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Topic 18. Pathophysiology of hemostasis and antihemostasis



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Topic 18. Pathophysiology of hemostasis and antihemostasis.
1. A 32-years-old male patient has hemorrhage after injury of vessel that connected to formation of friable thrombi. What coagulation factor deficiency has led to this disorder?

  1. II (prothrombin)

  2. III (thromboplastin)

  3. VII (proconvertin)

  4. XII (Hageman’s factor)

  5. XIII (fibrin stabilizing factor)*

2. A man, who has been to Arctic for a long time, has hemorrhage from gums, his teeth sway and pull out. What is the initial mechanism in scurvy development?



  1. Infringement of elastin synthesis

  2. Affection of alveolar process

  3. Impairment of collagen synthesis*

  4. Fragility of capillaries

  5. Insufficient tightness of round ligament of tooth

3. Preliminary exfoliation of placenta and hemorrhagic shock develop in a pregnant woman during the delivery. While taking woman’s blood for analysis it coagulates in syringe. The acute DIC syndrome is diagnosed in this woman. What pathogenic mechanism appears to be initial in disorder of hemostasis in this case?



  1. Activation of sympathetic-adrenal system

  2. Elevation of platelet aggregation

  3. Activation of tissue thromboplastin derived from destroyed tissues*

  4. Cascade activation of plasma coagulation factors

  5. Oppression of anticoagulative system of blood

4. It was found out before operating on that the patient has bleeding time increased up to 9 min. What blood cells deficiency do these changes result from?



  1. Monocytes

  2. Platelets*

  3. Erythrocytes

  4. Lymphocytes

  5. Leukocytes

5. Breathlessness, acute pain in the chest, cyanosis, and enlargement of neck veins rapidly develop in a patient suffered from thrombophlebitis. What is the most possible disorder of blood circulation in this patient?



  1. Pulmonary thromboembolism*

  2. Cerebral thromboembolism

  3. Coronary thromboembolism

  4. Mesenterial thromboembolism

  5. Portal thromboembolism

6. Numerous subcutaneous hemorrhages appear in a patient suffered from hepatic cirrhosis. What is a possible reason for this?

  1. Excessive decay of vitamin C

  2. Disorder of vitamin K synthesis

  3. Hypokalemia

  4. Reduction in synthesis of factor II (prothrombin)*

  5. Deficiency of factor III (thromboplastin) in blood plasma

7. Hemorrhagic syndrome with disorders of the third stage of blood coagulation develops in a patient after she was operated on uterus. What is the most probable mechanism of hemostasis disorder in this case?

  1. Qualitative abnormalities of fibrinogen

  2. Activation of fibrinolysis*

  3. Deficit of fibrin stabilizing factor

  4. Decrease in prothrombin synthesis

  5. Decrease in fibrinogen synthesis

8. Hemorrhagic diathesis has developed in a patient with streptococcus infection. What is the reason for hemorrhage development? A. Elevation of heparin content in the blood

  1. Vitamin A deficiency

  2. Increase in callicrein content in blood

  3. Enhanced fibrinolysis*

  4. Vitamin C deficit

9. Point hemorrhages appear on a forearm of a patient after putting a tourniquet on a patient’s arm. What functions of blood cells do these changes connect to?



  1. Neutrophils

  2. Platelets*

  3. Erythrocytes

  4. Basophils

  5. Macrophages

10. A teeth was pulled out from the patient with chronic hepatitis. Bleeding, which developed after that, could not be seized for 2 hours. Performed blood analysis establishes increase in content of several coagulation factors. What kind of hemostasis is damaged in this case?



  1. Platelet-vascular

  2. Coagulation*

  3. Vascular stasis

  4. Platelet reaction

  5. Vascular reaction

11. Numerous hemorrhages and bruises were found out on the patient’s body. At examination of this patient: his bleeding time by Duke is 25 min, his number of platelets is 25x109/L. What disease are these symptoms characteristic for?



