Unit 6 Flashcards
1
Q
Normal hemostasis depends on all of the following except
A
Inadequate numbers of platelets
2
Q
What is the sequence of events following injury to a small blood vessels?
A
- 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
3
Q
Which blood vessels have the thickest walls?
A
Arteries
4
Q
All blood and lymphatic vessels are lined with
A
Endothelium
5
Q
Blood passes from the arterial to the venous system via
A
Capillaries
6
Q
The initiating stimulus to blood coagulation following injury to a blood vessel is
A
Contact activation with collagen
7
Q
Endothelium is involved in the metabolism and clearance of molecules such as
A
*all of the above
- serotonin
- angiotensin
- bradykinin
8
Q
Which of the following is not correct? (1)
A
none of the above
9
Q
Which of the following is (are) true of endoreduplicaton?
A
- 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
10
Q
Which of the following is (are) true of thrombopoietin?
A
- 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
11
Q
Which of the following is not a characteristic of platelets?
A
The presence of a nucleus
12
Q
The cellular ultra structural component unique to the platelet is the
A
Glycocalyx
13
Q
Choose the incorrect statement regarding storage granules related to hemostasis in the mature platelet
A
Lysosomes contain actomyosin, myosin, and filamin
14
Q
At all the times, approximately ______ of the total number of platelets are in the system circulation `
A
Two thirds
15
Q
The reference range of platelets in the system circulation is
A
150 to 400 X 10^9/L
16
Q
The functions of platelets in response to vascular damage include
A
Formation of platelet plug
17
Q
If vascular injury exposes the endothelial surface and underlying collagen, platelets______ to the collagen fibers and _______
A
Adhere
18
Q
The end production of ___________ occurs with platelet aggregation
A
Cyclooxygenase
19
Q
AGents that are capable of aggregating platelets include
A
*all of the above `
- Collagen
- thrombin
- serotonin
20
Q
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
A
20
21
Q
If 10 platelets are seen per oil immersion field, what is the approximate platelet count?
A
200 X 10^9/L
22
Q
Aspirin ingestion has the following hemostatic effect in a normal person:
A
Prolongs the bleeding time
23
Q
The bleeding time test measures
A
Platelet adhesion and aggregation on locally injured vascular subendothelium
24
Q
The clot retraction test is
A
A reflection of the quantity and quality of platelets and other factors `
25
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
26
Wiskott-Aldrich syndrome is characterized by
Smallest platelets seen
27
May-Hegglin anomaly is characterized by
Large platelets
28
Bernard-soulier syndrome is characterized by
Giant platelets
29
Acquired platelet dysfunction can be caused by
Uremia
30
Drug-induced platelet dysfunction can be caused by
Aspirin
31
Hereditary platelet dysfunction can be caused by
Von Willebrand’s disease `
32
An example of an agent that does not produce significantly decreased primary platelet aggregation in patients suffering from glanzmanns thrombasthenia is
Collagen
33
When comparing Von willebrand’s` disease and glanzmanns thrombasthernia, glanzmanns thrombasthernia will demonstrate
Absent ADP
34
Fibrinogen group consists of
Factors I, V, VIII,and XIII
35
Prothrombin group consists of
Factors II, VII, IX, and X
36
Contact group consists of
Factors XI, XII, prekallikrein, and high-molecular weight kininogen
37
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
38
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
39
Warfarin acts by
Acting as a vitamin K antagonist
40
Warfarin drugs interfere with the normal synthesis of factors
II
41
Vitamin- dependent coagulation factors include factors
II
42
Symbolic designation for thrombin is
IIa
43
Symbolic designation for antihemophilic factor is
VIII
44
Symbolic designation for tissue thromboplastin is
III
45
Symbolic designation for Hageman factor is
XII
46
What is the proper sequence of the four stages of coagulation in their proper sequence?
