Postpartum Hemorrhage: Practice Test 2 (Units 8-13) -
Questions with Correct Answers
100 questions
1. Cryoprecipitate is used in postpartum hemorrhage primarily to replace:
A. Red blood cells
B. Platelets
C. Albumin
D. Fibrinogen
Correct Answer: D. Fibrinogen
Rationale: Cryoprecipitate is rich in fibrinogen, factor VIII, von Willebrand factor and factor XIII, and low
fibrinogen is a key driver of obstetric bleeding. Red cells and platelets are separate products. Albumin is
not a hemostatic product.
2. On thromboelastography, a low maximum amplitude (MA) indicates:
A. Prolonged clot initiation only
B. Normal clot
C. Weak clot strength from low platelets or fibrinogen
D. Excess clotting
Correct Answer: C. Weak clot strength from low platelets or fibrinogen
Rationale: Low MA guides replacement with platelets and fibrinogen, depending on which contributes
most, often clarified with fibrinogen-specific tests. It does not reflect initiation time. It indicates weakness,
not excess clotting.
3. Fresh frozen plasma contains:
A. Only platelets
B. All coagulation factors, including fibrinogen in lower concentration than cryoprecipitate
C. Only red blood cells
D. No clotting factors
Correct Answer: B. All coagulation factors, including fibrinogen in lower concentration than
cryoprecipitate
Rationale: FFP replaces multiple factors and is part of balanced massive transfusion, but large volumes
are needed to raise fibrinogen significantly. It must be thawed and ABO compatible. It contains no cells.
,4. A bedside clotting test that can be used in low-resource settings is the:
A. Lipid panel
B. Hemoglobin A1c
C. Urinalysis
D. 20-minute whole blood clotting test
Correct Answer: D. 20-minute whole blood clotting test
Rationale: Blood in a glass tube that fails to clot within 20 minutes suggests coagulopathy, guiding
treatment where laboratory testing is unavailable. The other tests do not assess clotting.
5. Tranexamic acid for postpartum hemorrhage treatment is given as:
A. 10 g IV push
B. 1 mg orally once
C. 1 g intrathecally
D. 1 g IV over 10 minutes, with a second 1 g dose if bleeding continues after 30 minutes or restarts
within 24 hours
Correct Answer: D. 1 g IV over 10 minutes, with a second 1 g dose if bleeding continues after
30 minutes or restarts within 24 hours
Rationale: This dosing comes from the WOMAN trial and is endorsed by WHO and ACOG. Giving it
slowly reduces hypotension. Massive doses, oral dosing for acute PPH, or intrathecal use are incorrect
and potentially dangerous.
6. Tranexamic acid dosing may need adjustment in women with:
A. Normal kidney function
B. Significant renal impairment, because it is cleared by the kidneys
C. Mild anemia
D. Hypertension alone
Correct Answer: B. Significant renal impairment, because it is cleared by the kidneys
Rationale: TXA accumulates in renal impairment, and high levels can lower the seizure threshold, so
dosing considerations apply for repeat doses. A single standard dose is usually given in hemorrhage.
Hypertension does not require adjustment.
,7. Point-of-care hemoglobin testing during hemorrhage:
A. Replaces QBL
B. Measures fibrinogen
C. Provides rapid results but must be interpreted with clinical status, as early values may not reflect
losses
D. Diagnoses DIC alone
Correct Answer: C. Provides rapid results but must be interpreted with clinical status, as
early values may not reflect losses
Rationale: Rapid hemoglobin results help track trends, but treatment decisions in active bleeding rely on
the overall picture. It does not measure fibrinogen or diagnose DIC.
8. The WOMAN trial demonstrated that early tranexamic acid in postpartum hemorrhage:
A. Reduced death due to bleeding without increasing thromboembolic events
B. Increased maternal mortality
C. Had no effect on bleeding deaths
D. Caused frequent strokes
Correct Answer: A. Reduced death due to bleeding without increasing thromboembolic
events
Rationale: This large international trial found a reduction in bleeding deaths, particularly when given
within 3 hours, and no increase in clots. TXA is now part of standard PPH treatment bundles. It did not
increase mortality.
9. Platelets for transfusion are stored at room temperature with a short shelf life, which means:
A. They are always available in unlimited quantities
B. They can be frozen for years
C. Smaller hospitals may have limited supplies and need advance planning or transfer
D. They need no compatibility consideration
Correct Answer: C. Smaller hospitals may have limited supplies and need advance planning
or transfer
Rationale: Platelets last about 5 to 7 days and require agitation at room temperature, so supply varies.
Hospitals arrange rapid delivery or transfer for high-risk patients. They cannot be frozen routinely.
, 10. Fibrinogen concentrate offers an advantage over cryoprecipitate because it:
A. Has a standardized dose, rapid preparation, and pathogen inactivation
B. Contains red cells
C. Raises platelets
D. Requires blood typing
Correct Answer: A. Has a standardized dose, rapid preparation, and pathogen inactivation
Rationale: Concentrate can be given quickly without thawing or ABO matching, though availability and
cost vary. It contains fibrinogen only. Cryoprecipitate requires thawing and pooling.
