Chp. 35,37,38 REVIEW QUESTIONS Flashcards
What intimal cell synthesizes and stores von willebrand factor (vwf)?
a. Smooth msucle cell
b. Endothelial cells
c. Fibroblast
d. Platelet
Endothelial cells
What subendothelial structural protein triggers coagulation through activation of factor VII?
a. Thrombomodulin
b. Nitric oxide
c. Tissue factor
d. Thrombin
Tissue factor
What coagulation plasma protein should be assayed when platelets fail to aggregate properly.
a. Factor VIII
b. Fibrinogen
c. Thrombin
d. Factor X
Fibrinogen
What is the primary role of vitamin K for the prothrombin group factors?
a. Provides a surface on which the proteolytic reactions of the factors occurs
b. Protects them from inappropriate activation by compounds such as thrombin
c. Accelerates the binding of the serine proteases and their cofactors
d. Carboxylates the factor to allow calcium binding
Carboxylates the factor to allow calcium binding
What is the source of prothrombin fragment F1.2?
a. Plasmin proteolysis of fibrin polymer
b. Thrombin proteolysis of fibrinogen
c. Proteolysis of prothrombin by factor Xa
d. Plasmin proteolysis of cross-linked fibrin
Thrombin proteolysis of fibrinogen
What serine protease forms a complex with factor VIIIa and what is the substrate of this complex?
a. Factor VIIa, factor X
b. Factor Va, prothrombin
c. Factor Xa, prothrombin
d. Factor IXa, factor X
Factor IXa, factor X
What protein secreted by endothelial cells activates fibrinolysis?
a. Plasminogen
b. TPA
c. PAI-1
d. TAFI
TPA
What two regulatory proteins form a complex that digests activated factors V and VIII?
a. TFPI and Xa
b. Antithrombin and protein C
c. APC and protein S
d. Thrombomodulin and plasmin
APC and Protein S
What are the primary roles of VWF?
a. Inhibit excess coagulation and activate protein C
b. Activate plasmin and promote lysis of fibrinogen
c. Mediate platelet adhesion and serve as a carrier molecule for factor VIII
d. Mediate platelet aggregation via the GP IIb/IIIa
Mediate platelet adhesion and serve as a carrier molecule for factor VIII
Most coagulation factors are synthesized by what organ?
a. Liver
b. Monocytes
c. Endothelial cells
d. Megakaryocytes
Liver
The events involved in secondary hemostasis:
a. Lead to the formation of a stable fibrin clot
b. Usually occur independently of primary hemostasis
c. Occur in a random fashion
d. Are the first line of defense against blood loss
Lead to the formation of a stable fibrin clot
Which of the following coagulation factors is activated by thrombin and mediates the stabilization of the fibrin clot?
a. Tissue factor
b. Factor VII
c. Factor IX
d. Factor XIII
Factor XIII
Which of the following endogenous plasma inhibitors are important for the control of excessive thrombin generation?
a. AT, TFPI
b. Platelet factor 4
c. TAT, F1.2
d. A and B
AT, TFPI
Normal hemostasis depends on all of the following except:
a. An intact vascular system
b. Inadequate numbers of platelets
c. Appropriate coagulation fcators
d. Fibrinolysis
Inadequate numbers of platelets
The sequence of events following injury to a small blood vessel is _________ to ________ to ________ to __________ to __________
- blood vessel spasm
- formation of a platelet plug
- contact between damaged blood vessel, blood platelets, and coagulation proteins
- development of a blood clot around the injury
- fibrinolysis and reestablishment of vascular integrity
Which blood vessels have the thickest walls?
a. Veins
b. Arteries
c. Capilliaries
d. Arterioles
Arteries
All blood and lymphatic vessels are lined with
a. Endothelium
b. Nerve endings
c. Stratified epithelial cells
d. Simple squamous epithelium
Endothelium
Blood passes from the arterial to the venous system via:
a. Arterioles
b. Capilliaries
c. Veins
d. Arteries
Capilliaries
The initiating stimulus to blood coagulation following injury to a blood vessel is:
a.contact activation with collagen
b. Vasoconstriction
c. Stenosis
d. Release of serotonin
Contact activation with collagen
Endothelium is involved in the metabolism and clearance of molecules such as:
a. Serotonin
b. Angiotensin
Bradykinin
d. All of the above
All of the above
Which of the following is not correct?
