Antiphospholipid Syndrome — MCQs
Which of the following conditions is not associated with antiphospholipid syndrome?
All of the following statements about Lupus Anticoagulant are true, EXCEPT:
A female with recurrent abortion and isolated prolonged activated partial thromboplastin time (APTT) is most likely associated with.
A patient with recurrent abortion is diagnosed to have antiphospholipid syndrome. What will be the treatment?
A 60-year-old man with atrial fibrillation presents with sudden right arm and leg weakness, speech loss, and right facial droop that started 2 hours ago. CT scan shows no bleeding. What is the next step in management?
The following condition is not associated with an Anti-phospholipid syndrome -
Etiology of disordered coagulation in antiphospholipid syndrome is
Most common cause of first-trimester abortion is:
A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?
A young man back from leisure trip has swollen knee joints & foreign body sensation in eyes. Likely cause is -
Antiphospholipid Syndrome Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following conditions is not associated with antiphospholipid syndrome?
- A. Venous thrombosis
- B. Neurological manifestations
- C. Thrombocytosis (Correct Answer)
- D. Recurrent foetal loss
Explanation: ***Thrombocytosis*** - **Antiphospholipid syndrome (APS)** is characterized by increased **thrombosis** (clotting), not an increase in platelet count (thrombocytosis). - Patients with APS may experience **thrombocytopenia** (low platelet count), which is distinct from thrombocytosis [1]. *Venous thrombosis* - **Venous thrombosis**, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE), is a hallmark feature of APS [2]. - The presence of **antiphospholipid antibodies** promotes a procoagulant state, leading to clot formation in veins. *Recurrent foetal loss* - **Recurrent foetal loss**, including miscarriages and stillbirths, is a classic obstetric manifestation of APS. - The antibodies interfere with placental function and blood supply, leading to pregnancy complications. *Neurological manifestations* - Various **neurological manifestations** are associated with APS, including stroke, transient ischemic attacks (TIAs), and cognitive dysfunction. - These are often due to **microthrombosis** in the cerebral vasculature or direct antibody effects.
Question 2: All of the following statements about Lupus Anticoagulant are true, EXCEPT:
- A. May present with Recurrent Abortions
- B. May occur with minimal clinical manifestations
- C. Thrombotic spells can be followed by severe life threatening hemorrhage (Correct Answer)
- D. May present with an isolated prolongation of APTT
Explanation: Self-Correction: None of the provided 5 references directly address Lupus Anticoagulant or its specific diagnostic criteria and clinical manifestations such as placental thrombosis or isolated APTT prolongation. Reference discusses Antithrombin and Protein C/S deficiencies. Reference discusses von Willebrand Factor. Reference discusses Monitoring Anticoagulant Therapy generally. Reference discusses Disseminated Intravascular Coagulation (DIC). Reference discusses Systemic Lupus Erythematosus (SLE) skin manifestations and mentions livedo reticularis as a feature of antiphospholipid syndrome (APS) [1], but provides no detail regarding the specific claims about Lupus Anticoagulant tests or clinical exclusions asked in the question. Consequently, none of the references meet the required relevance score of 7 or higher for citation. ***Thrombotic spells can be followed by severe life threatening hemorrhage*** - While lupus anticoagulant (LA) is associated with both **thrombosis** and, less commonly, **bleeding**, severe, life-threatening hemorrhage as a direct follow-up to a thrombotic spell is not a typical pattern. LA primarily predisposes to **thrombosis**. - In the rare instances where bleeding occurs, it is usually due to acquired **factor deficiencies** or **thrombocytopenia**, conditions that can sometimes co-exist with antiphospholipid antibody syndrome (APS) but are not direct consequences of the thrombotic event itself. *May present with Recurrent Abortions* - **Recurrent abortions** (miscarriages) are a classic and well-recognized clinical manifestation of **antiphospholipid syndrome (APS)**, of which lupus anticoagulant is a key diagnostic criterion. - The presence of lupus anticoagulant indicates an increased risk for **placental thrombosis**, which can lead to fetal loss. *May occur with minimal clinical manifestations* - Some individuals test positive for lupus anticoagulant antibodies without experiencing any significant **thrombotic events** or other clinical symptoms of antiphospholipid syndrome for extended periods. - This condition is often referred to as **asymptomatic antiphospholipid antibody positivity**, highlighting that the presence of the antibody does not always immediately translate into severe clinical disease. *May present with an isolated prolongation of APTT* - Lupus anticoagulant is an in-vitro phenomenon that interferes with **phospholipid-dependent coagulation tests**, such as the **activated partial thromboplastin time (APTT)**, causing it to be prolonged. - This prolongation occurs because the antibody binds to phospholipids used in the assay, mimicking an **anticoagulant effect** in the test tube, even though the patient is actually hypercoagulable in vivo.
