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exam 1 material

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1
what are the stages of coagulation
  • primary hemostasis
  • clot formation
  • secondary hemostasis
  • fibronolysis
  • tertiary hemostasis
2
what is primary hemostasis
  • injury factors signal to the body that a clot needs to form, vessels constrict
  • coagulation factors begin making fibrin to stabilize platelet plug
  • injury to a blood vessel, vessel constriction, then platelet accumulation
  • clot breaks down after wound heals
3
how is a chemically stable fibrin clot made
  • clot is made in the liver and sent to the injury site
  • fibrin strands react individually and bridge the gap
  • series of related, enzyme-mediated reactions reinforce the platelet plug
  • area of injury secretes factors that form fibrin plug
4
zymogens are:
  • signaling molecules released when vessels are injured
  • active coag factors
  • inactive coag factors
  • released during secondary hemostasis
5
end result of activated zymogens
  • initiation of primary hemostasis
  • fibrin clot degradation
  • blood vessel healing
  • fibrin clot formation
6
where are zymogens found
  • liver
  • lymphatic fluid
  • blood
  • bone marrow
7
main site of coag factor production
  • liver
  • pancreas
  • circulating blood
  • bone marrow
8
factor I
  • fibrinogen
  • proaccelerin
  • tissue factor
  • prothrombin
9
factor II
  • calcium
  • prothrombin
  • proaccelerin
  • von willebrand factor
10
factor III
  • stuart factor
  • prothrombin
  • tissue factor
  • fibrinogen
11
factor IV
  • fibrin-stabilizing factor
  • calcium (Ca ++)
  • fibrinogen
  • antihemophilic factor
12
factor V
  • stuart factor
  • calcium (Ca ++)
  • proaccelerin
  • hagemaan factor
13
factor VII
  • antihemophilic factor
  • proconvertin (stable factor)
  • stuart factor
  • von willebrand factor
14
factor VIII
  • calcium (Ca ++)
  • fletcher factor
  • hageman factor (contact factor)
  • antihemophilic factor
15
vWf
  • von willebrand factor
  • proaccelerin
  • fibrinogen
  • stuart factor
16
factor IX
  • antihemophilic factor
  • plasma thromboplastin component (PTC)
  • proconvertin
  • fibrin-stabilizing factor
17
factor X
  • stuart factor
  • fletcher factor
  • von willebrand factor
  • hageman factor
18
factor XI
  • plasma thromboplastin antecedent (PTA)
  • plasma thromboplastin component (PTC)
  • fitzgerald factor
  • fletcher factor
19
factor XII
  • fletcher factor
  • hageman factor (contact factor)
  • plasma thromboplastin component (PTC)
  • fibrin-stabilizing factor
20
factor XIII
  • fibrin-stabilizing factor
  • tissue factor
  • hageman factor
  • antihemophilic factor
21
HK (high molecular weight kiminogen)
  • proconvertin
  • fitzgerald factor
  • fletcher factor
  • proaccelerin
22
PK (prekallikrein)
  • von willebrand factor
  • stuart factor
  • fitzgerald factor
  • fletcher factor
23
which of the following is NOT a group of coag factors
  • antihemophilic group
  • fibrinogen group
  • contact group
  • prothrombin group
24
fibrinogen group includes factors
  • I, VI, VIII, XII
  • I, V, VIII, XIII
  • I, V, VII, XIII
  • II, V, VIII, XII
25
all factors in this group are consumed during the process of coag
  • prothrombin
  • proconvertin
  • contact
  • fibrinogen
26
where can the factors of the fibrinogen group be found in the body
  • present in plasma, absent in serum
  • only found in the liver
  • present in both plasma and serum
  • absent in plasma, present in serum
27
which factors make up the prothrombin group
  • II, VI, XII, XIII
  • II, VII, IX, X
  • III, VII, IX, X
  • I, V, VII, VIII
28
factors of this group (aside from factor II) are not consumed during the process of coag
  • contact
  • proaccelerin
  • prothrombin
  • fibrinogen
29
which member of the prothrombin group is found only in plasma, unlike the rest which are found in both plasma and serum
  • factor III
  • factor II
  • factor X
  • factor VII
30
which vitamin is required for the synthesis of factors in the prothrombin group
  • vit B
  • vit A
  • vit B12
  • vit K
31
why is vit K required for the synthesis of factors in the prothrombin group
