Practicum III: Exam 2

Apex - Blood I: Coagulation Place the events of the final common pathway in the correct sequence. A. 1st event B. 2nd event C. 3rd event Thrombin activates fibrin monomer Prothrombin activator activates thrombin Activated fibrin stabilizing factor crosslinks fibrin

1st event = Prothrombin activator activates thrombin 2nd event = Thrombin activates fibrin monomer 3rd event = Activated fibrin stabilizing factor crosslinks fibrin

RED (p. 233, #867) A 75-year-old woman with a history of pulmonary embolism is scheduled for a right lower lobectomy for lung cancer. She is receiving dalteparin (Fragmin) for DVT prophylaxis. How long after her last dose should one wait prior to placement of a thoracic epidural? A. 12 hours B. 24 hours C. 72 hours D. No waiting is necessary since the dose for prophylaxis is low

A. 12 hours

RED (p. 267, #1001) How long does the antiplatelet effect of ibuprofen last? A. 3 days B. 7 days C. 21 days D. Life of platelet

A. 3 days

Red Book (p. 108, #395) A 40-year-old, 78-kg patient with hemophilia A is scheduled for a right knee arthroplasty. His laboratory test results show a hematocrit of 40, a factor VIII level of 0%, and no inhibitors to factor VIII. How much factor VIII concentrate do you need to give him to bring his factor VIII level to 100%? A. 3,000 units B. 2,500 units C. 2,000 units D. 1,500 units

A. 3,000 units

RED (p. 120, #445) The mechanism of action of clopidogrel is: A. Adenosine diphosphate (ADP) receptor blockade (P2Y12) B. Platelet glycoprotein IIB/IIIa antagonism C. COX-1 and COX-2 inhibition D. Direct thrombin inhibition

A. Adenosine diphosphate (ADP) receptor blockade (P2Y12)

Red Book (p. 110, #413) The significance of immunoglobulin A (IgA) antibodies in transfusion medicine is related to: A. Allergic reaction B. Febrile reaction C. Delayed hemolytic reaction (immune extravascular reaction) D. Diagnosis of TRALI reaction

A. Allergic reaction

RED (p. 260, #930) Administration of protamine to a patient who has not received heparin can result in: A. Anticoagulation B. Hypercoagulation C. Profound bradycardia D. Hypertension

A. Anticoagulation

RED (p. 60, # 295) Direct thrombin inhibition: A. Argatroban B. Clopidogrel C. Abciximab D. Fondaparinux

A. Argatroban

RED (p. 60, #293) Alternative to heparin for CPB: A. Argatroban B. Clopidogrel C. Abciximab D. Fondaparinux

A. Argatroban

GREEN (p. 119, #19) Anesthetic management of a patient with sickle cell disease involves which of the following? A. Avoid the use of extremity tourniquets if at all possible B. Maintenance of the HCT between 40% and 42% C. Maintenance of mild hypothermia for all types of surgery D. Maintaining mild hypercapnia throughout emergence E. Maintaining moderate acidosis

A. Avoid the use of extremity tourniquets if at all possible

Apex - Blood I: Coagulation A patient with a history of type II heparin induced thrombocytopenia requires anticoagulation for cardiopulmonary bypass. What is the BEST treatment? A. Bivalirudin B. Enoxaparin C. Warfarin D. Heparin test dose

A. Bivalirudin

Red Book (p. 109, #400) An 18-year-old woman involved in an MVA is brought to the emergency room in shock. She is transfused with 10 units of type O, Rh-negative whole blood over 30 minutes. After infusion of the first 5 units, bleeding is controlled and her blood pressure rises to 85/51 mm Hg. During the next 15 minutes, as the remaining 5 units are infused, her blood pressure slowly falls to 60 mm Hg systolic. The patient remains in sinus tachycardia at 120 beats/min, but the QT interval is noted to increase from 310 to 470 msec, and the central venous pressure increases from 9 to 20 mm Hg. Her breathing is rapid and shallow. The most likely cause of this scenario is: A. Citrate toxicity B. Hyperkalemia C. Hemolytic transfusion reaction D. Tension pneumothorax

A. Citrate toxicity

RED (p. 258, #916) A 64-year-old man develops HIT type II after anticoagulation for aortic valve replacement with 25,000 unit of heparin. The same patient requires an elective tricuspid valve replacement soon thereafter because of trauma from transvenous pacemaker. The best option for CPB anticoagulation for this patient with the second operation would be: A. Defer until disappearance of antibodies; use heparin B. CPB with lepirudin in place of heparin C. CPB with tirofiban in place of heparin D. Anticoagulation with fondaparinux

