Exam 3- Unit 1 & 2 topics

Question 1

The brachial plexus is primarily formed by the ventral rami of which spinal nerve roots?
A) C1-C4
B) C5-T1
C) T2-T6
D) L1-L4

Answer 1

Answer: B) C5-T1

Rationale: The brachial plexus is formed by the union of the ventral rami of the fifth cervical to the first thoracic spinal nerves (C5-T1). It innervates the upper limb, with some contribution to shoulder and neck muscles.

Question 2

Which blood product is most appropriate to increase the oxygen-carrying capacity in an anemic patient without significantly increasing blood volume?

A) Fresh Frozen Plasma (FFP)
B) Packed Red Blood Cells (PRBCs)
C) Cryoprecipitate
D) Whole Blood

Answer 2

Answer: B) Packed Red Blood Cells (PRBCs)
Rationale: PRBCs are used to increase oxygen-carrying capacity in patients who need an increase in red cell mass but do not require the additional volume that comes with whole blood. This helps in avoiding circulatory overload, especially in patients with compromised cardiac function.

Question 3

For a patient with hypocalcemia during massive transfusion, which of the following is the best initial treatment?

A) Oral calcium supplements
B) Intravenous calcium gluconate
C) Intravenous calcium chloride
D) Dietary modifications

Answer 3

Answer: C) Intravenous calcium chloride
Rationale: During massive transfusion, citrate used in blood products can chelate serum calcium leading to hypocalcemia. IV calcium chloride is preferred in this acute setting because it provides a higher concentration of elemental calcium and is more effective in the presence of abnormal liver function, which may be compromised during massive hemorrhage.

Question 4

Which factor is primarily responsible for the hemostatic potential of cryoprecipitate?

A) Platelets
B) Red blood cells
C) Fibrinogen
D) Factor VIII

Answer 4

Answer: C) Fibrinogen
Rationale: Cryoprecipitate is used to correct deficiencies in fibrinogen, factor VIII, and von Willebrand factor. It is rich in fibrinogen, which is essential for the formation of a stable blood clot.

Question 5

A patient with thrombocytopenia is undergoing a surgical procedure. At what platelet count threshold is a preoperative transfusion indicated to prevent bleeding complications?

A) Below 150,000/μL
B) Below 100,000/μL
C) Below 50,000/μL
D) Below 10,000/μL

Answer 5

Answer: C) Below 50,000/μL
Rationale: Platelet transfusions are typically considered when counts drop below 50,000/μL for surgical patients to prevent perioperative bleeding. For major surgeries or in patients with additional risk factors, a higher threshold may be used.

Question 6

When using a thromboelastogram (TEG) to guide transfusion in a bleeding patient, an increased K time and decreased angle would indicate a need for:

A) Platelets
B) Fresh Frozen Plasma
C) Cryoprecipitate
D) Red Blood Cells

Answer 6

Answer: C) Cryoprecipitate
Rationale: An increased K time and a decreased angle on TEG suggest a deficiency in clot formation factors, such as fibrinogen. Cryoprecipitate is rich in fibrinogen and is used to treat this specific deficiency.

Question 7

What is the primary risk associated with the transfusion of platelets?

A) Hypocalcemia
B) Transfusion-related acute lung injury (TRALI)
C) Hemochromatosis
D) Hyperkalemia

Answer 7

Answer: B) Transfusion-related acute lung injury (TRALI)
Rationale: TRALI is a serious and potentially fatal complication that can occur with platelet transfusion, characterized by acute respiratory distress and noncardiogenic pulmonary edema.

Question 8

A patient undergoing liver transplantation presents with a microangiopathic hemolytic anemia and thrombocytopenia. Which blood product is most likely to be beneficial?

A) Packed Red Blood Cells (PRBCs)
B) Platelet concentrates
C) Fresh Frozen Plasma (FFP)
D) Cryoprecipitate

Answer 8

Answer: C) Fresh Frozen Plasma (FFP)
Rationale: The clinical presentation is suggestive of a disseminated intravascular coagulation (DIC) scenario, where FFP can provide multiple clotting factors required to manage the condition.

