ITP QUESTION.pdf
- 2. MCQs follow • Please indicate your responses on the paper as the questions appear • There are 15 questions, each with four options and with one correct response • We will move to next question when all are done
- 3. #1 All of the following are components in the definition of ITP except: a) Premature platelet destruction c) Presence of splenomegaly c) Immune mediated mechanism d) Secondary causes excluded
- 4. #2 All of the following distinguish adult and pediatric ITP, except: a) Most pediatric ITP is acute (resolves within 4-6 weeks) c) Most adult ITP is chronic (persists for years) e) Both adult and pediatric ITP are common in females g) Most adult ITP is autoimmune due to Gp IIb/IIIa antibodies, while pediatric ITP is due to antibodies which mimic viral antigens
- 5. #3 All of the following are differential diagnosis of adult ITP except: a) Systemic Lupus Erythematosus c) Sickle cell disease e) HIV infection g) Acute viral hepatitis
- 6. #4 Following drugs could cause thrombocytopenia, except a) Cephalosporins c) Heparin e) Hydrochlorthiazide g) Carbamezapine
- 7. #5 All are true about drug induced thrombocytopenias except a) Most drug induced thrombocytopenias would recover in 7 to 10 days. c) Upto 15% of individuals who receive heparin develop thrombocytopenia e) In case of heparin induced thrombocytopenia (HIT), LMWH are a safe choice g) If HIT occurs, it can cause worsening of thrombosis
- 8. #6 ITP is a diagnosis of exclusion because: a) The etiology of ITP is unknown c) Most isolated thrombocytopenias are secondary, and only a few remaining are ITP e) Secondary causes are treatable hence these must be diagnosed first g) Good tests are not available to diagnose ITP
- 9. #7 All of the following are expected with ITP, except a) Peripheral thrombocytopenia c) Reduced megakaryocytes in Bone marrow e) Normocytic anemia g) Absence of splenomegaly
- 10. #8 All of the following are risk factors for spontaneous bleeding in ITP except a) Presence of petechiae on skin c) Past history of a major bleed e) Age more than 60 years g) Platelet count less than 10,000/micro-L
- 11. #9 Complete Blood count in ITP would reveal a) Mega-thrombocytes (High MPV) c) Platelet anisocytosis (High PDW) e) Microparticles (Broken platelets) g) All of the above
- 12. #10 In management of adult ITP, the most logical sequence of therapies is a) Platelet transfusion, Antiglobulin, Steroids c) Steroids, Splenectomy, anti-globulins e) Splenectomy, steroids, repeat platelet transfusion g) Steroids, Antiglobulins, immunosuppresants, splenectomy
- 13. #11 Use of steroids in ITP is associated with all of the following except a) Platelets rise by 1 week, peak levels by 2-4 weeks c) In adults low dose and high dose had similar response e) If no response with a low dose by 4 weeks, a high dose for 12 weeks should be given g) No pre-treatment characteristics have predicted which patients are likely to respond
- 14. #12 Benefit due to steroids is due to all of the following mechanisms except a) Reduced production of anti-platelet antibodies c) Reduced destruction of Ab coated platelets e) Reduced sequestration of platelets in spleen g) Increased production of platelets in Bone marrow
- 15. #13 All of the following indicate need for splenectomy in ITP except a) No response to steroids c) Palpable spleen e) Relapse during steroid tapering g) Presence of a life threatening bleeding
- 16. #14 The following are expected post splenectomy except a) Rise in platelet counts within 48 hrs c) Maximum platelet count expected in 7-10 days e) Howell Jolly bodies appear in peripheral circulation g) Non-response suggests incomplete spleen removal
- 17. #15 True about platelet transfusions in ITP a) Are contraindicated c) Are useful but do-not alter natural course e) Are indicated if platelet counts <10,000 g) Should be given to prevent a major bleed
- 18. Correct Responses • Mark yourself • Honestly ………..
