Coagulation and Fibrinolysis Flashcards
Prolonged PT, Normal aPTT
FVII Deficiency
Normal aPTT and PT
- FXIII deficiency
- Henoch-Schonlein Purpura
- Isoniazid treatment for TB
- Errosive Gastritis
Prolonged aPTT, normal PT
Associated with bleeding:
* FVIII
* FIX
* FXI Deficiency
Not associated with bleeding:
* FXII deficiency
* Prekallikrein
* HMWK deficiency
* Lupus anticoagulant
* von willebrand disease
Prolonged aPTT and PT
- FI
- FII
- FV
- FX
- Vit-K
- CF
- acute hemorrhage (DIC)
- massive transfusion
Most potent inhibitor of FXIIa, Kalikrein and FXIa in plasma
C1 esterase inhibitor
Which is the most potent inhibitor of activated FV-
TF complex?
a. Prostacyclin
b. TFPI
c. Amyloid beta protein precursor
d. C1 esterase inhibitor
b. TFPI
What factor undergoes autoactivation when exposed to collagen and leads to production of thrombin?
a. Factor XII
b. Factor X
c. Facyor VIII
d. Factor VI
a. Factor XII
Which test should be measured routinely in a
bleeding patient and with c
b. Fibrinogen assay
What test is NOT commonly ordered because of its
limited utility in the laboratory for assessing
bleeding disorders?
a. PT
b. APTT
c. Fibrinogen test
d. Thrombin time
What test is NOT commonly ordered because of its
What is generated by plasmin that cleaves the cross-linked fibrin clot and suggests that a clot is undergoing lysis in the circulation?
a. Fibrinogen
b. D-dimers
c. Tissue factor
d. Thrombus
b. D-dimers
Which of the following is the main serine protease inhibitor of coagulation enzymes in the plasma serine protease inhibitor system?
a. TFPI
b. Scupa
c. AT
d. TPA
c. AT
The inhibitor effect brought about by activated protein C(APC) leads to the following effects,
EXCEPT:
a. Blocks fibrinolysis
b. Initiates inflammation
c. Reduces thrombin formation
d. Reduce thrombosis risk
a. Blocks fibrinolysis
Which of the following characterizes
thrombospondin 5?
a. Also known as cartilage oligomeric
matrix protein
b. It is a derivative of L arginine
c. It is a potent vasodilator
d. It is an intracellular protein and a
vasoconstrictor
a. Also known as cartilage oligomeric
matrix protein
THROMBOSPONDIN-5, ALSO KNOWN AS CARTILAGE OLIGOMERIC MATRIX PROTEIN (COM
What does “Decryption of encrypted TF” mean?
a. Endothelial cell TF is the initial nidus in
hemostasis and thrombosis
b. Activated macrophages express TF on
their cell membrane in physiologic
hemostasis
c. Microparticles released by leukocytes
involved in initiation of coagulation
d. Able to activate coagulation when cell
membrane properties are modified
d. Able to activate coagulation when cell
membrane properties are modified
Which of the following is NOT a characteristic of
normal hemostasis?
a. It is well regulated.
b. It is generalized.
c. It is localized.
d. It is rapidly initiated.
b. It is generalized.
AJ, a 56 year old male alcoholic has liver cirrhosis.
Which of the following would be an expected
laboratory finding with AJ’s condition?
a. Normal APTT and PT
b. Normal APTT with prolonged PT
c. Prolonged APTT with normal PT
d. Prolonged APTT and PT
d. Prolonged APTT and PT
RH, a 23-year old female, experienced postpartum
bleeding. Laboratory Tests: APTT- Prolonged, PT-
Normal. What is the MOST probable cause of her
bleeding?
a. Factor I Deficiency
b. Factor XII Deficiency
c. Factor XI Deficiency
d. Factor V Deficiency
c. Factor XI Deficiency
In which of the following patients would Vit. K
deficiency most likely occur?
a. Hepatitis B-positive patients
b. Very ill patients under total parenteral
nutrition
c. Patient with DIC
d. Patient with sepsis
b. Very ill patients under total parenteral
nutrition
A 5 year old male develops fever with severe
bleeding in the knee joint. Laboratory study shows
serum level of Factor VIII is decreased but levels of
Factor XI are within normal limits. Give your
diagnosis.
a. Henoch-Schonlein purpura
b. Hemophilia B
c. Von Willebrand Disease
d. Hemophilia A
d. Hemophilia A
What test is used to confirm a diagnosis of
Disseminated Intravascular Coagulation?
