Ib/IX complex
B)Abnormal glycoprotein IIb/IIIa
C)High platelet count
D)Low fibrinogen levels

Question 24

What laboratory tests are used to assess disorders of primary hemostasis? Secondary hemostasis?

Question 25

What is a common etiology of ITP in children?

A)Tooth extraction
B)Easy bruising syndrome
C)Vasculitis
D)Chickenpox

Question 26

Which of the following characteristics differentiate chronic ITP from acute ITP?

A)Platelet counts are less than 20 x 109/L in chronic ITP.
B)Chronic ITP has a 3:1 gender predilection in females.
C)Duration in chronic ITP is 2-6 weeks.
D)Lymphocytosis is common in chronic ITP.

Question 27

A patient is known to be a chronic alcoholic.His blood is drawn, and his platelet count is 72 x 109/L.What is the most likely reason for this occurrence?

A)Immune-mediated thrombocytopenia
B)Acquired hypoplasia due to alcohol consumption
C)Dilutional thrombocytopenia due to liver dysfunction
D)Increased destruction of platelets

Question 28

Explain the pathophysiology of the following, and why each typically has normal coagulation screening tests.

A)Bernard-Soulier syndrome
B)Glanzmann's thrombasthenia
C)Ϭ-Storage pool disease
D)Gray platelet syndrome

Question 29

Aspirin affects platelet aggregation because it interferes with:

A)Cyclooxygenase activity.
B)Platelet adhesion to collagen.
C)Development of platelets.
D)Binding of fibrinogen to platelets.

Question 30

What would be the expected laboratory results in a patient with thrombocytopenia?

A)Platelet counts < 50 x 109/L
B)Bleeding time normal
C)PT and APTT abnormally prolonged
D)Fibrinogen decreased

Question 31

Immune complexes induce vasculitis by which of the following processes?

A)Inducing aggregation of platelets and activation factor XII
B)Increasing pressure within the lumen of capillaries
C)Formation of thrombi in the small vessels, inducing necrosis.
D)Release of enzymes and free oxygen radicals from neutrophils which have migrated to the area to phagocytize the immune complexes

Question 32

Describe the following, and indicate where they are typically seen (disorders of primary hemostasis or secondary hemostasis).

A)Petechiae
B)Purpura
C)Ecchymoses
D)Hematomas

Question 33

What is the most common cause of thrombocytopenia?

A)Dilutional thrombocytopenia
B)Increased destruction
C)Decreased production
D)Increased splenic sequestration