A. Defer until disappearance of antibodies; use heparin

RED (p. 264, #969) Untoward effects associated with administration of sodium bicarb during massive blood transfusion include each of the following EXCEPT: A. Hyperkalemia B. Paradoxical cerebralspinal fluid acidosis C. Hypercarbia D. Hypernatremia

A. Hyperkalemia

RED (p. 128, #527) Causes of sickling in patients with sickle cell anemia include all of the following EXCEPT: A. Inhaled nitric oxide B. Dehydration C. Metabolic acidosis D. Hypothermia

A. Inhaled nitric oxide

RED (p. 126, #498) A 16-year-old boy whose maternal uncle has hemophilia A is scheduled for wisdom tooth extraction. Which test below would be the best screening test for hemophilia A? A. PTT B. Prothrombin time (PT) C. Thrombin time D. Bleeding time

A. PTT

Red Book (p. 107, #382) Each of the following treatments might be useful in restoring a prolonged prothrombin time (PT) to the normal range EXCEPT: A. Recombinant factor VIII B. Vitamin K C. Fresh frozen plasma (FFP) D. Cryoprecipitate

A. Recombinant factor VIII

Red Book (p. 110, #414) The most common cause of mortality associated with administration of blood is: A. TRALI B. Non-ABO hemolytic transfusion reaction C. Microbial infection D. Anaphylactic reaction

A. TRALI

Apex - Blood I: Coagulation Match each medication with its mechanism of action A. Abciximab B. Clopidogrel C. Enoxaparin D. Warfarin - GIIb/IIIa receptor antagonist - ADP receptor antagonist - Antithrombin catalyst - Vitamin K antagonist

Abciximab = GIIb/IIIa receptor antagonist Clopidogrel = ADP receptor antagonist Enoxaparin = Antithrombin catalyst Warfarin = Vitamin K antagonist

Apex - Review Exam: Coagulation Match each mediator with its classification A. Alpha-antiplasmin B. von Willebrand's factor C. Plasminogen D. Antithrombin III - Antifibrinolytic - Procoagulant - Fibrinolytic - Anticoagulant

Alpha-antiplasmin = Antifibrinolytic von Willebrand's factor = Procoagulant Plasminogen = Fibrinolytic Antithrombin III = Anticoagulant

RED (p. 156, #576) What volume of PRBCs with a HCT of 60 is needed to raise the HCT from 20 to 28 in a 10-kg, 11-month-old? A. 55 mL B. 105 mL C. 155 mL D. Cannot be calculated without additional information

B. 105 mL

Red Book (p. 109, #408) What is the storage life of whole blood stored with citrate phosphate dextrose (CPD)? A. 14 days B. 21 days C. 35 days D. 42 days

B. 21 days

RED (p. 156, #575) What is the MABL for a 10-kg, 11-month-old infant whose starting HCT is 36 and the minimal acceptable HCT is 25? A. 110 mL B. 245 mL C. 350 mL D. Cannot be calculated without additional information

B. 245 mL

RED (p. 30, #109) The P50 for normal adult hemoglobin is approximately: A. 15 mm Hg B. 25 mm Hg C. 35 mm Hg D. 45 mm Hg

B. 25 mm Hg

RED (p. 156, #583) An 8-year-old boy found at the site of an MVA has arrived to the OR for exploratory laparotomy. He has not received any sedation or pain medication because he appeared "confused and did not seem bothered." He is tachycardic, with thready distal pulses and cold extremities. In spite of a 500-mL fluid bolus, the patient has produced minimal urine. What is the approximate percentage of blood volume loss in this patient? A. <20% B. 25% C. 40% D. Cannot determine

B. 25%

RED (p. 263, #960) A 66-year-old patient is undergoing a three-vessel CABG. Anticoagulation is achieved with 20,000 units of heparin. How much protamine should be administered to this patient to completely reverse the heparin after CPB? A. 150 mg B. 250 mg C. 350 mg D. 450 mg

B. 250 mg

Red Book (p. 107, #385) In a 70-kg patient, 1 unit of platelet concentrate should increase the platelet count by: A. 2,000 to 5,000/mm3 B. 5,000 to 10,000/mm3 C. 15,000 to 20,000/mm3 D. 20,000 to 25,000/mm3

