VWD
Quiz by Sadeq K. Ali Al-Salait
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- Q1
A patient with von Willebrand disease (VWD) shows discordant results: VWF antigen (VWF:Ag) is 45 IU/dL, but VWF activity (VWF:GPIbM) is 25 IU/dL. What is the most likely subtype?
Type 1 VWD
Acquired von Willebrand syndrome (AVWS)
Type 2A or 2M VWD
Type 3 VWD
Type 2N VWD
30s - Q2
A patient with mild bleeding symptoms has normal VWF:Ag and normal VWF:GPIbM but a significantly reduced factor VIII level. Which test should be performed next?
VWF multimer analysis
Factor VIII binding assay (VWF:FVIIIB) to assess Type 2N VWD
Ristocetin-cofactor assay
Genetic testing
Chromogenic factor VIII assay
30s - Q3
Which VWD subtype is most likely to present with a normal APTT despite significant bleeding symptoms?
Type 2M VWD
Type 3 VWD
Acquired von Willebrand syndrome
Type 1 VWD
Type 2A VWD
30s - Q4
A patient has normal VWF antigen but a markedly reduced VWF:GPIbM ratio (<0.5). What is the most likely diagnosis?
Hemophilia A
Type 1 VWD
Type 2B VWD
Type 3 VWD
Type 2M VWD
30s - Q5
What is the most common reason for underdiagnosis of Type 1 VWD in women with menorrhagia?
Changes during pregnancy in the hemostasis may obscure VWD.
Bleeding scores are not standardized
VWF-Ag can be falsely raised in inflammatory conditions
VWF levels can be falsely normal
APTT is rarely prolonged in Type 1 VWD
30s - Q6
which of the following findings supports a diagnosis of AVWS over congenital VWD?
Normal ristocetin-induced platelet aggregation
High baseline VWF levels
Normal factor VIII levels
Rapid clearance of transfused VWF concentrate with a short half-life
Decreased VWF:Ag and VWF activity
30s - Q7
Which feature distinguishes Type 2B VWD from platelet-type (pseudo) VWD?
Low level of VWF activity measured by ristocetin co-factor assay
No response to desmopressin
Correction of RIPA by adding reagent platelets
Thrombocytopenia
Correction of RIPA by adding normal plasma
30s - Q8
A patient with Type 2B VWD has persistent thrombocytopenia after VWF concentrate infusion. What is the most likely cause?
Drug-induced thrombocytopenia
Platelet aggregation and clearance
Consumptive coagulopathy
Secondary ITP
Splenic sequestration
30s - Q9
A woman with known VWD presents with postpartum hemorrhage. Her factor VIII and VWF levels were normal in the third trimester. What is the best explanation?
Platelet dysfunction
Rapid postpartum decline in VWF levels
Undiagnosed hemophilia carrier status
Vitamin K deficiency
Amniotic fluid embolism
30s - Q10
A patient with VWD has an inadequate response to DDAVP challenge testing. What is the most likely reason?
Type 2 VWD
Poor platelet function
Hypersensitivity to DDAVP
Type 3 VWD
Type 1 VWD with inhibitor
30s - Q11
A child with severe epistaxis has a VWF:Ag of 55 IU/dL and VWF activity of 20 IU/dL. What is the next step?
Platelet aggregation studies
RIPA
Genetic testing
VWF multimer analysis to assess for Type 2M or 2A VWD
Collagen binding study
30s - Q12
A patient with Type 2N VWD is misdiagnosed with mild hemophilia A. What test could have prevented this?
Thromboelastography
RIPA test
Factor VIII binding assay (VWF:FVIIIB)
PFA-100
Genetic study
30s