Kathryn Borg
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DVM2 HLI (Semester 1) (Pathology (Jenny's lectures)) Quiz on Lecture 29 (Disorders of secondary haemostasis), created by Kathryn Borg on 15/04/2016.

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Lecture 29 (Disorders of secondary haemostasis)

Lecture 29 (Disorders of secondary haemostasis)

Question 1 of 27

1

What are the major mechanisms responsible for defective secondary haemostasis?

Select one or more of the following:

  • inherited coagulation factor deficiencies

  • vitamin K antagonism or deficiency

  • severe acute or chronic liver disease

  • excessive fibrinolysis or fibrinogenolysis

  • von Willebrand's disease

Explanation

Question 2 of 27

1

Which mechanism is the most common cause of secondary haemostasis in domestic animals?

Select one of the following:

  • inherited coagulation factor deficiencies

  • vitamin K antagonism

  • severe acute or chronic liver disease

  • excessive fibrinolysis or fibrinogenolysis

  • von Willebrand's disease

  • vitamin k deficiency

Explanation

Question 3 of 27

1

Clinical signs suggestive of defective secondary haemostasis may include?

Select one or more of the following:

  • Large volume bleeds

  • Haematoma formation

  • Bleeding into body cavities or joints

  • Petechiae, purpura or ecchymoses in skin or mucous membranes

Explanation

Question 4 of 27

1

In what domestic species are inherited coagulation factor deficiencies most often identified?

Select one of the following:

  • dogs

  • cats

  • horses

  • cattle

  • rabbits

Explanation

Question 5 of 27

1

Deficiencies in relation to which of the below factors are yet to be confirmed in domestic animals?

Select one or more of the following:

  • factor III (tissue factor)

  • factor V

  • factor XIII

  • high molecular weight kininogen (HMWK)

  • factor XII

  • prekallikrein

  • factor I

Explanation

Question 6 of 27

1

Why does factor XI deficiency (haemophilia C) usually only cause mild bleeding?

Select one of the following:

  • 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

Explanation

Question 7 of 27

1

When might deficiencies in factor XI result in massive bleeding?

Select one of the following:

  • 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

Explanation

Question 8 of 27

1

The most severe haemorrhage is associated with inherited deficiencies of factor(s)?

Select one or more of the following:

  • factor I

  • factor II

  • factor X

  • factor VIII

  • factor IX

  • combined factor deficiencies

  • factor XII

  • factor V

Explanation

Question 9 of 27

1

Which inherited factor deficiency is the most common inherited coagulopathy in domestic animals and humans?

Select one of the following:

  • factor VIII (haemophilia A)

  • factor IX (haemophilia B)

  • factor XI (haemophilia C)

  • factor VII

Explanation

Question 10 of 27

1

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)

Select one of the following:

  • True
  • False

Explanation

Question 11 of 27

1

Which factors are vitamin K-dependent?
Choose the correct combination

Select one of the following:

  • 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

Explanation

Question 12 of 27

1

A mutation in which gene (what does it encode for) causes a deficiency of the vitamin k-dependent factors?

Select one of the following:

  • γ-glutamyl carboxylase gene

  • Acetyl-CoA carboxylase gene

  • α-glutamyl carboxylase gene

  • Pyruvate carboxylase gene

Explanation

Question 13 of 27

1

Ingestion of which of the below can cause haemorrhage via antagonism of vitamin K epoxide reductase?

Select one or more of the following:

  • 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)

Explanation

Question 14 of 27

1

Mild intoxication by ingestion of anticoagulant rodenticides is a common cause of haemorrhage in cats and dogs. How can this be treated?

Select one of the following:

  • vitamin K1 administration

  • administration of warfarin

  • administration of prednisolone

  • vitamin D3 administration

  • Cartrophen (DMOAD) administration

Explanation

Question 15 of 27

1

Dietary vitamin K deficiency although rare, is most commonly reported in what species of domestic animals?

Select one of the following:

  • dogs

  • cats

  • horses

  • sheep

  • rabbits

Explanation

Question 16 of 27

1

What can cause vitamin K deficiency?

Select one or more of the following:

  • 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

Explanation

Question 17 of 27

1

Which coagulation factors are deficient in the inherited coagulopathy recognised in Devon rex cats?

Select one of the following:

  • II, VII, IX and X

  • III, VII, IX and XI

  • II, VI, X, XII

  • I, V, VI, X

Explanation

Question 18 of 27

1

Where in the body are most of the coagulation factors produced?

Select one of the following:

  • liver

  • spleen

  • bone marrow

  • endothelial cells

  • macrophages

Explanation

Question 19 of 27

1

What percentage reduction of functional liver mass causes significant decreases in coagulation factor activity?

Select one of the following:

  • ≥70%

  • ≥40%

  • ≥60%

  • ≤45%

Explanation

Question 20 of 27

1

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)

Select one of the following:

  • True
  • False

Explanation

Question 21 of 27

1

What is mandatory before subjecting an animal with known hepatic disease to a liver biopsy or other invasive surgery?

Select one of the following:

  • Laboratory tests of haemostatic capacity

  • Radiography

  • Leukogram

  • Physical exam

Explanation

Question 22 of 27

1

Why are animals with significant hepatic disease not only at risk of haemorrhage but also at risk of thrombosis?

Select one or more of the following:

  • 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

Explanation

Question 23 of 27

1

Why would excessive fibrinolysis be an issue?

Select one of the following:

  • Premature breakdown of secondary haemostatic fibrin plugs

  • Can result in the formation of a thrombus

  • Premature breakdown of primary haemostatic platelet plugs

Explanation

Question 24 of 27

1

- enzymatic lysis of fibrin by plasmin

- enzymatic lysis of fibrinogen by plasmin

Drag and drop to complete the text.

    Fibrinolysis
    Fibrinogenolysis
    Fibrinocatalase

Explanation

Question 25 of 27

1

In which conditions is excessive fibrinogenolysis thought to be a contributor to defective secondary haemostasis in domestic animals?

Select one or more of the following:

  • 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

Explanation

Question 26 of 27

1

In which condition is excessive fibrinolysis a contributor to defective secondary haemostasis in domestic animals?

Select one or more of the following:

  • 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

Explanation

Question 27 of 27

1

In what circumstances might a dog develop deficiency of vitamin K?

Select one or more of the following:

  • 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

Explanation

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