B. 5,000 to 10,000/mm3

RED (p. 233, #868) How long should a patient be off clopidogrel (Plavix) before a central neuraxial block is performed? A. 24 hours B. 7 days C. 14 days D. No waiting necessary

B. 7 days

RED (p. 267, #998) How long does the antiplatelet effect of Clopidogrel last? A. 3 days B. 7 days C. 21 days D. Life of platelet

B. 7 days

Red Book (p. 108, #398) The criterion used to determine how long blood can be stored before transfusion is: A. 90% of transfused erythrocytes must remain in circulation for 24 hours B. 70% of transfused erythrocytes must remain in circulation for 24 hours C. 70% of transfused erythrocytes must remain in circulation for 72 hours D. 75% of transfused erythrocytes must remain in circulation for 7 days

B. 70% of transfused erythrocytes must remain in circulation for 24 hours

Red Book (p. 108, #393) The blood volume of a 10-kg, 1-year-old infant is: A. 600 mL B. 800 mL C. 1,000 mL D. 1,300 mL

B. 800 mL

RED (p. 125, #497) A 58-year-old hemophiliac is scheduled for a total knee arthroplasty. His factor VIII levels are 35% of normal. Which of the following would be the most appropriate therapy before surgery? A. Administer sufficient cryoprecipitate to raise Factor VIII levels to 50% normal B. Administer Factor VIII concentrated to achieve levels of 100% normal C. Transfuse FFP until Factor VIII levels are 100% normal D. None of the above

B. Administer Factor VIII concentrated to achieve levels of 100% normal

Red Book (p. 110, #410) Anticoagulation with low-molecular-weight heparin (LMWH) can be best monitored through which of the following laboratory tests? A. Activated partial thromboplastin time (aPTT) B. Anti-Xa assay C. Thrombin time D. Reptilase test

B. Anti-Xa assay

RED (p. 60, #296) Used after angioplasty often for a year or more to prevent restenosis: A. Argatroban B. Clopidogrel C. Abciximab D. Fondaparinux

B. Clopidogrel

Apex - Blood I: Coagulation Identify the true statements regarding fibrinolysis (Select 2) A. tPA inhibitor inhibits the conversion of fibrinogen to fibrin B. D-dimer measures fibrin split products C. Alpha-2 antiplasmin inhibits the action of plasmin on fibrin D. Plasminogen is synthesized in the endothelium

B. D-dimer measures fibrin split products C. Alpha-2 antiplasmin inhibits the action of plasmin on fibrin

GREEN (p. 21, #7) One of the most common inherited prothrombotic risk factors is a point mutation in which factor? A. Factor II B. Factor V C. Factor VII D. Factor XI E. Factor XII

B. Factor V

Red Book (p. 109, #406) Hetastarch exerts an anticoagulative effect through interference with the function of: A. Antithrombin III B. Factor VIII C. Fibrinogen D. Prostacyclin

B. Factor VIII

Apex - Blood I: Coagulation A septic patient undergoing exploratory laparotomy has developed bleeding from the wound and around his IV sites. He has a platelet count of 40,000 mm3, fibrinogen of 95, and an elevated D-dimer. What is the BEST treatment for this patient? A. Albumin B. Fresh frozen plasma C. Tranexamic acid D. Heparin infusion

B. Fresh frozen plasma

Apex - Blood I: Coagulation Which coagulopathies present with a prolong PTT and normal PT? (Select 2) A. Factor II deficiency B. Hemophilia B C. Hemophilia A D. Factor X deficiency

B. Hemophilia B C. Hemophilia A

Red Book (p. 108, #394) Which of the infections below is the most common transfusion-related infection? A. Human T-cell lymphotropic virus (HTLV)-II B. Hepatitis B C. Hepatitis C D. Human immunodeficiency virus (HIV)

B. Hepatitis B

Apex - Blood I: Coagulation Identify the BEST predictor of bleeding during surgery. A. Thromboelastogram B. History and physical C. PT/INR D. Bleeding time

B. History and physical

RED (p. 59, #274) Which of the following mechanisms best explains the anticoagulative properties of tirofiban? A. COX inhibition B. Interaction with von Willebrand factor (vWF) C. Interaction with antithrombin III D. Enhanced anti-Xa activity

