Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Hematologic and Oncologic Disorders--->Platelet Disorders
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Question 1# Print Question

A 72-year-old male is admitted to the intensive care unit after undergoing aortic valve replacement for severe aortic stenosis. He was successfully weaned from bypass, required no blood products, and received appropriate protamine reversal. In the intensive care unit, he has been having persistent drainage from the thoracotomy tubes. A complete blood count (CBC) shows a hematocrit of 40% and platelet count of 150,000/mm3 . Coagulation studies including a thromboelastogram (TEG) are sent.

TEG results:

  • Prothombin Time: 11 seconds (11-13.5 seconds)
  • Partial Thromboplastin Time: 38 seconds (30-40 seconds)
  • R-time: 8 minutes (5-10 minutes)
  • K-time: 4 minutes (3-6 minutes)
  • Alpha angle: 52° (45-55°)
  • Maximum Amplitude (MA): 37 mm (50-70 mm)

Based on the results of the TEG, which of the following would be the best treatment option?

A. Platelet
B. Protamine
C. Fibrinogen
D. Fresh Frozen Plasma

Question 2# Print Question

A 63-year-old female with known lower-extremity deep vein thrombosis (DVT) is admitted to the intensive care unit after presenting with shortness of breath and chest pain. Imaging is negative for a pulmonary embolism, and blood tests including a CBC and serum electrolytes are normal. She is started on supplemental oxygen and a heparin infusion titrated to aPTT of 60 to 90 seconds. On admission day 7, her platelet count is found to have decreased from 150,000/mm3 to 62,000mm/ 3 over a 24-hour period. To assist in making the diagnosis, you calculate the patient’s 4-T score.

Which of the following is NOT a part of the 4-T score?

A. Timing of Platelet decrease
B. Presence of Thrombosis
C. Severity of thrombocytopenia
D. Tachycardia

Question 3# Print Question

After calculating a 4-T score of 6, you proceed to obtain confirmatory testing to support your diagnosis. A Heparin PF-4 antibody test is positive, and heparin-induced serotonin release assay (SRA) is under process. Given the presumptive diagnosis, which of the following treatment strategies would be most appropriate?

A. Discontinue Heparin and start low-molecular weight Heparin
B. Discontinue Heparin and start Argatroban
C. Discontinue Heparin and transfuse platelets
D. Start warfarin

Question 4# Print Question

A 32-year-old male presents to the hospital complaining of progressive fatigue, productive cough, and intermittent epistaxis. His initial evaluation is significant for left lower lobe consolidation on chest X-ray and a temperature of 38.7°C. During attempts to obtain peripheral venous access, he bruises easily and missed attempts bleed for over 2 minutes. A CBC and coagulation studies are obtained and are as follows:

  • WBC: 1.2 K/µL
  • Hgb: 6.5 mg/dL
  • Hct: 19.5%
  • Platelet count: 74000/µL PT: 22 seconds (normal 10-14)
  • aPTT: 56 seconds (normal 25-40)
  • Fibrinogen: 65 mg/dL (normal 140-400 mg/dL)

He is subsequently admitted to the ICU where broad spectrum antibiotics are initiated, and a bone marrow aspirate (BMA) is obtained, which shows finding consistent with acute myeloid leukemia.

Which of the following is the best initial treatment option for this patient?

A. Platelet transfusion
B. All-trans-retinoic acid (ATRA)
C. Packed RBC transfusion
D. Administer IV Vitamin K and Fresh Frozen Plasma

Question 5# Print Question

A 29-year-old male is admitted to the intensive care unit after undergoing an uncomplicated laparoscopic splenectomy for idiopathic thrombocytopenic purpura. On post-op day 2, he is recovering well, is afebrile, is hemodynamically stable, and has no complaints. Routine laboratory test results are sent, which are significant for a platelet count of 654,000/µL.

What is the most likely cause of thrombocytosis in this patient? 

A. Sepsis
B. Reactive thrombocytosis
C. Cancer
D. Lab error

Category: Critical Care Medicine-Hematologic and Oncologic Disorders--->Platelet Disorders
Page: 1 of 1