Multiple choice questions Dr. Mohammad Harith Al- Saaty

1. Which one of the followings mostly suggest coagulation disorders. a 1. Which one of the followings mostly suggest coagulation disorders? a. Epistaxis b. Hemarthrosis c. Petechi d. Purpura e. Gum bleeding

2. All of the followings associated with prolonged PT , EXCEPT: a 2. All of the followings associated with prolonged PT , EXCEPT: a. Factor VII deficiency b. Liver disease c. Factor VIII deficiency d. Warfarin therapy e. Vitamin K deficiency

3. Young age male previously well , presented with mild joint pain , as a part of routine check up , a blood count was done for him which revealed the followings : Hb 15 g/dl , WBC 6 *10^9/l , platelets 120 * 10^9/l , he has no evidence of bleeding tendency & there is no any organomegally , what should be done next ? a. Arrange for platelet transfusion b. Start steroids urgently . c. Obtain bone marrow examination d. Send for blood film to exclude platelets clumping e. Send for PT , APTT & factors assay .

4. 38 year old female , known case of SLE , presented to you with low grade fever , diffuse joint pain & epistaxis , on examination there is tenderness of hand joints , malar rash & few petechi . Platelet count was low , u suspect the dx. Of ITP , what is the 1st line treatment in such case ? a. Splenectomy b. Rituximab c. Iv IG d. Methyl prednisolon e. Romiplostim

5. All the following are vitamin K–dependent coagulation factors EXCEPT: A. Factor X B. Factor VII C. Protein C D. Protein S E. Factor VIII

6. A 31-year-old man with hemophilia A is admitted with persistent gross hematuria. He denies recent trauma and any history of genitourinary pathology. The examination is unremarkable. Hematocrit is 28%. All the following are treatments for hemophilia A EXCEPT: A. Desmopressin (DDAVP) B. Fresh-frozen plasma C. Cryoprecipitate D. Recombinant factor VIII E. Plasmapheresis

7. All of the following investigations are expected to be found in DIC , EXCEPT : a. Low platelets b. Elevated fibrinogen C . Prolonged PT d. Prolonged APTT e. Elevated D dimer.

8. 32 old female has history of missed abortion presented with petechi , multiple bruises & heavy menorrhagia , she has anemia , thrombocytopenia , elevated PT & APTT , elevated D dimer with elevated liver function test . Based on these informations , what is the most like dx.? a. DIC B. Acute fatty liver of pregnancy c. Von willebrand disease d. ITP E. Thrombotic thrombocytopenic purpura ( TTP)

9. a known case of hemophilia A on treatment with factor VIII , recently the patient has been not responding to the therapeutic dose of factor VIII , u suspect that the pt. has factor inhibitor , what is the most appropriate next step in his management ? a. Send him for PT b. Do mixing study c. Give him Fresh frozen plasma in addition to the factor . d. He mostly has christmas disease , give him factor IX. E. Send the patient for platelet function study .

10. A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. Laboratory studies are as follows: Hct: 38% WBC: 15,000/μL Platelet count: 40,000/μL (normal 150,000-400,000) Peripheral blood smear: fragmented RBCs PT: elevated PTT: elevated Plasma fibrinogen: 70 mg/dL (normal 200-400) Which of the following is the best course of therapy in this patient? a. Begin heparin. b. Treat underlying disease. c. Begin plasmapheresis. d. Give vitamin K. e. Begin red blood cell transfusion