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					                              ASCLS Continuing Education
                     Clinical Lab Investigations: Case Studies for the Lab Professional
                   Case set #5 – Hemostasis – Pulmonary Emboli and Possible Lab Error

                                              Final Quiz

Select the single best answer for each of the following multiple-choice questions and record on
the answer sheet.

   1. What are the four risk factors that predispose this patient to thromboembolic disease?
        a. Age, surgery, malignancy, immobility
        b. Trauma, surgery, congestive heart failure, immobility
        c. Trauma, congestive heart failure, age, elevated homocystine
        d. Hematoproliferative disorder, surgery, age, congestive heart failure

   2. What diagnostic procedure helped the emergency department physician detect a
      problem with the patient’s lungs?
         a. Abnormal EKG
         b. Elevated troponin I and BTNP
         c. Observing the patient cough up bloody sputum
         d. Detecting crackling noises when listening to the lungs

   3. What abnormality was identified on the patient’s basic chest x-ray?
        a. Atelectasis
        b. Cardiomegaly
        c. Pleural effusion
        d. Pulmonary embolism

   4. What laboratory test helped the physician diagnose pulmonary emboli in the patient?
         a. PT
         b. APTT
         c. D-dimer
         d. Basic metabolic panel
   5. Heparin acts as a cofactor to dramatically increase the activity of:
         a. Thrombin
         b. Protein C
         c. Antithrombin 3
         d. Activated factor X
6. Why did the physician order tests for homocystine, protein C activity, protein S activity,
   antithrombin 3 antigen, antithrombin 3 activity, factor V Leiden, and prothrombin
       a. These substances can interfere with several commonly used anticoagulants
       b. These substances are anticoagulants, and the doctor did not want to cause a
           bleeding episode
       c. The patient had a current condition and medical history that suggested a possible
           thrombotic disorder
       d. The supervisor of the coagulation department requested that these tests be
           performed due to the patient’s abnormal heparin assay

7. Why did the attempts to measure heparin activity on dilutions of heparin in saline
   solution fail?
       a. The UFH assay requires a source of antithrombin 3
       b. The pharmacy did not add heparin to the patient’s IV solution
       c. The solutions did not contain enough heparin for the analyzer to detect
       d. The solutions contained too much heparin for the analyzer to accurately measure

8. What was concluded based on the patient’s antithrombin 3 activity of 70%?
     a. This level was too low to produce measurable heparin activity
     b. This result was inconclusive because the normal range for antithrombin 3 activity
         is 80 – 120%
     c. No conclusion was reached because the reference lab had not yet carried out the
         antithrombin 3 antigen test
     d. Although this activity level is slightly below normal, it would produce a
         measurable heparin activity in the patient

9. Clinical laboratory scientists in the coagulation department planned to test the patient’s
   plasma for a heparin inhibitor. Why did this prove unnecessary?
       a. The most recent blood sample from the patient had a high heparin activity level
       b. Testing in the chemistry department revealed the presence of a heparin inhibitor
       c. Testing performed the previous day already indirectly revealed the absence of
           such an inhibitor
       d. The patient was no longer being treated with unfractionated heparin, so the result
           would not matter

10. Why is it unlikely that the patient’s heparin assay of <0.1 IU/mL was caused by a patient
    identification error in the phlebotomy department?
        a. The sample was collected by a nurse
        b. The patient identification system is misidentification impossible
        c. No conclusions were drawn regarding whether there was a patient identification
        d. The blood type of the specimen with an undetectable heparin level matched the
             blood type of another sample from the patient
11. Given that the patient’s hypercoagulation test battery produced normal results, what is
    one likely reason that her doctor wishes her to switch from low molecular weight heparin
    to warfarin?
        a. Warfarin is safer than low molecular weight heparin
        b. Warfarin is more effective in preventing pulmonary embolism
        c. There is no test that can measure the effectiveness of low molecular weight
        d. Low molecular weight heparin must be injected subcutaneously, while warfarin
            can be taken by mouth