B. Interaction with von Willebrand factor (vWF)

Red Book (p. 108, #399) The rationale for storage of platelets at room temperature (22 degrees celsius) is: A. There is less splenic sequestration B. It optimizes platelet function C. It reduces the chance for infection D. It decreases the incidence of allergic reactions

B. It optimizes platelet function

Apex - Blood I: Coagulation Triggers of sickle cell crisis include: (select 2) A. Hyperthermia B. Pain C. Dehydration D. Alkalosis

B. Pain C. Dehydration

GREEN (p. 119, #16) Which of the following factors should be considered when anesthetizing a patient with anemia? A. Healthy individuals do not develop symptoms until hemoglobin is below 10 g/dL B. Physiologic compensation includes increased cardiac output, and increased 2,3-diphosphoglycerate (2,3-DPG) levels C. Symptoms are highly variable and are rarely influenced by concurrent disease processes and the speed of developing anemia D. Transfusion should be administered at hemoglobin of 10 g/dL E. Physiologic compensation includes decreased plasma volume

B. Physiologic compensation includes increased cardiac output, and increased 2,3-diphosphoglycerate (2,3-DPG) levels

Red Book (p. 110, #416) Which of the following processes reduces the possibility of transmission of cytomegalovirus (CMV) to a susceptible recipient via transfusion of RBCs? A. Washing erythrocytes B. Reduction of leukocytes C. Irradiation D. Storage of Adsol

B. Reduction of leukocytes

Apex - Review Exam: Coagulation Which mediator promotes vasoconstriction in response to vascular injury? A. Prostacyclin B. Thromboxane A2 C. von Willebrand factor D. Nitric oxide

B. Thromboxane A2

Red Book (p. 108, #397) A 65-year-old man involved in a motor vehicle accident (MVA) is brought to the emergency room with a blood pressure of 60 mm Hg systolic. He is transfused with 4 units of type O, Rh-negative whole blood and 4 L of normal saline solution. After the patient is brought to the operating room, his blood type is determined to be A positive. Which of the following is the most appropriate blood type for further intraoperative transfusions? A. Type A, Rh-positive whole blood B. Type O, Rh-negative RBCs C. Type A, Rh-positive RBCs D. Type O, Rh-negative whole blood

B. Type O, Rh-negative RBCs

Apex - Blood I: Coagulation A patient scheduled for coronary revascularization is diagnosed with type III von Willebrand disease. What is the BEST treatment for this patient? A. Platelets B. vWF/factor VIII concentrate C. Cryoprecipitate D. DDAVP

B. vWF/factor VIII concentrate

Red Book (p. 107, #387) The likelihood of a clinically significant hemolytic transfusion reaction resulting from administration of type-specific blood is less than: A. 1 in 250 B. 1 in 500 C. 1 in 1,000 D. 1 in 10,000

C. 1 in 1,000

RED (p. 264, #972) What is the minimal time after angioplasty and placement of a drug-eluting stent that has dual antiplatelet therapy should be continued before considering stopping it for elective surgery? A. 3 months B. 6 months C. 1 year D. 18 months

C. 1 year

RED (p. 267, #999) How long does the antiplatelet effect of Ticlopidine last? A. 3 days B. 7 days C. 21 days D. Life of platelet

C. 21 days

RED (p. 118, #422) How many hours should elapse before performing a single-shot spinal anesthetic in a patient who is receiving 1 mg/kg enoxaparin (Lovenox) twice a day for the treatment of a DVT? A. 6 hours B. 12 hours C. 24 hours D. 48 hours

C. 24 hours

RED (p. 31, #119) The P50 of sickle cell hemoglobin is: A. 19 mm Hg B. 26 mm Hg C. 31 mm Hg D. 35 mm Hg

C. 31 mm Hg

RED (p. 158, #595) The predicted blood volume in a 4-kg neonate is: A. 240 mL B. 280 mL C. 340 mL D. 400 mL

C. 340 mL

Red Book (p. 109, #401) A 20-kg, 5-year-old child with a hematocrit of 40% could lose how much blood and still maintain a hematocrit of 30%? A. 140 mL B. 250 mL C. 350 mL D. 450 mL

C. 350 mL

RED (P. 60, #294) Glycoprotein (GP) IIb/IIIa inhibition: A. Argatroban B. Clopidogrel C. Abciximab D. Fondaparinux

C. Abciximab

Red Book (p. 107, #389) Which of the following clotting factors has the shortest half-life? A. Factor II B. Factor V C. Factor VII D. Factor IX

