What is the first step in hemostasis?
C. Vascular vasoconstriction
When there is disruption at the endothelium causing bleeding, the first step in hemostasis is vasoconstriction followed by the adherence of platelets to the injured site by the link of glycoprotein receptor 1b (platelet surface) to the vessel wall by circulation vWF. This expresses the surface receptor glycoprotein IIb/IIIa on the platelet. Platelets aggregate forming a platelet plug and this is followed by ultimately fibrin formation.
What is the most common congenital hypercoagulability disorder?
A. Prothrombin gene defect G20210 A
Factor V Leiden (resistance to activated Protein C) is reportedly present in 20% to 60% of cases of venous thrombosis. It is present in 1% to 2% of the population. Compared to other hypercoagulable disorders, it is of lower risk in forming thrombus and more likely the thrombus will be venous rather than arterial.
What blood product listed below does not carry the risk of HIV and hepatitis B or C?
Albumin carries the theoretical risk of Creutzfeldt-Jakob disease.
The drug that can be used to treat bleeding with transurethral prostate resection?
Aminocaproic acid is a lysine analogue that inhibits fibrinolysis. It competitively binds to the lysine-binding sites of a fibrin clot blocking the binding of plasminogen.
A 45-year-old male with the diagnosis of antithrombin III deficiency develops a DVT. What do you have to administer to the patient prior to starting heparin?
Fresh frozen plasma is needed to be administered with patients who are antithrombin III deficient so that the mechanism of heparin (ie, activating antithrombin III, thereby inactivating Factor Xa and thrombin) is effective.
A 55-year-old male was placed on a heparin drip for a lower extremity DVT. Three days later he had a platelet count of 52,000 (decreased from 180,000). You suspect heparin-induced thrombocytopenia (HIT). What antibody has he developed?
HIT develops when the body forms antibodies, usually IgG, against heparin when it is bound to platelet Factor 4 protein. With HIT, arterial and venous thromboses can both form.
All of the following are relative contraindications to thrombolytic therapy except:
B. Recent surgery (<10 days)
D. Recent CVA (<2 months)
Absolute contraindications to thrombolytic therapy include active internal bleeding, recent CVA (<2 months), and intracranial pathology.
A 36-year-old female is 32 weeks pregnant and has been diagnosed with a lower extremity DVT. The treatment that is absolutely contraindicated is:
B. Arixtra (Fondaparinux)
D. IV heparin transitioned to Coumadin
Coumadin is teratogenic and crosses the placenta.
This class of antibiotics can induce a platelet disorder:
Pencillins and cephalosporins can bind platelets and increase bleeding time.
Of the following scenarios, which patient has indication for an IVC filter?
A. A 36-year-old male who has a recurrent DVT while on Coumadin with an INR 1.5
B. A 42-year-old female with an upper extremity DVT
C. A 28-year-old female who is 27 weeks pregnant
D. A 67-year-old male with a PE while on therapeutic Coumadin
E. A 50-year-old male who has Factor V Leiden
Indications for an IVC filter include patients who have a contraindication to anticoagulation; a pulmonary embolus while on therapeutic anticoagulation; free-floating iliofemoral, IVC or femoral DVT; and patients who have had a pulmonary embolectomy.