Question 3: A female with recurrent abortion and isolated prolonged activated partial thromboplastin time (APTT) is most likely associated with.
- A. Lupus anticoagulant (Correct Answer)
- B. Hemophilia
- C. Von Willebrand disease
- D. DIC
Explanation: ***Lupus anticoagulant*** - **Lupus anticoagulant** is an antibody that paradoxically prolongs **APTT** [1] in vitro but is associated with a **prothrombotic state** in vivo, leading to recurrent abortions. - It is a key feature of **Antiphospholipid Syndrome (APS)**, which classically presents with **recurrent pregnancy loss and thrombotic events**. *DIC* - **Disseminated Intravascular Coagulation (DIC)** involves widespread activation of the clotting cascade, leading to both **thrombosis** and **hemorrhage**. - While it can cause prolonged **APTT**, it would also be characterized by **thrombocytopenia**, **prolonged PT**, and elevated **D-dimer** [2], which are not mentioned. *Von Willebrand disease* - **Von Willebrand disease (vWD)** is a common **bleeding disorder** due to deficiency or dysfunction of **von Willebrand factor** [3]. - It can cause a prolonged **APTT** (if factor VIII levels are significantly low) and bleeding, but it is not typically associated with **recurrent abortions** due to thrombosis [3]. *Hemophilia* - **Hemophilia** (A or B) is an **X-linked recessive bleeding disorder** characterized by a deficiency of **Factor VIII (Hemophilia A)** or **Factor IX (Hemophilia B)**. - It causes a prolonged **APTT** and significant bleeding episodes, but it is not associated with **thrombosis** or **recurrent abortions**.
Question 4: A patient with recurrent abortion is diagnosed to have antiphospholipid syndrome. What will be the treatment?
- A. Aspirin alone
- B. Aspirin, Low molecular weight Heparin, and Prednisolone
- C. No treatment required
- D. Aspirin and Low molecular weight Heparin (Correct Answer)
Explanation: ***Aspirin and Low molecular weight Heparin*** - The combination of **low-dose aspirin (75-100 mg daily)** and **low molecular weight heparin (LMWH)** is the **standard of care** for pregnant women with antiphospholipid syndrome (APS) to prevent recurrent pregnancy loss. - **Aspirin** inhibits platelet aggregation and reduces thrombosis, while **LMWH** provides anticoagulation to prevent placental thrombosis and improve pregnancy outcomes. - This combination has been shown to **increase live birth rates** from approximately 40% (untreated) to **70-80%** in women with APS. *Aspirin alone* - While aspirin is part of the treatment regimen, **aspirin monotherapy is insufficient** for preventing recurrent pregnancy loss in patients with established APS. - Randomized controlled trials have demonstrated that adding heparin to aspirin **significantly improves live birth rates** compared to aspirin alone. *Aspirin, Low molecular weight Heparin, and Prednisolone* - **Corticosteroids (prednisolone)** are **not recommended** as routine treatment for recurrent pregnancy loss in APS patients due to potential maternal complications (gestational diabetes, hypertension, infection) and fetal risks. - Corticosteroids might be considered only in specific cases with coexisting autoimmune conditions (e.g., SLE), but they are **not first-line therapy** for APS-related pregnancy loss. *No treatment required* - **Antiphospholipid syndrome (APS)** is a significant cause of recurrent pregnancy loss due to placental thrombosis and impaired placental function. - **Untreated APS** carries a **high risk** (>70%) of pregnancy loss, along with increased risks of fetal growth restriction, preeclampsia, and preterm delivery, making treatment **essential** for a successful pregnancy outcome.
Question 5: A 60-year-old man with atrial fibrillation presents with sudden right arm and leg weakness, speech loss, and right facial droop that started 2 hours ago. CT scan shows no bleeding. What is the next step in management?