Question 9

For a patient with a known Factor IX deficiency scheduled for surgery, which of the following would be the most appropriate treatment?

A) Prothrombin Complex Concentrate (PCC)
B) Cryoprecipitate
C) Factor VIII concentrate
D) Fresh Frozen Plasma (FFP)

Answer 9

Answer: A) Prothrombin Complex Concentrate (PCC)
Rationale: PCC contains Factors II, VII, IX, and X, making it suitable for treating Factor IX deficiency, which is also known as Hemophilia B.

Question 10

In a patient with acute bleeding and elevated PT/INR, which of the following blood products should be administered first?

A) Packed Red Blood Cells (PRBCs)
B) Platelet concentrates
C) Fresh Frozen Plasma (FFP)
D) Vitamin K

Answer 10

Answer: C) Fresh Frozen Plasma (FFP)
Rationale: FFP contains clotting factors which can rapidly reverse the effects of warfarin and correct coagulopathy as evidenced by elevated PT/INR.

Question 11

What is the most appropriate course of action for a patient with a platelet count of 20,000/μL and active mucosal bleeding?

A) Wait for spontaneous recovery of platelet count
B) Administer desmopressin (DDAVP)
C) Transfuse platelet concentrates
D) Administer erythropoietin

Answer 11

Answer: C) Transfuse platelet concentrates
Rationale: Transfusion of platelet concentrates is indicated to prevent or control bleeding in patients with thrombocytopenia and active hemorrhage.

Question 12

In thromboelastography (TEG), what does an increased ‘R time’ indicate?

A. Accelerated fibrinolysis
B. Rapid clot formation
C. Delayed clot initiation
D. Enhanced clot strength

Answer 12

Answer: C. Delayed clot initiation
Rationale: In TEG, the ‘R time’ represents the reaction time or time until clot initiation. An increased ‘R time’ indicates delayed clot formation, which can be due to a deficiency or dysfunction of clotting factors or inhibitors of the clotting cascade.

Question 13

In the setting of trauma and significant hemorrhage, the presence of which clotting factor is most critical for initial hemostasis?
A. Factor VIII
B. Factor IX
C. Fibrinogen
D. Von Willebrand factor

Answer 13

Answer: C. Fibrinogen
Rationale: Fibrinogen, also known as Factor I, is critical for initial clot formation. It is converted to fibrin in the clotting process, providing the primary matrix for blood clot formation.

Question 14

Which nerve is not typically a direct branch of the brachial plexus?
A) Ulnar nerve
B) Radial nerve
C) Median nerve
D) Supraclavicular nerve

Answer 14

Answer: D) Supraclavicular nerve.

arises from the Cervical plexus of C3-C4

Question 15

Which nerve provides sensory innervation to the lateral surface of the forearm?
A) Radial nerve
B) Musculocutaneous nerve
C) Median nerve
D) Ulnar nerve

Answer 15

Answer: B) Musculocutaneous nerve

Rationale: The musculocutaneous nerve continues as the lateral antebrachial cutaneous nerve to provide sensory innervation to the lateral surface of the forearm.

C5-C7

Question 16

Loss of function in which nerve would most likely impair a person’s ability to abduct their arm from 15 to 90 degrees?
A) Ulnar nerve
B) Axillary nerve
C) Median nerve
D) Radial nerve

Answer 16

Answer: B) Axillary nerve C5-C6 .. Not part of Cervical plexus, which is C1-C4

Question 17

Which nerve root is primarily responsible for sensation in the heel of the foot?
A) L4
B) L5
C) S1
D) S2

Answer 17

Answer: C) S1

Rationale: The S1 nerve root contributes to the tibial nerve, which innervates the heel area of the foot through its calcaneal branches.

Question 18

The web space between the first and second toes is innervated by which of the following nerve roots?
A) L4
B) L5
C) S1
D) S2

Answer 18

Answer: B) L5

Rationale: The deep peroneal nerve, which innervates the area between the first and second toes, is derived from the L5 nerve root.