a. D-dimer
b. APTT
c. TT
d. PT
a. D-dimer
SB, a23-year old female who developed profuse bleeding had sepsis following induced abortion. Platelet count is decreased, PT and APTT are both prolonged. Most probable condition?
a. Hereditary Hemorrhagic Disorders of
Fibrinolysis
b. Factor XIII deficiency
c. Disseminated intravascular coagulation
d. Vitamin K deficiency
c. Disseminated intravascular coagulation
Of the events in hemostasis which of the following immediately and markedly reduces blood flow to the injured area?
a. Formation of the platelet plug
b. Primary hemostasis
c. Activation of Tissue Factor
d. Arteriolar vasoconstriction
d. Arteriolar vasoconstriction
Olaf was diagnosed with von Willebrand disease. He sustained a 2-inch lacerated wound on his left leg after a motorcycle accident. What would be affected in his hemostasis?
a. Platelet aggregation
b. Platelet activation
c. Platelet dissolution
d. Platelet adhesion
d. Platelet adhesion
Which of the following is the most common rare hereditary coagulation factor deficiency?
a. Factor VII
b. Factor IX
c. Factor X
d. Factor VIII
a. Factor VII
Which laboratory test reflects Factor XIII
deficiency?
a. Normal APTT; Prolonged PT
b. Prolonged APTT and PT
c. Normal APTT and PT
d. Prolonged APTT; Normal PT
c. Normal APTT and PT
Abnormal PT and APTT may be due to which one of the following?
a. Disseminated intravascular coagulation
b. Lupus anticoagulant
c. Dysfibrinogenemia
d. Warfarin
a. Disseminated intravascular coagulation
The following describes platelet satellitism, except:
a. Occurs only in EDTA-anticoagulated blood
b. Platelets adhere to neutrophils, but may
also involve other normal cells
c. May not be clinically significant, but may
lead to low platelet count
d. Reversal of phenomenon after treatment
of an immune disease has been observed
d. Reversal of phenomenon after treatment
of an immune disease has been observed
Causes of isolated prolonged PT include:
a. Vitamin K deficiency
b. Severe Von Willebrand Disease
c. Immediately after acute hemorrhage
d. Fresh frozen plasma transfusion
a. Vitamin K deficiency
Causes of shortened PT include:
a. Vitamin K deficiency
b. Severe Von Willebrand Disease
c. Immediately after acute hemorrhage
d. Fresh frozen plasma transfusion
d. Fresh frozen plasma transfusion
Causes of isolated prolonged aPTT include
a. Vitamin K deficiency
b. Severe Von Willebrand Disease
c. Immediately after acute hemorrhage
d. Fresh frozen plasma transfusion
b. Severe Von Willebrand Disease
What is the advantage of using reptilase test vs thrombin time?
a. It is used to better assess abnormalities of
plasminogen
b. Having a normal reptilase test and a
prolonged thrombin time usually
indicates heparin contamination
c. Reptilase is inhibited by the presence of
heparin
d. Prolonged reptilase test and thrombin
time indicate normal fibrinogen
b. Having a normal reptilase test and a
prolonged thrombin time usually
indicates heparin contamination
The following are causes of thrombocytopenia except
a. Infiltration of the bone marrow by
malignancy
b. Chemotherapy via direct toxicity to
megakaryocytes
c. Ethanolism
d. Pregnancy
d. Pregnancy
MW, a 28 y/o call center agent, went to see her doctor for purpura and petechiae in her arms and legs for 3 to 4 days. Which of the following will you include in your differential diagnosis?
a. Hemophilia A
b. Thrombocytopenia
c. Von Willebrand Disease
d. Vasculitis
e. B,C and D only
e. B,C and D only
ES, a 24 y/o female, had recurrent deep venous thrombosis of both legs. The following conditions should be investigated EXCEPT:
a. Acquired inhibitor to Factor VIII
b. Antiphospholipid antibody syndrome
c. Factor V Leiden
d. Protein C deficiency
e. Prothrombin G20210A mutation
a. Acquired inhibitor to Factor VIII
WD, a 70 y/o male, has been on warfarin for 6 years for atrial fibrillation. The activity of which of the following coagulation factors is diminished in this patient?