a. Vasoconstriction reduces blood flow and promotes contact activation of platelets and coagulation factors
b. Platelets adhere to exposed endothelial connective tissues
c. Aggregation of platelets releases thromboxane A2 and vasoactive amines (serotonin and epinephrine)
d. None of the above
None of the above
Which of the following is (are) true of endoreduplication?
a. Duplicates DNA without cell division
b. Results in cells with ploidy values of 4n, 8n, 16n, and 32n
c. Is unique to the megakaryocytuc type of blood cell
d. All of the above
All of the above
Which of the following is (are) true of thrombopoietin?
a. Thought stimulate the production and maturation of megakaryocytes
b. Is influenecd by various cytokines, which increase megakaryocyte size
c. Is influenced by various cytokines, which impart maturational stage and ploidy
d. All of the above
All of the above
Which of the following is not a characteristic of platelets?
a. The presence of a nucleus
b. Life span of 9-12 dats
c. Cytoplasm is light blue with fine red purple granules
d. A discoid shape as an inactive cell
The presence of a nucleus
The cellular ultrastructural component unique to the platelet is the
a. Cytoplasmic membrane
b. Glycocalyx
c. Mitochondrion
d. Microtubule
Glycocalyx
Choose the incorrect statement regarding storage granules related to hemostasis in the mature platelet.
a. Alpha-granules containplatelet factor 4, beta-thromboglobulin, and platelet-derived growth factor
b. Alpha-grabules contain platelet fibrinogen and VWF.
c. Dense bodies contain serotonin and ADP
d. Lysosomes contain actomyosin, myosin, and filamin
Lysosomes contain actomyosin, myosin, and filamin
At all time, approximately _________ of the total number pf platelets are in the systemic circulation.
a. 1/4
b. 1/3
c. 1/2
d. 2/3
2/3
The reference range of platelets in the systemic circulation is
a. 50 - 150 x 10^9/L
b. 100 - 200 x 10^9/L
c. 150 -350 x 10^9/L
d. 150 - 400 x 10^9/L
150 - 400 x 10^9/L
The function of platelets in response to vascular damage include
a. Maintenance of vascular integrity by sealing minor defects of the endothelium
b. Formation of a platelet plug
c. Promotion of fibrinolysis
d. All of the above
Formation of a platelet plug
If vascular injury exposes the endothelial surface and underlying collagen, platelets __________ to the collagen fibers and ______
Adhere, Aggregate
The end production of ________ occurs with platelet aggregation.
a. Thromboxane A2
b. Cyclooxygenase
c. Prostacyclin
d. Arachidonic acid
Cyclooxygenase
Agents that are capable of aggregating platelets include
a. Collagen
b. Thrombin
c. Serotonin
d. All of the above
All of the above
Examination of a Wright-stained peripheral blood smear provides anestimate of platelet numbers. Using 100x (oil) immersion in the areas of erythrocytes just touching each other, the upper limit of the number of platelets seen per field should not exceed
a. 10
b. 15
c. 20
d. 25
20
If 10 platelets are seen per oil immersion field, what is the approximate platelet count?
a. 50 x 10^9/L
b. 100 x 10^9/L
c. 150 x 10^9/L
d. 200 x 10^9/L
200 x 10^9/L
Aspirin ingestion has the following hemostatic effect in a normal person:
a. Prolongs the bleeding time
b. Prolongs the clotting time
c. Inhibits factor VIII
D. Has no effect
Prolongs the bleeding time
The bleeding time test measures
a. The ability of platelets to stick together
b. Platelet adhesion and aggregation on locally injured vascular subendothelium
c. The quantity and quality of platelets
d. Antibodies against platelets
Platelet adhesion and aggregation on locally injured vascular subendothelium
The clot retraction test is:
a. A visible reaction to the activation of platelet actomyosin
b. A reflection of the quantity and quality of platelets and other factors
c. A measurement of the ability of platelets to stick to glass
d. A measurement of the cloudiness of blood
A reflection of the quantity and quality of platelets and other factors
What is the most common acquired bleeding disorder?
