Lecture 29 (Disorders of secondary haemostasis)

Descrição

DVM2 HLI (Semester 1) (Pathology (Jenny's lectures)) Quiz sobre Lecture 29 (Disorders of secondary haemostasis), criado por Kathryn Borg em 15-04-2016.
Kathryn Borg
Quiz por Kathryn Borg, atualizado more than 1 year ago
Kathryn Borg
Criado por Kathryn Borg aproximadamente 8 anos atrás
26
2

Resumo de Recurso

Questão 1

Questão
What are the major mechanisms responsible for defective secondary haemostasis?
Responda
  • inherited coagulation factor deficiencies
  • vitamin K antagonism or deficiency
  • severe acute or chronic liver disease
  • excessive fibrinolysis or fibrinogenolysis
  • von Willebrand's disease

Questão 2

Questão
Which mechanism is the most common cause of secondary haemostasis in domestic animals?
Responda
  • inherited coagulation factor deficiencies
  • vitamin K antagonism
  • severe acute or chronic liver disease
  • excessive fibrinolysis or fibrinogenolysis
  • von Willebrand's disease
  • vitamin k deficiency

Questão 3

Questão
Clinical signs suggestive of defective secondary haemostasis may include?
Responda
  • Large volume bleeds
  • Haematoma formation
  • Bleeding into body cavities or joints
  • Petechiae, purpura or ecchymoses in skin or mucous membranes

Questão 4

Questão
In what domestic species are inherited coagulation factor deficiencies most often identified?
Responda
  • dogs
  • cats
  • horses
  • cattle
  • rabbits

Questão 5

Questão
Deficiencies in relation to which of the below factors are yet to be confirmed in domestic animals?
Responda
  • factor III (tissue factor)
  • factor V
  • factor XIII
  • high molecular weight kininogen (HMWK)
  • factor XII
  • prekallikrein
  • factor I

Questão 6

Questão
Why does factor XI deficiency (haemophilia C) usually only cause mild bleeding?
Responda
  • because factor X can be activated by the extrinsic system
  • because factor V can be activated by the extrinsic system
  • because factor X can be activated by the intrinsic system
  • because factor XI is not required for coagulation

Questão 7

Questão
When might deficiencies in factor XI result in massive bleeding?
Responda
  • Following trauma (including surgical trauma) when sustained coagulation is required (as factor XI is required for sustained X activation)
  • When the disease manifests in a male (as it is inherited as an X-linked recessive disorder)
  • Factor XI has major roles in pregnancy
  • When the disease occurs in a Saint Bernard dog

Questão 8

Questão
The most severe haemorrhage is associated with inherited deficiencies of factor(s)?
Responda
  • factor I
  • factor II
  • factor X
  • factor VIII
  • factor IX
  • combined factor deficiencies
  • factor XII
  • factor V

Questão 9

Questão
Which inherited factor deficiency is the most common inherited coagulopathy in domestic animals and humans?
Responda
  • factor VIII (haemophilia A)
  • factor IX (haemophilia B)
  • factor XI (haemophilia C)
  • factor VII

Questão 10

Questão
Haemophilia A it is inherited as an X-linked recessive disorder and manifests almost exclusively in hemizygous females (usually in the first six months of post-natal life)
Responda
  • True
  • False

Questão 11

Questão
Which factors are vitamin K-dependent? Choose the correct combination
Responda
  • factors II, VII, IX and X
  • factors III, VIII, IX and X
  • factors II, VII, IX and XI
  • factors II, VII, IIX and X
  • factors I, II, IIX and XI

Questão 12

Questão
A mutation in which gene (what does it encode for) causes a deficiency of the vitamin k-dependent factors?
Responda
  • γ-glutamyl carboxylase gene
  • Acetyl-CoA carboxylase gene
  • α-glutamyl carboxylase gene
  • Pyruvate carboxylase gene

Questão 13

Questão
Ingestion of which of the below can cause haemorrhage via antagonism of vitamin K epoxide reductase?
Responda
  • anticoagulant rodenticides containing hydroxycoumarins or indandiones
  • mouldy sweet clover (Melilotus alba) or sweet vernal grass (Anthoxanthum odoratum) containing bishydroxycoumarin
  • sulphaquinoxaline (a coccidiostat)
  • overdose with therapeutic coumadins (eg. warfarin)
  • paracetamol
  • 2-acetoxybenzoic acid (aspirin)
  • cholecalciferol (Vitamin D3)

