Unit 6 Flashcards
Normal hemostasis depends on all of the following except
Inadequate numbers of platelets
What is the sequence of events following injury to a small blood vessels?
- Blood vessel spasm (vasoconstriction)
- Formation of a platelet plug
- Contact between damaged blood vessel, blood platelets, and coagulation proteins
- Development of blood clot around the injury
- Fibrinolysis and reestablishment of vascular integrity
Which blood vessels have the thickest walls?
Arteries
All blood and lymphatic vessels are lined with
Endothelium
Blood passes from the arterial to the venous system via
Capillaries
The initiating stimulus to blood coagulation following injury to a blood vessel is
Contact activation with collagen
Endothelium is involved in the metabolism and clearance of molecules such as
*all of the above
- serotonin
- angiotensin
- bradykinin
Which of the following is not correct? (1)
none of the above
Which of the following is (are) true of endoreduplicaton?
- all of the above
- duplicates DNA without cell division
- results in cells with ploidy values of 4n, 8n, 16n, and 32n
- is unique to the megakaryocytic type of blood cell
Which of the following is (are) true of thrombopoietin?
- all of the above
- thought to stimulate the production and maturation of megakaryocytes
- is influenced by various cytokines, which increase megakaryocytes size
- `is influenced by various cytokines, which impact maturational stage and ploidy
Which of the following is not a characteristic of platelets?
The presence of a nucleus
The cellular ultra structural component unique to the platelet is the
Glycocalyx
Choose the incorrect statement regarding storage granules related to hemostasis in the mature platelet
Lysosomes contain actomyosin, myosin, and filamin
At all the times, approximately ______ of the total number of platelets are in the system circulation `
Two thirds
The reference range of platelets in the system circulation is
150 to 400 X 10^9/L
The functions of platelets in response to vascular damage include
Formation of platelet plug
If vascular injury exposes the endothelial surface and underlying collagen, platelets______ to the collagen fibers and _______
Adhere
The end production of ___________ occurs with platelet aggregation
Cyclooxygenase
AGents that are capable of aggregating platelets include
*all of the above `
- Collagen
- thrombin
- serotonin
Examination of a Wright-stained peripheral blood smear provides an estimate 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
20
If 10 platelets are seen per oil immersion field, what is the approximate platelet count?
200 X 10^9/L
Aspirin ingestion has the following hemostatic effect in a normal person:
Prolongs the bleeding time
The bleeding time test measures
Platelet adhesion and aggregation on locally injured vascular subendothelium
The clot retraction test is
A reflection of the quantity and quality of platelets and other factors `
Which of the following is a condition associated with purpura?
*All of the above
- direct endothelial damage
- inherited disease of the connective tissue
- mechanical disruption of small venules
Wiskott-Aldrich syndrome is characterized by
Smallest platelets seen
May-Hegglin anomaly is characterized by
Large platelets
Bernard-soulier syndrome is characterized by
Giant platelets
Acquired platelet dysfunction can be caused by
Uremia
Drug-induced platelet dysfunction can be caused by
Aspirin
Hereditary platelet dysfunction can be caused by
Von Willebrand’s disease `
An example of an agent that does not produce significantly decreased primary platelet aggregation in patients suffering from glanzmanns thrombasthenia is
Collagen
When comparing Von willebrand’s` disease and glanzmanns thrombasthernia, glanzmanns thrombasthernia will demonstrate
Absent ADP
Fibrinogen group consists of
Factors I, V, VIII,and XIII
Prothrombin group consists of
Factors II, VII, IX, and X
Contact group consists of
Factors XI, XII, prekallikrein, and high-molecular weight kininogen
The fibrinogen group of coagulation factors is
*all of the above
- know to increase during pregnancy
- known to increase in conditions of inflammation
- known to increase subsequent to the use of oral contraceptives
The prothrombin group of coagulation factors is
- all of the above
- dependent on vitamin K for production
- considered to be stable
- well preserved in stored plasma
Warfarin acts by
Acting as a vitamin K antagonist
Warfarin drugs interfere with the normal synthesis of factors
II
Vitamin- dependent coagulation factors include factors
II
Symbolic designation for thrombin is
IIa
Symbolic designation for antihemophilic factor is
VIII
Symbolic designation for tissue thromboplastin is
III
Symbolic designation for Hageman factor is
XII
What is the proper sequence of the four stages of coagulation in their proper sequence?