  Record all answers on the answer sheet. Detach and mail or fax your answer sheet.
                 Faxed forms only accepted with credit card payment.
        Send completed P.A.C.E.® evaluation form with payment to ASCLS to:
                                    Sherry Miner
                             ASCLS PACE Coordinator
                                   720 West Main
                                Rochester, IL 62563
                                Fax) 217- 498-2075
                      ASCLS Continuing Education
                            Answer Sheet
              Clinical Lab Investigations: Case set #5 - Hemostasis

Multiple Choice Questions                               Each quiz must be accompanied
                                                                 with payment.
Circle the single best answer for each
                                                             ASCLS members - $15
1.        A       B      C       D                            Non-members - $25
2.        A       B      C       D
3.        A       B      C       D                    Please allow 3-4 weeks for receipt of
4.        A       B      C       D
5.        A       B      C       D
6.        A       B      C       D
7.        A       B      C       D
8.        A       B      C       D                 Print your name and contact information
                                                   legibly for emailing of your P.A.C.E.®
9.        A       B      C       D                 certificate.
10.       A       B      C       D
                                                   Name ____________________________
11.       A       B      C       D
      Mail or fax the completed answer sheet &     Address __________________________
            P.A.C.E. evaluation form to:
                     Sherry Miner                  _________________________________
             ASCLS PACE Coordinator
                    720 West Main                  City ______________________________
                 Rochester, IL 62563
                  Fax) 217-498-2075                State ______ Zip ___________________
        Must be received by June 1, 2012.
             to receive P.A.C.E. credit.
                                                   ASCLS member # ______________ ____
                                                   State license # _____________________
A certificate of 1.0 contact hour will be
emailed to you upon successful completion          Daytime phone _____________________
of the quiz; a passing grade is 70% or             Email _____________________________
better. P.A.C.E.® credits are accepted for
continuing education requirements for              Credit card – Visa/MasterCard/AmEx only
maintaining certification by the BOC and for       Credit card # _______________________
maintaining the licensure of laboratory
professionals in the states of CA, FL, LA,         Expiration date _____________________
MT, NV, RI and TN.                                 Name on card ______________________
                                                                                               PROGRAM EVALUATION
                                                                       Professional Acknowledgment for Continuing Education
                                                                                             6701 Democracy Blvd., Suite 300
                                                                                                        Bethesda, MD 20817
                                                                                     Phone: 301-657-2768 FAX: 301-657-2909

    Program/Session Title: Clinical Lab Investigations: Case set #5 - Hemostasis
    Date Completed:                                               Program Number: 015-624-10

    Use this form to evaluate the above titled session. Circle the number (1-low, 5-high) to indicate your ratings of
    this program, objectives, and speaker; use one response per line. Please complete this form to fulfill the
    session requirements.

AUTHOR RATING                                                                  Low/Poor         High/Excellent Not Applicable
    To what extent:

    Did the author present a knowledgeable, organized and concise case
    study?                                                                             1   2    3    4   5       N/A

    Did the author clarify and focus on the stated objectives?                         1   2    3    4   5       N/A

    Were the presentation methods & graphic information appropriate &
    effectively used?                                                                  1   2    3    4   5       N/A

OBJECTIVES RATING                                                              Low/Poor         High/Excellent    Not Applicable

    To what extent was each objective achieved?

    1. Identify a laboratory test commonly used to aid the diagnosis
       of pulmonary embolism.                                                          1   2     3   4 5         N/A

    2. Describe the activity of heparin in the body and the principle
       of a typical laboratory assay for heparin.                                      1   2     3   4 5         N/A

    3. Describe the connection between heparin and antithrombin 3,
       and relate this connection to the laboratory assay for heparin.                 1   2     3   4 5         N/A

CONTENT RATING                                                                 Low/Poor        High/Excellent     Not Applicable

    To what extent did the content relate to each case study’s
    objectives?                                                                        1   2    3    4   5       N/A

    Rate the contribution of reading these case studies to your overall knowledge
    of these subjects.                                                                 1   2    3    4   5       N/A

    Rate your overall degree of satisfaction with this activity.                       1   2    3    4   5       N/A

    Rate your level of expertise in these subjects prior to reading this case study.   1   2    3    4   5       N/A


      Return completed form with answer sheet to: Sherry Miner, ASCLS PACE Coordinator, 720 West Main,
                                    Rochester, IL 62563; fax, 217-498-2075.

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