C. Factor VII

Red Book (p. 110, #417) What is the process aimed at reducing graft-versus-host disease (GVHD) in transfusion recipients? A. Washing erythrocytes B. Reduction of leukocytes C. Irradiation D. Storage of Adsol

C. Irradiation

Red Book (p. 108, #390) Which of the measures below does NOT reduce the incidence of transfusion-related acute lung injury (TRALI)? A. Exclusion of female donors B. Use of autologous blood C. Leukocyte reduction D. Use of blood less than 14 days old

C. Leukocyte reduction

RED (p. 182, #670) A patient having which of the following conditions is LEAST likely to develop DIC? A. Severe preeclampsia B. Placenta abruption C. Placenta previa (bleeding) D. Dead fetus syndrome

C. Placenta previa (bleeding)

Red Book (p. 108, #391) A 42-year-old woman is anesthetized for resection of a large (22-kg), highly vascular sarcoma in the abdomen. During the resection, 20 units of RBCs, 6 units of platelets, 10 units of cryoprecipitate, 5 units of FFP, and 1L of albumin are administered. At the conclusion of the operation, the patient's vital signs are stable, and she is transported to the intensive care unit. Three and a half hours later, a diagnosis of sepsis is made, and antibiotic therapy is started. Which of the items below would be the most likely cause of sepsis in this patient? A. Packed RBCs B. Cryoprecipitate C. Platelets D. FFP

C. Platelets

Red Book (p. 107, #383) Proper processing of platelet concentrates (to avoid future hemolytic transfusion reactions) before administration involves: A. Type and crossmatching B. ABO and Rh matching C. Rh matching only D. ABO matching only

C. Rh matching only

Red Book (p. 108, #392) Blood is routinely screened (serologically) for: A. Hepatitis A B. Severe acute respiratory syndrome C. West Nile virus D. Bovine spongiform encephalitis (BSE, or mad cow disease)

C. West Nile virus

Red Book (p. 107, #384) The most common inherited coagulopathy is: A. Hemophilia A B. Hemophilia B C. von Willebrand disease (vWD) D. Factor V deficiency

C. von Willebrand disease (vWD)

RED (p. 184, #184) C-section delivery is associated with a blood loss of about: A. 250 mL B. 500 mL C. 750 mL D. 1,000 mL

D. 1,000 mL

Red Book (p. 107, #388) Frozen erythrocytes can be stored for: A. 1 year B. 3 years C. 5 years D. 10 years

D. 10 years

Red Book (p. 109, #403) Paramedics respond to an MVA site and immediately stabilize the neck, secure the airway, and place an intravenous line into a 19-year-old 70-kg man lying in a pool of blood. Before the infusion is started, 3 milliliters of blood are withdrawn for hemoglobin and drug screening. The first responders estimate that the patient has lost one half of his entire blood volume. Given a starting value of 18 g/dL, the new value would likely be: A. 9 g/dL B. 11 g/dL C. 14 g/dL D. 17 g/dL

D. 17 g/dL

Red Book (p. 109, #405) In an emergency when there is limited supply of type O-negative RBCs, type O-positive RBCs are reasonable for transfusion for each of the following patients EXCEPT: A. A 60-year-old woman with diabetes who was involved in an MVA B. A 23-year-old man who sustained a gunshot wound to the upper abdomen C. An 84-year-old man with a ruptured abdominal aortic aneurysm D. A 21-year-old, gravida 2, para 1 woman with placenta previa who is bleeding profusely

D. A 21-year-old, gravida 2, para 1 woman with placenta previa who is bleeding profusely

Red Book (p. 110, #409) In the adult, the liver is the primary organ for: A. Hemoglobin synthesis B. Hemoglobin degradation C. Factor VIII synthesis D. Antithrombin III synthesis

D. Antithrombin III synthesis

Red Book (p. 110, #411) Heparin resistance is likely in patients with which of the following heritable conditions? A. Factor V Leiden mutation B. Prothrombin G20210A gene mutation C. Protein S deficiency D. Antithrombin or antithrombin III (AT3) deficiency

D. Antithrombin or antithrombin III (AT3) deficiency

GREEN (p. 119, #17) Which of the following fact is TRUE regarding nutritional deficiency anemias? A. All deficiency anemias result in microcytic hypochromic RBCs B. Vitamin B12 deficiency cannot manifest as CNS dysfunction C. The use of N2O is contraindicated in patients with iron deficiency anemia D. Causes of folic acid deficiency include alcoholism, pregnancy, and malabsorption syndromes E. Ferritin levels are helpful in detecting folic acid deficiency

