NRMS 5190 Advanced Pathophysiology Final Exam Review 2026 | 100 Questions and Answers with
Rationales | SUNY Downstate.
SECTION I — HEMOSTASIS,
THROMBOSIS & BLEEDING
DISORDERS
1. Immediately after a small blood vessel is injured, which response occurs first
to limit blood loss?
A. Fibrinolysis
B. Vessel constriction
C. Erythropoiesis
D. Complement activation
Answer: B. Vessel constriction
Rationale: Vascular spasm reduces blood flow immediately after vessel injury. Platelet-plug
formation and coagulation subsequently reinforce hemostasis. NHLBI describes narrowing of the
injured vessel as an early step followed by platelet recruitment and plug formation. (NHLBI,
NIH)
2. What is the principal function of von Willebrand factor during primary
hemostasis?
A. Destroy fibrin
B. Promote platelet adhesion to the damaged vessel wall
C. Activate erythropoietin
D. Convert plasminogen to plasmin
Answer: B. Promote platelet adhesion
Rationale: vWF binds exposed subendothelial structures and platelets, permitting adhesion at
sites of vascular injury. It also binds and stabilizes circulating factor VIII. (NHLBI, NIH)
3. Which substance converts fibrinogen into fibrin?
A. Plasmin
B. Thrombin
,C. Histamine
D. Erythropoietin
Answer: B. Thrombin
Rationale: Thrombin is the major final effector of the coagulation cascade and converts soluble
fibrinogen into fibrin, which stabilizes the platelet plug.
4. Which enzyme ultimately degrades fibrin during fibrinolysis?
A. Thrombin
B. Plasmin
C. Factor VIII
D. ADP
Answer: B. Plasmin
Rationale: Plasmin is produced from plasminogen and breaks down fibrin after a clot has served
its purpose.
5. Which combination constitutes Virchow's triad?
A. Anemia, leukopenia, thrombocytopenia
B. Endothelial injury, abnormal blood flow, hypercoagulability
C. Vasodilation, bradycardia, hypotension
D. Hemolysis, hypoxia, acidosis
Answer: B.
Rationale: Endothelial injury, stasis/turbulent flow, and hypercoagulability are the major
pathophysiologic factors predisposing to thrombosis.
6. Which patient has the greatest risk for a venous thromboembolism?
A. Healthy ambulatory teenager
B. Postoperative patient with malignancy who has been immobile for several days
C. Patient with mild seasonal allergies
D. Patient with isolated tension headache
Answer: B.
,Rationale: Surgery, malignancy, and immobility combine hypercoagulability with venous stasis,
creating a strong thrombotic environment.
7. Venous thrombi are particularly associated with:
A. Increased velocity and turbulent arterial flow
B. Blood stasis
C. Severe thrombocytopenia
D. Factor VIII deficiency
Answer: B. Blood stasis
Rationale: Slow venous flow permits accumulation of activated coagulation factors and favors
fibrin-rich clot formation.
8. Which manifestation most strongly suggests a platelet disorder?
A. Recurrent hemarthrosis
B. Petechiae and mucosal bleeding
C. Deep intramuscular bleeding only
D. Progressive bone deformity
Answer: B.
Rationale: Primary-hemostasis disorders typically cause petechiae, purpura, epistaxis, gingival
bleeding, and other mucocutaneous bleeding.
9. A patient has widespread petechiae, epistaxis, and a markedly decreased
platelet count. Which mechanism is most directly impaired?
A. Primary hemostasis
B. Erythropoiesis
C. Oxygen diffusion
D. Bone mineralization
Answer: A. Primary hemostasis
Rationale: Platelets are essential for forming the initial platelet plug.
, 10. Immune thrombocytopenia primarily involves:
A. Autoimmune platelet destruction
B. Excess factor IX
C. Excess erythropoietin
D. Increased fibrinogen synthesis
Answer: A.
Rationale: ITP involves immune-mediated destruction of platelets, producing isolated
thrombocytopenia and bleeding manifestations.
11. Severe deficiency of ADAMTS13 is characteristically associated with:
A. Hemophilia A
B. Thrombotic thrombocytopenic purpura
C. Iron-deficiency anemia
D. Polycythemia
Answer: B. TTP
Rationale: ADAMTS13 deficiency allows very large vWF multimers to persist, promoting
platelet-rich microvascular thrombi.
12. A septic patient develops thrombocytopenia, bleeding from venipuncture
sites, elevated D-dimer, and evidence of organ ischemia. Which disorder is most
likely?
A. Iron deficiency
B. DIC
C. Hemophilia B
D. Polycythemia vera
Answer: B. Disseminated intravascular coagulation
Rationale: DIC begins with pathologic systemic clotting and microthrombus formation. Platelets
and coagulation factors are then consumed, creating secondary hemorrhage. The final review
explicitly identifies the initial DIC mechanism as a priority. NHLBI similarly describes DIC as
excessive clotting followed by consumption-related bleeding. (NHLBI, NIH)
Rationales | SUNY Downstate.
