🥵 HARD

Blood clots are a huge burden on healthcare systems across the world, make sure you are up to date by testing yourself on this set of questions!

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Hypercoagulability

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Question 1

Stem 1, question 1 of 4

Colette, a 35 year old, presents with 3 episodes venous thromboembolism in the last 12 months

Which of the following does not increase the risk of venous thromboembolism?
A
Liver disease
B
Anti-phosphlipid syndrome
C
Factor V Leiden
D
Anti-thrombin deficiency
E
Oestrogen therapy
Question 1 Explanation: 
Liver disease does not increase the risk of venous thromboembolism, but increases the risk of bleeding due to reduction in factor F and fibrinogen and increased plasminogen activator. All other answer options increase the risk of venous thromboembolism
Question 2

Stem 1, question 2 of 4

Collette is diagnosed with Factor V Leiden, why has this genetic disease been selected through evolution?
A
Provides resistance against malaria
B
Provides resistance against cholera
C
Reduced risk of breast cancer
D
Increased viral immunity
E
Reduced bleeding tendency postpartum
Question 2 Explanation: 
Factor V Leiden is the most common inherited cause of increased risk fo venous thromboembolism. Factor V is less susceptible to cleavage by APC meaning it does not degrade as quickly hence a tendency to thrombosis. There are theories this disease has been selected as it provides a reduced bleeding tendency post partum and thus is protective for people giving birth
Question 3

Stem 1, question 3 of 4

Upon further questioning, Colette reveals she has had 6 miscarriages over a 10 year period. What disease encompasses both a tendency to thrombosis and recurrent miscarriages?
A
Anti-phospholipid syndrome
B
Anti-thrombin deficiency
C
Protein C deficiency
D
Protein S deficiency
E
Disseminated intravascular coagulation
Question 3 Explanation: 
Anti-phospholipid syndrome is the occurrence of venous and arterial thrombosis and/or recurrent miscarriage in associated with laboratory evidence of persistent anti-phospholipid antibody. The other answers all explain a tendency to thrombosis but do not account for recurrent miscarriages
Question 4

Stem 1, question 4 of 4

Colette is given heparin but has a prolonged bleeding episode, what is the reversal agent for heparin?
A
Fondaparinux
B
Bivalirudin
C
Tranexamic acid
D
Co-amoxiclav
E
Protamine
Question 4 Explanation: 
Heparin often does not need to be reversed due to it's short half life, so the infusion can simply be stopped. However, in the event that reversal is needed protamine is the reversal agent.
Question 5

Stem 2, question 1 of 6

Clementine, 24 year old female, presents with a sore and swollen leg. She has recently returned from Singapore on a business trip

What is the most likely diagnosis?
A
Cellulitis
B
Deep vein thrombosis
C
Haematoma
D
Ruptured popliteal's cyst
E
Sprained ankle
Question 5 Explanation: 
Clementine has recently had an extended period of immobility during her flight from Singapore, putting her at risk of a deep vein thrombosis. There is no history of trauma making a haematoma or sprained ankle unlikely
Question 6

Stem 2, question 2 of 6

Clementine takes the oral contraceptive pill. Which of the following is not an effect of the oral contraceptive pill on coagulation?  
A
Increased plasma levels of I
B
Decreased anti-thrombin
C
Increased plasma levels of IX
D
Increased plasma levels of X
E
Decreased tissue plasminogen activator
Question 6 Explanation: 
Oestrogen therapy greatly increases the risk of venous thromboembolism due to increased plasma levels of II, VII, VIII, IX and X with decreased anti-thrombin and tissue plasminogen activator. This effect is dependent on the dose of oestrogen
Question 7

Stem 2, question 3 of 6

Another inherited cause of venous thromboembolism is anti-thrombin deficiency, what is the inheritance pattern of this deficiency?
A
Autosomal dominant
B
Autosomal recessive
C
X-linked
D
Mitochondrial
E
Y-linked
Question 7 Explanation: 
Anti-thrombin deficiency is a autosomal dominant inheritance pattern. Y-linked conditions are incredibly rare, mitochondrial diseases are only passed by the mother to her children.
Question 8

Stem 2, question 4 of 6

A few days later, after her leg pain has settled, Clementine becomes very breathless and is diagnosed with Pulmonary Embolism. Describe the local of the oblique lung fissure.
A
Runs from the superior border of the lung in a inferoposterior direction
B
Runs horizontally from the sternum at the level of the 4th rib
C
Runs from the lateral border of the lung in a superoposterior direction
D
Runs from the inferior border of the lung in a superoposterior direction
E
Runs vertically from the sternum at the level of the 4th rib
Question 8 Explanation: 
Oh anatomy back to haunt us once again! The oblique fissure runs from the inferior border of the lung un a superior posterior direction until it meets the posterior lung border. Teach me anatomy has a great resource on lung positions and relations.
Question 9

Stem 2, question 5 of.6

Clementine is given warfarin for her pulmonary embolism. Which of the following drugs must Clementine not take?
A
Ibuprofen
B
Calcitriol
C
Denosumab
D
Methotrexate
E
Naloxone
Question 9 Explanation: 
Warfarin is a notorious drug for having a huge list of drug interactions! Notably on the phase II drugs list are NSAIDs and diuretics, thus ibuprofen is the correct answer here. Remember that the BNF is a great resource to look at drug interactions!
Question 10

Stem 2, question 6 of 6

What is the use of a D-dimer in combination with a Wells score for Deep vein thrombosis of less than 2?
A
A positive D-dimer rules out a deep vein thrombosis
B
A negative D-dimer means a deep vein thrombosis is very likely
C
A positive D-dimer means a deep vein thrombosis is highly likely
D
A negative D-dimer means a pulmonary embolism is highly likely
E
A negative D-dimer rules out a deep vein thrombosis
Question 10 Explanation: 
A D-dimer is used for it's negative predictively value, aka if it is negative, it means it is very very very unlikely to be a deep vein thrombosis, effectively ruling it out.
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