D. Causes of folic acid deficiency include alcoholism, pregnancy, and malabsorption syndromes

Apex - Blood I: Coagulation Platelets contain all of the following components EXCEPT: A. Calcium B. Adenosine diphosphate C. Actin D. Deoxyribonucleic acid

D. Deoxyribonucleic acid

RED (p. 53, #203) Ketorolac: A. Is a selective COX-2 inhibitor B. Does not inhibit thromboxane A2 (TXA2) C. Does not inhibit prostaglandin I2 D. Exhibits a dose ceiling effect with regard to analgesia

D. Exhibits a dose ceiling effect with regard to analgesia

Apex - Blood I: Coagulation Warfarin inhibits: A. Factors III and X B. Factors II, VII, IX, X C. Factors II, VII, IX, X and protein C D. Factors II, VII, IX, X, and protein C and S

D. Factors II, VII, IX, X, and protein C and S

RED (p. 60, #297) Anti-Xa activity mechanism of action: A. Argatroban B. Clopidogrel C. Abciximab D. Fondaparinux

D. Fondaparinux

RED (p. 264, #973) Bivalrudin is used as an anticoagulant for CPB primarily in patients with: A. Heparin resistance B. Protamine allergy C. HIT type I D. HIT type II

D. HIT type II

Apex - Blood I: Coagulation Heparin inhibits the: A. Extrinsic pathway B. Intrinsic pathway C. Extrinsic and final common pathway D. Intrinsic and final common pathway

D. Intrinsic and final common pathway

RED (p. 158, #602) An otherwise healthy 3-month-old black female infant with a hemoglobin of 9 mg/dL at birth presents for elective repair of an inguinal hernia. Her preoperative hemoglobin is 10 mg/dL. Her father has a history of polycystic kidney disease. The most likely explanation for this patient's anemia is: A. Sickle cell anemia B. Iron deficiency anemia C. Undiagnosed polycystic kidney disease D. It is a normal finding

D. It is a normal finding

RED (p. 124, #479) Low-molecular-weight heparin (LMWH): A. Is as likely to cause HIT as unfractionated heparin B. Should be monitored with PTT for clinical effect C. Can be fully reversed with protamine D. LMWH has a longer plasma half-life than unfractionated heparin

D. LMWH has a longer plasma half-life than unfractionated heparin

RED (p. 267, #1000) How long does the antiplatelet effect of ASA last? A. 3 days B. 7 days C. 21 days D. Life of platelet

D. Life of platelet

RED (p. 110, #415) Fluid resuscitation during major abdominal surgery with which of the following agents is associated with the BEST survival data? A. 5% Albumin B. 6% Hydroxyethyl starch C. Dextran 70 D. None of the above

D. None of the above

RED (p. 155, #567) A previously healthy 1-month-old infant with a strong history of sickle cell anemia is brought to the ER with an incarcerated inguinal hernia. Which of the following should be carried out before surgery? A. Hemoglobin electrophoresis B. Peripheral smear C. Hematology consult D. None of the above

D. None of the above

RED (p. 182, #665) Which of the following conditions is associated with increased bleeding during pregnancy? A. Lupus anticoagulant B. Factor V Leiden mutation C. Protein C deficiency D. None of the above

D. None of the above

RED (p. 264, #975) The effects of clopidogrel (Plavix) can be reversed with: A. FFP B. Factor VIII concentrate C. Aprotinin D. None of the above

D. None of the above

Red Book (p. 107, #386) A 68-year-old patient receives a 1-unit transfusion of packed red blood cells (RBCs) in the recovery room after a laparoscopic prostatectomy. As the blood is slowly dripping into the peripheral intravenous line, the patient complains of itching on his chest and arms, but his vital signs remain stable. The antibody most likely responsible for this is directed against: A. Rh B. ABO C. MN, P, and Lewis D. None of the above

D. None of the above

Red Book (p. 109, #407) All of the following characterize packed RBCs that have been stored for 35 days at 4 degrees celsius in citrate phosphate dextrose adenine-1 (CPDA-1) anticoagulant preservative EXCEPT: A. Serum potassium greater than 70 mEq/L B. pH less than 7.0 C. Blood glucose less than 100 mg/dL D. P50 of 28