  1. Hemophilia B

  2. Von Willebrand’s disease

  3. Vitamin C deficiency

  4. Hereditary defect of platelet formation*

  5. Hemophilia A

12. A 65-years-old male patient suffered from atherosclerosis was admitted to the surgical department because of diffuse purulent peritonitis. When the patient was operated on thrombosis of mesenterial vessels was diagnosed in him. What is the most possible reason for peritonitis development?



  1. Hemorrhagic infarction

  2. Angiospastic ischemia

  3. Ischemic infarction*

  4. Stasis

  5. Compressive ischemia

13. Hemorrhagic syndrome connected to disorders of the third phase of coagulation developed in a patient after hi was operated on pancreas. What is the possible mechanism of development of hemostasis disorder?



  1. Elevation in content of heparin in patient’s blood

  2. Reduction in fibrinogen synthesis

  3. Activation of fibrinolysis*

  4. Deficit of fibrin stabilizing factor

  5. Reduction in prothrombin synthesis

14. Sharp pain and edema of tissues develop in a patient with thrombosis of veins of his right calf. What is the possible consequence of thrombosis?



  1. Hypertrophy of tissues

  2. Circulatory hypoxia*

  3. Enhancement of drainage of tissues

  4. Intensification of metabolism

  5. Enhancement of functional activity of tissues

15. Thrombosis of coronary arteries occurs in a patient with atherosclerosis of cordial vessels. What is the reason for formation of thrombi?



  1. Heparin deficiency*

  2. Thrombocytopenia

  3. Acceleration of blood flow

  4. Activation of fibrinolysis

  5. Vitamin K deficiency

16. An elderly patient was admitted to the hospital with thrombosis of veins of his calf.

What is the reason for thrombosis development?


  1. Decrease in prothrombin concentration in blood

  2. Increase in heparin concentration in blood

  3. Injury of vessel wall*

  4. Slowing-down of blood flow

  5. Activation of plasmin

17. When examining a patient increased blood coagulation (thrombophilia) was found out in him. What reasons favor such state development? A. Intensification of prostacyclin synthesis in vessel wall



  1. Low concentration of thrombin in blood

  2. High concentration of heparin in blood

  3. Deficit of inhibitors of proteolytic enzymes*

  4. High concentration of adrenalin in blood

18. Thrombocytopenia was found out in blood of a patient with Werlhof's disease. Why the pathology of platelets leads to hemorrhage?



  1. Decrease in thromboplastin formation*

  2. Decrease in concentration of prothrombin in blood

  3. Decrease in concentration of heparin in blood

  4. Activation of fibrinolytic system

  5. Decrease in concentration of fibrinogen in blood

19. Hemophilia A was diagnosed in a patient with hemorrhagic syndrome. What is the reason for this disease development?



  1. Absence of Stuart-Prower factor (factor X)

  2. Absence of Christmas factor (factor IX)

  3. Absence of factor VIII*

  4. Absence of Rosenthal factor (factor XI)

  5. Low concentration of Hageman factor (factor XII) in blood

20. A patient was admitted to the hospital with abundant hemorrhoid bleeding. This patient has been suffering from hepatic cirrhosis for a long time. What is the reason for hemorrhage development under hepatic cirrhosis?



  1. Activation of fibrinolysis

  2. Plasmin deficiency

  3. Prothrombin deficiency*

  4. Low concentration of thrombosthenin in blood

  5. Excess of heparin

21. Schönlein-Henoch disease was diagnosed in a patient. What changes in blood cells number are characteristic for this disease?



  1. Eosinophilia*

  2. Thrombocytopenia

  3. Erythropenia

  4. Polycythemia

  5. Eosinopenia

22. Patient has hemorrhage from gums, subcutaneous hemorrhages, and frequent nasal bleedings. Significant Thrombocytopenia was revealed in blood test of this patient. What is the reason for bleeding development in case of thrombocytopenia?