- Generation plasma thromboplastin
- Formation of thrombin from prothrombin
- Formation of fibrin from fibrinogen
- Fibrinolysis
The extrinsic pathway of coagulation is triggered by by the entry of _______ into the circulation
Tissue thromboplastin
The intrinsic pathway of coagulation begins with the activation of _______ in the early stage
Factor XII
The final common pathway of the intrinsic-extrinsic pathway is
Factor X activation
Prothrombin to thrombin conversion is accelerated by
Factor V and ionized calcium
Fibrinogen is converted to fibrin monomers by
Thrombin
The inactive plasminogen is activated to______ by proteolytic enzymes
Plasmin
Which of the following statements are true of the fibrinolytic system?
*all of the above
- plasmin digest fibrin and fibrinogen
- the active enzyme of the system is plasmin
- inactive plasminogen circulates in the plasma until an injury occurs
If pediatric pre operative patient has a family history of bleeding but has never had a bleeding episode herself, what test should be included in a coagulation profile in addition to the PT, APTT and platelet count?
Bleeding time
A patient with a severe decrease in factor X activity would demonstrate normal
Bleeding time
Neither the APTT nor the PT detects a deficiency of
Platelet factor 3
The function of thromboplastin in the prothrombin test is to provide ____ to the assay
Phospholipoprotein
An abnormally prolonged APTT may indicate:
- all of above
- a severe depletion of fibrinogen
- the presence of a circulating anticoagulant
- factor VIII deficiency
If a child ingested rat poison, which of the following tests should be performed to test the effect of the poison on the child’s coagulation mechanism?
PT
Which of the following conditions can cause an increased thrombin time?
*all of the above
- fibrin split products
- high concentrations of immunoglobulins
- heparin therapy
Heparin inhibits the clotting of blood by neutralizing the effeft of
Thrombin
A patient has a prolonged APTT and a normal PT. The APTT is not corrected by factor VIII-deficient plasma but is corrected by factor IX-deficient plasma. In which factor foes the patent appear to be deficient?
Factor VIII
The normal protective mechanism against thrombosis include
*all of the above
- the flow of blood
- the action of antithrombin
- protein C and protein S
If heparin therapy is initiated in a patient, a decreased anticoagulant response can be caused by decreased levels of
Platelet factor 4
Which of the following is (are) characteristic of protein C?
*Both B and C
- it is formed in response to thrombin generation
- it inactivates factors Va and VIIIa
Which of the following characteristics is (are) trie of protein S?
*all of the above
- it is a cofactor of protein C
- it increases the rate of inactivation of factor Va
- it enhances the binding of activated protein C to phospholipids
Antithrombin is the principal physiological inhibitor of
Thrombin
Which of the following is not correct regarding cellular proteases?
- they participate in clot formation
Which of the following parameters can be abnormal in classic Von willebrands disease type I?
Bleeding time
Platelet aggregation studies in cases of classic Von willebrands diasease should reveal
Decreased aggregation when factors such as ristocetin are used for testing
The most common form of Von willebrands disease is
Type I
Unique characteristic associated with deficiency of factor XII deficiency is
No history of bleeding
Disseminated intravascular coagulation (DIC) can be initiated by:
- all of the above
- septic shock
- severe sepsis
- hemolytic RBC crisis
Laboratory results in acute DIC reflect abnormalities in which of the following coagulation components?
Excessive clotting and fibrinolysis
Primary fibrinolysis is characterized by
- all of the above
- gross activation of fibrinolytic mechanism
- consumption of fibrinogen
- consumption of coagulation factors
The hallmark of secondary fibrinolysis is the presence of
- all of the above
- fibrin split products
- fibrin degradation products
- fibrin monomers
DIC is characterized by
- all of the above
- microvascular thrombosis
- fibrin deposition
- active fibrinolysis
Which of the following factors a contribute to hypercoagulation?