SECTION I — HEMOSTASIS,
THROMBOSIS & BLEEDING
DISORDERS
1. Immediately after a small blood vessel is injured, which response occurs first
to limit blood loss?
A. Fibrinolysis
B. Vessel constriction
C. Erythropoiesis
D. Complement activation
Answer: B. Vessel constriction
Rationale: Vascular spasm reduces blood flow immediately after vessel injury. Platelet-plug
formation and coagulation subsequently reinforce hemostasis. NHLBI describes narrowing of the
injured vessel as an early step followed by platelet recruitment and plug formation. (NHLBI,
NIH)
2. What is the principal function of von Willebrand factor during primary
hemostasis?
A. Destroy fibrin
B. Promote platelet adhesion to the damaged vessel wall
C. Activate erythropoietin
D. Convert plasminogen to plasmin
Answer: B. Promote platelet adhesion
Rationale: vWF binds exposed subendothelial structures and platelets, permitting adhesion at
sites of vascular injury. It also binds and stabilizes circulating factor VIII. (NHLBI, NIH)
3. Which substance converts fibrinogen into fibrin?
A. Plasmin
B. Thrombin
,C. Histamine
D. Erythropoietin
Answer: B. Thrombin
Rationale: Thrombin is the major final effector of the coagulation cascade and converts soluble
fibrinogen into fibrin, which stabilizes the platelet plug.
4. Which enzyme ultimately degrades fibrin during fibrinolysis?
A. Thrombin
B. Plasmin
C. Factor VIII
D. ADP
Answer: B. Plasmin
Rationale: Plasmin is produced from plasminogen and breaks down fibrin after a clot has served
its purpose.
5. Which combination constitutes Virchow's triad?
A. Anemia, leukopenia, thrombocytopenia
B. Endothelial injury, abnormal blood flow, hypercoagulability
C. Vasodilation, bradycardia, hypotension
D. Hemolysis, hypoxia, acidosis
Answer: B.
Rationale: Endothelial injury, stasis/turbulent flow, and hypercoagulability are the major
pathophysiologic factors predisposing to thrombosis.
6. Which patient has the greatest risk for a venous thromboembolism?
A. Healthy ambulatory teenager
B. Postoperative patient with malignancy who has been immobile for several days
C. Patient with mild seasonal allergies
D. Patient with isolated tension headache
Answer: B.
,Rationale: Surgery, malignancy, and immobility combine hypercoagulability with venous stasis,
creating a strong thrombotic environment.
7. Venous thrombi are particularly associated with:
A. Increased velocity and turbulent arterial flow
B. Blood stasis
C. Severe thrombocytopenia
D. Factor VIII deficiency
Answer: B. Blood stasis
Rationale: Slow venous flow permits accumulation of activated coagulation factors and favors
fibrin-rich clot formation.
8. Which manifestation most strongly suggests a platelet disorder?
A. Recurrent hemarthrosis
B. Petechiae and mucosal bleeding
C. Deep intramuscular bleeding only
D. Progressive bone deformity
Answer: B.
Rationale: Primary-hemostasis disorders typically cause petechiae, purpura, epistaxis, gingival
bleeding, and other mucocutaneous bleeding.
9. A patient has widespread petechiae, epistaxis, and a markedly decreased
platelet count. Which mechanism is most directly impaired?
A. Primary hemostasis
B. Erythropoiesis
C. Oxygen diffusion
D. Bone mineralization
Answer: A. Primary hemostasis
Rationale: Platelets are essential for forming the initial platelet plug.
, 10. Immune thrombocytopenia primarily involves:
A. Autoimmune platelet destruction
B. Excess factor IX
C. Excess erythropoietin
D. Increased fibrinogen synthesis
Answer: A.
Rationale: ITP involves immune-mediated destruction of platelets, producing isolated
thrombocytopenia and bleeding manifestations.
11. Severe deficiency of ADAMTS13 is characteristically associated with:
A. Hemophilia A
B. Thrombotic thrombocytopenic purpura
C. Iron-deficiency anemia
D. Polycythemia
Answer: B. TTP
Rationale: ADAMTS13 deficiency allows very large vWF multimers to persist, promoting
platelet-rich microvascular thrombi.
12. A septic patient develops thrombocytopenia, bleeding from venipuncture
sites, elevated D-dimer, and evidence of organ ischemia. Which disorder is most
likely?
A. Iron deficiency
B. DIC
C. Hemophilia B
D. Polycythemia vera
Answer: B. Disseminated intravascular coagulation
Rationale: DIC begins with pathologic systemic clotting and microthrombus formation. Platelets
and coagulation factors are then consumed, creating secondary hemorrhage. The final review
explicitly identifies the initial DIC mechanism as a priority. NHLBI similarly describes DIC as
excessive clotting followed by consumption-related bleeding. (NHLBI, NIH)
