Haematology Flashcards
A. Cycloxygenase B. Endothelial cell C. Protein C D. Thromboxane A2 E. Erythrocyte F. a2 macroglobulin G. Fibrinogen H. Fibrin I. Platelet J. Tissue plasminogen-activator (t-PA) K. Antithrombin III L. Plasmin M. Megakaryocyte
The most important cell in the initiation of haemostasis
B - endothelial cell
A. Cycloxygenase B. Endothelial cell C. Protein C D. Thromboxane A2 E. Erythrocyte F. a2 macroglobulin G. Fibrinogen H. Fibrin I. Platelet J. Tissue plasminogen-activator (t-PA) K. Antithrombin III L. Plasmin M. Megakaryocyte
The main component involved in stabilising the primary haemostatic plug
H - fibrin
A. Cycloxygenase B. Endothelial cell C. Protein C D. Thromboxane A2 E. Erythrocyte F. a2 macroglobulin G. Fibrinogen H. Fibrin I. Platelet J. Tissue plasminogen-activator (t-PA) K. Antithrombin III L. Plasmin M. Megakaryocyte
A serine protease which assists in the break down of blood clots by binding to the clot and localising agents which break it down.
J - tPA
A. Cycloxygenase B. Endothelial cell C. Protein C D. Thromboxane A2 E. Erythrocyte F. a2 macroglobulin G. Fibrinogen H. Fibrin I. Platelet J. Tissue plasminogen-activator (t-PA) K. Antithrombin III L. Plasmin M. Megakaryocyte
A potent inhibitor of plasmin in the blood
F - a2 macroglobulin
A. Cycloxygenase B. Endothelial cell C. Protein C D. Thromboxane A2 E. Erythrocyte F. a2 macroglobulin G. Fibrinogen H. Fibrin I. Platelet J. Tissue plasminogen-activator (t-PA) K. Antithrombin III L. Plasmin M. Megakaryocyte
A single chain glycoprotein, synthesised by the liver and endothelium, which has strongly anticoagulant action and is important in the mode of action of heparin.
Antithrombin III
A. von Willebrand deficiency B. Christmas disease C. Megakaryocyte D. Factor VIII deficiency E. Sensitised platelet F. Marfan syndrome G. Autoimmune thrombocytopenic purpura H. Thromboxane A2 I. Ehlers-Danlos syndrome J. Vitamin K deficiency K. Haemophilia L. Prostacyclin PGI2 M. Factor XII deficiency
This product of the cyclic endoperoxides induces platelet aggregation
H - thromboxane A2
A. von Willebrand deficiency B. Christmas disease C. Megakaryocyte D. Factor VIII deficiency E. Sensitised platelet F. Marfan syndrome G. Autoimmune thrombocytopenic purpura H. Thromboxane A2 I. Ehlers-Danlos syndrome J. Vitamin K deficiency K. Haemophilia L. Prostacyclin PGI2 M. Factor XII deficiency
A 6 foot 7 inch rower presents to his GP complaining of easy skin bruising. On further examination he is found to have pectus excavatum, lax joints and a high-arched palate.
I - Ehlers Danlos
A. von Willebrand deficiency B. Christmas disease C. Megakaryocyte D. Factor VIII deficiency E. Sensitised platelet F. Marfan syndrome G. Autoimmune thrombocytopenic purpura H. Thromboxane A2 I. Ehlers-Danlos syndrome J. Vitamin K deficiency K. Haemophilia L. Prostacyclin PGI2 M. Factor XII deficiency
A 62 year old overweight woman presents to the Emergency Department following a Road Traffic Accident. A full set of investigations is carried out – which shows an increased Activated Partial Thromboplastin Time (APTT) and Prothrombin Time (PT)
Vitamin K deficiency
A. von Willebrand deficiency B. Christmas disease C. Megakaryocyte D. Factor VIII deficiency E. Sensitised platelet F. Marfan syndrome G. Autoimmune thrombocytopenic purpura H. Thromboxane A2 I. Ehlers-Danlos syndrome J. Vitamin K deficiency K. Haemophilia L. Prostacyclin PGI2 M. Factor XII deficiency
A 25 year old man presents to the Emergency Department a day after attending his dentist for a routine check-up. After treatment at the dentists the previous day, his gums had not stopped bleeding. On investigation, his APTT and bleeding time are prolonged but a normal PT.
von-Willebrand deficiency
A. von Willebrand deficiency B. Christmas disease C. Megakaryocyte D. Factor VIII deficiency E. Sensitised platelet F. Marfan syndrome G. Autoimmune thrombocytopenic purpura H. Thromboxane A2 I. Ehlers-Danlos syndrome J. Vitamin K deficiency K. Haemophilia L. Prostacyclin PGI2 M. Factor XII deficiency
A 16 year old girl presents to the Haematology Outpatients clinic describing a fluctuating history of easy bruising, epistaxis and menorrhagia. On investigation there is a thrombocytopaenia with increased megakaryocytes on BM examination.
