Wayground logo

Free Printable Worksheets

Font size

S
M
L
XL
Worksheets

Chapter 118 (51 to up)

Total questions: 100

Worksheet time: 50mins

Name
Class
Date
1.

Which anticoagulant is LEAST affected by plasma protein binding?

a)

UFH

b)

LMWH

c)

Fondaparinux

d)

Warfarin

2.

Which anticoagulant has NO available reversal agent?

a)

UFH

b)

LMWH

c)

Fondaparinux

d)

Warfarin

3.

Protamine sulfate completely reverses

a)

UFH only

b)

LMWH only

c)

Fondaparinux

d)

Warfarin

4.

Which anticoagulant accumulates most in renal failure?

a)

Argatroban

b)

UFH

c)

LMWH

d)

Warfarin

5.

Preferred anticoagulant in pregnancy

a)

Warfarin

b)

UFH

c)

LMWH

d)

Fondaparinux

6.

Which drug prolongs INR but should NOT be monitored with INR?

a)

Warfarin

b)

Argatroban

c)

Dabigatran

d)

Heparin

7.

The primary reason LMWH does not require routine aPTT monitoring

a)

Short half-life

b)

Weak thrombin inhibition

c)

Minimal effect on aPTT reagents

d)

Hepatic clearance

8.

Which anticoagulant is contraindicated in mechanical heart valves?

a)

UFH

b)

LMWH

c)

Warfarin

d)

DOACs

9.

The most common cause of heparin treatment failure

a)

HIT

b)

Heparin resistance

c)

Inadequate dosing

d)

Platelet activation

10.

In extensive DVT with iliac vein involvement, an adjunctive option is

a)

Aspirin

b)

Systemic fibrinolysis

c)

Catheter-directed thrombolysis

d)

Oral warfarin monotherapy

11.

The single most important determinant of arterial thrombosis is

a)

Blood stasis

b)

Endothelial denudation

c)

High shear stress

d)

Hypercoagulability

12.

Venous thrombi are typically rich in

a)

Platelets and VWF

b)

Platelets and collagen

c)

Fibrin and red blood cells

d)

Tissue factor and platelets

13.

The earliest platelet response after vascular injury is

a)

Platelet aggregation

b)

Platelet secretion

c)

Platelet adhesion

d)

Thrombin generation

14.

Platelet adhesion to exposed collagen requires

a)

GpIIb/IIIa

b)

GpIa/IIa

c)

P2Y₁₂

d)

PAR-1

15.

Binding of platelets to VWF occurs via

a)

GpIb

b)

GpIIb/IIIa

c)

GpIa/IIa

d)

Integrin αvβ3

16.

Platelet aggregation is mediated by

a)

VWF bridging GpIb

b)

Fibrin bridging GpIa

c)

Fibrinogen bridging GpIIb/IIIa

d)

Collagen bridging GpIa

17.

Thrombin amplifies coagulation by activating

a)

Factors II and X

b)

Factors V, VIII, and XI

c)

Factors VII and IX

d)

Protein C and S

18.

Which drug blocks thromboxane A₂ synthesis?

a)

Dipyridamole

b)

Aspirin

c)

Ticagrelor

d)

Vorapaxar

19.

Aspirin inhibits platelet function by

a)

Reversibly inhibiting COX-1

b)

Irreversibly inhibiting COX-1

c)

Inhibiting COX-2 only

d)

Blocking ADP receptors

20.

At high doses, aspirin also inhibits

a)

COX-1 selectively

b)

COX-2 in endothelial cells

c)

ADP-mediated aggregation

d)

PAR-1 receptors

21.

The main reason aspirin is no longer recommended for routine primary prevention

a)

Poor efficacy

b)

High cost

c)

Bleeding risk outweighs benefit

d)

Resistance is common

22.

Which P2Y₁₂ inhibitor is a prodrug requiring CYP metabolism?

a)

Ticagrelor

b)

Cangrelor

c)

Clopidogrel

d)

Dipyridamole

23.

Which genetic polymorphism explains clopidogrel resistance?

a)

VKORC1

b)

CYP2C9

c)

CYP2C19

d)

CYP3A4

24.

Which P2Y₁₂ inhibitor is reversible and orally active?

a)

Clopidogrel

b)

Prasugrel

c)

Ticagrelor

d)

Cangrelor

25.

