A 76-year-old woman is hospitalized after falling and fracturing her left femoral trochanter. Two weeks later, the left leg is swollen, particularly below the knee. She experiences pain on movement of the leg; on palpation, there is tenderness. Which of the following complications is most likely to occur after these events_ _
A. Gangrenous necrosis of the foot
B. Hematoma of the thigh
C. Disseminated intravascular coagulation
D. Pulmonary thromboembolism
E. Fat embolism
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A l2-year-old boy has a history of multiple left tissue hemorrhages and acute upper airway obstruction from hematoma formation in the neck. On physical examination, he has decreased range of motion of the large joints, particularly the knees and ankles. He has no petechiae or purpura of the skin. Laboratory studies show normal prothrombin time, elevated partial thromboplastin time, and normal platelet count, but markedly decreased factor VIII activity. Which of the following mechanisms best describes the development of this disease _ _
A. Decrease in a reaction accelerator (cofactor) in the coagulation cascade
B. Decrease in phospholipid necessary for assembly of coagulation factors, cofactors, and calcium
C. Failure of platelet aggregation
D. Failure of fibrin polymerization
E. Inability to neutralize antithrombin III
A 29-year-old woman has a history of frequent nosebleeds and increased menstrual flow. On physical examination, petechiae and purpura are present on the skin of her extremities. Laboratory studies show normal partial thromboplastin time, prothrombin time, and platelet count, and decreased von Willebrand factor activity. This patient most likely has a derangement in which of the following steps in hemostasis _ _
A. Vasoconstriction
B. Platelet adhesion
C. Platelet aggregation
D. Prothrombin generation
E. Prothrombin inhibition
A 25-year-old woman who has had altered consciousness and slurred speech for the past 24 hours is brought to the emergency department. A head CT scan shows a right temporal hemorrhagic infarction. Cerebral angiography shows a distal right middle cerebral arterial occlusion. Within the past 3 years, she has had an episode of pulmonary embolism. A pregnancy 18 months ago ended in miscarriage. Laboratory studies show a false-positive serologic test for syphilis, normal prothrombin time, elevated partial thromboplastin time, and normal platelet count. Which of the following is the most likely cause of these findings _ _
A. Disseminated intravascular coagulation
B. Factor V mutation
C. Hypercholesterolemia
D. Lupus anticoagulant
E. Von Willebrand disease
A 66-year-old woman comes to the emergency department 3 hours after the onset of chest pain that radiates to her neck and left arm. She is diaphoretic and hypotensive; the serum troponin I level is elevated. Thrombolytic therapy is begun. Which of the following drugs is most likely to be administered _ _
A. Tissue plasminogen activator
B. Aspirin
C. Heparin
D. Nitric oxide
E. Vitamin K