Question 19

Sensation to the lateral aspect of the foot is typically supplied by which nerve root?
A) L4
B) L5
C) S1
D) S2

Answer 19

Answer: C) S1

Rationale: The sural nerve, which provides sensory innervation to the lateral aspect of the foot, receives fibers from the S1 nerve root.

Question 20

Which nerve root is involved in the sensory innervation of the medial side of the foot?
A) L4
B) L5
C) S1
D) S2

Answer 20

Answer: A) L4

Rationale: The saphenous nerve, a branch of the femoral nerve supplied by the L4 nerve root, innervates the medial aspect of the foot.

Question 21

The plantar aspect of the foot receives its sensory innervation primarily from which of the following nerve roots?
A) L4 and L5
B) L5 and S1
C) S1 and S2
D) S2 and S3

Answer 21

Answer: B) L5 and S1

Rationale: The plantar nerves, branches of the tibial nerve arising from the L5 and S1 nerve roots, are responsible for the sensory innervation of most of the plantar aspect of the foot.

Question 22

The femoral nerve, responsible for extending the knee, arises from which spinal segments?
A) L2-L4
B) L4-L5
C) L5-S1
D) S1-S2

Answer 22

Answer: A) L2-L4

Rationale: The femoral nerve is derived from the lumbar plexus, receiving contributions from the L2, L3, and L4 nerve roots. It provides motor innervation to the muscles that extend the knee and sensory innervation to the anterior thigh and medial leg.

Question 23

Which nerve is primarily responsible for sensation to the medial aspect of the thigh and receives contributions from the L2-L4 nerve roots?
A) Femoral nerve
B) Obturator nerve
C) Sural nerve
D) Sciatic nerve

Answer 23

Answer: B) Obturator nerve

Rationale: The obturator nerve, which arises from the anterior divisions of the L2-L4 nerve roots, supplies sensory innervation to the medial aspect of the thigh and also provides motor innervation to the adductor muscles of the thigh

Question 24

Sensation to the lateral aspect of the foot is provided by which nerve?
A) Femoral nerve
B) Obturator nerve
C) Sural nerve
D) Deep peroneal nerve

Answer 24

Answer: C) Sural nerve

Rationale: The sural nerve, composed of branches from the tibial nerve and common fibular nerve (which have contributions from S1 and S2 nerve roots), supplies sensory innervation to the lateral aspect of the foot.

Question 25

Which nerve is not typically involved in knee joint sensation?
A) Femoral nerve
B) Obturator nerve
C) Sural nerve
D) Saphenous nerve

Answer 25

Answer: C) Sural nerve

Rationale: The sural nerve is involved in sensory innervation of the lower leg and foot, not the knee joint. The knee joint’s sensation is mainly mediated by the femoral nerve (and its saphenous branch) and the obturator nerve.

Question 26

What is the initial recommended shock energy for defibrillation in pediatric cardiac arrest?
A) 0.5 J/kg
B) 1 J/kg
C) 2 J/kg
D) 4 J/kg

Answer 26

Answer: C) 2 J/kg
Rationale: The Pediatric Cardiac Arrest Algorithm suggests the first shock should be 2 J/kg. Subsequent is 4J/Kg, then max is 10J/Kg or adult dose

Question 27

For subsequent shocks after the initial defibrillation in pediatric cardiac arrest, the energy should be:
A) 2 J/kg
B) At least 4 J/kg, not exceeding the maximum of 10 J/kg or the adult dose.
C) A consistent 2 J/kg for each shock.
D) Increased progressively by 1 J/kg with each shock.

Answer 27

Answer: B) At least 4 J/kg, not exceeding the maximum of 10 J/kg or the adult dose.
Rationale: After the first shock at 2 J/kg, subsequent shocks should be at least 4 J/kg, with a maximum of 10 J/kg or an adult dose.

Question 28

What is the recommended intravenous dose of epinephrine during pediatric cardiac arrest?
A) 0.1 mg/kg
B) 0.01 mg/kg
C) 1 mg/kg
D) 0.1 mg/kg with a maximum dose of 1 mg

Answer 28

Answer: B) 0.01 mg/kg
Rationale: Epinephrine should be given IV/IO at a dose of 0.01 mg/kg. The maximum dose should not exceed 1 mg. Repeat every 3-5 minutes if needed. If there is no IV/IO access, an endotracheal dose may be given.

