MCQ-Coagulation-1

1. A 4-year-old male is in the intensive care unit and has been intubated and sedated. You are asked to consult because of the presence of numerous generalized petechiae and some large ecchymosis on the abdomen and trunk. Laboratory evaluation demonstrates suspicion of APML, Hb-8.2, TLC-2.5 and platelet count of 45 × 109/L, a PT of 15.4 seconds (N=9.7–11.2 seconds), a PTT of 48 seconds (N=22–36 seconds), and a fibrinogen level of 0.87 g/L. Suspecting DIC you want to calculate ISTH DIC score which includes:-

2. In Any patient predisposed to developing DIC as in earlier Q or in a septic patient ISTH DIC score of 6 means:-

3. A patient on dual antiplatelet therapy (ASA+CLOPIDOGREL) after Acute Coronary Syndrome episode needs and urgent surgery however the risk of perioperative bleeding is increased by up to 50% in patients receiving dual antiplatelet therapy. So what would be best approach?

4. A 13-year-old girl develops menorrhagia at the onset of menarche requiring several packed red blood cell transfusions. She also required a transfusion after a tonsillectomy and adenoidectomy when she was 5 years old, but it was never evaluated. She also has easy bruising and gingival bleeding daily when she brushes her teeth. She is referred to you by her pediatrician for an evaluation. There is a history of menorrhagia in the mother though she never required any transfusions. In addition, there is a history of epistaxis and postsurgical bleeding in the father. Her parents have normal aPTTs and the patient has an abnormal screening laboratory test. Which of the following is the most likely diagnosis?

5. A 50 year old anemic female, mother of two children underwent Hysterectomy because of multiple fibroids. She was doing well when on day 7 of her OT she developed petechiae, gum bleeding and oozing from venipuncture sites. Her platelet count was 10000/mm3 and the platelet count further dropped to 2000/mm3 the following day. PT and APTT was normal. What is probable diagnosis? 

6. A 3-year-old boy with nephrotic syndrome is admitted for an acute exacerbation of his proteinuria. His albumin is 0.7 on admission. He is treated with albumin infusions and he is started on prednisone. The second hospital day, he develops pain in his right leg and his right leg is swollen more than the left leg. A Doppler ultrasound reveals a femoral to iliac vein deep vein thrombosis. In addition to anticoagulation with an unfractionated or low molecular weight heparin, what else should be administered to this patient?

7. A 2-year-old girl presents with prolonged oozing from her tongue after apparently biting it. Her platelet count is normal. Her PT is 68 seconds (normal range is 9–12 seconds), her aPTT is 123 seconds (normal range is 22–33 seconds) and her thrombin time is 58 seconds (normal range is 12–18 seconds). Which of the following tests should be ordered next?

8. A 1-year-old male presents to the emergency room with irritability and vomiting, and a CT scan demonstrates a large intracranial parenchymal hemorrhage. The mother reports that his only other bleeding symptom was prolonged bleeding from the umbilical stump. The patient comes from a large pedigree with numerous male and female first- and second-degree relatives; however, there is no history of excessive bleeding in any of them. Which of the laboratory test patterns is most consistent with this history?

9. A 3-day-old infant is brought to the ER following a seizure. A CT scan demonstrates massive intracranial hemorrhage. On your examination, the child has numerous bruises on the abdomen and trunk. Which of the below scenarios is most likely?

10. A 12-year-old male with cystic fibrosis is going to undergo a partial pneumonectomy because of severe bronchiectasis. Preoperative coagulation testing, which demonstrates a PT of 17.2 seconds (N=9.7–11.2 seconds) and a APTT of 36 seconds (N=22–36 seconds). She is given supplemental oral vitamin K of 5 mg once a day for 3 days and repeat testing demonstrates a PT of 16.9 seconds and a APTT of 37 seconds. What is the most appropriate next step?