a. Fibrinogen, VIII, IX & X
b. Prothrombin, VII, IX & X
c. I, V, IX & XI
d. II, VI, VII & XII
e. Proteins C & S
b. Prothrombin, VII, IX & X
CD, an 8 y/o boy, suffers from hemophilia A. The coagulation factor he is deficient in belongs to:
a. Contact group
b. Fibrinogen group
c. Prothrombin group
d. Fibrinolytic group
e. Anticoagulation group
b. Fibrinogen group
AP was delivered with the help of forceps due to failure of progress of labor. After delivery, the midwife noticed that he developed a larged hematoma on the scalp. Further history revealed his maternal grandfather and uncle have repeated episodes of bleeding into joints. The bleeding mostlikely is a problem of:
a. Primary hemostasis
b. Secondary hemostasis
c. Tertiary hemostatis
d. Consumption coagulopathy
b. Secondary hemostasis
Gh, a 65 y.o diabetic, was admitted to the ICU for sepsis. Despite antibiotics, he went into shock and started bleeding from the gums and gastrointestinal tract. Clinical impression was disseminated intravascular coagulation. In this condition, the following is/are activated:
a. Coagulation cascade
b. Fibrinolytic system
c. Both
d. Neither
c. Both
Inhibitor/s of clotting include:
a. Anti-plasmin
b. Anti-thrombin
c. Calcium
d. Coagulation factors
e. Phospholipids
b. Anti-thrombin
TRUE statement/s regarding disorders of tertiary
hemostasisa.
a. Components affected are the coagulation
factors
b. Inheritance is usually autosomal dominant
c. Sites of bleeding include wounds and
genitourinary tract
d. Timing of bleeding is immediate
e. All of the above
c. Sites of bleeding include wounds and
genitourinary tract
What is the action of the blood vessels in
hemostasis immediately after an injury?
a. Platelet aggregation
b. Platelet adhesion
c. Thrombosis
d. Vasoconstriction
e. Vasodilation
d. Vasoconstriction
Which factors are involved in the initial activation
of the coagulation system and require contact with
a negatively charged surface for their activation?
a. Factors II, V, VII, X
b. Factors XII, XI, PK, HK
c. Factors II, VII, IX, X
d. Factors I, V, VIII, XIII
b. Factors XII, XI, PK, HK
What activates the extrinsic pathway?
a. Contact with tissue factor
b. Exposure to negatively charged surfaces
c. Factor XIIA
d. Intrinsic pathway
a. Contact with tissue factor
Homeostasis depends on the balance of:
a. Blood flow, platelet & coagulation cascade
b. Coagulation, fibrinolytic & anticoagulation systems
c. Contact, prothrombin and fibrinogen
groups of coagulation factors
d. Vascular injury, vasoconstriction and
thrombosis
b. Coagulation, fibrinolytic & anticoagulation systems
Which of the following pertains to clotting factor 1?
a. Thromboplastin
b. Prothrombin
c. Fibrinogen
d. Tissue factor
c. Fibrinogen
All of the following characterize hemostasis, EXCEPT
a. It is a pathologic response to vascular injury
b. It is initiated rapidly
c. It is well regulated
d. It limits the amount of blood loss
a. It is a pathologic response to vascular injury
What is the final product of the coagulation cascade?
a. Thrombin
b. Fibrinogen
c. Fibrin clot
d. Tissue factor
c. Fibrin clot
Which of the following is not included in the cellular component of the physiologic hemostatic system?
a. Neutrophils
b. Plasma proteins
c. Monocytes
D. Endothelial cells
b. Plasma proteins
All of the following are vitamin K-dependent factors except?
a. Factor X
b. Prothrombin
c. Tissue factor
D. Stable factor
c. Tissue factor
What clotting factor helps platelets adhere to injured vessel walls through exposed collagen?
a. Tissue factor
b. Christmas factor
c. Stuart power factor
d. Von Willebrand factor
d. Von Willebrand factor
Which is the main serine protease inhibitor of coagulation enzyme in the plasma serine inhibitor system?
a. Anti-thrombin
b. protein C
c. Protein S
d. Plasmin
a. Anti-thrombin
What is the most potent inhibitor of factor XIIa, Kalikrein and factor XIa in the plasma?
a. C1 esterase inhibitor
b. protein Z inhibitor
c. Heparin cofactor 2
d. Tissue factor pathway inhibitor
a. C1 esterase inhibitor
Which of the following is believed to be a cerebral anticoagulant?
a. Protein Z inhibitor
b. Amyloid beta protein precursor
c. Clopidogrel
d. Heparin
b. Amyloid beta protein precursor
Patients with bleeding tendency due to secondary hemostasis present with the following, EXCEPT:
a. Hemarthrosis
b. Ecchymoses
c. Mucocutaneous bleeding
d. Hematochezia
b. Ecchymoses