Which antiplatelet agent is given IV with immediate onset and offset?

a)

Prasugrel

b)

Ticagrelor

c)

Cangrelor

d)

Abciximab

26.

The final common pathway of platelet aggregation is blocked by

a)

Aspirin

b)

Clopidogrel

c)

Abciximab

d)

Vorapaxar

27.

Abciximab differs from other Gp IIb/IIIa inhibitors because it

a)

Is renally cleared

b)

Has a very short platelet binding time

c)

Is a monoclonal antibody fragment

d)

Is orally active

28.

The most serious adverse effect of Gp IIb/IIIa inhibitors

a)

Hepatic failure

b)

Immune thrombocytopenia

c)

Hypertension

d)

Bronchospasm

29.

Dipyridamole is avoided in symptomatic coronary artery disease because

a)

It increases thrombosis

b)

It causes vasodilation

c)

It causes severe hypertension

d)

It blocks aspirin metabolism

30.

Unfractionated heparin inhibits thrombin by

a)

Direct binding to thrombin

b)

Bridging thrombin and antithrombin

c)

Inhibiting factor Xa only

d)

Blocking tissue factor

31.

The pentasaccharide sequence of heparin is required for

a)

Platelet inhibition

b)

Antithrombin activation

c)

Thrombin binding

d)

Protein C activation

32.

LMWH differs from UFH because LMWH

a)

Inhibits thrombin more strongly

b)

Has dose-independent clearance

c)

Preferentially inhibits factor Xa

d)

Requires aPTT monitoring

33.

Best laboratory test to monitor LMWH when needed

a)

aPTT

b)

INR

c)

Anti-factor Xa level

d)

Bleeding time

34.

Fondaparinux inhibits

a)

Thrombin directly

b)

Thrombin via antithrombin

c)

Factor Xa via antithrombin

d)

Factors II and X

35.

Fondaparinux does NOT

a)

Bind antithrombin

b)

Inhibit factor Xa

c)

Cause HIT

d)

Inhibit thrombin

36.

Heparin-induced thrombocytopenia is mediated by

a)

IgM antibodies

b)

Platelet destruction

c)

Antibodies to PF4–heparin complexes

d)

Bone marrow suppression

37.

The paradox of HIT is explained by

a)

Low platelet count causing bleeding

b)

Antibody-mediated platelet activation

c)

Reduced fibrinolysis

d)

Depletion of clotting factors

38.

First management step in suspected HIT

a)

Platelet transfusion

b)

Stop heparin

c)

Start warfarin

d)

Increase LMWH dose

39.

Preferred anticoagulant in HIT with renal failure

a)

Fondaparinux

b)

Enoxaparin

c)

Argatroban

d)

Dabigatran

40.

Argatroban is cleared primarily by

a)

Kidneys

b)

Liver

c)

Platelets

d)

Endothelium

41.

Warfarin exerts its effect by inhibiting

a)

Thrombin directly

b)

Factor Xa

c)

Vitamin K epoxide reductase

d)

Antithrombin

42.

Warfarin causes initial hypercoagulability due to depletion of

a)

Factor VII

b)

Protein C

c)

Factor X

d)

Prothrombin

43.

The clotting factor most closely associated with warfarin’s antithrombotic effect

a)

Factor VII

b)

Factor IX

c)

Factor X

d)

Factor II

44.

Genetic polymorphism with greatest impact on warfarin dose

a)

CYP2C19

b)

CYP3A4

c)

VKORC1

d)

P-glycoprotein

45.

Warfarin skin necrosis is most likely in patients with

a)

Factor V Leiden

b)

Protein C deficiency

c)

HIT

d)

Antithrombin deficiency

46.

Why must warfarin overlap with heparin initially?

a)

INR rises before anticoagulation

b)

Protein C declines before clotting factors

c)

Warfarin increases platelet activation

d)

Warfarin has poor absorption

47.

Which anticoagulant has no reliable reversal agent?

a)

UFH

b)

LMWH

c)

Fondaparinux

d)

Warfarin

48.

Long-term unfractionated heparin is associated with

a)

Renal failure

b)

Osteoporosis

c)

Hepatic necrosis

d)

Myelosuppression

49.

Preferred anticoagulant in pregnancy

a)

Warfarin

b)

DOACs

c)

LMWH

d)

Fondaparinux

50.