Question 29

The intravenous or intraosseous dose of amiodarone during pediatric cardiac arrest is:
A) 1 mg/kg
B) 5 mg/kg
C) 10 mg/kg
D) 0.5 mg/kg

Answer 29

Answer: B) 5 mg/kg
Rationale: For refractory VF/pulseless VT during cardiac arrest, amiodarone can be given IV/IO at a dose of 5 mg/kg. This may be repeated up to 3 total doses.

lidocaine is 1mg/kg

Question 30

What is the recommended initial biphasic shock energy level according to the Adult Cardiac Arrest Algorithm?

A) 50-100 Joules
B) 120-200 Joules
C) 300-360 Joules
D) Maximum available if the manufacturer’s recommendation is unknown

Answer 30

Answer: B) 120-200 Joules or D) Maximum available if the manufacturer’s recommendation is unknown
Rationale: The algorithm suggests using a manufacturer’s recommended initial dose of 120-200 Joules for a biphasic defibrillator, or the maximum available if the manufacturer’s recommendation is unknown. If monophasic then Monophasic:360J

Question 31

For patients who require drug therapy during cardiac arrest, what is the correct dosing for amiodarone IV/IO?

A) First dose: 150 mg bolus, Second dose: 300 mg
B) First dose: 300 mg bolus, Second dose: 150 mg
C) First dose: 1 mg/kg, Second dose: 0.5 mg/kg
D) Amiodarone is not recommended for use during cardiac arrest

Answer 31

Answer: B) First dose: 300 mg bolus, Second dose: 150 mg
Rationale: The recommended dose for amiodarone during cardiac arrest is a 300 mg bolus for the first dose, followed by a second dose of 150 mg if needed.

Question 32

If a monophasic defibrillator is being used for a patient in VF/pVT, what energy level should be used for defibrillation?

A) 120-200 Joules
B) 200-300 Joules
C) 360 Joules
D) Energy levels are the same for biphasic and monophasic defibrillators

Answer 32

Answer: C) 360 Joules
Rationale: For monophasic defibrillators, a shock of 360 Joules is recommended, which is typically higher than the initial doses suggested for biphasic defibrillators.

Question 33

What is the first-line drug and dosage for chemical cardioversion in adult tachycardia with a pulse according to the provided algorithm?
A. Procainamide IV, 20 mg/min
B. Amiodarone IV, 150 mg over 10 minutes
C. Adenosine IV, 6 mg rapid push
D. Sotalol IV, 100 mg over 5 minutes

Answer 33

Answer: C. Adenosine IV, 6 mg rapid push
Rationale: The initial recommended dose for adenosine in the treatment of regular, narrow-complex tachycardia as per the Adult Tachycardia With a Pulse Algorithm is a rapid IV push of 6 mg, followed by a normal saline flush.

Question 34

When considering synchronized cardioversion for a patient with persistent tachyarrhythmia, what should be considered according to the algorithm?
A. Sedation prior to cardioversion
B. Immediate administration of amiodarone
C. Starting an antiarrhythmic infusion
D. Consulting a cardiologist

Answer 34

Answer: A. Sedation prior to cardioversion
Rationale: For patient comfort and safety, considering sedation before synchronized cardioversion is recommended if the patient is experiencing a persistent tachyarrhythmia with symptoms such as hypotension or altered mental status.

Question 35

In adult tachycardia with a pulse, if the first dose of adenosine is ineffective, what is the recommended second dose?
A. 6 mg rapid IV push
B. 12 mg rapid IV push
C. Repeat 150 mg of amiodarone IV
D. 20-50 mg/min of procainamide IV

Answer 35

Answer: B. 12 mg rapid IV push
Rationale: If the initial 6 mg dose of adenosine is not effective, the recommended second dose is a 12 mg rapid IV push, followed by a normal saline flush.

