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Worksheetsbleeding
Total questions: 11
Worksheet time: 33mins
The parents of a 13-month-old boy are contacted by a local social agency because the day care they are using has reported them for suspected child abuse. The abuse was suspected because the day care personnel thought that the toddler had "too many bruises." The parents deny the abuse, and promptly arrange to have their child seen by the chairman of the pediatrics department in a clinic run by a
university medical center On physical examination, the child is noted to have multiple large bruises on his legs, arms, and buttocks. No skin abrasions are seen, and no "pattern marks" (suggestive of being hit by an object such as a belt buckle or rod) are seen. A blood smear isunremarkable. PTT is prolonged, and PT and bleeding times are normaI.
Hemophilia
Disseminated intravascular coagulation
Thrombocytopenia
Von Willebrand's disease
Acute myelogenous leukemia
Deficiency of which of the following has been linked to this patient's condition?
Factor VII
Factor VIII
Factor X
Factor XII
This child's condition is due to a defective enzyme encoded on which of the following chromosomes?
13
18
X
Y
Which of the following can temporarily increase secretion of the needed factor in some patients with a milder form of this disease?
Desmopressin
Factor VIII concentrate
Factor IX concentrate
Fresh frozen plasma
Following a viral illness, a previously healthy 3-year-old child develops multiple petechiae and purpura, and is noted to be oozing blood from
the mouth. Prothrombin and activated partial thromboplastin times are within normal limits. Review of a peripheral smear demonstrates that
platelet counts are markedly decreased, but all the platelets that are present appear morphologically normaI. The remainder of the blood
smear and additional bone marrow studies are normaI.
Which of the following is the most likely diagnosis?
Disseminated intravascular coagulation
Hemophilia A
Hemophilia B
immune thrombocytopenic purpura
Von Willebrand disease
Which of the following tests would be most helpful in confirming the probable diagnosis?
D-dimer levels
Factor VIII concentration
Factor IX concentration
IgG autoantibodies on platelet surfaces
Approximately what percentage of children with this condition will undergo spontaneous remission?
Less than 5%
30%
60%
More than 80%
A 7-year-old girl is evaluated by a pediatrician for a possible bleeding disorder. The girI's father and grandmother have both had life-Iong histories of easy bruising. On physical examination, the child is noted to have multiple small bruises over her body, and the mother reports that she will frequently bleed for most of an hour following a small cut. The child has also had numerous nosebleeds that were stopped only when the nose was packed with facial tissue. CBC is normal on all measured values. The peripheral smear shows the usual number and morphology of platelets. Template bleeding time is longer than normaI. Prothrombin time is within the reference range. Activated partial thromboplastin time is slightly longer than normaI.
Which of the following is the most likely diagnosis?
DIC
Hemophilia A
Von Willebrand disease
ITP
Multimers of all sizes of von Willebrand's factor form complexes in plasma with which of the following?
Factor X
Factor VIII
Factor VI
Factor V
Which of the following is the binding site for the von Willebrand's factor multimers on the platelets?
ADP
Factor VIII
GIycoprotein 1b
Prostaglandin l2
In an individual with one of the milder forms of the disease presented in this case, which of the following medications could be used to increase von Willebrand's factor and factor VIII after treatment?
Aspirin
Aminocaproic acid
Desmopressin
Ibuprofen