  1. Thrombin deficiency

  2. Reduction of thromboplastin formation*

  3. Excessive heparin formation

  4. Activation of fibrinolysis

  5. Excess of prostacyclins

23. While performing intravenous injections trauma of venous vessels leads to thrombosis. What favors thrombosis under injury of vessel wall?



  1. Activation of plasmin

  2. Activation of fibrinolysis

  3. Activation of phospholipase D

  4. Enhanced production of prostacyclin by endotheliocytes

  5. Accumulation of thromboxane A2 *

24. Changes of some indices of blood were revealed at examination of a patient suffered from hemophilia. What of enumerated indices corresponds to this condition?



  1. Thrombocytopenia

  2. Bleeding time by Duke takes longer

  3. Eosinophilia

  4. Time of coagulation takes longer*

  5. Afibrinogenemia

25. A boy has congenital disorder of hemostasis: he has prolonged hemorrhage even in case of insignificant injuries, subcutaneous bruises, and bleedings in joint cavities, which restrict the movement activity. Patient’s blood does not coagulate for a long time if it is taken out from the organism and it does not contain coagulation factor VIII. Blood cells count including number of platelets is within norm.

What underlies the congenital disease of this boy?


  1. Hereditary gene defect linked with X chromosome*

  2. Toxicosis of pregnancy in boy’s mother

  3. Intrauterine infection

  4. Intrauterine intoxication

  5. Intrauterine immune conflict

26. Hemophilia B was diagnosed in a child who has hemorrhagic syndrome. This type of hemophilia results from absence of:



  1. Coagulation factor IX (Christmas’s factor)*

  2. Coagulation factor II (prothrombin)

  3. Coagulation factor VIII (antihemophilic globulin)

  4. Coagulation factor XI (thromboplastin)

  5. Coagulation factor XII (Hageman’s factor)

27. It is known that thrombus undergo same changes after its formation. What sort of finishing of thrombus formation is the most dangerous for a patient?



  1. Aseptic lysis

  2. Septic lysis*

  3. Organization without recanalization

  4. Organization with recanalization

  5. Calcification of thrombus

28. Such appearances as petechiae and ecchymoses develop in a boy aged 7, who often fall ill with acute respiratory diseases. Pathology of internal organs is absent in this patient. What pathology is present in this case?



  1. Hypoplastic anemia

  2. Thrombocytopenia*

  3. Acute leukemia

  4. Hemophilia

  5. Chronic leukemia

29. Course of atherosclerosis in 70-years-old patient is complicated by thrombosis of vessels of lower extremities and development of gangrene of left foot toes. The beginning of thrombosis is connected to:



  1. Activation of prothrombinase

  2. Adhesion, aggregation and agglutination of platelets*

  3. Conversion of prothrombin to thrombin

  4. Conversion of fibrinogen to fibrin

  5. Decreased heparin synthesis

30. Antihemophilic globulin A (factor VIII) is absent in the blood plasma of a boy with significant hemorrhagic syndrome. What phase of hemostasis is infringed primarily in this boy? A. Retraction of blood clot



  1. Conversion of fibrinogen to fibrin

  2. Conversion of prothrombin to thrombin

  3. Extrinsic pathway of prothrombinase (thrombokinase) activation

  4. Intrinsic pathway of prothrombinase (thrombokinase) activation*

31. Which of essential factors of thrombus formation the most often serves as the reason for thrombosis?



  1. Decrease in activity of anticoagulative system

  2. Activation of systems of blood sedimentation

  3. Injury of vessel wall*

  4. Acceleration of blood flow

  5. Turbulence of blood

32. A patient complains of hemorrhage from gums. What vitamin deficiency may lead to this phenomenon?



  1. B1

  2. D

  3. B2

  4. A

  5. K*

33. Prolonged bleeding complicated pulling out of a tooth in a patient, who suffered from chronic leukemia. What may serve a reason for hemorrhagic syndrome in this patient?