D. P50 of 28

RED (p. 34, #156) The time course of anticoagulation therapy is variable after different percutaneous coronary interventions (PCIs). Arrange the interventions in order starting with the one requiring the shortest course of aspirin and clopidogrel (Plavix) therapy to the one requiring the longest course. A. Bare-metal stent, percutaneous transluminal coronary angioplasty (PTCA), drug-eluting stent B. Drug-eluting stent, bare-metal stent, PTCA C. PTCA, drug-eluting stent, bare-metal stent D. PTCA, bare-metal stent, drug-eluting stent

D. PTCA, bare-metal stent, drug-eluting stent

RED (p. 186, #710) Which condition MOST frequently requires blood transfusions during or after a cesarean delivery? A. Multiple gestations B. Placenta abruption C. Placenta previa D. Postpartum hemorrhage

D. Postpartum hemorrhage

RED (p. 55, #219) Some COX-2 inhibitors (rofecoxib [Vioxx]) have been withdrawn from the U.S. pharmaceutical market because of serious complications involving: A. Platelet inhibition and GI hemorrhage B. Renal failure C. Hypertension D. Promotion of thrombotic state

D. Promotion of thrombotic state

Red Book (p. 110, #412) Von Willebrand disease (vWD) could be treated by any of the following EXCEPT: A. Cryoprecipitate B. Desmopressin (DDAVP) C. FFP D. Recombinant factor VIII

D. Recombinant factor VIII

GREEN (p. 119, #18) Which of the following statements regarding spherocytosis and G6PD deficiency is TRUE? A. Spherocytosis is a disorder of the hemoglobin-carrying capacity of the RBC B. Elliptocytosis is far more common than spherocytosis C. The life span of an RBC in a patient with hereditary spherocytosis is 120 days D. Splenectomy may be indicated in patients with hereditary spherocytosis E. G6PD deficiency is characterized by elevated NAPDH

D. Splenectomy may be indicated in patients with hereditary spherocytosis

RED (p. 118, #425) A 62-year-old patient with a bare-metal stent in the mid portion of the left anterior descending artery is scheduled for rotator cuff repair under general anesthesia. The stent was placed 6 weeks before surgery and the patient is on dual therapy (aspirin and clopidogrel). Which of the paradigms below would be best for managing the anticoagulation before surgery? A. Continue both up to the day of surgery B. Stop both 7 to 10 days before surgery C. Stop aspirin and continue clopidogrel D. Stop clopidogrel and continue aspirin

D. Stop clopidogrel and continue aspirin

Apex - Blood I: Coagulation Which factors are specific to the classical intrinsic pathway? (select 3) A. IV B. VI C. VII D. VIII E. IX F. XI

D. VIII (8) E. IX (9) F. XI (11)

Apex - Blood I: Coagulation Which substance is responsible for adhering the platelet to the damaged vessel? A. Thromboxane A2 B. ADP C. Tissue factor D. von Willebrand factor

D. von Willebrand factor

Apex - Review Exam: Coagulation Match each coagulation factor with its other name A. Factor I B. Factor II C. Factor III D. Factor IV - Fibrinogen - Prothrombin - Tissue factor - Calcium

Factor I = Fibrinogen Factor II = Prothrombin Factor III = Tissue factor Factor IV = Calcium

Apex - Blood I: Coagulation Match each coagulation factor with its pathway. A. Hageman factor B. Tissue factor C. Prothrombin D. Calcium Intrinsic pathway Extrinsic pathway Final common pathway Affects all pathways

Hageman factor = Intrinsic pathway Tissue factor = Extrinsic pathway Prothrombin = Final common pathway Calcium = Affects all pathways

Apex - Blood I: Coagulation Match each phase of the contemporary model of coagulation with its key event. A. Propagation B. Amplification C. Initiation - A large quantity of thrombin is produced - Platelets are activated - The TF/VIIa reaction activates the final common pathway

Propagation = A large quantity of thrombin is produced Amplification = Platelets are activated Initiation = The TF/VIIa reaction activates the final common pathway

Apex - Blood I: Coagulation Match each mediator with its primary function in the blood. A. von Willebrand factor B. tPA C. Plasminogen activation inhibitor D. Protein C Procoagulant Fibrinolytic Antifibrinolytic Anticoagulant

von Willebrand factor = Procoagulant tPA = Fibrinolytic Plasminogen activation inhibitor = Antifibrinolytic Protein C = Anticoagulant