1. Generation plasma thromboplastin
2. Formation of thrombin from prothrombin
3. Formation of fibrin from fibrinogen
4. Fibrinolysis
47
The extrinsic pathway of coagulation is triggered by by the entry of _______ into the circulation
Tissue thromboplastin
48
The intrinsic pathway of coagulation begins with the activation of _______ in the early stage
Factor XII
49
The final common pathway of the intrinsic-extrinsic pathway is
Factor X activation
50
Prothrombin to thrombin conversion is accelerated by
Factor V and ionized calcium
51
Fibrinogen is converted to fibrin monomers by
Thrombin
52
The inactive plasminogen is activated to______ by proteolytic enzymes
Plasmin
53
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
54
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
55
A patient with a severe decrease in factor X activity would demonstrate normal
Bleeding time
56
Neither the APTT nor the PT detects a deficiency of
Platelet factor 3
57
The function of thromboplastin in the prothrombin test is to provide ____ to the assay
Phospholipoprotein
58
An abnormally prolonged APTT may indicate:
* all of above
- a severe depletion of fibrinogen
- the presence of a circulating anticoagulant
- factor VIII deficiency
59
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
60
Which of the following conditions can cause an increased thrombin time?
*all of the above
- fibrin split products
- high concentrations of immunoglobulins
- heparin therapy
61
Heparin inhibits the clotting of blood by neutralizing the effeft of
Thrombin
62
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
63
The normal protective mechanism against thrombosis include
*all of the above
- the flow of blood
- the action of antithrombin
- protein C and protein S
64
If heparin therapy is initiated in a patient, a decreased anticoagulant response can be caused by decreased levels of
Platelet factor 4
65
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
66
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
67
Antithrombin is the principal physiological inhibitor of
Thrombin
68
Which of the following is not correct regarding cellular proteases?
- they participate in clot formation
69
Which of the following parameters can be abnormal in classic Von willebrands disease type I?
Bleeding time
70
Platelet aggregation studies in cases of classic Von willebrands diasease should reveal
Decreased aggregation when factors such as ristocetin are used for testing
71
The most common form of Von willebrands disease is
Type I
72
Unique characteristic associated with deficiency of factor XII deficiency is
No history of bleeding
73
Disseminated intravascular coagulation (DIC) can be initiated by:
* all of the above
- septic shock
- severe sepsis
- hemolytic RBC crisis
74
Laboratory results in acute DIC reflect abnormalities in which of the following coagulation components?
Excessive clotting and fibrinolysis
75
Primary fibrinolysis is characterized by
* all of the above
- gross activation of fibrinolytic mechanism
- consumption of fibrinogen
- consumption of coagulation factors
76
The hallmark of secondary fibrinolysis is the presence of
* all of the above
- fibrin split products
- fibrin degradation products
- fibrin monomers
77
DIC is characterized by
* all of the above
- microvascular thrombosis
- fibrin deposition
- active fibrinolysis
78
Which of the following factors a contribute to hypercoagulation?
Vascular endothelial damage
79
Antithrombin deficiency can cause a
Primary hypercoagulable state
80
Oral contraceptives can cause a
Secondary hypercoagulable state
81
Protein C deficiency can cause a
Primary hypercoagulable state
82
Cancer can cause a
Secondary hypercoagulable state
83
Pregnancy can cause a
Secondary hypercoagulable state
84
A characteristic of circulating anticoagulants is which of the following?`
Acquired inhibitors of clotting proteins
85
A characteristic of lupus anticoagulant is which of the following
Also known as antiphospholipid or anticardiolipin
86
A characteristic of factor VIII inhibitor is which of the following?
