APPLIED PHYSIOLOGY | Hemostasis and Coagulation

Question 1

The first screening test for hemostatic problems should always be the patient’s medical history

A. CBC

B. Medical history

C. Coagulation study

D. TEG

Answer 1

B. Medical history

The first screening test for hemostatic problems should always be the patient’s medical history.

Question 2

TRUE or FALSE

Von Willebrand disease (vWD) is the most common hereditary bleeding disorder.

Answer 2

TRUE

1% of general population

Question 3

The ______ complex is the target antigen for the antibodies causing heparin-induced
thrombocytopenia [HIT]:

A. Heparin–PF4
B. PKA–GP IIB
C. PGI2-cAMP
D. Ca-IP3

Answer 3

A. Heparin–PF4

Question 4

This part of TEG reflects clot strength?

A. K time

B. R time

C. MA (max amplitude)

Answer 4

C. MA (max amplitude)

Question 5

Which clotting factor is NOT vitamin-K dependent?

A. Factor VII
B. Factor IX
C. Factor VIII
D. Factor II

Answer 5

C. Factor VIII

Question 6

TEG graph shows a prolongation of the R value/time. What should be the treatment of choice?

A. FFP

B. TXA

C. Cryoprecipitate

D. Platelet concentrate

Answer 6

A. FFP

The R value represents the time for initial fibrin formation and measures the intrinsic coagulation pathway, the extrinsic coagulation pathway, and the final common pathway.

Question 7

In the TEG graph, __ is a measure of the speed of clot formation:

A. R value

B. K value

C. alpha angle

D. LY30

Answer 7

B. K value

Question 8

The role of factor VIII in secondary
hemostasis is seen in _______

A. Extrinsic pathway
B. Intrinsic pathway
C. Both extrinsic and intrinsic pathway

Answer 8

B. Intrinsic pathway

Question 9

Which clotting factor is NOT exclusively
produced by the liver?

A. Factor VII
B. Factor IX
C. Factor VIII
D. Factor II

Answer 9

C. Factor VIII

Question 10

The abnormal protein in some patients with
amyloidosis absorbs and leads to a
deficiency of this factor:

A. Factor VII
B. Factor VIII
C. Factor II
D. Factor X

Answer 10

D. Factor X

Question 11

This point of care test assesses the intrinsic clotting pathway and is used mainly to monitor heparin anticoagulation and its protamine reversal during cardiopulmonary bypass or vascular surger

A. ECT
B. ACT
C. PT
D. aPTT

Answer 11

B. ACT

Question 12

This test is primarily used for measuring the
clinical effects of direct thrombin inhibitors
(DTIs) such as bivalirudin.
A. ECT
B. ACT
C. PT
D. aPTT

Answer 12

A. ECT

Question 13

Reversal of urokinase in a hemorrhaging patient requiring surgery:

A. FFP

B. Cryoprecipitate

C. Platelet concentrate

Answer 13

B. Cryoprecipitate

Question 14

1 unit of PRBC increases the Hct by:

A. 3%

B. 5%

C. 7%

Answer 14

A. 3%

Question 15

Shelf life of PRBC is:

A. 21 days

B. 2 days

C. 2 weeks

D. 48 hrs

Answer 15

A. 21 days

Question 16

Which is NOT present in DIC?

A. Prolonged PT
B. Low platelet count
C. High fibrinogen
D. High fibrin split products

Answer 16

C. High fibrinogen

Question 17

Which of the following is INACCURATE regarding desmopressin:

A. It causes the release of FVIII and vWF from within vascular endothelial
cells.
B. Tachyphylaxis occurs with frequent repeat dosing.
C. Hypotension is the most commonly reported side effect.
D. It increases the synthesis of vWF and FVIII.

Answer 17

D. It increases the synthesis of vWF and FVIII.

Question 18

Which drug competitively inhibits the binding site on plasminogen thereby preventing cleavage to plasmin and the resultant fibrinolysis?

A. Lepirudin
B. Fondaparinux
C. Aprotinin
D. Tranexamic acid

Answer 18

D. Tranexamic acid

Question 19

This is the most common hereditary
bleeding disorder:

A. vWD
B. Hemophilia A
C. ITP
D. Factor V Leiden mutation

Answer 19

A. vWD

Question 20

Which procedure reduces the risk of human
leukocyte antigen (HLA) alloimmunization,
febrile nonhemolytic transfusion reactions
(FNHTRs), and CMV transmission?

A. Leukoreduction
B. Washing
C. Irradiation
D. RBC preservation

Answer 20

A. Leukoreduction

Question 21

This complication of warfarin therapy occurs in
patients with congenital protein C deficiency:

A. Warfarin-induced thrombocytopenia
B. Warfarin-induced skin necrosis
C. Warfarin-induced anemia
D. Warfarin-induced anaphylactic shock

Answer 21

B. Warfarin-induced skin necrosis

Question 22

The reversal agent Andexxa is indicated for life threatening or uncontrollable hemorrhage in patients receiving:

A. Enoxaparin (Lovenox)
B. Apixaban (Eliquis)
C. Pradaxa (Dabigatran)
D. Clopidogrel (Plavex)

Answer 22

B. Apixaban

Andexxa, (coagulation factor Xa [recombinant], inactivated-zhzo) is a specific antidote for direct factor Xa inhibitors. These include rivaroxaban, edoxaban and betrixaban.

There is also a specific reversal for Dabigatran,
idarucizumab, sold as Praxabind. Enoxaparin can be reversed with protamine, but clopidogrel has no specific reversal agent.

RIVAROXABAN = Andexxa

ENOXAPARIN = Protamine

CLOPIDOGREL = No reversal agent

Question 23

All of the clotting factors are primarily produced in the liver EXCEPT:

A. Factor VIII

B. Factor X

C. Factor V

D. Factor IX

Answer 23

A. Factor VIII

It is also released by endothelial cells and is well maintained in liver disease.