  1. Thrombocytopenia*

  2. Anemia

  3. Erythropenia

  4. Lymphocytosis

  5. Neutropenia

34. Bleeding developed in a 15-years-old patient after her teeth was pulled out. It was found out that after endued hepatitis A this patient has point hemorrhages (petechiae and ecchymoses) and bruises on her skin, and she had three accidents of nasal bleeding. Before this she did not have hemorrhages even after pulling out of her tooth. It was established under examination that the bleeding time is increased in this patient. At the patient’s blood test hypochromic anemia, decrease in number of platelets, and markedly reduced adhesion of platelets are present. Prothrombin and thrombin time are normal in this patient. Her differential blood count is normal too. What is the most possible diagnosis?



  1. Hereditary thrombocytopathy

  2. Acquired thrombocytopenia

  3. Hereditary thrombocytopenia

  4. Hemophilia

  5. Acquired thrombocytopathy*

35. A patient complains of frequent hemorrhages from gums. When carrying out blood test in this patient deficiency of factor of hemocoagulation (prothrombin) was revealed. What phase of blood coagulation is primarily impaired in the patient?



  1. Formation of thrombin*

  2. Fibrinolysis

  3. Formation of fibrin

  4. Retraction of blood clot

  5. Formation of prothrombinase

36. A 12-years-old patient was admitted to the hospital with hemarthrosis of knee joint (hemorrhage into joint cavity). This patient has been suffering from hemorrhages since early childhood. What disease does this boy suffer from?



  1. Hemophilia*

  2. Hemorrhagic vasculitis

  3. Iron deficiency anemia

  4. Vitamin B12 deficiency anemia

  5. Thrombocytic purpura

37. A 30-years-old female patient, who is suffering from megrim, often takes analgin. Hemorrhages on skin and frequent nasal bleedings appear in her at the recent time. At her blood analysis: number of platelets is 30x109/L; bleeding time is increased. What do these changes result from?



  1. Autoimmune thrombocytopenia*

  2. Hemorrhagic vasculitis

  3. Hemolytic anemia

  4. Angiohemophilia

  5. Thrombocytopathy

38. What kind of pathologic processes underlie formation of thrombus?



  1. Astringent metamorphose of thrombocytes*

  2. Increase of osmotic pressure

  3. Decrease in number of thrombocytes

  4. Increase of oncotic pressure

  5. Decrease in number of erythrocytes

39. A worker at pharmaceutical plant addresses the doctor with complaints of general malaise, significant hemorrhages from gums, nasal bleedings, and numerous subcutaneous hemorrhages. At blood analysis of this patient following was revealed: number of erythrocytes is 2.2x1012, content of hemoglobin is 48 g/L, presence of neutropenia with relative lymphocytosis, and number of platelets is 35x109/L. What is the possible pathogenesis of thrombocytopenia in this patient?



  1. Decrease of platelet production*

  2. Enhanced platelet destruction

  3. Increase platelet utilization

  4. Redistribution of platelets

  5. Increased loss of platelets

40. Intravenous injection of mercury chloride to experimental animal evokes development of thrombosis in it. What is the basic pathogenic factor in development of this pathologic process? A. Injury of vessel wall*

C. Activation of coagulation system

B. Activation of platelets adhesion



  1. Slowing-down of blood flow

  2. Decrease in anticoagulants activity

1.-E, 2.-C, 3.-C, 4.-B, 5.-A, 6.-D, 7.-B, 8.-D, 9.-B, 10.-B, 11.-D, 12.-C, 13.-C, 14.-B,

15.-A, 16.-C, 17.-D, 18.-A, 19.-C, 20.-C, 21.-A, 22.-B, 23.-E, 24.-D, 25.-A, 26.-A, 27.B, 28.-B, 29.-B, 30.-E, 31.-C, 32.-E, 33.-A, 34.-E, 35.-A, 36.-A, 37.-A, 38.-A, 39.-A, 40.-A.



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