- 19. #1 All of the following are components in the definition of ITP except: • Premature platelet destruction • Presence of splenomegaly c) Immune mediated mechanism d) Secondary causes excluded
- 20. #1 All of the following are components in the definition of ITP except: a) Premature platelet destruction c) Immune mediated mechanism d) Secondary causes excluded Typically splenomegaly is absent
- 21. #2 All of the following distinguish adult and pediatric ITP, except: • Most pediatric ITP is acute (resolves within 4-6 weeks) • Most adult ITP is chronic (persists for years) • Both adult and pediatric ITP are common in females • Most adult ITP is autoimmune due to Gp IIb/IIIa antibodies, while pediatric ITP is due to antibodies which mimic viral antigens
- 22. #2 All of the following distinguish adult and pediatric ITP, except: • Most pediatric ITP is acute (resolves within 4-6 weeks) • Most adult ITP is chronic (persists for years) • Pediatric ITP has no sex prediliction, adult ITP is common in females • Most adult ITP is autoimmune due to Gp IIb/IIIa antibodies, while pediatric ITP is due to antibodies which mimic viral antigens
- 23. #3 All of the following are differential diagnosis of adult ITP except: • Systemic Lupus Erythematosus • Sickle cell disease • HIV infection • Acute viral hepatitis
- 24. #3 All of the following are differential diagnosis of adult ITP except: a) Acute Leukemias Bone Marrow b) SLE ANA c) HIV infection HIV serology If ITP with Hepato-splenomegaly, Lymphadenopathy, or Atypical lymphocytes consider: g) Acute viral hepatitis h) Toxoplasmosis i) EBV infection j) CMV infection k) HIV
- 25. #4 Following drugs could cause thrombocytopenia, except • Cephalosporins • Heparin • Hydrochlorthiazide • Carbamezapine
- 26. #4 Following drugs could cause thrombocytopenia, except a) Cephalosporins, Penicillin, Sulphonamide c) Heparin (UFH) e) Hydrochlorthiazide, rare ACE Inhibitors g) Chemotherapeutic agents – carboplatin, alkylating agents, anti-metabolites
- 27. #5 All are true about drug induced thrombocytopenias except • Most drug induced thrombocytopenias would recover in 7 to 10 days. • Upto 15% of individuals who receive heparin develop thrombocytopenia • In case of heparin induced thrombocytopenia (HIT), LMWH are a safe choice • If HIT occurs, it can cause worsening of thrombosis
- 28. #5 All are true about drug induced thrombocytopenias except • Most drug induced thrombocytopenias would recover in 7 to 10 days. • Upto 15% of individuals who receive heparin develop thrombocytopenia • 80 to 90% of antibodies generated against heparin, cross react against LMWH as well. • If HIT occurs, it can paradoxically cause worsening of thrombosis due to development of DIC
- 29. #6 ITP is a diagnosis of exclusion because: • The etiology of ITP is unknown • Most isolated thrombocytopenias are secondary, and only a few remaining are ITP • Secondary causes are treatable hence these must be diagnosed first • Good tests are not available to diagnose ITP
- 30. #6 ITP is a diagnosis of exclusion because: a) ITP is due to presence of anti-platelet antibodies directed against Gp IIb/IIIa c) The tests for detection of these antibodies are technically difficult, and may be positive in non-ITP cases as well. e) Normal platelets also release Immunoglobulin and it is difficult to distinguish between endogenous and exogenous antibodies g) Newer assays to detect anti-platelet antibodies are under development, till that time ITP remains a diagnosis of exclusion
- 31. #7 All of the following are expected with ITP, except • Peripheral thrombocytopenia • Reduced megakaryocytes in Bone marrow • Normocytic anemia • Absence of splenomegaly
- 32. #7 All of the following are expected with ITP, except a) Peripheral thrombocytopenia due to platelet destruction c) Normal megakaryocytes in Bone marrow – Although abnormal platelets are produced hyperplasia of megakaryocytes does not occur e) Normocytic anemia – Due to blood loss g) Absence of splenomegaly
- 33. #8 All of the following are risk factors for spontaneous bleeding in ITP except • Presence of petechiae on skin • Past history of a major bleed • Age more than 60 years • Platelet count less than 10,000/micro-L
