Multiple Choice Questions (MCQ)

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Category: Hematologic and Oncologic Disorders--->Transfusion Medicine
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Question 1#Print Question

A patient with a history of prior transfusions is receiving a unit of packed red blood cells following a lengthy surgery and has a temperature increase from 37.0° to 38.3°. The patient is otherwise not in distress and has stable vital signs. The nurse stops the transfusion and asks you what he should do next.

What is the BEST next course of action and which blood management modality could have prevented this reaction?

A. Stop transfusion, evaluate patient, rule out infectious etiology and acute hemolytic reaction, and administer antipyretics; leukoreduction
B. Stop transfusion; evaluate patient, rule out infectious etiology and acute hemolytic reaction, and administer antipyretics; washed RBCs
C. Continue transfusion without further intervention or evaluation; leukoreduction
D. Continue transfusion after ruling out an infectious source and acute hemolytic reaction and administration of antipyretics; washed RBCs

Question 2#Print Question

A patient presents with a subdural hematoma with midline shift and was noted to be on warfarin. The patient’s INR is 3.5, and he is scheduled for an emergent decompressive craniotomy.

Which of the following is the best treatment for his coagulopathy?

A. Fresh Frozen Plasma
B. Cryoprecipitate
C. Platelets
D. Prothrombin complex concentrate (PCC)

Question 3#Print Question

A 32-year-old woman with a history of a ruptured ectopic pregnancy who underwent a laparoscopic salpingectomy 4 days ago presents to the hospital after 1 day of feeling short of breath. In the ED, her examination is significant for labored breathing and her vital signs show a heart rate of 105 bpm, blood pressure of 98/65 mm Hg, SpO2 of 88%, with respiratory rate of 22/min. Her chest X-ray is clear. Her laboratory test results are notable for a NT proBNP of 600 pg/mL and troponin I of 0.5 ng/mL. CT angiogram of her chest demonstrates large, central pulmonary embolus (PE), and RV/LV ratio of 1. You are called for admission to the ICU given the patient’s newly diagnosed PE.

Which of the following interventions is contraindicated in this patient? 

A. IVC filter
B. Heparin anticoagulation only
C. Directed catheter therapy
D. Systemic tPA

Question 4#Print Question

A 38-year-old woman with no prior medical history presents to the ED with altered mental status and a temperature of 38.3°C. Physical examination reveals petechiae on both arms but is otherwise unremarkable. Her vital signs are normal and labs are significant for:

  • platelets of 30,000/µL
  • normal INR
  • normal aPTT
  • normal fibrinogen
  • a mildly elevated Creatinine
  • normal liver enzymes
  • the appearance of schistocytes on peripheral blood smear

What is the most likely diagnosis?

A. Heparin induced thrombocytopenia (HIT)
B. Idiopathic thrombocytopenic purpura (ITP)
C. Disseminated intravascular coagulation (DIC)
D. Thrombotic thrombocytopenic purpura (TTP)

Question 5#Print Question

A 65-year-old man with end-stage renal disease on hemodialysis is transferred to the ICU with new onset hematemesis. After adequate IV access is established, he is transfused four units of packed red blood cells, four units of fresh frozen plasma, and one apheresis unit of platelets. His vital signs improve though he still is having episodes of hematemesis. As you await the GI consult for possible endoscopy, what is the next best step in management? 

A. Prothrombin complex concentrate (PCC)
B. Desmopressin
C. Fresh frozen plasma
D. Additional packed red blood cells

Category: Hematologic and Oncologic Disorders--->Transfusion Medicine
Page: 1 of 1