Chapter 25 Principles of Hemostasis and Thrombosis: Vasculature and Platelets, Chapter 26 Disorders of Primary Hemostasis and Thrombosis Vasculature and Platelets, Chapter 27 Principles of Hemostasis and Thrombosis: Blood Coagulation Factors and Natu…

Normal hemostasis depends on all of the following except

a. an intact vascular system

b. inadequate numbers of platelets

c. appropriate coagulation factors

d. fibrinolysis

b. inadequate numbers of platelets

# 2-6 The sequence of events following injury to a small blood

vessel is (2) ______ to (3) ______ to (4) ______ to (5) ______ to

(6) ______.

a. contact between damaged blood vessel, blood platelets, and

coagulation proteins

b. formation of a platelet plug

c. fibrinolysis and reestablishment of vascular integrity

d. development of a blood clot around the injury

e. blood vessel spasm (vasoconstriction)

E, B, A, D, C,

Which blood vessels have the thickest walls?

a. Veins

b. Arteries

c. Capillaries

d. Arterioles

b. Arteries

All blood and lymphatic vessels are lined with

a. endothelium

b. nerve endings

c. stratified epithelial cells

d. simple squamous epithelium

a. endothelium

Blood passes from the arterial to the venous system via

a. arterioles

b. capillaries

c. veins

d. arteries

b. capillaries

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

a. contact activation with collagen

Endothelium is involved in the metabolism and clearance of

molecules such as

a. serotonin

b. angiotensin

c. bradykinin

d. all of the above

d. 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.

d. 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 megakaryocytic type of blood cell

d. All of the above

d. All of the above

Which of the following is (are) true of thrombopoietin?

a. Thought to stimulate the production and maturation of

megakaryocytes

b. Is influenced by various cytokines, which increase

megakaryocyte size

c. Is influenced by various cytokines, which impact maturational stage and ploidy

d. All of the above

d. 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 to 12 days.

c. Cytoplasm is light blue with fine red-purple granules.

d. A discoid shape as an inactive cell.

a. The presence of a nucleus

The cellular ultrastructural component unique to the platelet is the

a. cytoplasmic membrane

b. glycocalyx

c. mitochondrion

d. microtubule

b. glycocalyx

Choose the incorrect statement regarding storage granules related

to hemostasis in the mature platelet.

a. Alpha-granules contain platelet factor 4, beta-thromboglobulin,

and platelet-derived growth factor.

b. Alpha-granules contain platelet fibrinogen and von Willebrand

factor.

c. Dense bodies contain serotonin and ADP.

d. Lysosomes contain actomyosin, myosin, and filamin.

d. Lysosomes contain actomyosin, myosin, and filamin.

At all times, approximately ______ of the total number of platelets

are in the systemic circulation.

a. one fourth

b. one third

c. one half

d. two thirds

d. two thirds

The reference range of platelets in the systemic circulation is

a. 50 to 150 × 10^9 /L

b. 100 to 200 × 10^9 /L

c. 150 to 350 × 10^9 /L

d. 150 to 400 × 10^9 /L

d. 150 to 400 × 10^9 /L

The functions 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

b. formation of a platelet plug

If vascular injury exposes the endothelial surface and underlying

collagen, platelets (21A) ______ to the collagen fibers and (21B)

______.

a. adhere

b. aggregate

c. do not adhere

d. both a and b

a. adhere

The end production of _________ occurs with platelet

aggregation.

a. thromboxane A2

b. cyclooxygenase

c. prostacyclin

d. arachidonic acid

b. cyclooxygenase

Agents that are capable of aggregating platelets include

a. collagen

b. thrombin

c. serotonin

d. all of the above

d. all of the above

Examination of a Wright-stained peripheral blood smear provides

an estimate of platelet numbers. Using 100× (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

c. 20

If 10 platelets are seen per oil immersion field, what is the approximate platelet count?