G - Autoimmune thrombocytopenic purpura
A. Tissue factor pathway inhibitor B. Cyclooxygenase C. Protein S D. Thrombin E. Vascular endothelium F. Arichidonic acid G. Activated factor X H. Protein C I. Vascular subendothelium J. Tissue factor K. Factor VII L. Platelets
Which protein, important in haemostasis, is vitamin K dependent but is not a serine protease?
Protein S
A. Tissue factor pathway inhibitor B. Cyclooxygenase C. Protein S D. Thrombin E. Vascular endothelium F. Arichidonic acid G. Activated factor X H. Protein C I. Vascular subendothelium J. Tissue factor K. Factor VII L. Platelets
Which option is required as a cofactor for protein C activity?
Protein S
A. Tissue factor pathway inhibitor B. Cyclooxygenase C. Protein S D. Thrombin E. Vascular endothelium F. Arichidonic acid G. Activated factor X H. Protein C I. Vascular subendothelium J. Tissue factor K. Factor VII L. Platelets
Which option synthesises tissue factor, vWF, prostacyclin, plasminogen activator, antithrombin III and thrombomodulin?
Vascular endothelium
A. Tissue factor pathway inhibitor B. Cyclooxygenase C. Protein S D. Thrombin E. Vascular endothelium F. Arichidonic acid G. Activated factor X H. Protein C I. Vascular subendothelium J. Tissue factor K. Factor VII L. Platelets
Which enzyme, important for platelet aggregation, is irreversibly inhibited by aspirin?
Cyclooxygenase
A. Tissue factor pathway inhibitor B. Cyclooxygenase C. Protein S D. Thrombin E. Vascular endothelium F. Arichidonic acid G. Activated factor X H. Protein C I. Vascular subendothelium J. Tissue factor K. Factor VII L. Platelets
Which key clotting factor activates both factors V and VIII, and also activates protein C?
Thrombin
A. Von Willebrand’s Disease B. Bile acid malabsorption C. Malignancy D. Sickle cell anaemia E. Factor V Leiden F. Warfarin overdose G. Antiphospholipid antibody syndrome H. Haemophilia A I. B-Thalassaemia J. Osler-Weber-Rendu Syndrome K. Disseminated intravascular coagulation L. Vitamin K Deficiency M. Christmas Disease N. Henoch – Schönlein Purpura
A 37 year old mother of 4 children, presents to her GP because of recurrent nose bleeds and feeling tired all the time and heavy periods.
J - Osler-Weber-Rendu
A rare autosomal dominant disorder. Alternative name = hereditary haemorrhagic telangiectasia. There is a structural abnormality of the blood vessels, resulting in telangiectases, which are thin walled so are likely to bleed. This leads to haemorrhage and anaemia. It is more common in females, and may not present until later in life. Epistaxis is the commonest presenting symptom. This patient is feeling tired, not just because of her 4 children, but because she also has iron deficiency anaemia.
A. Von Willebrand’s Disease B. Bile acid malabsorption C. Malignancy D. Sickle cell anaemia E. Factor V Leiden F. Warfarin overdose G. Antiphospholipid antibody syndrome H. Haemophilia A I. B-Thalassaemia J. Osler-Weber-Rendu Syndrome K. Disseminated intravascular coagulation L. Vitamin K Deficiency M. Christmas Disease N. Henoch – Schönlein Purpura
3 year old boy is brought to see his GP by his mother. A fortnight ago he had been brought along because of cold-like symptoms, unsurprising since it was the middle of winter and he attends nursery. He was therefore sent home with some Calpol, and as expected his symptoms soon resolved. However this morning his mother noticed a rash on his bottom, and he said his tummy ached.
N - Henoch-Schonlein Purpura
Affects children between 2-8yrs old. More common in winter. Usually presents following an upper respiratory tract infection. Rapid onset, with a palpable purpuric rash over the buttocks and legs, as well as symmetrical urticarial plaques, and haemorrhagic bullae. Arthritis of the knee and ankle. Abdominal pain – perhaps due to mesenteric vasculitis. Can have renal involvement – with haematuria/proteinuria. (not idiopathic thrombocytopenic purpura – because it’s not an option here)
A. Von Willebrand’s Disease B. Bile acid malabsorption C. Malignancy D. Sickle cell anaemia E. Factor V Leiden F. Warfarin overdose G. Antiphospholipid antibody syndrome H. Haemophilia A I. B-Thalassaemia J. Osler-Weber-Rendu Syndrome K. Disseminated intravascular coagulation L. Vitamin K Deficiency M. Christmas Disease N. Henoch – Schönlein Purpura
22 year old Saharawi refugee presents with anaemia, weight loss, loose stools and blood tests reveal an increased PT and slightly increased APTT, with normal thrombin time and platelet count.
Vitamin K deficiency
Prevalence of coeliac disease is highest in Saharawi refugees. This patient has coeliac disease, and as a result of malabsorption is losing weight and has loose stools (steatorrhoea), and vitamin K deficiency. The blood results related to vitamin K deficiency.