Question 36

What is the recommended maximum total dose of procainamide for a stable patient with wide-QRS tachycardia?
A. 17 mg/kg
B. 12 mg as a rapid IV push
C. 150 mg over 10 minutes
D. 1.5 mg/kg over 5 minutes

Answer 36

Answer: A. 17 mg/kg
Rationale: For procainamide, the dose is 20-50 mg/min until the arrhythmia is suppressed, or there is the onset of hypotension, or the QRS duration increases by more than 50%, or a maximum dose of 17 mg/kg is given

Question 37

A 65-year-old patient presents with symptomatic bradycardia with a heart rate of 45/min and signs of hypotension and altered mental status. After establishing IV access, what is the initial IV dose of atropine you should administer?

A) 0.5 mg bolus
B) 1 mg bolus
C) 1.5 mg bolus
D) 2 mg bolus

Answer 37

Answer: B) 1 mg bolus

Rationale: According to the Adult Bradycardia Algorithm, the first dose of atropine for symptomatic bradycardia should be a 1 mg bolus, repeated every 3-5 minutes if ineffective, with a maximum dose of 3 mg.

Question 38

In treating a patient with persistent bradycardia unresponsive to atropine, which of the following is the usual starting infusion rate for dopamine?

A) 2-5 mcg/kg per minute
B) 5-10 mcg/kg per minute
C) 5-20 mcg/kg per minute
D) 10-25 mcg/kg per minute

Answer 38

Rationale: Dopamine infusion can be initiated for patients with bradycardia when atropine is ineffective. The usual starting dose is between 5-20 mcg/kg per minute, which should be titrated to the patient’s response.

Question 39

A patient with bradycardia is being treated with an epinephrine infusion due to inadequate response to atropine. What is the infusion rate range for epinephrine in this scenario?

A) 0.1-1 mcg per minute
B) 2-10 mcg per minute
C) 10-20 mcg per minute
D) 20-30 mcg per minute

Answer 39

Answer: B) 2-10 mcg per minute

Rationale: If atropine is ineffective, an epinephrine infusion may be started. The infusion rate for epinephrine to treat persistent bradycardia is 2-10 mcg per minute, which should be adjusted based on the patient’s response.

And obviously if they are unstable they get the cable and pace.

Question 40

A 58-year-old male patient with a history of well-controlled hypertension and diabetes mellitus comes in for elective hernia repair. He is active, does not smoke, and has a BMI of 29. What is the most appropriate ASA classification for this patient?

A) ASA I
B) ASA II
C) ASA III
D) ASA IV

Answer 40

Answer: B) ASA II

Rationale: The patient has mild systemic disease with well-controlled hypertension and diabetes, which does not limit his daily activity, classifying him as ASA II according to the given ASA Physical Status classification system.

Question 41

A 70-year-old female with a recent (<3 months) myocardial infarction, severe valve dysfunction, and history of a stroke is scheduled for an urgent cholecystectomy. She is wheelchair-bound with limited mobility. How would you classify her ASA status?

A) ASA II
B) ASA III
C) ASA IV
D) ASA V

Answer 41

Answer: C) ASA IV

Rationale: Given the patient’s recent myocardial infarction, severe valve dysfunction, history of stroke, and limited mobility, she has severe systemic disease that is a constant threat to life, which places her in ASA IV.

Question 42

A 40-year-old individual with a BMI of 42, poorly controlled type 2 diabetes, and an implanted pacemaker for chronic atrial fibrillation presents for a knee replacement surgery. Which ASA classification applies to this patient?

A) ASA II
B) ASA III
C) ASA IV
D) ASA V

Answer 42

Answer: B) ASA III

Rationale: The patient has severe systemic disease given the poorly controlled diabetes, morbid obesity, and chronic heart condition requiring a pacemaker. This aligns with an ASA III classification.

Question 43

A 55-year-old smoker with end-stage renal disease on scheduled dialysis and a history of alcohol dependence is scheduled for vascular access surgery. What ASA Physical Status class would this patient be?

A) ASA II
B) ASA III
C) ASA IV
D) ASA V

Answer 43

Answer: B) ASA III

Rationale: The patient’s end-stage renal disease requiring dialysis and history of alcohol dependence indicate severe systemic disease, which corresponds to an ASA III classification.