a. 50 × 10 9 /L

b. 100 × 10 9 /L

c. 150 × 10 9 /L

d. 200 × 10 9 /L

d. 200 × 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

a. 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

b. platelet adhesion and aggregation on locally injured vascular

subendothelium

The clot retraction test is

a. a visible reaction to the activation of platelet actomyosin

(thrombosthenin)

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

b. a reflection of the quantity and quality of platelets and other

factors

Which of the following is a condition associated with purpura?

a. Direct endothelial damage

b. Inherited disease of the connective tissue

c. Mechanical disruption of small venules

d. All of the above

d. All of the above

Wiskott-Aldrich syndrome is characterized by

a. Giant platelets

b. Smallest platelets seen

c. Large platelets

d. Absence of platelets

b. Smallest platelets seen

May-Hegglin anomaly is characterized by

a. Giant platelets

b. Smallest platelets seen

c. Large platelets

d. Absence of platelets

c. Large platelets

Bernard-Soulier syndrome is characterized by

a. Giant platelets

b. Smallest platelets seen

c. Large platelets

d. Absence of platelets

a. Giant platelets

Acquired platelet dysfunction can be caused by

a. Aspirin

b. von Willebrand's disease

c. Uremia

d. Factor V deficiency

c. Uremia

Drug-induced platelet dysfunction can be caused by

a. Aspirin

b. von Willebrand's disease

c. Uremia

d. Factor V deficiency

a. Aspirin

Hereditary platelet dysfunction can be caused by

a. Aspirin

b. von Willebrand's disease

c. Uremia

d. Factor V deficiency

b. von Willebrand's disease

An example of an agent that does not produce significantly

decreased primary platelet aggregation in patients suffering from

Glanzmann's thrombasthenia is

a. Collagen

b. Ristocetin

c. ADP

Thrd. ombin

a. Collagen

When comparing von Willebrand's disease and Glanzmann's

thrombasthenia, Glanzmann's thrombasthenia will demonstrate

a. Absent ADP

b. Normal clot retraction

c. Abnormal ristocetin aggregation

d. Abnormal release of ADP

a. Absent ADP

Fibrinogen group consists of

a. factors II, VII, IX, and X

b. factors I, V, VIII, and XIII

c. factors XI, XII, prekallikrein, and high-molecular weight

kininogen

b. factors I, V, VIII, and XIII

Prothrombin group consists of

a. factors II, VII, IX, and X

b. factors I, V, VIII, and XIII

c. factors XI, XII, prekallikrein, and high-molecular weight

kininogen

b. factors I, V, VIII, and XIII

Contact group consists of

a. factors II, VII, IX, and X

b. factors I, V, VIII, and XIII

c. factors XI, XII, prekallikrein, and high-molecular weight

kininogen

c. factors XI, XII, prekallikrein, and high-molecular weight

kininogen

The fibrinogen group of coagulation factors is

a. known to increase during pregnancy

b. known to increase in conditions of inflammation

c. known to increase subsequent to the use of oral

contraceptives

d. all of the above

d. all of the above

The prothrombin group of coagulation factors is

a. dependent on vitamin K for production

b. considered to be stable

c. well preserved in stored plasma

d. all of the above

d. all of the above

Warfarin acts by

a. neutralizing the effects of thrombin

b. interfering with fibrin monomer formation

c. acting as a vitamin K antagonist

d. inducing hypercoagulation

c. acting as a vitamin K antagonist

Warfarin drugs interfere with the normal synthesis of factor(s)

a. II

b. VII

c. X

d. all of the above

a. II

Vitamin-K dependent coagulation factors include factor(s)

a. II

b. V

c. VIII

d. XIII

a. II

Symbolic designation for thrombin is

a. III

b. XII

c. VIII

d. IIa

d. IIa

Symbolic designation for tissue thromboplastin is

a. III

b. XII

c. VIII

d. IIa

a. III

Symbolic designation for antihemophilic factor is

a. III

b. XII

c. VIII

d. IIa

c. VIII

Symbolic designation for Hageman factor is

a. III

b. XII

c. VIII

d. IIa

b. XII

Arrange the four stages of coagulation in their proper

sequence.