- A. Intravenous thrombolysis (Correct Answer)
- B. Surgical thrombectomy
- C. Heparin
- D. Aspirin
Explanation: No change to the explanation was requested other than the addition of citations. ***Intravenous thrombolysis*** - The patient presents with **acute ischemic stroke symptoms** [1] within the 4.5-hour window from symptom onset , and the CT scan shows no hemorrhage , making him a candidate for **tPA**. - **Atrial fibrillation** puts the patient at high risk for cardioembolic stroke , which can be effectively treated with tPA if given early . *Surgical thrombectomy* - This is an intervention for **large vessel occlusion** but is typically considered for patients who are outside the IV tPA window (usually 4.5 hours) or have contraindications, and it often has a longer therapeutic window (up to 24 hours in select cases). - While it may be considered for this patient, **IV thrombolysis** is the immediate next step given he is within the 4.5-hour window and has no contraindications. *Heparin* - **Anticoagulation with unfractionated heparin** is not recommended for acute ischemic stroke without clear indications due to the increased risk of hemorrhagic transformation. - While the patient has atrial fibrillation, starting anticoagulation acutely is usually deferred for at least 24 hours after tPA administration or in cases of larger infarcts due to the risk of bleeding. *Aspirin* - **Aspirin** is an antiplatelet agent used for **secondary stroke prevention** and in some cases for acute ischemic stroke, but it is less effective than tPA for acute reperfusion . - While it may be given later, it is not the primary immediate treatment for acute ischemic stroke eligible for thrombolysis.
Question 6: The following condition is not associated with an Anti-phospholipid syndrome -
- A. Neurological manifestations
- B. Thrombocytosis (Correct Answer)
- C. Venous thrombosis
- D. Recurrent foetal loss
Explanation: ***Thrombocytosis*** - **Antiphospholipid syndrome (APS)** is characterized by a **prothrombotic state**, leading to **thrombocytopenia** (low platelet count), not thrombocytosis (elevated platelet count) [1]. - Elevated platelet counts are not part of the diagnostic criteria or typical clinical manifestations of APS. *Neurological manifestations* - **Neurological symptoms** are common in APS and can include **stroke**, **transient ischemic attacks (TIAs)**, **seizures**, and **cognitive dysfunction**. - These manifestations are due to the prothrombotic tendency affecting the cerebral vasculature. *Venous thrombosis* - **Venous thrombosis**, particularly **deep vein thrombosis (DVT)** and **pulmonary embolism (PE)**, is a hallmark feature of APS [2]. - The presence of antiphospholipid antibodies promotes clot formation in both venous and arterial systems. *Recurrent foetal loss* - **Recurrent foetal loss** (miscarriages or stillbirths) is a classic obstetric manifestation of APS [1]. - This occurs due to thrombosis in the placental circulation, impairing fetal development and viability [2].
Question 7: Etiology of disordered coagulation in antiphospholipid syndrome is
- A. Hyper coagulation (Correct Answer)
- B. Slow blood flow
- C. Thrombocytosis
- D. Vitamin K malabsorption
Explanation: ***Hyper coagulation*** - Antiphospholipid Syndrome (APS) is characterized by the presence of **antiphospholipid antibodies** that promote a **prothrombotic state**, leading to both arterial and venous clotting. [1] - These antibodies interfere with regulatory proteins of coagulation (e.g., **protein C, protein S**) and interact with phospholipids on cell surfaces, causing increased platelet activation and endothelial dysfunction. *Slow blood flow* - While **venous stasis** can contribute to thrombosis, it is not the primary etiological factor for disordered coagulation in APS itself. - Slow blood flow is a component of **Virchow's triad**, which also includes endothelial injury and hypercoagulability, with the latter being the core issue in APS. [2] *Thrombocytosis* - **Thrombocytosis** (an abnormally high platelet count) can increase the risk of thrombosis, but it is not the direct or primary cause of disordered coagulation in APS. - APS specificially involves **antibody-mediated hypercoagulability**, not just an increased number of platelets. *Vitamin K malabsorption* - **Vitamin K malabsorption** can lead to a *deficiency* in vitamin K-dependent clotting factors, typically resulting in a **bleeding tendency** rather than hypercoagulation. - This condition is associated with **hypocoagulability**, which is the opposite of the disordered coagulation seen in APS.