Vascular endothelial damage
Antithrombin deficiency can cause a
Primary hypercoagulable state
Oral contraceptives can cause a
Secondary hypercoagulable state
Protein C deficiency can cause a
Primary hypercoagulable state
Cancer can cause a
Secondary hypercoagulable state
Pregnancy can cause a
Secondary hypercoagulable state
A characteristic of circulating anticoagulants is which of the following?`
Acquired inhibitors of clotting proteins
A characteristic of lupus anticoagulant is which of the following
Also known as antiphospholipid or anticardiolipin
A characteristic of factor VIII inhibitor is which of the following?
The most common specific factor inhibitor
Warfarin is a vitamin _______ antagonist
K
The anatomical structures associated with the circulation of CSF are
Ventricles and subarachnoid spaces
CSF production is associated with the
Choroid plexus and ependymal lining
CSF is collected from an intervertebral space between the ______ and ______ vertebrae
L4, L5
Tube 1 is commonly for
Chemical and serological examination
Tube 2 is commonly used for
Microbial examination
Tube 3 or the final tube is commonly used for
Gross examination, cell counting, and morphology examination
A cloudy and turbid specimen is most commonly caused by :
Increased numbers of leukocytes
A grossly bloody specimen is most commonly caused b`y
Subarachnoid hemorrhage
A xanthochromic (yellow color) specimen is most commonly caused by
Subarachnoid hemorrhage (more than 12 hours after the bleed)
Gel formation in a specimen is most commonly caused by
Increased fibrinogen
Intravascular rupture of brain abscess is associated with
Extremely elevated leukocyte count in CSF
Viral infection is associated with
Lymphocytosis
A leukocyte count of 0 to 5 X 10^6/L is associated with
Normal leukocyte reference range for CSF
Bacterial infection is associated with
Increased polymorphonuclear segmented neutrophils (PMNs) is CSF
CNS leukemia or lymphoma is associated with
Macrophages `
Normal CSF contains
Lymphocytes and ependymal cells
The cell count on a CSF specimen should be performed within _______ of collection
1 hour
Clotting in CSF may be caused by
Increased protein concentration
An increased total leukocyte count in a CSF specimen can be caused by
*both of A and C
- bacterial meningitis
- intrvascular rupture of a brain abscess
An increase in the number of lymphocytes in a CSF specimen can be caused by
- all of the above
- multiple sclerosis
- viral meningoencephalitis
- fungal meningitis
The observation of cloudy CSF samples suggests
Bacterial infection present `
Which of the following is/are characteristic of an effusion?
- all of the above
- abnormal accumulation of fluid
- can be transudate
- can be an exudate
A transudate can be described as
Specific gravity less than 1.016, pH 7.4-7.5, and lactic dehydrogenase less than 200 IU/L`
Pleura
Covers the lungs
Peritoneum
Covers abdominal walls and viscera of the abdomen
Pericardium
Is a fibrous sac around the heart
Conditions not associated with pleural effusion induce
Viral pneumonia
Yellow and turbid is a representative exudate appearance typically associated with
Infectious process
Milky is a representative exudate appearance typically associate with
Chylothorax
Bloody is a representative exudate appearance typically associated with
Malignancy in the absence of trauma
Clearly visible pus is a representative exudate appearance typically associated with
Empyema
Foul odor is a representative exudate appearance typically associated with
Anaerobic bacterial infection
Pleural fluid can have a white supernatant fluid after centrifugation owing to
Presence of Chylomicrons
An extremely elevated leukocyte concentration in pleural fluid is typically associated with
Empyema
Which of the following cells can be seen in pleural fluid?