Questão 14

Questão
Mild intoxication by ingestion of anticoagulant rodenticides is a common cause of haemorrhage in cats and dogs. How can this be treated?
Responda
  • vitamin K1 administration
  • administration of warfarin
  • administration of prednisolone
  • vitamin D3 administration
  • Cartrophen (DMOAD) administration

Questão 15

Questão
Dietary vitamin K deficiency although rare, is most commonly reported in what species of domestic animals?
Responda
  • dogs
  • cats
  • horses
  • sheep
  • rabbits

Questão 16

Questão
What can cause vitamin K deficiency?
Responda
  • complete extrahepatic bile duct obstruction
  • exocrine pancreatic insufficiency
  • intestinal malabsorption
  • chronic lipid maldigestion/malabsorption syndromes
  • long term oral antibiotic use
  • prolonged anorexia or malnutrition
  • diabetes
  • diarrhoea

Questão 17

Questão
Which coagulation factors are deficient in the inherited coagulopathy recognised in Devon rex cats?
Responda
  • II, VII, IX and X
  • III, VII, IX and XI
  • II, VI, X, XII
  • I, V, VI, X

Questão 18

Questão
Where in the body are most of the coagulation factors produced?
Responda
  • liver
  • spleen
  • bone marrow
  • endothelial cells
  • macrophages

Questão 19

Questão
What percentage reduction of functional liver mass causes significant decreases in coagulation factor activity?
Responda
  • ≥70%
  • ≥40%
  • ≥60%
  • ≤45%

Questão 20

Questão
Surprisingly, most animals with hepatic disease of enough severity to cause inadequate synthesis of coagulation factors do not bleed spontaneously, instead, they are at risk of uncontrollable haemorrhage if haemostatic capacity is challenged (e.g. if a liver biopsy is undertaken)
Responda
  • True
  • False

Questão 21

Questão
What is mandatory before subjecting an animal with known hepatic disease to a liver biopsy or other invasive surgery?
Responda
  • Laboratory tests of haemostatic capacity
  • Radiography
  • Leukogram
  • Physical exam

Questão 22

Questão
Why are animals with significant hepatic disease not only at risk of haemorrhage but also at risk of thrombosis?
Responda
  • Hepatocytes synthesise anticoagulants, fibrinolytic agents and fibrinolytic inhibitors
  • The liver is responsible for clearance from the circulation of many of the activated products of coagulation and fibrinolysis
  • Most of the coagulation factors are synthesised by hepatocytes
  • The liver is responsible for the maturation of platelets

Questão 23

Questão
Why would excessive fibrinolysis be an issue?
Responda
  • Premature breakdown of secondary haemostatic fibrin plugs
  • Can result in the formation of a thrombus
  • Premature breakdown of primary haemostatic platelet plugs

Questão 24

Questão
[blank_start]Fibrinolysis[blank_end]- enzymatic lysis of fibrin by plasmin [blank_start]Fibrinogenolysis[blank_end]- enzymatic lysis of fibrinogen by plasmin
Responda
  • Fibrinolysis
  • Fibrinogenolysis
  • Fibrinocatalase

Questão 25

Questão
In which conditions is excessive fibrinogenolysis thought to be a contributor to defective secondary haemostasis in domestic animals?
Responda
  • snake envenomation - e.g. Eastern and Western diamondback rattlesnakes
  • administration of plasminogen activators - e.g. t-PA, streptokinase
  • excessive endothelial release of t-PA - e.g. shock, heat stroke, severe tissue trauma
  • Disseminated intravascular coagulation (DIC)
  • prolonged anorexia or malnutrition
  • anticoagulant rodenticides containing hydroxycoumarins or indandiones

Questão 26

Questão
In which condition is excessive fibrinolysis a contributor to defective secondary haemostasis in domestic animals?
Responda
  • Disseminated intravascular coagulation (DIC)
  • snake envenomation - e.g. Eastern and Western diamondback rattlesnakes
  • administration of plasminogen activators - e.g. t-PA, streptokinase
  • excessive endothelial release of t-PA - e.g. shock, heat stroke, severe tissue trauma
  • prolonged anorexia or malnutrition

Questão 27

Questão
In what circumstances might a dog develop deficiency of vitamin K?
Responda
  • prolonged anorexia or malnutrition
  • long term antibiotics (which can kill off gut bacteria, which synthesise vit K)
  • chronic lipid maldigestion/malabsorption syndromes (eg. bile duct obstruction)
  • ingestion of anticoagulant rodenticides
  • snake envenomation - e.g. Eastern and Western diamondback rattlesnakes

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