Question 8: Most common cause of first-trimester abortion is:
- A. Genetic factors (Correct Answer)
- B. Endocrine disorders
- C. Immunological disorders
- D. Infection
Explanation: ***Genetic factors*** - **Chromosomal abnormalities**, such as aneuploidies (e.g., **trisomy**), account for the majority of first-trimester spontaneous abortions. - These genetic errors often lead to **non-viable embryos**, resulting in early pregnancy loss as a natural selection mechanism. *Endocrine disorders* - While endocrine disorders like **luteal phase defect**, **uncontrolled diabetes**, or **thyroid dysfunction** can contribute to recurrent miscarriages, they are not the most common cause of *first-trimester abortions overall*. - Their impact is often more pronounced in **recurrent pregnancy loss** rather than sporadic first-trimester events. *Immunological disorders* - **Autoimmune disorders** such as **antiphospholipid syndrome** are important causes of **recurrent pregnancy loss** and can lead to first-trimester abortions. - However, they are **less common** than genetic factors as the primary cause of a single, sporadic first-trimester abortion. *Infection* - Certain **TORCH infections** (**T**oxoplasmosis, **O**ther [syphilis, varicella-zoster, parvovirus B19], **R**ubella, **C**ytomegalovirus, **H**erpes simplex virus) can cause miscarriage. - While significant, infections are a **less frequent cause** of first-trimester abortion compared to genetic anomalies.
Question 9: A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?
- A. Syphilis
- B. Gestational Diabetes Mellitus (GDM)
- C. TORCH infections
- D. Antiphospholipid Antibody Syndrome (APLA) (Correct Answer)
Explanation: ***Antiphospholipid Antibody Syndrome (APLA)*** - The presentation of **recurrent abortions** (especially with normal fetal cardiac activity) and a history of **preeclampsia** is highly characteristic of Antiphospholipid Antibody Syndrome (APLA). - In APLA, antibodies cause **thrombosis** in the placental vasculature, leading to placental insufficiency, fetal loss, and complications like preeclampsia. *Syphilis* - While syphilis can cause fetal loss, it typically presents with **hydrops fetalis**, hepatosplenomegaly, and bone abnormalities, rather than recurrent losses with normal cardiac activity in the early stages. - Untreated syphilis usually leads to congenital syphilis or stillbirths later in pregnancy, not necessarily early recurrent abortions with good fetal heart tones. *Gestational Diabetes Mellitus (GDM)* - GDM is associated with complications like **macrosomia**, polyhydramnios, and an increased risk of shoulder dystocia, but it is not a direct cause of recurrent early and mid-trimester abortions with normal fetal cardiac activity. - While poorly controlled diabetes can affect fetal development and pregnancy outcomes, it does not typically manifest as recurrent unexplained fetal demise with this specific presentation. *TORCH infections* - TORCH infections (Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus, and Herpes simplex virus) can cause congenital anomalies and fetal death. - However, they would usually present with specific fetal abnormalities, signs of infection, or hydrops, and not typically with recurrent, apparently healthy fetal losses followed by preeclampsia, as often seen in APLA.
Question 10: A young man back from leisure trip has swollen knee joints & foreign body sensation in eyes. Likely cause is -
- A. Behcet's disease
- B. SLE
- C. Reiter's syndrome (Correct Answer)
- D. Sarcoidosis
Explanation: REITER'S SYNDROME [1] - Reiter's syndrome, also known as **reactive arthritis**, is characterized by the classic triad of **arthritis**, **conjunctivitis** (foreign body sensation in eyes), and **urethritis** [1]. - It often develops after a **genitourinary or gastrointestinal infection**, which aligns with a recent leisure trip [1]. *Behcet's disease* - Behcet's disease primarily presents with recurrent **oral and genital ulcers**, along with **uveitis** and **skin lesions**. - While arthritis can occur, the combination of specific eye foreign body sensation and a recent trip isn't as characteristic as for Reiter's. *SLE* - **Systemic lupus erythematosus (SLE)** is a systemic autoimmune disease with diverse manifestations, including polyarthritis and serositis. - **Conjunctivitis** as a primary eye symptom or a direct association with a preceding infection/trip is less typical compared to Reiter's syndrome. *Sarcoidosis* - **Sarcoidosis** is a multisystem inflammatory disease often involving the **lungs, skin, and lymph nodes**, and can cause arthritis. - However, its acute presentation with foreign body sensation in the eyes and post-trip history is not its common debut.
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