The most common specific factor inhibitor
87
Warfarin is a vitamin _______ antagonist
K
88
The anatomical structures associated with the circulation of CSF are
Ventricles and subarachnoid spaces
89
CSF production is associated with the
Choroid plexus and ependymal lining
90
CSF is collected from an intervertebral space between the ______ and ______ vertebrae
L4, L5
91
Tube 1 is commonly for
Chemical and serological examination
92
Tube 2 is commonly used for
Microbial examination
93
Tube 3 or the final tube is commonly used for
Gross examination, cell counting, and morphology examination
94
A cloudy and turbid specimen is most commonly caused by :
Increased numbers of leukocytes
95
A grossly bloody specimen is most commonly caused b`y
Subarachnoid hemorrhage
96
A xanthochromic (yellow color) specimen is most commonly caused by
Subarachnoid hemorrhage (more than 12 hours after the bleed)
97
Gel formation in a specimen is most commonly caused by
Increased fibrinogen
98
Intravascular rupture of brain abscess is associated with
Extremely elevated leukocyte count in CSF
99
Viral infection is associated with
Lymphocytosis
100
A leukocyte count of 0 to 5 X 10^6/L is associated with
Normal leukocyte reference range for CSF
101
Bacterial infection is associated with
Increased polymorphonuclear segmented neutrophils (PMNs) is CSF
102
CNS leukemia or lymphoma is associated with
Macrophages `
103
Normal CSF contains
Lymphocytes and ependymal cells
104
The cell count on a CSF specimen should be performed within _______ of collection
1 hour
105
Clotting in CSF may be caused by
Increased protein concentration
106
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
107
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
108
The observation of cloudy CSF samples suggests
Bacterial infection present `
109
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
110
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`
111
Pleura
Covers the lungs
112
Peritoneum
Covers abdominal walls and viscera of the abdomen
113
Pericardium
Is a fibrous sac around the heart
114
Conditions not associated with pleural effusion induce
Viral pneumonia
115
Yellow and turbid is a representative exudate appearance typically associated with
Infectious process
116
Milky is a representative exudate appearance typically associate with
Chylothorax
117
Bloody is a representative exudate appearance typically associated with
Malignancy in the absence of trauma
118
Clearly visible pus is a representative exudate appearance typically associated with
Empyema
119
Foul odor is a representative exudate appearance typically associated with
Anaerobic bacterial infection
120
Pleural fluid can have a white supernatant fluid after centrifugation owing to
Presence of Chylomicrons
121
An extremely elevated leukocyte concentration in pleural fluid is typically associated with
Empyema
122
Which of the following cells can be seen in pleural fluid?
* All of the above
- LE cells
- mononuclear phagocytes
- mesothelial cells
123
All of the following describe the characteristics of malignant cells except
Smooth chromatin
124
Many neutrophils, histiocytes and mesothelial cells are associated with (a)
Acute bacterial inflammation
125
Abundant, multinuclear cells and clusters of cells are associated with a(n)
Metastatic adenocarcinoma
126
Many malignant cells (in clusters) are associated with a(n)
Malignant mesothelioma
127
Many lymphocytes, mesothelial cells, histiocytes, and plasma cells are associated with a(n)
Viral infection
128
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
129
The cause of peritoneal effusion include all of the following except
TB
130
An abnormal-appearing peritoneal effusion can be caused by all of the following except
TB peritonitis `
131
The peritoneal effusion color of pale yellow is associated with
Normal
132
The peritoneal effusion color of straw colored is associated with
Congestive heart failure
133
The peritoneal effusion color of blood is associated with
Pulmonary infarct
134
An extremely increased leukocyte concentration in peritoneal fund can be caused by
Bacterial peritonitis
135
Eosinophils are associated with with
Chronic peritoneal dialysis
136
Lymphocytes are associated with
Congestive heart failure, cirrhosis, and nephrotic syndrome
137
Mesothelial cells are associated with
TB peritonitis
138
Infection agents are associated with
Coxsackie group viruses
139
Collagen vascular disease is associated with
Rheumatic disease
140
Neoplastic disease is associated with
Mesothelioma
141
A cause of an increased concentration of cells in peripheral fluid is
*both A and B
- microbial infection
- malignancy
142
Testicles are associated with
Sperm
143
Seminal vesicles are associated with
Fructose and prostaglandins
144
Prostrate gland is associated with
p30 glycoprotein
145
Cowper glands are associated with
Unknown
146
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
147
The normal value of sperm cells is ______ X 10^9/L
60-150
148
The reference value for sperm motility (fresh specimen) is
Greater than 60%
149
The reference value for sperm morphology is
40-90% (mature and oval headed)
150
The reference value for sperm agglutination is
At least 50%
151
A consideration value for specimens used for artificial insemination
Test for infectious disease
152
Arthrocentesis is
A liquid biopsy
153
Disorders than can be diagnosed definitively by synovial fluid analysis are
Gout, CPPD deposition disease, and septic arthritis
154
Which of the following would not be as aspiration site for synovial fluid?
Posterior iliac crest
155
If a synovial fluid aspirate is very turbid and septic arthritis is suspected, a ______ should definitely be performed
Gram’s stain and culture
156
Crystals that are in multiple three-dimensional forms are
CPPD crystals
157
An increased percentage of polymorphonuclear segmented neutrophils (PMNs) is characteristic of
Septic arthritis
158
MSU is associated with
Acute gouty arthritis
159
Calcium oxalate is associated with
Chronic renal disease
160
Cholesterol is associated with
Chronic rheumatoid effusions
161
Lipid liquid “Maltese cross” is associated with
Acute and chronic arthritis ````
162
Amniotic fluid consists of
* all of the above
- water
- proteins
- carbohydrates
163
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
164
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
165
For a normal prothrombin time, the following plasma factor is in adequate concentration is NOT required
Factor VIII
166
The degree of increased capillary fragility is reflected in the:
Number of petechiae
167
Which of the following coagulation factors is present in serum?