- All of the above
- LE cells
- mononuclear phagocytes
- mesothelial cells
All of the following describe the characteristics of malignant cells except
Smooth chromatin
Many neutrophils, histiocytes and mesothelial cells are associated with (a)
Acute bacterial inflammation
Abundant, multinuclear cells and clusters of cells are associated with a(n)
Metastatic adenocarcinoma
Many malignant cells (in clusters) are associated with a(n)
Malignant mesothelioma
Many lymphocytes, mesothelial cells, histiocytes, and plasma cells are associated with a(n)
Viral infection
In a pleural effusion, the percentage of ______ is extremely high in pneumonia and the percentage of ______ is extremely high in viral peritonitis
Polymorphonuclear segmented neutrophils/ lymphocytes
The cause of peritoneal effusion include all of the following except
TB
An abnormal-appearing peritoneal effusion can be caused by all of the following except
TB peritonitis `
The peritoneal effusion color of pale yellow is associated with
Normal
The peritoneal effusion color of straw colored is associated with
Congestive heart failure
The peritoneal effusion color of blood is associated with
Pulmonary infarct
An extremely increased leukocyte concentration in peritoneal fund can be caused by
Bacterial peritonitis
Eosinophils are associated with with
Chronic peritoneal dialysis
Lymphocytes are associated with
Congestive heart failure, cirrhosis, and nephrotic syndrome
Mesothelial cells are associated with
TB peritonitis
Infection agents are associated with
Coxsackie group viruses
Collagen vascular disease is associated with
Rheumatic disease
Neoplastic disease is associated with
Mesothelioma
A cause of an increased concentration of cells in peripheral fluid is
*both A and B
- microbial infection
- malignancy
Testicles are associated with
Sperm
Seminal vesicles are associated with
Fructose and prostaglandins
Prostrate gland is associated with
p30 glycoprotein
Cowper glands are associated with
Unknown
Sperm motility can become decreased if the specimen is
*all of the above
- stored at room temperature
- stored in a plastic container for more than 1 hour
- examined after 2 hours of storage
The normal value of sperm cells is ______ X 10^9/L
60-150
The reference value for sperm motility (fresh specimen) is
Greater than 60%
The reference value for sperm morphology is
40-90% (mature and oval headed)
The reference value for sperm agglutination is
At least 50%
A consideration value for specimens used for artificial insemination
Test for infectious disease
Arthrocentesis is
A liquid biopsy
Disorders than can be diagnosed definitively by synovial fluid analysis are
Gout, CPPD deposition disease, and septic arthritis
Which of the following would not be as aspiration site for synovial fluid?
Posterior iliac crest
If a synovial fluid aspirate is very turbid and septic arthritis is suspected, a ______ should definitely be performed
Gram’s stain and culture
Crystals that are in multiple three-dimensional forms are
CPPD crystals
An increased percentage of polymorphonuclear segmented neutrophils (PMNs) is characteristic of
Septic arthritis
MSU is associated with
Acute gouty arthritis
Calcium oxalate is associated with
Chronic renal disease
Cholesterol is associated with
Chronic rheumatoid effusions
Lipid liquid “Maltese cross” is associated with
Acute and chronic arthritis ````
Amniotic fluid consists of
- all of the above
- water
- proteins
- carbohydrates
Fetal fibronectin (fFN) is
*all of the above
- a protein produced during pregnancy
- a biological glue, attaching the fetal sac to the uterine lining
- associated with fetal lung maternity
Lamallea bodies are
- all of the above
- associated with the risk of developing respiratory stress syndrome in a premature infant
- composed of concentrated layers of phospholipid secreted by type II alveolar cells
- act as storage packets for surfactants in amniotic fluid
For a normal prothrombin time, the following plasma factor is in adequate concentration is NOT required
Factor VIII
The degree of increased capillary fragility is reflected in the:
Number of petechiae
Which of the following coagulation factors is present in serum?
Factor VII
What is the best indicator of a bleeding disorder?
Bleeding time
Which of the following groups is Factor XI listed in?
Contact group
The precursor of thrombin is:
Prothrombin
All blood and lymphatic vessels are lined with:
Endothelium
Factor XIII is:
Necessary for formation of stable clot
A patient with severe decrease in Factor X activity would demonstrate abnormal results in the:
- both A and B
- APTT
PT
The conversion of fibrinogen to fibrin requires:
Thrombin
All of the following are true of the international normalized ration (INR), except
The World Health Organization recommends reporting the INR on patients on long-term anticoagulant therapy
Laboratory results in acute disseminated intravascular coagulation reflect abnormalities in which of the following coagulation components?
- all of the above
- platelets
- fibrinolysis
- thrombin formation
- fibrin formation
An increase total leukocyte counts in a CSF specimen can be caused by:
*Both A and C
- Bacterial Meningitis
- intravascular rupture of a brain abscess
Hageman Factor is
Factor XII
A xanthochromic (yellow color) specimen is most commonly caused by:
Subarachnoid hemorrhage (more than 12 hours after the bleed)
Results on a patient presenting with sudden severe hemorrhagic problems are as follows:
- Bleeding time: Normal
- PT: Normal
- APTT: Prolonged
- APTT 1:1 mixingi study: no correction
(Patients serum mixed with normal plasma)
These clinical manifestations & lab results are consistent with:
Presence of a circulating inhibitor
The action of heparin is directly dependent on the amount of _________ in the blood.
