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Hema 2 > Chp. 35,37,38 REVIEW QUESTIONS > Flashcards

Chp. 35,37,38 REVIEW QUESTIONS Flashcards

1
Q

What intimal cell synthesizes and stores von willebrand factor (vwf)?
a. Smooth msucle cell
b. Endothelial cells
c. Fibroblast
d. Platelet

A

Endothelial cells

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2
Q

What subendothelial structural protein triggers coagulation through activation of factor VII?
a. Thrombomodulin
b. Nitric oxide
c. Tissue factor
d. Thrombin

A

Tissue factor

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3
Q

What coagulation plasma protein should be assayed when platelets fail to aggregate properly.
a. Factor VIII
b. Fibrinogen
c. Thrombin
d. Factor X

A

Fibrinogen

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4
Q

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

A

Carboxylates the factor to allow calcium binding

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5
Q

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

A

Thrombin proteolysis of fibrinogen

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6
Q

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

A

Factor IXa, factor X

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7
Q

What protein secreted by endothelial cells activates fibrinolysis?
a. Plasminogen
b. TPA
c. PAI-1
d. TAFI

A

TPA

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8
Q

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

A

APC and Protein S

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9
Q

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

A

Mediate platelet adhesion and serve as a carrier molecule for factor VIII

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10
Q

Most coagulation factors are synthesized by what organ?
a. Liver
b. Monocytes
c. Endothelial cells
d. Megakaryocytes

A

Liver

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11
Q

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

A

Lead to the formation of a stable fibrin clot

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12
Q

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

A

Factor XIII

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13
Q

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

A

AT, TFPI

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14
Q

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

A

Inadequate numbers of platelets

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15
Q

The sequence of events following injury to a small blood vessel is _________ to ________ to ________ to __________ to __________

A
  • 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
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16
Q

Which blood vessels have the thickest walls?
a. Veins
b. Arteries
c. Capilliaries
d. Arterioles

A

Arteries

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17
Q

All blood and lymphatic vessels are lined with
a. Endothelium
b. Nerve endings
c. Stratified epithelial cells
d. Simple squamous epithelium

A

Endothelium

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18
Q

Blood passes from the arterial to the venous system via:
a. Arterioles
b. Capilliaries
c. Veins
d. Arteries

A

Capilliaries

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19
Q

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

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20
Q

Endothelium is involved in the metabolism and clearance of molecules such as:
a. Serotonin
b. Angiotensin
Bradykinin
d. All of the above

A

All of the above

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21
Q

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

A

None of the above

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22
Q

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

A

All of the above

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23
Q

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

A

All of the above

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24
Q

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

A

The presence of a nucleus

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25
Q

The cellular ultrastructural component unique to the platelet is the
a. Cytoplasmic membrane
b. Glycocalyx
c. Mitochondrion
d. Microtubule

A

Glycocalyx

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26
Q

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

A

Lysosomes contain actomyosin, myosin, and filamin

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27
Q

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

A

2/3

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28
Q

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

A

150 - 400 x 10^9/L

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29
Q

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

A

Formation of a platelet plug

30
Q

If vascular injury exposes the endothelial surface and underlying collagen, platelets __________ to the collagen fibers and ______

A

Adhere, Aggregate

31
Q

The end production of ________ occurs with platelet aggregation.
a. Thromboxane A2
b. Cyclooxygenase
c. Prostacyclin
d. Arachidonic acid

A

Cyclooxygenase

32
Q

Agents that are capable of aggregating platelets include
a. Collagen
b. Thrombin
c. Serotonin
d. All of the above

A

All of the above

33
Q

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

A

20

34
Q

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

A

200 x 10^9/L

35
Q

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

36
Q

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

A

Platelet adhesion and aggregation on locally injured vascular subendothelium

37
Q

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

A reflection of the quantity and quality of platelets and other factors

38
Q

What is the most common acquired bleeding disorder?
A. Trauma-induced coagulopathy
B. Vitamin K deficiency
C. Liver disease
D. VWD

