Deck 27: Interaction of the Fibrinolytic, Coagulation, and Kinin Systems; Disseminated Intravascular Coagulation; and Related Pathology

Question 1

Plasminogen is synthesized in the __________.

A) Liver
B) Kidney
C) Spleen
D) Bone marrow
E) None of the above

Answer 1

Liver

Question 2

Which of the following are characteristics of urokinase?

A) Synthesized by the kidney
B) Low affinity for fibrin
C) Excreted in the urine
D) None of the above
E) All of the above

Answer 2

All of the above

Question 3

Which diffuse pathologic form of coagulation results from an accentuated coagulation response leading to consumption of coagulation factors and platelets with subsequent fibrin thrombi throughout the microcirculation as well as the site of endothelial damage?

A) Fibrinolysis
B) Disseminated intravascular coagulation (DIC)
C) Coagulation
D) All of the above
E) None of the above

Answer 3

Disseminated intravascular coagulation (DIC)

Question 4

At concentration greater than 100 µg/mL, the FDPs are capable of:

A) Inhibiting platelet aggregation and release
B) Enhancing platelet aggregation and release
C) Enhancing platelet adhesiveness and release
D) Inhibiting platelet adhesiveness and release
E) None of the above

Question 5

Which of the following is/are an example(s) of plasminogen activators?

A) Urokinase
B) Streptokinase
C) Staphylokinase
D) TPA
E) All of the above

Question 6

Which fibrinogen degradation product (FDP) fragment is capable of clotting?

A) X
B) D
C) E
D) Y
E) None of the above

Question 7

Which serine protease proteolytically degrades both fibrin in clots and native fibrinogen in the circulation into a series of well-characterized end-products collectively known as fibrin/fibrinogen degradation products?

A) Protein C
B) Plasmin
C) Kallikrein
D) Plasminogen
E) None of the above

Question 8

Exogenous streptokinase is a product of __________.

A) Gamma-hemolytic streptococci
B) Alpha-hemolytic streptococci
C) Beta-hemolytic streptococci
D) Viridans streptococci
E) None of the above

Question 9

Elevated FDPs have which of the following effects?

A) Prolong thrombin time
B) Form soluble complexes with fibrin
C) Inhibit platelet function
D) None of the above
E) All of the above

Question 10

The __________ complex rapidly converts protein C to its activated state, resulting in proteolytic cleavage of activated factor V.

A) Prothrombin
B) Thrombin-thrombomodulin
C) Fibrin-fibrinogen
D) Plasmin-plasminogen
E) None of the above

Question 11

__________ activators are serine proteases present in the blood and a variety of other tissues, particularly the vascular endothelium.

A) Exogenous
B) Endogenous
C) Xenogenous
D) All of the above
E) None of the above

Question 12

The primary physiologic inhibitor of plasmin in-vivo is __________.

A) C1 inactivator
B) AT-III
C) α₂-Anti-plasmin inhibitor
D) α₂-Antitrypsin
E) None of the above

Question 13

The molecular components of the fibrinolytic system consist of all of the following except:

A) Plasminogen
B) Plasmin
C) Thrombin
D) α₂-anti-Plasmin inhibitor
E) Fibrin/fibrinogen

Question 14

Which substance forms a complex with protein C in the inhibition of activated factors V and VIII?

A) Protein S
B) Urokinase
C) Tissue plasminogen activator (TPA)
D) Kallikrein
E) None of the above

Question 15

₂-Anti-plasmin inhibitor irreversibly binds to the __________ binding site on plasmin in a 1:1 molar ratio.

A) Glutamic acid
B) Valine
C) Arginine
D) Lysine
E) None of the above

Question 16

Native plasminogen is a single-chain plasma __________ of approximately 90,000 daltons that circulates in two molecular forms.

A) Chromogen
B) Zymogen
C) Mitogen
D) All of the above
E) None of the above

Question 17

Streptokinase forms a 1:1 stoichiometric complex with __________.

A) Plasmin
B) Plasminogen
C) Thrombin
D) Prothrombin
E) None of the above

Question 18

Which form of plasminogen is more readily converted to active plasmin by plasminogen activators?

A) Glu-plasminogen
B) Val-plasminogen
C) Lys-plasminogen
D) Arg-plasminogen
E) None of the above

Question 19

What is the overall effect of ₂-anti-plasmin inhibitor?

A) Release free plasmin into circulation
B) Limits plasmin activity to the area of fibrin deposition
C) Inhibit clot lysis
D) All of the above
E) None of the above

Question 20

Venous occlusion and strenuous exercise release which of the following from the endothelium?

A) Activated protein C
B) Protein S
C) TPA
D) Thrombomodulin
E) All of the above

Question 21

Therapy in DIC is directed at:

A) Treatment of the underlying pathologic stimulus
B) Removal of the underlying pathologic stimulus
C) Maintenance of blood volume and hemostatic function
D) All of the above
E) None of the above

Question 22

The secondary action of the fibrinolytic system in DIC involves the action of __________ on fibrin/fibrinogen.