Which cell type contributes to thrombosis by producing neutrophil extracellular traps (NETs)?

a)

Monocytes

b)

Neutrophils

c)

Endothelial cells

d)

Platelets

51.

DNA released in NETs promotes thrombosis primarily by

a)

Degrading fibrin

b)

Activating factor XII

c)

Inhibiting antithrombin

d)

Increasing prostacyclin

52.

Venous thrombi rarely form at sites of

a)

Valve cusps

b)

Sluggish blood flow

c)

Endothelial activation

d)

Atheroscle

53.

Venous thrombi rarely form at sites of

a)

Valve cusps

b)

Sluggish blood flow

c)

Endothelial activation

d)

Atherosclerotic plaque rupture

54.

Reduced clearance of activated clotting factors in veins is due to

a)

Endothelial dysfunction

b)

Platelet consumption

c)

Impaired blood flow

d)

Low oxygen tension

55.

The color difference between arterial and venous thrombi is due to

a)

Degree of endothelial injury

b)

Platelet content

c)

Trapped red blood cells

d)

Thrombin concentration

56.

The primary platelet agonists released from dense granules include

a)

ADP and calcium

b)

Thromboxane and serotonin

c)

ADP and thromboxane A₂

d)

Calcium and fibrinogen

57.

Thromboxane A₂ synthesis occurs via

a)

Lipoxygenase

b)

Cyclooxygenase

c)

Phosphodiesterase

d)

Adenylate cyclase

58.

Platelet shape change after adhesion is triggered by

a)

Fibrin

b)

ADP secretion

c)

von Willebrand factor

d)

Thrombin inhibition

59.

Activated platelets potentiate coagulation primarily by

a)

Secreting fibrinogen

b)

Providing a phospholipid surface

c)

Inhibiting fibrinolysis

d)

Binding tissue plasminogen activator

60.

Which factor converts fibrinogen to fibrin?

a)

Factor Xa

b)

Factor IXa

c)

Thrombin

d)

Factor XIII

61.

Factor XIII activation results in

a)

Platelet aggregation

b)

Fibrin cross-linking

c)

Thrombin amplification

d)

Protein C activation

62.

Aspirin doses >1 g/day reduce platelet inhibition because

a)

COX-1 is saturated

b)

COX-2 inhibition reduces prostacyclin

c)

Platelet turnover increases

d)

TXA₂ synthesis increases

63.

Dual antiplatelet therapy increases major bleeding risk by approximately

a)

5%

b)

10%

c)

20%

d)

40%

64.

Which antiplatelet agent has the longest half-life?

a)

Aspirin

b)

Ticagrelor

c)

Clopidogrel

d)

Vorapaxar

65.

Vorapaxar blocks platelet activation by inhibiting

a)

ADP signaling

b)

Thromboxane synthesis

c)

PAR-1 receptors

d)

GpIIb/IIIa binding

66.

The most important contraindication to vorapaxar use

a)

Renal insufficiency

b)

Prior intracranial hemorrhage

c)

Peptic ulcer disease

d)

Thrombocytopenia

67.

Why is dipyridamole avoided in symptomatic coronary artery disease?

a)

Platelet activation

b)

Coronary steal phenomenon

c)

Increased bleeding

d)

Reduced aspirin efficacy

68.

Dipyridamole increases local adenosine levels by

a)

Enhancing synthesis

b)

Blocking reuptake

c)

Increasing degradation

d)

Inhibiting receptors

69.

Which Gp IIb/IIIa inhibitor is cleared by the kidneys?

a)

Abciximab

b)

Eptifibatide

c)

Both B and C

d)

None

70.

The shortest plasma half-life among Gp IIb/IIIa inhibitors

a)

Abciximab

b)

Eptifibatide

c)

Tirofiban

d)

Vorapaxar

71.

UFH clearance becomes slower at higher doses because

a)

Renal saturation

b)

Endothelial binding saturation

c)

Platelet activation

d)

Reduced antithrombin

72.

Which heparin chain length is required to inhibit thrombin?

a)

≥5 saccharide units

b)

≥10 saccharide units

c)

≥18 saccharide units

d)

≥25 saccharide units

73.

Anti-factor Xa levels are preferred over aPTT when

a)

INR is elevated

b)

Factor VIII is increased

c)

Platelets are low

d)

Warfarin is used

74.

Heparin resistance is commonly due to elevated levels of

a)

Antithrombin

b)

Protein C

c)

Acute-phase reactants

d)

Vitamin K

75.