a. Fibrinolysis

b. Formation of thrombin from prothrombin

c. Generation of plasma thromboplastin

d. Formation of fibrin from fibrinogen

C, B, D, A,

The extrinsic pathway of coagulation is triggered by the entry of

_______ into the circulation.

a. membrane lipoproteins (phospholipoproteins)

b. tissue thromboplastin

c. Ca^2+

d. factor VII

b. tissue thromboplastin

The intrinsic pathway of coagulation begins with the activation of

_______ in the early stage.

a. factor II

b. factor I

c. factor XII

d. factor V

c. factor XII

The final common pathway of the intrinsic-extrinsic pathway is

a. factor X activation

b. factor II activation

c. factor I activation.

d. factor XIII activation.

a. factor X activation

Prothrombin to thrombin conversion is accelerated by

a. a complex of activated factors IX and VII

b. factor V and ionized calcium

c. a complex of phospholipids and factor VII

d. a complex of activated factors X and V

b. factor V and ionized calcium

Fibrinogen is converted to fibrin monomers by

a. prothrombin

b. thrombin

c. calcium ions

d. factor XIIIa

b. thrombin

The inactive plasminogen is activated to _______ by proteolytic

enzymes.

a. prothrombin

b. plasmin

c. plasma kallikrein

d. plasma thromboplastin antecedent

b. plasmin

Which of the following statements are true of the fibrinolytic

system?

a. Plasmin digests fibrin and fibrinogen

b. The active enzyme of the system is plasmin

c. Inactive plasminogen circulates in the plasma until an injury

occurs

d. All of the above

d. All of the above

If a pediatric preoperative 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?

a. Lee-White clotting time

b. Clot retraction

c. Bleeding time

d. Fibrin split products

c. Bleeding time

A patient with a severe decrease in factor X activity would demonstrate normal

a. APTT

b. PT

c. thrombin time

d. bleeding time

d. bleeding time

Neither the APTT nor the PT detects a deficiency of

a. platelet factor 3

b. factor VII

c. factor VIII

d. factor IX

a. platelet factor 3

The function of thromboplastin in the prothrombin test is to provide

_______ to the assay.

a. kaolin

b. fibrinogen

c. phospholipoprotein

d. thrombin

c. phospholipoprotein

An abnormally prolonged APTT may indicate

a. a severe depletion of fibrinogen

b. the presence of a circulating anticoagulant

c. factor VIII deficiency

d. all of the above

d. all of the above

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?

a. APTT

b. PT

c. Fibrinogen assay

d. Thrombin time

b. PT

Which of the following conditions can cause an increased thrombin

time?

a. Fibrin split products

b. High concentrations of immunoglobulins

c. Heparin therapy

d. All of the above

d. All of the above

Heparin inhibits the clotting of blood by neutralizing the effect of

a. thrombin

b. calcium ions

c. platelets

d. factor VIII

a. 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 does the patient appear to be

deficient?

a. Factor II

b. Factor V

c. Factor VIII

d. Factor IX

c. Factor VIII

The normal protective mechanisms against thrombosis include

a. the flow of blood

b. the action of antithrombin.

c. protein C and protein S

d. all of the above

d. all of the above

If heparin therapy is initiated in a patient, a decreased

anticoagulant response can be caused by decreased levels of

a. platelet factor 3

b. platelet factor 4

c. antithrombin

d. factor XIII

b. platelet factor 4

Which of the following is (are) characteristic of protein C?

a. It is not vitamin K dependent.

b. It is formed in response to thrombin generation.

c. It inactivates factors Va and VIIIa.

d. Both B and C.

d. Both B and C.

Which of the following characteristics is (are) true of protein S?

a. It is a cofactor of protein C.

b. It increases the rate of inactivation of factor Va.

c. It enhances the binding of activated protein C to

phospholipids.

d. All of the above.

d. All of the above.