A. Trauma-induced coagulopathy
B. Vitamin K deficiency
C. Liver disease
D. VWD
Trauma-induced coagulopathy
Which is a typical form of anatomic bleeding?
A Epistaxis
B Menorrhagia
C Hematemesis
D Central Nervous system bleed
Central nervous system bleed
What factor become deficient early in liver disease, and what assay does its deficiency prolong?
A Prothrombin deficiency, the PT
B Factor VII deficiency, the PT
C Factor VIII deficiency, the PTT
D Factor IX deficiency, the PTT
Factor VII deficiency, the PT
In what subtype of VWD is the RIPA test result positive when ristocetin is used at a concentration of less than 0.5 mg.mL?
A Subtype 2A
B Subtype 2B
C Subtype 2N
D Type 3
Subtype 2B
Which of the following conditions causes a prolonged thrombin time?
A Antithrombin Deficiency
B Prothrombin deficiency
C hypofibrinogenemia
D Warfarin therapy
hypofibrinogenemia
What is the typical treatment for vitamin K deficiency when the patient is bleeding?
A Vitamin K and 4 factor PCC
B Vitamin K and plasma
C Vitamin K and platelet concentrate
D Vitamin K and factor VIII concentrate
Vitamin K and 4 factor PCC
If a patient has anatomic soft tissue bleeding and poor wound healing, but the PT, PTT, thrombin time, platelet count, and platelet functional assay results are normal, what factor deficiency is indicated?
A Fibrinogen
B Prothrombin
C Factor XII
D Factor XIII
Factor XIII
What therapy may be used for a hemophilic boy who is bleeding and who has a high titer of factor VIII inhibitor?
A rFVIIa
B Plasma
C Cryoprecipitate
D Factor VIII concentrate
rFVIIa
What is the most prevalent form of VWD?
A Type 1
B Type 2A
C Type 2B
D Type 3
Type 1
Which of the following assays is used to distinguish vitamin K deficiency from liver disease?
A PT
B Protein C assay
C Factor V assay
D Factor VII assay
Factor V assay
Mucocutaneous hemorrhage is typical of:
A Acquired hemorrhagic disorders
B Localized hemorrhagic disorders
C Defects in primary hemostasis
D Defects in fibrnolysis
Defects in primary hemostasis
The clinical presentation of platelet-related bleeding may include all of the following except:
a. Bruising
b. Nosebleeds
c. Gastrointestinal bleeding
d. Bleeding into the joints (hemarthroses)
Bleeding into the joints (hemarthroses)
A defect in GP IIb/IIIa causes:
a. Glanzmann thrombasthenia
b. Bernard-Soulier syndrome
c. Gray platelet syndrome
d. Storage pool disease
Glanzmann thrombasthenia
Aspirin ingestion blocks the synthesis of:
a. Thromboxane A2
b. Ionized calcium
c. Collagen
d. ADP
Thromboxane a2
Patients with Bernard-Soulier syndrome have which of the following laboratory test findings?
a. Abnormal platelet response to arachidonic acid
b. Abnormal platelet response to ristocetin
c. Abnormal platelet response to collagen
d. Thrombocytosis
Abnormal platelet response to ristocetin
Which of the following is the most common of the hereditary platelet function defects?
a. Glanzmann thrombasthenia
b. Bernard-Soulier syndrome
c. Storage pool defects
d. Multiple myeloma
Storage pool defects
A mechanism of antiplatelet drugs targeting GP IIb/IIIa function is:
a. Interference with platelet adhesion to the subendothelium by blocking of the collagen binding site
b. Inhibition of transcription of the GP IIb/IIIa gene
c. Direct binding to GP IIb/IIIa
d. Interference with platelet secretion
Direct bidnding to GP IIb/IIIa
The impaired platelet function in myeloproliferative neoplasms results from:
a. Abnormally shaped platelets
b. Extended platelet life span
c. Increased procoagulant activity
d. Decreased numbers of alpha- and dense granules
Decreased numbers of alpha and dense granules
Which is a congenital qualitative platelet disorder?
a. Senile purpura
b. Ehlers-Danlos syndrome
c. Henoch-Schönlein purpura
d. Waldenström macroglobulinemia
b. Ehlers-Danlos syndrome
In uremia, platelet function is impaired by higher than normal levels of:
a. Urea
b. Uric acid
c. Creatinine
d. NO
NO
The platelet defect associated with increased paraproteins is:
a. Impaired membrane activation owing to protein coating
b. Hypercoagulability owing to antibody binding and membrane activation
c. Impaired aggregation because the hyperviscous plasma prevents platelet-endothelium interaction
d. Hypercoagulability because the increased proteins bring platelets closer together, which leads to inappropriate aggregation
Impaired membrane activation owing to protein coating
A reduction in thrombin generation in patients with Scott syndrome results from?