Platelet factor 4 reduces heparin efficacy by

a)

Increasing clearance

b)

Neutralizing heparin

c)

Inhibiting antithrombin

d)

Activating fibrinolysis

76.

HIT typically develops

a)

Within 24 hours of heparin exposure

b)

1–3 days after initiation

c)

5–14 days after initiation

d)

After 1 month

77.

HIT is more common in

a)

Medical patients

b)

Surgical patients

c)

Pediatric patients

d)

Pregnant patients

78.

The most specific diagnostic test for HIT

a)

ELISA for PF4

b)

Platelet count trend

c)

Serotonin release assay

d)

Bleeding time

79.

Why is warfarin contraindicated in acute HIT?

a)

INR is unreliable

b)

Platelet count falls further

c)

Rapid protein C depletion

d)

Hepatic toxicity

80.

Argatroban monitoring is performed using

a)

INR

b)

Anti-Xa level

c)

aPTT

d)

ACT

81.

Which anticoagulant does NOT bind plasma proteins significantly?

a)

UFH

b)

LMWH

c)

Fondaparinux

d)

Warfarin

82.

Warfarin effect is delayed because

a)

Slow absorption

b)

Delayed inhibition of VKOR

c)

Existing clotting factors must degrade

d)

Platelet turnover

83.

Factor VII has the shortest half-life among vitamin K–dependent factors, making it useful for

a)

Monitoring thrombosis risk

b)

Monitoring early warfarin effect

c)

Assessing bleeding risk

d)

Guiding heparin dosing

84.

Warfarin is highly protein bound; the active fraction is

a)

Albumin-bound

b)

Free drug

c)

Hepatic metabolite

d)

Renal metabolite

85.

Which CYP enzyme metabolizes S-warfarin?

a)

CYP3A4

b)

CYP2D6

c)

CYP2C9

d)

CYP1A2

86.

Patients with CYP2C9 variants have

a)

Higher warfarin dose requirements

b)

Lower bleeding risk

c)

Reduced warfarin clearance

d)

Faster onset of action

87.

LMWH bioavailability after subcutaneous injection is approximately

a)

50%

b)

70%

c)

90%

d)

100%

88.

LMWH accumulation is most likely in

a)

Obesity

b)

Hepatic failure

c)

Renal insufficiency

d)

Pregnancy

89.

Protamine incompletely reverses LMWH because

a)

It cannot bind LMWH

b)

Short heparin chains remain active

c)

LMWH inhibits factor Xa directly

d)

Protamine is renally cleared

90.

Fondaparinux is preferred over heparin in HIT because it

a)

Is reversible

b)

Does not bind PF4

c)

Inhibits thrombin

d)

Has hepatic clearance

91.

Which physiologic anticoagulant is enhanced by heparin?

a)

Protein C

b)

Protein S

c)

Antithrombin

d)

Tissue factor pathway inhibitor

92.

The anticoagulant effect of antithrombin is strongest against

a)

Factor VIIa

b)

Factor IXa

c)

Factor Xa and thrombin

d)

Factor XIIIa

93.

Which coagulation factor is NOT vitamin K–dependent?

a)

Factor II

b)

Factor VII

c)

Factor IX

d)

Factor VIII

94.

The INR primarily reflects the activity of

a)

Intrinsic pathway

b)

Common pathway only

c)

Extrinsic pathway

d)

Fibrinolytic system

95.

Which clotting factor contributes MOST to INR prolongation early in warfarin therapy?

a)

Factor II

b)

Factor VII

c)

Factor IX

d)

Factor X

96.

The half-life of platelets is approximately

a)

24 hours

b)

3 days

c)

7–10 days

d)

21 days

97.

The duration of aspirin’s antiplatelet effect is determined by

a)

Drug half-life

b)

Platelet regeneration

c)

Hepatic metabolism

d)

Renal clearance

98.

Which agent inhibits platelet aggregation by increasing prostacyclin effect indirectly?

a)

Aspirin

b)

Dipyridamole

c)

Clopidogrel

d)

Vorapaxar

99.

Platelet granules that store fibrinogen are

a)

Dense granules

b)

Lysosomes

c)

Alpha granules

d)

Peroxisomes

100.

Dense platelet granules contain

a)

Fibrinogen

b)

von Willebrand factor

c)

ADP and calcium

d)

Factor V