Week

Question
A 29 year old woman is seen in your office for fatigue and
exertional shortness of
breath of 2 week duration. Past medical history is significant
for hospitalization for
splenic vein thrombosis 1 year ago. She received heparin 1
year ago and
thereafter, coumadin for 6 months. She is off anticoagulation
now. Physical
examination is unremarkable. Laboratory Studies reveal
WBC 2400/l
HGB: 6.8 gm%
MCV 84 f
Platelets : 80k/l
Reticulocyte count 4.5%
Haptoglobin : Undetectable
Lactic Dehydrogenase (LDH) 800U/L
Direct Coombs Test : Negative
Which of the following is the best step in diagnosing this condition?
Options

A) Hemoglobin Electrophoresis
B) Flow cytometry
C) Osmotic Fragility Test
D) Urine Hemosiderin
E) Heparin Antibody Testing

Correct Answer B
Explanation
common.

PNH flow cytometry. Large vein thrombosis are

Week

Question Deep vein thrombosis (DVT) of the lower limb involves stasis or
slowing of venous blood fow. Which component of the deep venous system is
the most likely site of early thrombosis?
Options A) Anterior tibial vein
B) Greater saphenous vein
C) Popliteal vein
D) Sinusoids of the posterior leg
E) Superficial femoral vein
Answer

Explanation The posterior tibial veins, which drain the superficial and
deep plantar veins, are inferior to the medial malleolus and follow the
course of the posterior tibial artery. The peroneal veins lie directly
behind and medial to the fibula and ascend along the peroneal artery.
These deep veins of the calf have frequent interconnections. The soleal
muscle sinusoids are without valves and are referred to as venous
lakes. The venous lakes in the calf are a common site of early thrombus
formation. They coalesce to join the posterior tibial and peroneal veins.
These sinusoids are less apparent in the gastrocnemius muscle, where
the veins tend to be linear and exhibit valves.

Week

Question Which of the following statements regarding the management of

venous thrombosis are
correct, and which are not?
Options A) Heparin therapy in DVT has the direct effect of shrinking the clot.
B) If the patient has a prolonged PTT and PT which do not correct, an
antiphospholipid
antibody should be suspected.
C) Low molecular weight heparin (LMWH) has a higher incidence of
bleeding complications
than unfractionated heparin.
D) A pregnant patient should be fully anticoagulated with heparin
(unfractionated or
LMWH).
E) When using unfractionated heparin, the aim is to increase the
baseline PTT by a factor of
5 (5 x increase).
Answer

Explanation Antiphospholipid antibody usually occurs together with

lupus patient and its a very
rare condition.

Week

Question
A 28 year old man with haemophilia A, came to ask you the
chances of his future
children developing haemophilia. The wife recently had a genetic
testing and found out
that she is not a carrier of haemophilia. what is the correct
answer.
Options

A) 100%
B) 0%
C) 25%
D) 50% of male, 0% if female
E) 50%

Answer

B)

Explanation Haemophilia A is a X- linked recessive condition. therefore

there is no male to male
transmission. affected males can only have unaffected
sons and carrier daughters.