Which of the following best describes the typical presentation of heparin-induced thrombocytopenia?

A 72 year-old female was admitted to the hospital and had undergone elective cardiac surgery for aortic valve replacement. She was administered heparin for the prevention of thrombosis. On the second day of her admission, she developed a urinary tract infection and was started on trimethoprim-sulfamethoxazole. On the sixth day of her hospital stay, she developed fever, chills, hypertension, tachycardia, chest pain and shortness of breath. On physical examination, you noticed pain, redness, and swelling of her right arm. A severe rash developed in the skin where heparin was given. The attending nurse reports that she is meticulously administering heparin via intravenous route and using heparin flushes before using intravenous lines. Ultrasound of the right arm revealed deep venous thrombosis and a CT angiogram revealed a blood clot in the right lung. Laboratory tests reveal the following: Erythrocyte count (RBC) 4.2 million/mm³ Male: 4.3 – 5.9 million/mm³ Female: 3.5 – 5.5 million/mm³ Erythrocyte sedimentation rate (Westergren) 12 mm/h Male: 0-15 mm/h Female:0-20 mm/h Hematocrit 39% Male:41% – 53% Female: 36% – 46% Hemoglobin, blood 13.4 g/dL Male:13.5-17.5 g/dL Female 12.0 – 16.0 g/dL Leukocyte count (WBC) 7200 /mm³ 4500-11,000/mm³ Neutrophils, segmented 56% 54% – 62% Neutrophils, bands 4% 3% – 5% Eosinophils 1% 1% – 3% Basophils 0.5% 0% – 0.75% Lymphocytes 28% 25% – 33% Monocytes 4% 3% – 7% CD4+ T-lymphocyte count 1100 /mm³ ≥500/mm³ Platelet count 40,000/mm³ (on the day of admission: platelet count was 340,000/mm³ 150,000 – 400,000/mm³ Reticulocyte count 1.0% 0.5% – 1.5% D-Dimer 450 ng/mL ≤250 ng/mL Partial thromboplastin time (aPTT) (activated) 27 seconds 25-40 seconds Prothrombin time (PT) 10 seconds 11-15 seconds Mean corpuscular hemoglobin (MCH) 29 pg/cell 25 – 35 pg/cell Mean corpuscular hemoglobin concentration (MCHC) 34% Hb/cell 31% – 36% Hb/cell Mean corpuscular volume (MCV) 94 μ m³ 80-100 μ m³ 4T score 7 PF4 ELISA Test Positive Regarding this complication patient developed in the hospital, which of the following is true about its risk factors?

Which of the following is an inherited platelet disease?

Of the following, which is a disorder of platelet adhesion?

A 28 year-old male patient comes to your office and reports severe headache, nausea, vomiting, lethargy and weakness. You notice he has a slurred speech as he answers your questions. He reports he frequently has been having nose bleeds since his childhood. Unlike in other children, his nose bleeds never stopped. His gums often bleed when he brushes his teeth. He has family members with bleeding disorders. Occasionally, he takes aspirin for his headaches. Later in physical examination, you notice focal neurological deficits and minor bruises. CT head reveals an intracranial hemorrhage. Laboratory results show low platelet count, prolonged bleeding time, normal prothrombin time and normal activated partial thromboplastin time. Peripheral smear is notable for giant, enormously large megakaryocytes and platelets. Platelet aggregation studies demonstrate a reduced response to ristocetin that is not corrected by the addition of normal plasma. Of the following, which is the most likely diagnosis in this patient?

A 34 year-old female comes to your office and reports easy bruising, mucosal bleeding, and heavy menstrual periods for the last 6 months. After diagnostic investigations, she was found to have von Willebrand disease. She reports she has family members with the history of this disease and of bleeding. You ordered coagulation studies which included Prothrombin Time (PT), Partial Thromboplastin Time (PTT), D-Dimer, platelet counts and peripheral smear. Which of the following is expected in her laboratory test results?

Of the following, which is the most common hereditary bleeding disorder?

John is a 17 year-old male who comes to your office for the establishment of his primary care. He reports a family history of von Willebrand disease. Of the following, which best explains the pathophysiology of von Willebrand disease?

A patient with a history of severe hemophilia A is scheduled to have a dental extraction. Of the following, which is the best management of her hemophilia as she is being prepared for this procedure?

A mother brings her 6 year-old boy to the emergency room with a swollen left knee joint. He denies a history of trauma to the knee. He reports similar swellings in the right knee joint, right and left elbow joints. Many times he feels the bleeding before he notices the swelling. For the last few days, he has been passing very red colored urine. In the physical examination, you notice a warm, swollen, erythematous left knee joint with severe effusion. There is sensory loss over the lateral and anterior thigh. The quadriceps muscle is weak and small compared to the muscle on his right lower extremity. Patellar reflex is absent. Upon direct questioning, the mother reports that her brother suffers from a bleeding disorder, with frequent nosebleeds. Many of her relatives also have similar bleeding disorders, affecting mostly males. Laboratory tests reveal a normal bleeding time, a normal prothrombin time but a prolonged PTT. As you review the labs with the patient, he developed a severe headache, unrelenting vomiting, and slurred speech. A gross physical examination showed focal neurologic deficits. What is the next best step in the management of this patient?