Antithrombin is the principal physiological inhibitor of

a. thrombin

b. factor Xa

c. factor XIa

d. both A and B

a. thrombin

Which of the following is not correct regarding cellular proteases?

a. They block the activation or action of plasmin.

b. They include alpha-2 inhibitor.

c. They rapidly neutralize the fibrinolytic properties of plasmin.

d. They participate in clot formation.

d. They participate in clot formation.

Which of the following parameters can be abnormal in classic von

Willebrand's disease type I?

a. Bleeding time

b. PT

c. Platelet count

d. All of the above

a. Bleeding time

Platelet aggregation studies in cases of classic von Willebrand's

disease should reveal

a. normal platelet aggregation when factors such as ristocetin are

used for testing

b. absence of aggregation when factors such as epinephrine are

used for testing

c. decreased aggregation when factors such as ristocetin are

used for testing

d. decreased ADP activity when tested

c. decreased aggregation when factors such as ristocetin are

used for testing

The most common form of von Willebrand's disease is

a. type I

b. type II

c. type III

d. all have about the same incidence

a. type I

Unique characteristic associated with a deficiency of factor XII

deficiency is

a. frequent nosebleeds

b. no history of bleeding

c. a common factor deficiency

d. decreased risk of forming blood clots

b. no history of bleeding

Disseminated intravascular coagulation (DIC) can be initiated by

a. septic shock

b. severe sepsis

c. hemolytic RBC crisis

d. all of the above

d. all of the above

Laboratory results in acute DIC reflect abnormalities in which of

the following coagulation components?

a. Platelet function

b. Excessive clotting and fibrinolysis

c. Accelerated thrombin formation

d. Fibrin formation

b. Excessive clotting and fibrinolysis

Primary fibrinolysis is characterized by

a. gross activation of the fibrinolytic mechanism

b. consumption of fibrinogen

c. consumption of coagulation factors

d. all of the above

d. all of the above

The hallmark of secondary fibrinolysis is the presence of

a. fibrin split products

b. fibrin degradation products

c. fibrin monomers

d. all of the above

d. all of the above

DIC is characterized by

a. microvascular thrombosis

b. fibrin deposition

c. active fibrinolysis

d. all of the above

d. all of the above

Which of the following factors can contribute to hypercoagulation?

a. Vascular endothelial damage

b. Increased blood flow

c. Decreased platelets

d. Decreased titers of clotting factors

a. Vascular endothelial damage

Oral contraceptives can cause a

a. primary hypercoagulable state

b. secondary hypercoagulable state

a. primary hypercoagulable state

Antithrombin deficiency can cause a

a. primary hypercoagulable state

b. secondary hypercoagulable state

b. secondary hypercoagulable state

Protein C deficiency can cause a

a. primary hypercoagulable state

b. secondary hypercoagulable state

a. primary hypercoagulable state

Cancer can cause a

a. primary hypercoagulable state

b. secondary hypercoagulable state

b. secondary hypercoagulable state

Pregnancy can cause a

a. primary hypercoagulable state

b. secondary hypercoagulable state

b. secondary hypercoagulable state

A characteristic of circulating anticoagulants is which of the

following?

a. The most common specific factor inhibitor

b. Acquired inhibitors of clotting proteins

c. Also known as antiphospholipid or anticardiolipin

d. None of the above

b. Acquired inhibitors of clotting proteins

A characteristic of lupus anticoagulant is which of the following?

The most common specific factor inhibitor

a. The most common specific factor inhibitor

b. Acquired inhibitors of clotting proteins

c. Also known as antiphospholipid or anticardiolipin

d. None of the above

c. Also known as antiphospholipid or anticardiolipin

A characteristic of factor VIII inhibitor is which of the following?

a. The most common specific factor inhibitor

b. Acquired inhibitors of clotting proteins

c. Also known as antiphospholipid or anticardiolipin

d. None of the above

a. The most common specific factor inhibitor

Warfarin is a vitamin ________ antagonist.

a. B

b. C

c. D

d. K

d. K