Antithrombin III
Foul odor is a representative exudate appearance typically associated with
Anaerobic bacterial infection
Which of the following groups is consumed in the clotting process?
Fibrinogen group
What tests should be performed to diagnose Von Willebrand’s Disease?
1-PT
2-PTT
3-Platelet Count
4-Ristocetin Co-factor
5-platelet aggregation studies
6-bleeding time
All are correct
Which of the following groups is the vitamin K-dependent group listed in?
Prothrombin group
The synonym for coagulation Factor X is:
Stuart-Prower factor
Alpha granules that are contained in platelets contain:
- A and B only
- PF4
- Von Willebrand’s Factor
What test will separate Von Willebrand’s Disease from Factor VIII deficiency?
Bleeding time
In pleural effusion, the percentage of ________ is extremely high in viral peritonitis
Lymphocytes
The prothrombin time (PT) is affected by levels of:
*All of the above
- Factor II
- Factor V
- Factor VIII
- Factor X
Von Willebrand factor is associated with which function?
Prothrombotic
Angiotensin II is associated with which function?
Constrictor
Anti-thrombin III inhibits:
1- Factor IXa
2- Factor Xa
3- Factor XIa
4- Factor XIIa
1, 2, 3, and 4
The Roman numerical nomenclature for fibrin-stabilizing factor is:
XIII
Which of the following groups is inhibited by warfarin?
Prothrombin group
Which of the following groups in increased in pregnancy?
Fibrinogen group
Platelet-activating factor is associated with which function?
Prothrombotic
Factor I is:
Fibrinogen
SHORT ANSWER: what is the difference between primary and secondary hemostasis?
Primary hemostasis occurs after blood vessel injury occurs which activates all systems needed. It relies on platelet response and vasculature to stimulate and drive platelet plug formation through the aggregation of platelets to the injured area
Secondary hemostasis involves the intrinsic or extrinsic activation of the coagulation cascade by tissue factors. TF are released from damaged epithelium, which results in insoluble fibrin production
Thrombocytosis is:
An increase in platelets over 250 X 10^9/L
The in-vivo existence of a natural anti coagulation system includes which of the following:
1- Anti-thrombin III
2- Protein S
3- Protein C
4- Heparin
1, 2, 3, and 4
Which of the following coagulation is NOT vitamin-K dependent?
Factor VIII
Endothelin-I is associated with which function?
Constrictor
Which of the following tests monitor Coumadin therapy?
Prothrombin time
The bleeding time test measures:
The quality of platelets
Liable factor is:
Factor V
If a synovial fluid aspirate is very turbid and septic arthritis is suspected, a _______ should definitely be performed
- all of the above
- total cell count & differential count
- crystal examination
- Grams’s stain & culture
The synonym for coagulation Factor XI is:
Plasma Thromboplastin Antecedent
The synonym for coagulation Factor XI is:
Plasma thromboplastin antecedent
Which of the following anticoagulants is unsuitable for coagulation studies?
Sodium heparin
SHORT ANSWER: Hypercoaguable states can be caused by a deficiency in which 3 components?
- Protein S
- Factor Va
- Factor VIIIa
The molarity of the calcium chloride for APTT is:
0.025
Which of the following is the proper sequence for the four stages of coagulation?
Thromboplastin
Thrombin
Fibrin
Fibrinolysis
Prostacyclin is associated with which function?
Antithrombotic
In the intrinsic pathway, the first factor that requires the presence of calcium to continue the clotting process is:
Factor IX
Which of the following groups is Factor V listed in?
Fibrinogen group
The cause of idiopathic thrombocytopenia purpura (ITP) is:
Unknown
Heparin inhibits the clotting of blood by indirectly neutralizing the effect of:
Calcium ions
A transudate can be described as:
Specific gravity less than 1.016, pH 7.4-7.5, and lactic dehydrogenase less than 200 IU/L
Thrombomodulin is associated with which function?
Antithrombotic
Which of the following groups is Factor II listed in?
Prothrombin Group