  • activates factors when an injury occurs
  • prevents factors from binding calcium
  • allows for clot formation when other groups are unavailable or dysfunctional
  • allows factors to bind calcium
32
why is it important for calcium to bind to factors in the prothrombin group
  • binding is required to activate the factors
  • binding signals to factors in other families to start working
  • binding causes a conformational change that allows them to interact
  • binding helps fibrin strands come together and form a plug
33
which factors are in the contact group
  • XI, XII, PK, vWf
  • X, XIII, PK, HK
  • VII, VIII, X, XIII
  • XI, XII, PK, HK
34
factors of this group are not consumed during coag
  • contact
  • thromboplastin
  • prothrombin
  • fibrinogen
35
where are factors in the contact group found
  • present in plasma and serum
  • only factor XII is found in plasma, the rest are found in serum
  • present in plasma, absent in serum
  • absent in plasma, present in serum
36
what is a requirement for the activation of factors in the contact group
  • reception of signaling molecule from the liver
  • binding with calcium
  • contact with a surface
  • binding with vit K
37
the ______ and _______ pathways come together in the _______ pathway
  • internal, external, vascular
  • intrinsic, extrinsic, vascular
  • intrinsic, extrinsic, common
  • hepatic, extrinsic, common
38
which pathway is necessary for large amounts of fibrin
  • common
  • all of the above
  • extrinsic
  • intrinsic
39
which substance not normally present in blood serves as the start of the extrinsic pathway
  • fibrinogen
  • vit K
  • von willebrand factor
  • tissue factor/tissue thromboplastin
40
how does tissue factor/tissue thromboplastin serve as the start of the extrinsic pathway
  • it enters the vascular endothelium when a clot needs to be dissolved
  • it's a glycoprotein that's only expressed in the presence of vit K
  • it's exposed to the bloodstream when a blood vessel is injured
  • it stops the process of the intrinsic pathway
41
tissue factor/thromboplastin combines with ________ to begin the extrinsic pathway
  • vit K
  • factor XII
  • fibrinogen
  • factor VII
42
what is required for the activation of the serine protease factor VIIa
  • serine cleavage of zymogen factor V
  • serine cleavage of zymogen factor VII
  • binding to calcium
  • interaction with fibrinogen
43
at what point during the coag process is the clot formed
  • end of the common pathway
  • during the transition from the extrinsic to common pathway
  • end of the extrinsic pathway
  • end of the intrinsic pathway
44
what are the components that make up the extrinsic Xase complex
  • factor VIIa, TF, calcium
  • von willebrand factor, TF, vit K
  • factor VIIa, TF, vit K
  • factor VIIa, fibrinogen, calcium
45
exposure to negatively charged foreign subtstances such as collagen or subendothelium can activate ______
  • factor XII -> factor XIIa
  • factor HK -> PK
  • factor VIII -> factor VIIIa
  • factor XII -> factor XIII
46
describe the process of secondary hemostasis
  • platelets aggregate at the site of injury
  • coag factors form fibrin that stabilize the plt plug
  • coag factors initiate the intrinsic pathway
  • blood vessel injury signals to circulating factors that a clot must be formed
47
which of the following is not a step in the process of primary hemostasis
  • platelet shape change
  • platelet accumulation
  • platelet secretion of granules
  • platelet activation
  • platelet aggregation
  • platelet adhesion
48
which factors are considered labile?
  • V, VII
  • V, VIII
  • VIII, IX
  • VII, VIII
49
which factors are cofactors?
  • III, V, VIII
  • V, VIII, XII
  • II, III, IX
  • III, VI, VII
50
why is the INR important
  • it's used to correct for differences in reagents/instruments in PT testing
  • it corrects for differences in clotting time for patients on anticoagulants
  • it's used to calculate accurate aPTT results
  • none of the above
51
reference range for platelet count
  • 150-450 x 10^6 /microliter
  • 150-450 x 10^3 /microliter
  • 150-450 x 10^9 /microliter
  • 150-450 x 10^5 /microliter
52
what is the purpose of vasoconstriction following an injury?
