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Bleeding tendency

Quiz by Sadeq K. Ali Al-Salait

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15 questions
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  • Q1
    Which of the following conditions can lead to an acquired bleeding tendency?
    Idiopathic thrombocytopenic purpura
    Hemophilia B
    Vitamin B12 deficiency
    Factor V Leiden mutation
    Chronic kidney disease
  • Q2
    What is the most common hereditary bleeding disorder?
    Von Willebrand disease
    Factor V Leiden mutation
    Hemophilia A
    Hemophilia B
  • Q3
    Which hereditary bleeding disorder is characterized by prolonged bleeding times and easy bruising?
    Factor V Leiden mutation
    Von Willebrand disease
    Hemophilia A
    Hemophilia B
  • Q4
    Hemophilia A
    Mucosal and CNS bleeds are common.
    The clinical severity of the disease correlates inversely with the factor VIII level.
    Severe deficiency indicates factor level less than 5%.
    Autosomal recessive disorder.
    Female carriers have normal factor level.
  • Q5
    Factor VIII gene
    It is situated near the tip of the short arm of X chromosome
    It is small gene consisting of 3 exons
    Missense or frameshift mutations, or deletions result in approximately half of cases of hemophilia A.
    The resultant protein contains a triplicated region A1A2A3 region which is the site of activation by thrombin.
    Most mutations result in dysfunctional factor VIII rather than reduced factor level
  • Q6
    Laboratory findings in uncomplicated hemophilia
    Isolated prolonged PTT correctable with normal plasma.
    Prolonged bleeding time.
    Prolonged PT and PTT.
    Isolated prolonged PTT uncorrectable with normal plasma.
    Abnormal platelet response to ristocetin.
  • Q7
    Factor inhibitor …
    Seen in less than 1% of hemophilia A patients with intron 22 inversion.
    It is recommended to test for prior to major surgery.
    Less common with recombinant factor VIII therapy.
    It occurs more frequent with hemophilia B.
    It is suspected when the patient gets suboptimal response to factor replacement.
  • Q8
    Gene therapy in hemophilia…
    Retrovirus is the vector of choice to deliver the gene to hepatocytes.
    No clinical trial yielded satisfactory results so far.
    In successful cases, the patient gets factor level sufficient for steady state but not for trauma and surgery.
    It is more successful with hemophilia A than hemophilia B.
    The use of wild type factor IX produces higher plasma levels than mutant type.
  • Q9
    produced mainly in hepatocytes
    it is responsible for factor VIII activation
    promotes platelet adhesion to subendothelial tissue and to each other at high shear rates
    its average half-life in plasma is 3 days.
    people with blood group O have higher plasma level
  • Q10
    type 1 account for 10-20% of cases
    mostly inherited as autosomal recessive disorder
    hemarthrosis is a common clinical finding
    type 2 is mostly functional defect rather than quantitative defect
  • Q11
    type 3 is inherited as autosomal recessive disorder
    factor VIII level is usually normal
    Women are more severely affected than men at a given VWF level
    epigenetic factors determine disease severity but not the type of mutation
  • Q12
    Type 2 vWD
    2A is characterized by absence of high MW multimers
    2B has low affinity for GPIb
    2M has reduced binding to factor VIII
    2N is autosomal dominant
  • Q13
    Platelet count is an essential part of hemostatic screen.
    Yes, not to do bleeding time if platelet count is markedly reduced.
    All are true.
    Yes, because thrombocytopenia is the most common cause of acquired bleeding tendency.
    Yes, because it may be reduced in some acquired coagulation disorders.
  • Q14
    One of the following is not associated with DIC
    Protein C deficiency
    Head injury
    Fat embolism
  • Q15
    Coagulopathy associated with liver disease can be differentiated from DIC by:
    Normal PT and PTT
    Low F VIII
    Normal fibrinogen level
    Usually normal D-dimer
    bleeding is uncommon

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