Question 44

A 67-year-old woman with a history of atrial fibrillation has been on warfarin therapy for stroke prevention. She presents with a high INR and minor bleeding gums. Her recent diet history reveals a significant increase in green leafy vegetables. What is the mechanism by which her dietary changes have likely altered her warfarin therapy effectiveness?

A) Inhibition of clotting factors II, VII, IX, and X synthesis
B) Increased degradation of clotting factors II, VII, IX, and X
C) Reduced absorption of warfarin due to dietary fibers
D) Restoration of reduced clotting factors by the increased vitamin K intake

Answer 44

Answer: D) Restoration of reduced clotting factors by the increased vitamin K intake

Rationale: Warfarin functions as a vitamin K antagonist, reducing the hepatic synthesis of vitamin K-dependent clotting factors II, VII, IX, and X, as well as protein C and S. An increased intake of vitamin K, found in green leafy vegetables, can counteract the effect of warfarin, leading to higher levels of functional clotting factors, which would explain the patient’s high INR and bleeding gums. The correct course of action would involve adjusting the dose of warfarin or advising the patient on consistent dietary vitamin K intake to maintain therapeutic anticoagulation.

Question 45

A 24-year-old male presents to the emergency department with spontaneous bleeding and petechiae. Laboratory tests reveal a prolonged prothrombin time (PT) with a normal activated partial thromboplastin time (aPTT). Which of the following factors is most likely deficient in this patient?

A) Factor VIII
B) Factor IX
C) Factor XI
D) Factor VII

Answer 45

Answer: D) Factor VII

Rationale: The patient’s prolonged PT with a normal aPTT suggests a defect in the extrinsic pathway of the coagulation cascade, which involves Factor VII. Factor VII, when activated to Factor VIIa, initiates the extrinsic pathway by activating Factor X in the presence of tissue factor (TF). A deficiency in Factor VII would impair the extrinsic pathway, as reflected by the prolonged PT, while leaving the intrinsic pathway, measured by aPTT, unaffected.

Question 46

A laboratory is analyzing a sample where the clotting cascade is initiated by the addition of calcium and phospholipid. This assay is designed to assess which pathway?

A) Extrinsic pathway
B) Intrinsic pathway
C) Common pathway
D) Fibrinolysis pathway

Answer 46

Answer: B) Intrinsic pathway

Rationale: The addition of calcium and phospholipid in a laboratory setting is indicative of the activated partial thromboplastin time (aPTT) assay, which evaluates the integrity of the intrinsic and common pathways. The intrinsic pathway is initiated by contact activation, and in vitro, it is typically triggered by the addition of an artificial surface for factor XII activation. Phospholipids and calcium are essential cofactors for the enzymatic reactions in the cascade.

Question 47

A patient undergoing routine preoperative screening has a prolonged bleeding time, normal PT, and normal aPTT. Which aspect of hemostasis is most likely affected?

A) Platelet function
B) Coagulation factor synthesis
C) Fibrinolysis
D) Vitamin K metabolism

Answer 47

Answer: A) Platelet function

Rationale: A prolonged bleeding time with normal PT and aPTT is indicative of a potential defect in platelet function or number. The bleeding time test specifically assesses platelet interaction with the vascular endothelium and the formation of the primary platelet plug, which is the initial response to vascular injury. It does not assess coagulation factor activity, fibrinolysis, or vitamin K metabolism, which would alter PT and aPTT values.

Question 48

Musculocutaneous

Answer 48

C5-C7
Lateral Forearm

Question 49

Median Nerve

Answer 49

C6-T1
Lateral palm- 3 fingers
Brings thumb and pinky together

Question 50

Stellate Ganglion

Answer 50

C7,C8,T1
Near Vertebral Artery

Question 51

Cervical Plexus

Answer 51

C1-C4
contains supraclavicular nerves

Question 52

Lumbar Plexus

Answer 52

L1-L4

Question 53

Sacral Plexi

Answer 53

S1-S4

Question 54

Nerves of Lumber plexus

Answer 54

I -iliohypogastric: L-1 (some T-12)
I-lioinguinal: L-1
G-entitofemoral: 2,3
L-ateral Cutaneous: 2,3
O-bturator: 2-4
f-emoral: 2-4

I, I get Leftovers on Fridays
(Tip: an easy way to remember that the IlioHypogastric comes before the IlioInguinal is thatHcomes beforeIin the alphabet!)