A. Von Willebrand’s Disease B. Bile acid malabsorption C. Malignancy D. Sickle cell anaemia E. Factor V Leiden F. Warfarin overdose G. Antiphospholipid antibody syndrome H. Haemophilia A I. B-Thalassaemia J. Osler-Weber-Rendu Syndrome K. Disseminated intravascular coagulation L. Vitamin K Deficiency M. Christmas Disease N. Henoch – Schönlein Purpura
A 5 year old boy has the following blood results: normal PT, increased APTT, normal platelet count, decreased VIII:C and decreased vWF.
A - Von willebrands disease
The most common hereditary bleeding disorder, affect 1% of the population. vWF is a carrier protein for factor VIII and stabilises it. Mutation is in chromosome 12.
A. Von Willebrand’s Disease B. Bile acid malabsorption C. Malignancy D. Sickle cell anaemia E. Factor V Leiden F. Warfarin overdose G. Antiphospholipid antibody syndrome H. Haemophilia A I. B-Thalassaemia J. Osler-Weber-Rendu Syndrome K. Disseminated intravascular coagulation L. Vitamin K Deficiency M. Christmas Disease N. Henoch – Schönlein Purpura
A 32 week pregnant lady who has gestational diabetes and is epileptic has a caesarean section while on holiday in rural China. Her newborn baby is suffering from bleeding from the umbilical stump, as well as nose and gums. What is wrong with the baby?
L - Vitamin K deficiency
Drugs, such as anticonvulsants, which the mother is likely to be taking as she suffers from epilepsy, as well as isoniazid, rifampicin and anticoagulants, are risk factors for haemorrhagic disease of the newborn – which is what this baby has. This is due to vitamin K deficiency – although rare now in the UK as prophylactic vitamin K is given to newborns.
A. Varicose veins B. Superior vena caval obstruction C. Superficial venous thrombosis D. Thrombophlebitis E. Deep vein thrombosis F. Postphlebitic syndrome G. Pulmonary embolism H. DIC I. Inferior vena caval obstruction J. Axillary vein thrombosis
A fit 48-year-old investment banker presents to A&E with a painful R arm that was present when he woke up that morning. He is otherwise well and there is no history of trauma or abnormalities of any system. On examination there is marked tenderness and mild erythema along the anterolateral aspect of the forearm and cubital fossa, with no abnormality of the upper arm or axilla.
Superficial venous thrombosis
A. Varicose veins B. Superior vena caval obstruction C. Superficial venous thrombosis D. Thrombophlebitis E. Deep vein thrombosis F. Postphlebitic syndrome G. Pulmonary embolism H. DIC I. Inferior vena caval obstruction J. Axillary vein thrombosis
A 45-year-old lady, known heavy smoker with chronic respiratory problems, presents to her GP with increasing dyspnoea and swelling of her R arm and face. On examination of her chest there is no asymmetry or tracheal deviation, but there are added sounds over the R upper lobe and on bending forward her face becomes congested.
SVCO
A. Varicose veins B. Superior vena caval obstruction C. Superficial venous thrombosis D. Thrombophlebitis E. Deep vein thrombosis F. Postphlebitic syndrome G. Pulmonary embolism H. DIC I. Inferior vena caval obstruction J. Axillary vein thrombosis
A 56-year-old woman returns to the Vascular Clinic with recurrence of her L leg ulcer after the area has been knocked by a shopping trolley. On examination the ulcer is situated above the medial malleolus, its dimensions being 6cm x 5cm. The base is filled with yellowish slough and the surrounding area is erythematous, with prominent oedema.
Postphlebitic syndrome
A. Varicose veins B. Superior vena caval obstruction C. Superficial venous thrombosis D. Thrombophlebitis E. Deep vein thrombosis F. Postphlebitic syndrome G. Pulmonary embolism H. DIC I. Inferior vena caval obstruction J. Axillary vein thrombosis
A 48-year-old man develops R-sided pleuritic chest pain and coughs up a trace of bloodstained sputum 8 days after a R hemicolectomy. He has mild dyspnoea but chest examination and chest radiography are normal.
Pulmonary embolism
A. Varicose veins B. Superior vena caval obstruction C. Superficial venous thrombosis D. Thrombophlebitis E. Deep vein thrombosis F. Postphlebitic syndrome G. Pulmonary embolism H. DIC I. Inferior vena caval obstruction J. Axillary vein thrombosis
A 32-year-old lady develops acute swelling of her L leg 2 days post-partum. She had bilateral leg swelling during the pregnancy but the delivery was normal. On examination there is tense swelling of the leg and thigh and some deep tenderness over the calf and medial aspect of the thigh.
DVT
A drug that is administered intravenously and has a rapid effect by potentiating the action of antithrombin. Action can be reversed quickly which is of relevance in myocardial infarction patients who may require early invasive treatment (ie PTCA).
Unfractionated heparin
Potentiates antithrombin III. Usually given subcutaneously. Can cause osteoporosis and hyperkalaemia.
Dalteparin (LMWH)
Used to monitor patients undergoing warfarin therapy.
Prothrombin time
Used to monitor patients undergoing unfractionated heparin therapy.
APTT