A) Thrombin
B) Prothrombin
C) Plasmin
D) Plasminogen
E) None of the above

Question 23

Diffuse hemorrhage present in DIC is the result of:

A) Increased platelets/decreased coagulation factors
B) Decreased platelets/increased coagulation factors
C) Decreased platelets/decreased coagulation factors
D) Vascular occlusion
E) None of the above

Question 24

What red cell morphology might you expect in DIC?

A) Ovalocytes
B) Teardrop cells
C) Schistocytes
D) Target cells
E) None of the above

Question 25

The pathophysiologic effect of DIC is reflective of the balance between:

A) Fibrin deposition
B) Fibrinolysis
C) Action of thrombin
D) Action of plasmin
E) All of the above

Question 26

Heparin therapy is most effective in the __________ state of DIC with evident vascular thrombosis.

A) Hypercoagulability
B) Compensatory
C) Decompensated
D) All of the above
E) None of the above

Question 27

The peripheral blood smear in DIC resembles that of:

A) Iron-deficiency anemia
B) Microangiopathic hemolytic anemia
C) Hemoglobin C disease
D) Megaloblastic anemia
E) None of the above

Question 28

Blood component replacement therapy in DIC includes transfusion of:

A) Packed red blood cells
B) Fresh frozen plasma
C) Platelets
D) Cryoprecipitate
E) All of the above

Question 29

Thrombin-anti-thrombin complexes are elevated in which of the following conditions?

A) TTP
B) DIC
C) Primary fibrinolysis
D) Heparin therapy
E) None of the above

Question 30

Which of the following is/are consistent with a compensated state of DIC?

A) Increased fibrinopeptide A
B) Soluble fibrin monomer complexes
C) Increased FDPs
D) Increased D-dimer levels
E) All of the above

Question 31

Which laboratory test differentiates compensated DIC from a state of hypercoagulability DIC?

A) PT
B) APTT
C) TT
D) Reptilase time
E) None of the above

Question 32

DIC associated with conditions activated by factor X include which of the following?

A) Acute pancreatitis
B) Snake venom
C) Liver disease
D) Fat emboli syndrome
E) All of the above

Question 33

All of the following are known mechanisms for activation of the coagulation cascade except:

A) Activation of the extrinsic coagulation pathway by factor XIa
B) Activation of the extrinsic coagulation pathway by the release of tissue thromboplastin
C) Activation of the intrinsic coagulation pathway by factor XIIa
D) Direct activation of factor X or II
E) None of the above

Question 34

What is meant by primary fibrinolysis?

A) Thrombin is formed without coagulation taking place.
B) Plasmin is formed without coagulation taking place.
C) Formation of plasmin with evidence of coagulation
D) Formation of thrombin with evidence of coagulation
E) None of the above

Question 35

Which laboratory tests are abnormal in DIC?

A) Prothrombin time (PT)
B) Activated partial thromboplastin time (APTT)
C) Reptilase clotting time
D) Thrombin time (TT)
E) All of the above

Question 36

Which of the following are laboratory tests to detect the action of plasmin on fibrin/fibrinogen?

A) D-dimer assay
B) Euglobulin test
C) Level of plasminogen in plasma
D) FDPs
E) All of the above

Question 37

Which term refers to a condition of DIC in which active hemorrhage is evident and the consumption of coagulation factors and platelets exceeds the capacity to increase the synthesis of these components?

A) Decompensated
B) Compensated
C) Hypercoagulability
D) All of the above
E) None of the above

Question 38

DIC due to direct activation of factor VII seen after massive injury results from:

A) Release of tissue thromboplastin
B) Release of calcium
C) Plasminogen activation
D) Thrombo-thrombomodulin complex
E) None of the above

Question 39

Which laboratory test differentiates decompensated DIC from compensated DIC?

A) PT
B) APTT
C) Fibrinogen
D) All of the above
E) None of the above

Question 40

The clinical picture in DIC is dependent on:

A) Duration of the triggering stimulus
B) Functional ability of the reticuloendothelial system (RES) to remove activated coagulation factors
C) Compensatory ability of the liver and bone marrow to accelerate platelet production
D) Organ involvement
E) All of the above

Question 41

Which of the following has/have been used in the treatment of TTP?

A) Antiplatelet drugs
B) Plasmapheresis
C) Exchange transfusion
D) None of the above
E) All of the above

Question 42

Which laboratory test differentiates primary fibrinolysis from DIC?

A) Platelet count
B) PT
C) APTT
D) TT
E) None of the above

Question 43

Which of the following procedures or disease states is/are associated with mechanisms of primary fibrinolysis?

A) Urologic procedures
B) Metastatic prostatic carcinoma
C) Cirrhosis
D) Cardiopulmonary bypass surgery
E) All of the above

Question 44

Thrombotic thrombocytopenic purpura (TTP) represents an abnormality of the fibrinolytic system in which there is diminished __________ activity in plasma and blood vessels affected with microthrombi.

A) Tissue thromboplastin
B) TPA
C) Thrombin
D) Protein C
E) None of the above