Question 55

ulnar Nerve

Answer 55

C8-T1
Pinky Finger
Abduct Fingers

Question 56

Brachial Plexus

Answer 56

C5-T1
Not part of shoulder

Question 57

Supra Clavicular

Answer 57

C3-C4
Top of shoulder

Question 58

Axillary

Answer 58

C5-C6
Deltoid

Question 59

Radial Nerve

Answer 59

C5-T1
Dorsal Hand- top of hand
posterior side of arm - all the way to deltoids
Lateral 3 fingers- (radial side)

Question 60

Cryoprecipitate is particularly rich in which coagulation factor?
a. Factor VII
b. Factor VIII: C
c. Factor IX
d. Factor XI

Answer 60

Answer: b. Factor VIII: C
Rationale: Cryoprecipitate contains a concentrated amount of Factor VIII: C, which is important for fibrinogen replacement, especially in patients with hemophilia A

Contains:
Factor VIII: C
Factor VIII: vWF
Factor XIII
Fibrinogen

Stored at –18C & below.

Question 61

What is the primary source of all labile and stable clotting factors found in Fresh Frozen Plasma (FFP)?
a. Spleen
b. Liver
c. Bone marrow
d. Kidneys

Answer 61

Answer: b. Liver
Rationale: The liver is the primary source of all labile and stable clotting factors present in FFP, as it is the main site for the synthesis of most plasma protein

Question 62

Which factor is the starting point of the extrinsic clotting pathway and is assessed by the Prothrombin Time (PT) test?
a. Factor VIII
b. Factor IX
c. Factor X
d. Factor III

Answer 62

Answer: d. Factor III (Tissue Factor)
Rationale: The extrinsic pathway starts with Tissue Factor (Factor III) and is evaluated by the PT test, which is also sensitive to the levels of Factors VII, X (stuart prowler), V, II (prothrombin), and I (fibrinogen)

Question 63

The S3 heart sound is most commonly associated with:
a. Hypertension
b. Valvular regurgitation
c. Heart failure
d. Healthy young adults

Answer 63

Answer: c. Heart failure
Rationale: An S3 gallop is often heard in cases of heart failure and can indicate increased left ventricular end-diastolic pressure

Question 64

The medical treatment goals for aortic stenosis include:
a. Decreasing left ventricular contractility to reduce workload
b. Increasing SVR and carefully managing HR
c. Reducing SVR to improve ejection
d. Increasing HR to improve cardiac output

Answer 64

Answer: b. Increasing SVR and carefully managing HR
Rationale: In aortic stenosis, it is critical to maintain systemic vascular resistance (SVR) and avoid rapid increases in heart rate (HR) which the heart cannot compensate for due to the obstruction in outflow .

Question 65

Which component is NOT typically found in cryoprecipitate?
a. Factor VIII: C
b. Factor IX
c. Fibrinogen
d. von Willebrand factor (vWF)

Answer 65

Answer: b. Factor IX
Rationale: Cryoprecipitate contains Factor VIII: C, von Willebrand factor, Factor XIII, and fibrinogen. Factor IX, also known as Christmas Factor, is not a component of cryoprecipitate and is instead involved in the intrinsic coagulation pathway .

Question 66

The administration of Fresh Frozen Plasma (FFP) is primarily indicated for:
a. An isolated deficiency of Factor VIII
b. Replenishment of multiple clotting factors in coagulopathy
c. Immediate reversal of heparin effect
d. Volume expansion in hypovolemic shock

Answer 66

Answer: b. Replenishment of multiple clotting factors in coagulopathy
Rationale: FFP contains all the coagulation factors, both labile and stable, making it suitable for treating coagulopathies with multiple factor deficiencies. It is also a source of Antithrombin III and other plasma proteins .