- 34. #8 All of the following are risk factors for spontaneous bleeding in ITP except • Past history of a major bleed • Age more than 60 years • Platelet count less than 10,000/micro-L • Any associated coagulopathy Relation of bleeding to platelet count <10,000 Severe spontaneous bleeding 10,000 to 50,000 Significant bleeding (Ecchymosis / Petechiae) >50,000 Bleeding after trauma / surgery
- 35. #9 Complete Blood count in ITP would reveal • Mega-thrombocytes (High MPV) • Platelet anisocytosis (High PDW) • Microparticles (Broken platelets) • All of the above
- 36. #9 Complete Blood count in ITP would reveal a) Mega-thrombocytes (High MPV) c) Platelet anisocytosis (High PDW) e) Microparticles (Broken platelets) g) Lower the platelet count, higher MPV which is paradoxical to other conditions associated with Thrombocytopenia such as sepsis / DIC where MPV is low
- 37. #10 In management of adult ITP, the most logical sequence of therapies is • Platelet transfusion, Antiglobulin, Steroids • Steroids, Splenectomy, anti-globulins • Splenectomy, steroids, repeat platelet transfusion • Steroids, Antiglobulins, immunosuppresants, splenectomy
- 38. #10 In management of adult ITP, the most logical sequence of therapies is a) Steroids are conventional first line therapy c) Failure to respond to steroids (by 6 weeks) is indication for splenectomy e) Failure to respond to both of above is known as refractory ITP g) Immunoglobulins / immunosuppresants have been tried in refractory ITP
- 39. #11 Use of steroids in ITP is associated with all of the following except • Platelets rise by 1 week, peak levels by 2-4 weeks • In adults low dose and high dose had similar response • If no response with a low dose by 4 weeks, a high dose for 12 weeks should be given • No pre-treatment characteristics have predicted which patients are likely to respond
- 40. #11 Use of steroids in ITP is associated with all of the following except a) Platelets rise by 1 week, peak levels by 2-4 weeks c) In adults low dose (0.25 mg/kg/d) and high dose (1mg/kg/d) had similar response e) If no response with a low dose by 4-6 weeks, alternate modalities (splenectomy) to be considered g) No pre-treatment characteristics have predicted which patients are likely to respond
- 41. #12 Benefit due to steroids is due to all of the following mechanisms except • Reduced production of anti-platelet antibodies • Reduced destruction of Ab coated platelets • Reduced sequestration of platelets in spleen • Increased production of platelets in Bone marrow
- 42. #12 Benefit due to steroids is due to all of the following mechanisms except a) Reduced production of anti-platelet antibodies (both in BM and in spleen) c) Reduced destruction of Ab coated platelets f) Increased production of platelets in Bone marrow
- 43. #13 All of the following indicate need for splenectomy in ITP except • No response to steroids • Palpable spleen • Relapse during steroid tapering • Presence of a life threatening bleeding
- 44. #13 All of the following indicate need for splenectomy in ITP except a) No response (platelets <10,000) to steroids in 4-6 weeks c) Relapse during steroid tapering e) Low platelets (<30,000) for more than 3 months despite steroid therapy
- 45. #14 The following are expected post splenectomy except • Rise in platelet counts within 48 hrs • Maximum platelet count expected in 7-10 days • Howell Jolly bodies appear in peripheral circulation • Non-response suggests incomplete spleen removal
- 46. #14 The following are expected post splenectomy except a) Rise in platelet counts within 48 hrs c) Maximum platelet count expected in 7-10 days e) Howell Jolly bodies appear in peripheral circulation g) Non-response suggests presence of accesory spleens (50% of non-responders may have them). Which calls for Technicium / Indium scans, followed by accessory splenectomy
- 47. #15 True about platelet transfusions in ITP • Are contraindicated • Are useful but do-not alter natural course • Are indicated if platelet counts <10,000 • Should be given to prevent a major bleed
- 48. #15 True about platelet transfusions in ITP a) Will transiently increase platelet count c) Useful in management of serious life threatening bleeding such as sub-arachnoid hemorrhage e) Used pre-operatively while planning splenectomy