Elsevier Hemostasis

B

1. Which of the following lists the steps of the hemo- static response in the correct order?

a. Fibrinolysis → injury → secondary hemostasis → primary hemostasis

b. Injury → primary hemostasis → secondary hemostasis → fibrinolysis

c. Injury → secondary hemostasis → primary hemostasis → fibrinolysis

d. Injury → fibrinolysis → primary hemostasis → secondary hemostasis

C

2. Which of the following properties renders the vessel wall prothrombotic?

a. Negatively charged surface

b. Production of prostacyclin and nitric oxide

c. Release of tissue factor

d. Inactivation of thrombin

A

3. Which of the following is not true regarding platelets?

a. Platelets are not affected by aspirin

b. Platelets have a life span of 7 to 10 days

c. Platelets undergo shape change and develop pseudopods when activated

d. Von Willebrand factor serves as a bridge between platelets and collagen

C

4. Which of the following factors binds to platelets via the glycoprotein IIb/IIIa receptor?

a. Von Willebrand factor

b. Factor II

c. Fibrinogen

d. Thrombin

A

5. Which of the following is not an agonist of platelet aggregation?

a. Saline

b. ADP

c. Collagen

d. Epinephrine

B

6. Which enzyme is blocked by the presence of aspirin?

a. Phospholipase A2

b. Cyclooxygenase

c. Protein kinase

d. ATPase

A

7. Secondary hemostasis occurs when a sufficient stimulus is present to cause the release of internal ADP, synthesis and release of thromboxane A2, and increased calcium release.

a. True

b. False

B

8. Which of the following factors is called prothrombin?

a. Fibrinogen

b. Factor II

c. Factor X

d. Factor XIII

A

9. Which of the following factors usually results in no clinical bleeding when deficient?

a. Factor XII

b. Factor IX

c. Factor VIII

d. Factor VII

D

10. The step necessary for the functionary factors II, VII, IX, and X is called the ______________ step.

a. Oxidation

b. Hydrolysis

c. Cleavage

d. g-Carboxylation

B

11. Monitoring of the intrinsic pathway is accomplished by performing which of the following analytical tests?

a. PT

b. PTT

c. Thrombin time

d. Fibrinogen assay

A

12. Monitoring of the extrinsic pathway is accomplished by performing which of the following analytical tests?

a. PT

b. PTT

c. Thrombin time

d. Fibrinogen assay

B

13. Which of the following cleaves the fibrinopeptides from fibrinogen?

a. Factor VIII

b. Thrombin

c. Tissue factor

d. Factor XIII

B

14. Activation of factor VII after the release of tissue fac- tor initiates which of the following pathways?

a. Intrinsic pathway

b. Extrinsic pathway

c. Common pathway

d. Fibrinolytic pathway

C

15. Which of the following is not true?

a. Factor VIII is a cofactor for factor IXa

b. Factor V is a cofactor for factor Xa

c. Protein K is a cofactor for protein C

d. High-molecular-weight kininogen is a cofactor for factor XIIa

D

16. If a deficiency of this factor is present, the cross-linking of fibrin will not occur.

a. Factor II

b. Factor V

c. Factor XI

d. Factor XIII

C

17. Factor VIII is protected from degradation when cir- culating in the plasma by its carrier protein __________.

a. Factor IX

b. Thrombin

c. Von Willebrand factor

d. Glycoprotein IIb/IIIa

B

18. Which of the following factors is associated with hemophilia B?

a. Factor VIII

b. Factor IX

c. Factor XI

d. Fibrinogen

C

19. The activation of plasmin results in which of the following?

a. The formation of a fibrin clot

b. The formation of the bridge between platelets and the vessel wall

c. The start of the process to break down a fibrin clot

d. The point at which the intrinsic and extrinsic

C

20. Which of the following proteins is degraded by plasmin?

a. Fibrin

b. Fibrinogen

c. A and B

d. None of the above

C

21. Streptokinase differs from urokinase plasminogen activator (uPA) in that:

a. Streptokinase activates plasminogen to plasmin conversion, whereas uPA inhibits the conversion

b. uPA is effective only when given as a medication

c. Streptokinase is an exogenous activator, whereas uPA is a physiologic activator