A

Trauma-induced coagulopathy

39
Q

Which is a typical form of anatomic bleeding?
A Epistaxis
B Menorrhagia
C Hematemesis
D Central Nervous system bleed

A

Central nervous system bleed

40
Q

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

A

Factor VII deficiency, the PT

41
Q

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

A

Subtype 2B

42
Q

Which of the following conditions causes a prolonged thrombin time?
A Antithrombin Deficiency
B Prothrombin deficiency
C hypofibrinogenemia
D Warfarin therapy

A

hypofibrinogenemia

43
Q

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

A

Vitamin K and 4 factor PCC

44
Q

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

A

Factor XIII

45
Q

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

A

rFVIIa

46
Q

What is the most prevalent form of VWD?
A Type 1
B Type 2A
C Type 2B
D Type 3

A

Type 1

47
Q

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

A

Factor V assay

48
Q

Mucocutaneous hemorrhage is typical of:
A Acquired hemorrhagic disorders
B Localized hemorrhagic disorders
C Defects in primary hemostasis
D Defects in fibrnolysis

A

Defects in primary hemostasis

49
Q

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)

A

Bleeding into the joints (hemarthroses)

50
Q

A defect in GP IIb/IIIa causes:

a. Glanzmann thrombasthenia
b. Bernard-Soulier syndrome
c. Gray platelet syndrome
d. Storage pool disease

A

Glanzmann thrombasthenia

51
Q

Aspirin ingestion blocks the synthesis of:

a. Thromboxane A2
b. Ionized calcium
c. Collagen
d. ADP

A

Thromboxane a2

52
Q

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

A

Abnormal platelet response to ristocetin

53
Q

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

A

Storage pool defects

54
Q

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

A

Direct bidnding to GP IIb/IIIa

55
Q

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

A

Decreased numbers of alpha and dense granules

56
Q

Which is a congenital qualitative platelet disorder?

a. Senile purpura
b. Ehlers-Danlos syndrome
c. Henoch-Schönlein purpura
d. Waldenström macroglobulinemia

A

b. Ehlers-Danlos syndrome

57
Q

In uremia, platelet function is impaired by higher than normal levels of:

a. Urea
b. Uric acid
c. Creatinine
d. NO

A

NO

58
Q

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

A

Impaired membrane activation owing to protein coating

59
Q

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

A

Altered expression of phospholipids on the platelet membrane

60
Q

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

A

Anti-GP IIb/IIIa

61
Q

The autosomal dominant disorder associated with decreased platelet production is:

a. Fanconi anemia
b. TAR syndrome
c. May-Hegglin anomaly
d. Wiskott-Aldrich anomaly

A

May-Hegglin anomaly

62
Q

Which of the following is not a hallmark of ITP?

a. Petechiae
b. Thrombocytopenia
c. Large overactive platelets
d. Megakaryocyte hypoplasia

A

Large overactive platelets

63
Q

The specific antigen most commonly responsible for the development of NAIT is:

a. Bak
b. HPA-1a
c. GP Ib
d. Lewis antigen a

A

HPA-1a

64
Q

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

A

Acute ITP

65
Q

Which drug causes a reduction in platelet count by inhibiting megakaryocyte maturation?
A. Gold salts
B. Abciximab
C. Anagrelide
D. Quinidine

A

Anagrelide

66
Q

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

A

Mucosal bleeding

67
Q

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

A

The combination of the drug and the platelet membrane protein to which it is bound

68
Q

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

A

Abnormal bone formation, including hypoplasia of the forearms

69
Q

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

A

The mother has an autoimmune antibody to her own platelets, which crosses the placenta and reacts with the infant’s platelets

70
Q

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

A

Diarrhea caused by Shigella species

71
Q

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

A

Atypical HUS

72
Q

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

A

Thrombocytosis is self correcting

Hema 2 (6 decks)

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