  • recuit factors for the extrinsic pathway
  • minimizes blood flow to wound area
  • allow blood to come into contact with collagen in the subendothelium
  • trigger local release of epinephrine and a myogenic spasm
53
what hormone is secreted by endothelial cells that serves as a vasoconstrictor
  • thromboplastin
  • endothelin
  • epinephrine
  • collagen
54
what is the difference between intact and damaged endothelial cells during coagulation
  • intact, negatively charged cells repel platelets and proteins
  • injured, negatively charged cells repel platelets and proteins
  • intact, positively charged cells repel platelets and proteins
  • injured, positively charged cells repel platelets and proteins
55
what cells immediately begin forming a plug to stop the bleeding caused by an injury
  • intact endothelial cells
  • platelets
  • red blood cells
  • injured endothelial cells
56
what is platelet adhesion
  • platelets extends its membrane into pseudopods to increase contact with other platelets
  • vWf is released into plasma, binds to GPIb, and attaches platelets to collagen in the blood vessel wall
  • platelets generate agonists thrombin and ADP to help bind platelets to colagen in the vessel wall
  • collagen attaches to GPIb receptor to recruit vWf
57
where is vWf made and what does it do
  • liver/megakaryocytes - activates granule release
  • bone marrow/megakaryocytes - binds to collagen
  • endothelial cells/liver - binds agonist TXA2
  • edothelial cells/megakaryocytes - binds GPIb receptor
58
what triggers platelet activation
  • binding of vWf to GPIb
  • adhesion of platelets to collagen
  • synthesis of myosin
  • release of vWf from endothelial cells
59
what is an agonist
  • agent that induces fibrolysis
  • agent that induces platelet activation
  • molecule that binds GPIb receptor
  • molecule that recruits activates platelets to plug
60
what are the 2 types of agonists
  • platelet derived, endothelial derived
  • surface binding, intracellular binding
  • platelet derived, non platelet derived
  • positive, negative
61
what is the purpose of platelet shape change
  • allow cytoskeleton to grow
  • increase surface area for more vWf binding
  • pseudopods decrease the chances of platelets coming into contact
  • pseudopods increase the chances of platelets coming into contact
62
what is secreted from platelets following their shape change?
  • light and dense granules
  • primary and secondary graunles
  • alpha and beta granules
  • alpha and dense granules
63
which are commonly found in alpha granules
  • thrombospondin, vWf, PDGF
  • thrombospondin, collagen, ADP
  • vWF, ADP, calcium
  • ADP, calcium, serotonin
64
which are commonly found in dense granules
  • ADP, potassium, serotonin
  • ADP, calcium, serotonin
  • PDGF, thrombospondin, vWf
  • vWf, calcium, dopamine
65
what is platelet aggregation
  • attachment of platelets to one another
  • attachment of platelets to the vessel wall
  • binding of vWf to GPIb
  • platelet pseudopods interlink
66
why do platelets secrete granules
  • granules participate in immune responses
  • granules release activated coag factors
  • they help the platelet attach to the vessel wall
  • their contents attract and activate new platelets
67
how is fibrin stabilizing factor (FXIII) activated
  • thrombin cleaves a peptide to form FXIIIa
  • prothrombin cleaves a peptide to form YXIIIa
  • binding with TF/FIII after a vessel is injured
  • fibrin crosslinks molecules of FXIII
68
what is the function of activated FXIII (FXIIIa)
  • it creates crosslinked fibrin
  • it converts prothrombin to thrombin
  • it converts fibrinogen to fibrin
  • it joins the prothrombinase complex
69
what PT/aPTT results would you expect from an underfilled blue top
  • both are falsely prolonged
  • both are falsely decreased
  • PT is prolonged, aPTT is normal
  • PT is normal, aPTTT is decreased
70
what is NOT tested by thromboelastography
71
what receptor participates in platelet aggregation but not paltelet adhesion
72
what is the activator for the PT test
  • tissue factor (III)
  • FV
  • FVIII
  • calcium chloride
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