d. No differenceexists between streptokinaseand uPA

D

22. Which of the following are fibrin degradation products?

a. Fragment X

b. Fragment Y

c. Fragment D

d. All of the above

A

23. Which of the following describes the role of PAI-1 in hemostasis?

a. Plasminogen activator inhibitor–1 limits the activation of plasminogen

b. Plasminogen activator inhibitor–1 stimulates the activation of plasminogen

c. Plasminogen activator inhibitor–1 is involved in limiting clot formation in vessels

d. Plasminogen activator inhibitor–1 blocks platelet binding to the fibrin clot

C

24. Which of the following fibrinolytic inhibitors is useful when a2-antiplasmin activity has been exhausted?

a. PAI-1

b. Thrombin-activatable fibrinolysis inhibitor

c. a2-Macroglobulin

d. Plasminogen

C

25. Positive feedback control of the hemostatic response is accomplished by:

a. Fibrin binding to thrombin to limit further activation

b. Fibrin degradation products interfere with fibrin formation and polymerization

c. Thrombin activates platelets and promotes the release of platelet factor V

d. Thrombin initiates activation of the protein C pathway

C

26. Which of the following descriptions best describes the actions of protein S?

a. Protein S inactivates factors Va and VIIIa

b. Protein S is involved in the activation of thrombin

c. Protein S serves as a cofactor for protein C

d. None of above are functions of protein S

A

27. A child presents to the pediatrician after having recovered from a viral infection, because the child now has petechiae. The pediatrician orders laboratory testing, and the results reveal that the platelets are decreased.

An increase in lymphocytes and eosinophils is also found. What is the probable diagnosis?

a. Acute ITP

b. Chronic ITP

c. NAIT

d. Medication reaction

D

28. Which of the following tests would help to differentiate between Bernard-Soulier syndrome and Glanz- mann’s thrombasthenia?

a. Bleeding time

b. Platelet count

c. PT

d. Response to ADP, collagen, and epinephrine in an aggregation assay

C

29. Glanzmann’s thrombasthenia is best described as a:

a. Platelet deficiency

b. Deficiency of glycoprotein Ib/IX

c. Deficiency of glycoprotein IIb/IIIa

d. Deficiency of dense granules

D

30. The lack of a secondary wave of platelet aggregation in response to ADP is associated with which of the following disorders?

a. Bernard-Soulier syndrome

b. Gray platelet syndrome

c. Glanzmann’s thrombasthenia

d. D-Storage pool disease

A

31. A yong boy is taken to the hospital, he noticed that he seems to bleed easily and has swollen knees. The following test results were obtained:

PT = normal aPTT = Prolonged

Fibrinogen = Normal aPTT w/ normal pooled plasma= Corrected

Plt ct = Normal

Which of the following statements best describes the next steps?

a. The pediatrician should order factor assays for factors VIII and IX

b. The pediatrician should order factor assays for factors X and V

c. The pediatrician should order platelet aggregation testing

d. The pediatrician should request a molecular test for the factor V Leiden defect

A

32. Which of the following results would be expected in a patient with dysfibrinogenemia?

a. Normal PT, normal aPTT, prolonged thrombin time

b. Abnormal PT, normal aPTT, prolonged thrombin time

c. Abnormal PT, abnormal aPTT, normal thrombin time

. Normal PT, normal aPTT, normal thrombin time

A

33. In factor deficiencies, normal PT and aPTT results may be recorded until a factor level is ________.

a. Less than 30%

b. Less than 50%

c. Less than 75%

d. Less than 100%

C

34. The following results were obtained from a patient who recently underwent major surgery.

PT=Prolonged APTT=Prolonged

Fibrinogen=Decreased Plt ct = Decreased

D-Dimer=Positive Plt ct = Decreased

Which of the following conditions is likely?

a. Fibrinogenolysis

b. Fibrinogen deficiency

c. Disseminated intravascular coagulation

d. Vitamin K deficiency

D

35. Which of the following conditions is not usually associated with thrombosis?

a. Protein C deficiency

b. Antithrombin deficiency

c. Factor V Leiden mutation

d. Factor V deficiency

C

36. Which of the following accelerates the activity of antithrombin?

a. Coumadin

b. Aspirin

c. Heparin

d. tPA

D

37. Which of the following tests is helpful in differentiating fibrinogenolysis from DIC?

a. PT

b. aPTT

c. Fibrinogen

d. D-Dimer

A

38. A patient who has been receiving a broad-spectrum antibiotic is found to have a prolonged PT. After run- ning a couple of factor assays, you conclude that both the factor X and factor VII levels are decreased. The PT corrected when mixed with normal pooled plasma. What is a possible cause?

