Deck 29: Secondary Hemostasis and Fibrinolysis

Question 1

All of the following are necessary for a clot to form except:

A)Platelets.
B)Coagulation protein.
C)Plasmin.
D)Endothelial cells.

Answer 1

Plasmin.

Question 2

Which of the following degrades factors V and VIII?

A)TFPI
B)SERPINs
C)Proteins C and S
D)APS

Answer 2

Proteins C and S

Question 3

Which of the following is responsible for urokinase-catalyzed PLG activation?

A)ADAMTS-13
B)LRP
C)UPAR
D)EPCR

Answer 3

UPAR

Question 4

Platelet activation and subsequent formation of the platelet plug are involved in:

A)Primary hemostasis.
B)Secondary hemostasis.
C)Fibrinolysis.
D)Inhibitory system.

Question 5

Activation of the contact activation factors of the intrinsic pathway does not require which of the following components?

A)Vitamin K
B)Calcium
C)A serine protease
D)Kinins

Question 6

What is the role of vitamin K in hemostasis?

A)To promote contact factor activation
B)To facilitate calcium binding to essential factors
C)To initiate extrinsic pathway activation
D)To cross-link the fibrin monomers

Question 7

Which of the following is the smallest degradation product of fibrin?

A)Fragment X
B)Fragment Y
C)D-dimer
D)E fragment

Question 8

The substance directly responsible for the physical breakdown of the thrombus is:

A)Plasmin.
B)Plasminogen.
C)Tissue plasminogen activator.
D)F.
E)ibrin.

Question 9

Which of the following are formed on a phospholipid surface?

A)Extrinsic Xase
B)Intrinsic Xase
C)Prothrombinase
D)All of the above

Question 10

Which plasma PA is unique among the serine proteases because it does not circulate as a zymogen but is fully active toward its substrate plasminogen in a single-chain form?

A)uPA
B)uPAR
C)PLG
D)tPA

Question 11

Which of the following is responsible for cleaving ultra-large VWF multimers into functional units?

A)LRP
B)ADAMTS-13
C)EPCR
D)UPAR

Question 12

Activation of circulating zymogens is achieved through:

A)Sympathetic nervous system stimulation.
B)Endomitosis.
C)Splenic sequestration.
D)Proteolytic cleavage.

Question 13

What is the key component in secondary hemostasis that binds the platelets into a solid plug?

A)Fibrin
B)Tissue factor
C)Plasminogen
D)Thrombin

Question 14

Which of the following is primarily responsible for neutralizing the extrinsic tenase complex?

A)TFPI
B)SERPINs
C)Proteins C and S
D)APS

Question 15

The prothrombin group includes of which of the following?

A)Factor V
B)Factor VII
C)Factor XII
D)Factor VIII

Question 16

Why is vitamin K necessary for some coagulation proteins to become functional?

A)Vitamin K activates coagulation zymogens.
B)Vitamin K binds coagulation factors to a phospholipid surface.
C)Vitamin K combines with VWF in the circulation.
D)Vitamin K is required for gamma-carboxylation of glutamic acid residues.

Question 17

Which of the following coagulation factors are found in the extrinsic pathway?

A)HK and F-XII
B)F-XI and F-IX
C)F-VII and TF
D)F-X

Question 18

Which domain of the blood coagulation protein is responsible for its unique identity?

A)Signal peptide domain
B)Catalytic domain
C)Epidermal growth factor domain
D)Noncatalytic domain

Question 19

Hemostasis is dependent upon which of the following?

A)The interaction between coagulation and fibrinolysis inhibitors
B)The interaction between platelets, coagulation proteins, and blood vessels
C)The rate of platelet destruction
D)the rate of endothelial cell turnover
E)All of the above

Question 20

Which of the following are involved in "contact activation"?

A)Factor XII
B)Factor XI
C)PK
D)All of the above

Question 21

How do the following systems contribute to coagulation?

A)Complement
B)Fibrinolysis
C)Kinin

Question 22

During activation of coagulation, all of the following bind to the phospholipid membrane surface forming a complex except:

A)Procoagulant zymogen (substrate).
B)Coagulation inhibitors .
C)Procoagulant cofactors.
D)Activated serine protease.

Question 23

How does systemic fibrinolysis differ from physiologic fibrinolysis?

A)Systemic produces rapid fibrinolysis, whereas physiologic produces adequate fibrinolysis.
B)Systemic results from improper plasminogen activation, whereas physiologic results from proper plasminogen activation.
C)Physiologic is naturally occurring, whereas systemic results from an external trigger.
D)Physiologic is localized to the fibrin clot, whereas systemic results in circulating plasmin.

Question 24

On which chromosome does the factor VIII locus reside?

A)3
B)4
C)11
D)X

Question 25

Which of the following is a role of thrombin?

A)Anticoagulant (protein C activation)
B)Increases fibrinolysis
C)Inhibits endothelial cell release of tissue plasminogen activator
D)Inhibits the formation of fibrin monomers

Question 26

TAFI is defined as a:

A)Procoagulant.
B)Anticoagulant.
C)Pro-fibrinolytic.
D)Anti-fibrinolytic.

Question 27

Which of the following are role(s) of high molecular weight kininogen?

A)Accelerates the rate of surface-dependent activation of F-XII
B)Nonenzymatic cofactor in contact factor activation
C)Source of bradykinin
D)All of the above

Question 28

Thrombin activity impacts coagulation by which of the following mechanism(s)?

A)Altering blood flow
B)Positive feedback only
C)Negative feedback only
D)positive and negative feedback

Question 29

Compare and contrast systemic and physiologic fibrinolysis.

Question 30

What are the roles of thrombin in coagulation?

Question 31

What reflex test should be done on a patient with an abnormal APTT who is suspected of having hemophillia?

A)Platelet function assay
B)Factor assay
C)Quantitative fibrinogen assay
D)Assay for D-dimer

Question 32

Interpret the results below: -Patient: 12-year-old boy with unexplained bruising, swollen knee joints, and prolonged bleeding from injuries
-Screening tests:
-PT = 12.2 sec (control: 11.5-13.3 sec)/INR: 1.09
-APTT = 57 sec (control: 23-32 sec)
-Bleeding time = 5 min (control: 2-10 min)
Pending results from confirmation tests, this patient could be suffering from:

A)An intrinsic pathway problem.
B)An extrinsic pathway problem.
C)A primary hemostasis problem.
D)A common pathway problem.

Question 33

What factor does the extrinsic pathway require that the intrinsic and common do not?

A)Vitamin K
B)Zymogens
C)Tissue factor
D)tPA