A. Defectie granule secretion
B. Altered platelet aggregation
C. Altered expression of phospholipids on the platelet membrane
D. Deficiency of vitamin K dependent clotting factors
Altered expression of phospholipids on the platelet membrane
Thrombocytopenia associated with the use of cardiopulmonary bypass is not caused by?
A. Anti-GP IIb/IIIa antibodies
B. Hemodilution
C. Platelet binding to bypass circuitry
D. Platelet consumption associated with normal postsurgical hemostatic activity
Anti-GP IIb/IIIa
The autosomal dominant disorder associated with decreased platelet production is:
a. Fanconi anemia
b. TAR syndrome
c. May-Hegglin anomaly
d. Wiskott-Aldrich anomaly
May-Hegglin anomaly
Which of the following is not a hallmark of ITP?
a. Petechiae
b. Thrombocytopenia
c. Large overactive platelets
d. Megakaryocyte hypoplasia
Large overactive platelets
The specific antigen most commonly responsible for the development of NAIT is:
a. Bak
b. HPA-1a
c. GP Ib
d. Lewis antigen a
HPA-1a
A 2-year-old child with an unexpected platelet count of 15,000/mL and a recent history of a viral infection most likely has:
a. HIT
b. NAIT
c. Acute ITP
d. Chronic ITP
Acute ITP
Which drug causes a reduction in platelet count by inhibiting megakaryocyte maturation?
A. Gold salts
B. Abciximab
C. Anagrelide
D. Quinidine
Anagrelide
A defect in primary hemostasis (platelet response to an injury) often results in:
a. Musculoskeletal bleeding
b. Mucosal bleeding
c. Hemarthroses
d. None of the above
Mucosal bleeding
When a drug acts as a hapten to induce thrombocytopenia, an antibody forms against which of the following?
a. Typically unexposed, new platelet antigens
b. The combination of the drug and the platelet membrane protein to which it is bound
c. The drug alone in the plasma, but the immune complex then binds to the platelet membrane
d. The drug alone, but only when it is bound to the platelet membrane
The combination of the drug and the platelet membrane protein to which it is bound
TAR refers to:
a. Abnormal platelet morphology in which the radial striations of the platelets are missing
b. Abnormal appearance of the iris of the eye in which radial striations are absent
c. Abnormal bone formation, including hypoplasia of the forearms
d. Neurologic defects affecting the root (radix) of the spinal nerves
Abnormal bone formation, including hypoplasia of the forearms
Neonatal autoimmune thrombocytopenia occurs when:
a. The mother lacks a platelet antigen that the infant possesses, and she builds antibodies to that antigen, which cross the placenta
b. The infant develops an autoimmune process such as ITP secondary to in utero infection
c. The infant develops an autoimmune disease such as lupus erythematosus before birth
d. The mother has an autoimmune antibody to her own platelets, which crosses the placenta and reacts with the infant’s platelets
The mother has an autoimmune antibody to her own platelets, which crosses the placenta and reacts with the infant’s platelets
HUS in children is associated with:
a. Diarrhea caused by Shigella species
b. Meningitis caused by Haemophilus species
c. Pneumonia caused by Mycoplasma species
d. Pneumonia caused by respiratory viruses
Diarrhea caused by Shigella species
Treatment with an anticomplement agent such as eculuzumab is first line therapy for:
A. Hereditary TTP
B. Hemolytic uremic syndrome (HUS)
C. ITP
D. Atypical HUS
Atypical HUS
Which of the following statements regarding thrombocytosis is not true?
A. Thrombocytosis can be associated with hemorrhage and thrombosis
B. Affected patients have platelet counts in excess of 450,000/mL
C. Thrombocytosis is self correcting
D. Thrombocytosis can be congenital or acquired
Thrombocytosis is self correcting
