Deck 32: Secondary Hemostasis and Fibrinolysis

Question 1

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

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

Answer 1

Noncatalytic domain

Question 2

Hemostasis depends on 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

Answer 2

The interaction between platelets, coagulation proteins, and blood vessels

Question 3

Which of the following degrades factors V and VIII?

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

Answer 3

Proteins C and S

Question 4

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

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

Question 5

The role of vitamin K in hemostasis is to:

A) Promote contact factor activation
B) Facilitate calcium binding to essential factors
C) Initiate extrinsic pathway activation
D) Cross-link the fibrin monomers

Question 6

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

A) Plasmin
B) Plasminogen
C) Tissue plasminogen activator
D) Fibrin

Question 7

Which of the following is not formed on a phospholipid surface?

A) Extrinsic Xase
B) Intrinsic Xase
C) Prothrombinase
D) Factor VIIa

Question 8

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

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

Question 9

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

A) HK and FXII
B) FXI and FIX
C) FVII and TF
D) FX

Question 10

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 11

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

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

Question 12

Activation of circulating zymogens is achieved through:

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

Question 13

Which of the following is not involved in "contact activation"?

A) Factor XII
B) Factor XI
C) PK
D) Factor X

Question 14

Which plasminogen activator (PA) is distinctive 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 15

The prothrombin group includes of which of the following?

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

Question 16

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

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

Question 17

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

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

Question 18

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

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

Question 19

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 20

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 21

Compare and contrast systemic and physiologic fibrinolysis.

Question 22

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

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

Question 23

What are the roles of thrombin in coagulation?

Question 24

Which of the following is a role of thrombin?

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

Question 25

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

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

Question 26

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 27

How do the following systems contribute to coagulation?
a. Complement
b. Fibrinolysis
c. Kinin

Question 28

Interpret the following results: • Patient: 12-year-old boy with unexplained bruising, swollen knee joints, and prolonged bleeding from injuries
• Screening tests:
O PT = 12.2 sec (control: 11.5-13.3 sec)/INR: 1.09
O APTT = 57 sec (control: 23-32 sec)
O 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 29

Complete the following table by listing the coag factors in the Intrinsic, Extrinsic and Common Pathways using both the Factor designation and common name.

Question 30

Which of the following is not a role of high molecular weight kininogen?

A) Accelerate the rate of surface-dependent activation of F-XII
B) Serves as a non-enzymatic cofactor in contact factor activation
C) Provide bradykinin
D) Accelerates the formation of Factor VIIa

Question 31

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 32

Fill in the missing factors in the traditional coagulation cascade:

Question 33

Thrombin activatable fibrinolysis inhibitor (TAFI) is defined as a:

A) Procoagulant
B) Anticoagulant
C) Profibrinolytic
D) Antifibrinolytic

Question 34

On which chromosome does the factor VIII locus reside?

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

Question 35

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