a. Inherited factor deficiency

b. Circulating anticoagulant

c. Vitamin K deficiency

d. Effect resulting from antibiotic presence in plasma

C

39. Which of the following descriptions best describes the principle of platelet aggregation?

a. The decrease in optical density is observed after the addition of an agonist in platelet-poor plasma

b. The increase in optical density is observed after the addition of an agonist in platelet-rich plasma

c. The decrease in optical density is observed after the addition of an agonist in platelet-rich plasma

d. The increase in optical density is observed after the addition of an agonist in platelet-poor plasma

B

40. When performing platelet aggregation assays, which of the following is an important preanalytical factor?

a. The patient should have fasted overnight

b. The patient must refrain from aspirin-containing products for 7 days before testing

c. After collection, the specimen can be frozen before transport to the laboratory

d. All of the above are important

B

41. Which of the following conditions will cause an increase in fibrinogen levels?

a. DIC

b. Afibrinogenemia

c. Acute phase reactions

d. Liver disease

C

42. Which of the following describes the principle of the thrombin time test?

a. After the addition of thromboplastin, the time needed for plasma to form a clot is measured

b. Patient plasma is mixed with thrombin-deficient plasma, and the time to clot is measured

c. An excess of thrombin is added to patient plasma, and the time to clot is measured

d. Clot solubility is assessed using 5 M urea

C

43. When performing a factor assay for factor VIII, the MLS accidentally added factor IX–deficient plasma to the patient specimens. Which of the following best describes the expected results?

a. The test will not be affected because the correct factor-deficient plasma was added

b. The test will not be affected because factor- deficient plasma is not needed in a factor assay

c. The test results will not be an assessment of factor VIII levels because factor VIII is present in the factor IX–deficient plasma

d. The test results will be an assessment of factor IX levels and can be calculated using the factor VIII standard curve

C

44. What are the reagents needed to perform the aPTT test?

a. Calcium chloride

b. Partial thromboplastin

c. A and B

d. None of the above

A

45. Which of the following tests is reported in conjunction with the INR?

a. PT

b. APTT

c. Thrombin time

d. Fibrinogen assay

C

46. The following test results were obtained on a patient who is being seen for easy bruising.

Bleeding Time = Increased

PT = Normal

aPTT = Prolonged (mix w normal pooled plasma corrected aPTT)

Plt count = Normal

ADP, collagen, epinephrine platelet aggregation = Normal

Ristocetin plt aggregation= Absent

Which of the following conditions is expected?

a. Hemophilia A

b. Hemophilia B

c. Von Willebrand’s disease

d. Factor XII deficiency

C

47. During a lengthy overseas trip, a 60-year-old man went to a laboratory in Italy to have PT measured to assess his dosage of Coumadin. Typically, in the United States, his results are in the range of 17 to 18 seconds, with an average INR of 1.75. In the

laboratory in Italy, his PT was 20.2 seconds and his INR was 1.74. Which of the following descriptions best describes the situation?

a. The patient is taking excessive anticoagulation medication, causing his PT to be prolonged

b. An error is expected in the results from the laboratory in Italy

c. The result is not concerning because the INR results are essentially the same

d. He should immediately return to the United States for further assessment

C

48. During presurgical testing, the aPTT for a patient was longer than 120 seconds. The patient’s history for bleeding is negative. The result was corrected after mixing with normal pooled plasma. The surgery is delayed because the surgeon is concerned about bleeding. Which of the following descriptions best describes this situation?

a. The patient is at risk for a bleeding incident if the surgery proceeds

b. The patient likely has a circulating inhibitor

c. The patient likely has a deficiency of a contact factor that is not associated with bleeding

d. The sample was likely contaminated with heparin

D

49. A 30-year-old woman with a history of miscarriages is being seen by an obstetrician/gynecologist. Which of the following tests would be included in a panel to assess her condition?

a. DRVVT

b. PT and PTT

c. PT and PTT using normal pooled plasma mix

d. All of the above

D

50. A patient presents to the emergency department with symptoms consistent with a DVT. Which of the fol- lowing tests is helpful as a screening test for the factor V Leiden mutation?

a. Protein S assay

b. Antithrombin assay

c. Prothrombin 20210 molecular test

d. APCR test