Question 67

A patient presenting with a prolonged aPTT but normal PT is likely deficient in which factor?
a. Factor VII
b. Factor VIII
c. Factor IX
d. Both b and c

Answer 67

Answer: d. Both b and c
Rationale: A prolonged aPTT with a normal PT suggests a defect in the intrinsic pathway. Factor VIII (Antihemophilic Factor) and Factor IX (Christmas Factor) are part of the intrinsic pathway and their deficiencies would prolong aPTT but not PT .
PTT/aPTT is particularly sensitive to deficiencies in the intrinsic pathway factors (VIII, IX, XI, and XII) and is used to monitor heparin therapy, as well as to investigate bleeding disorders.

Question 68

What is the main role of Factor XIII in the clotting process found in cryoprecipitate?
a. Initiating the extrinsic pathway
b. Catalyzing the conversion of fibrinogen to fibrin
c. Stabilizing the formed fibrin clot
d. Acting as a cofactor for Factor VIII

Answer 68

Answer: c. Stabilizing the formed fibrin clot
Rationale: Factor XIII, present in cryoprecipitate, is involved in the final stages of the clotting process, where it stabilizes the fibrin clot by cross-linking fibrin strands, thus giving the clot its definitive structure .

Question 69

In patients with liver disease, which blood product is essential to provide stable clotting factors?
a. Cryoprecipitate
b. Fresh Frozen Plasma (FFP)
c. Platelet concentrate
d. Packed Red Blood Cells (PRBC)

Answer 69

Answer: b. Fresh Frozen Plasma (FFP)
Rationale: Patients with liver disease may have deficiencies in multiple clotting factors synthesized by the liver. FFP is indicated in this setting as it contains both stable and labile clotting factors necessary for hemostasis .

Question 70

Vitamin K is essential for the synthesis of which clotting factor?
a. Factor VIII: C
b. Factor IX
c. Factor XI
d. Factor XIII

Answer 70

Answer: b. Factor IX
Rationale: Vitamin K is necessary for the hepatic synthesis of several clotting factors, including Factor IX (Christmas Factor), Factor VII (Proconvertin), Factor X (Stuart-Prower Factor), and Prothrombin (Factor II) .

Question 71

Which of the following sets of factors are involved in the extrinsic pathway of the coagulation cascade?
a. Factors VII, IX, and X
b. Factors III (Tissue Factor) and VII
c. Factors I (Fibrinogen), V, and VIII
d. Factors XI, XII, and XIII

Answer 71

Answer: b. Factors III (Tissue Factor) and VII
Rationale: The extrinsic pathway is initiated by Factor III (Tissue Factor), which is released from damaged tissue and interacts with Factor VII. This complex then activates Factor X, leading into the common pathway. Factor VII is the only clotting factor apart from Tissue Factor that is part of the extrinsic pathway . Measured by PT

Question 72

The intrinsic pathway of the coagulation cascade includes which of the following factors?
a. Factors VII, X, and V
b. Factors II, VII, and IX
c. Factors VIII, IX, XI, and XII
d. Factors I, II, and III

Answer 72

Answer: c. Factors VIII, IX, XI, and XII
Rationale: The intrinsic pathway is initiated by Factor XII (Hageman factor) and involves Factors XI, IX, and VIII. These factors are activated in a sequence leading to the activation of Factor X, which then joins the common pathway. The intrinsic pathway is tested by the activated partial thromboplastin time (aPTT)

Question 73

What factors does the liver not synthesizes?

Answer 73

3, 4, 8 & vWF

Question 75

In the management of adult tachycardia with a pulse, synchronized cardioversion is recommended when the patient presents with which of the following conditions?
A. Heart rate <150 beats per minute
B. Stable blood pressure with no signs of shock
C. Evidence of hypotension or altered mental status
D. Wide QRS complex without any symptoms

Answer 75

Answer: C. Evidence of hypotension or altered mental status
Rationale: According to the Adult Tachycardia With a Pulse Algorithm, synchronized cardioversion is indicated if the patient is symptomatic with signs such as hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure, as these may indicate hemodynamic instability.