Factor VII
168
What is the best indicator of a bleeding disorder?
Bleeding time
169
Which of the following groups is Factor XI listed in?
Contact group
170
The precursor of thrombin is:
Prothrombin
171
All blood and lymphatic vessels are lined with:
Endothelium
172
Factor XIII is:
Necessary for formation of stable clot
173
A patient with severe decrease in Factor X activity would demonstrate abnormal results in the:
* both A and B
- APTT
PT
174
The conversion of fibrinogen to fibrin requires:
Thrombin
175
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
176
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
177
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
178
Hageman Factor is
Factor XII
179
A xanthochromic (yellow color) specimen is most commonly caused by:
Subarachnoid hemorrhage (more than 12 hours after the bleed)
180
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
181
The action of heparin is directly dependent on the amount of _________ in the blood.
Antithrombin III
182
Foul odor is a representative exudate appearance typically associated with
Anaerobic bacterial infection
183
Which of the following groups is consumed in the clotting process?
Fibrinogen group
184
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
185
Which of the following groups is the vitamin K-dependent group listed in?
Prothrombin group
186
The synonym for coagulation Factor X is:
Stuart-Prower factor
187
Alpha granules that are contained in platelets contain:
* A and B only
- PF4
- Von Willebrand’s Factor
188
What test will separate Von Willebrand’s Disease from Factor VIII deficiency?
Bleeding time
189
In pleural effusion, the percentage of ________ is extremely high in viral peritonitis
Lymphocytes
190
The prothrombin time (PT) is affected by levels of:
*All of the above
- Factor II
- Factor V
- Factor VIII
- Factor X
191
Von Willebrand factor is associated with which function?
Prothrombotic
192
Angiotensin II is associated with which function?
Constrictor
193
Anti-thrombin III inhibits:
1- Factor IXa
2- Factor Xa
3- Factor XIa
4- Factor XIIa
1, 2, 3, and 4
194
The Roman numerical nomenclature for fibrin-stabilizing factor is:
XIII
195
Which of the following groups is inhibited by warfarin?
Prothrombin group
196
Which of the following groups in increased in pregnancy?
Fibrinogen group
197
Platelet-activating factor is associated with which function?
Prothrombotic
198
Factor I is:
Fibrinogen
199
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
200
Thrombocytosis is:
An increase in platelets over 250 X 10^9/L
201
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
202
Which of the following coagulation is NOT vitamin-K dependent?
Factor VIII
203
Endothelin-I is associated with which function?
Constrictor
204
Which of the following tests monitor Coumadin therapy?
Prothrombin time
205
The bleeding time test measures:
The quality of platelets
206
Liable factor is:
Factor V
207
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
208
The synonym for coagulation Factor XI is:
Plasma Thromboplastin Antecedent
209
The synonym for coagulation Factor XI is:
Plasma thromboplastin antecedent
210
Which of the following anticoagulants is unsuitable for coagulation studies?
Sodium heparin
211
SHORT ANSWER: Hypercoaguable states can be caused by a deficiency in which 3 components?
- Protein S
- Factor Va
- Factor VIIIa
212
The molarity of the calcium chloride for APTT is:
0.025
213
Which of the following is the proper sequence for the four stages of coagulation?
Thromboplastin
Thrombin
Fibrin
Fibrinolysis
214
Prostacyclin is associated with which function?
Antithrombotic
215
In the intrinsic pathway, the first factor that requires the presence of calcium to continue the clotting process is:
Factor IX
216
Which of the following groups is Factor V listed in?
Fibrinogen group
217
The cause of idiopathic thrombocytopenia purpura (ITP) is:
Unknown
218
Heparin inhibits the clotting of blood by indirectly neutralizing the effect of:
Calcium ions
219
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
220
Thrombomodulin is associated with which function?
Antithrombotic
221
Which of the following groups is Factor II listed in?
Prothrombin Group