11. Dilutional coagulopathy develops during massive hemorrhage when:
A. Only plasma is transfused
B. Bleeding stops early
C. Large volumes of crystalloid or red cells alone are given without plasma, platelets, or fibrinogen
D. No fluids are given
Correct Answer: C. Large volumes of crystalloid or red cells alone are given without plasma,
platelets, or fibrinogen
Rationale: Replacing lost blood with fluids that lack clotting factors dilutes the remaining factors,
worsening bleeding. Balanced transfusion ratios and early fibrinogen prevent this. Limiting crystalloid is
part of modern resuscitation.
12. In a woman with significant coagulopathy, an epidural catheter should:
A. Be removed immediately regardless of labs
B. Not be removed until coagulation has normalized, to reduce the risk of spinal epidural hematoma
C. Be flushed with heparin
D. Be left in place indefinitely without assessment
Correct Answer: B. Not be removed until coagulation has normalized, to reduce the risk of
spinal epidural hematoma
Rationale: Both placement and removal of neuraxial catheters carry hematoma risk when platelets or
clotting factors are abnormal, so timing follows coagulation recovery and guidelines. Heparin flushes are
inappropriate. Ongoing assessment is required.
Questions with Correct Answers
100 questions
1. Cryoprecipitate is used in postpartum hemorrhage primarily to replace:
A. Red blood cells
B. Platelets
C. Albumin
D. Fibrinogen
Correct Answer: D. Fibrinogen
Rationale: Cryoprecipitate is rich in fibrinogen, factor VIII, von Willebrand factor and factor XIII, and low
fibrinogen is a key driver of obstetric bleeding. Red cells and platelets are separate products. Albumin is
not a hemostatic product.
2. On thromboelastography, a low maximum amplitude (MA) indicates:
A. Prolonged clot initiation only
B. Normal clot
C. Weak clot strength from low platelets or fibrinogen
D. Excess clotting
Correct Answer: C. Weak clot strength from low platelets or fibrinogen
Rationale: Low MA guides replacement with platelets and fibrinogen, depending on which contributes
most, often clarified with fibrinogen-specific tests. It does not reflect initiation time. It indicates weakness,
not excess clotting.
3. Fresh frozen plasma contains:
A. Only platelets
B. All coagulation factors, including fibrinogen in lower concentration than cryoprecipitate
C. Only red blood cells
D. No clotting factors
Correct Answer: B. All coagulation factors, including fibrinogen in lower concentration than
cryoprecipitate
Rationale: FFP replaces multiple factors and is part of balanced massive transfusion, but large volumes
are needed to raise fibrinogen significantly. It must be thawed and ABO compatible. It contains no cells.
,4. A bedside clotting test that can be used in low-resource settings is the:
A. Lipid panel
B. Hemoglobin A1c
C. Urinalysis
D. 20-minute whole blood clotting test
Correct Answer: D. 20-minute whole blood clotting test
Rationale: Blood in a glass tube that fails to clot within 20 minutes suggests coagulopathy, guiding
treatment where laboratory testing is unavailable. The other tests do not assess clotting.
5. Tranexamic acid for postpartum hemorrhage treatment is given as:
A. 10 g IV push
B. 1 mg orally once
C. 1 g intrathecally
D. 1 g IV over 10 minutes, with a second 1 g dose if bleeding continues after 30 minutes or restarts
within 24 hours
Correct Answer: D. 1 g IV over 10 minutes, with a second 1 g dose if bleeding continues after
30 minutes or restarts within 24 hours
Rationale: This dosing comes from the WOMAN trial and is endorsed by WHO and ACOG. Giving it
slowly reduces hypotension. Massive doses, oral dosing for acute PPH, or intrathecal use are incorrect
and potentially dangerous.
6. Tranexamic acid dosing may need adjustment in women with:
A. Normal kidney function
B. Significant renal impairment, because it is cleared by the kidneys
C. Mild anemia
D. Hypertension alone
Correct Answer: B. Significant renal impairment, because it is cleared by the kidneys
Rationale: TXA accumulates in renal impairment, and high levels can lower the seizure threshold, so
dosing considerations apply for repeat doses. A single standard dose is usually given in hemorrhage.
Hypertension does not require adjustment.
,7. Point-of-care hemoglobin testing during hemorrhage:
A. Replaces QBL
B. Measures fibrinogen
C. Provides rapid results but must be interpreted with clinical status, as early values may not reflect
losses
D. Diagnoses DIC alone
Correct Answer: C. Provides rapid results but must be interpreted with clinical status, as
early values may not reflect losses
Rationale: Rapid hemoglobin results help track trends, but treatment decisions in active bleeding rely on
the overall picture. It does not measure fibrinogen or diagnose DIC.
8. The WOMAN trial demonstrated that early tranexamic acid in postpartum hemorrhage:
A. Reduced death due to bleeding without increasing thromboembolic events
B. Increased maternal mortality
C. Had no effect on bleeding deaths
D. Caused frequent strokes
Correct Answer: A. Reduced death due to bleeding without increasing thromboembolic
events
Rationale: This large international trial found a reduction in bleeding deaths, particularly when given
within 3 hours, and no increase in clots. TXA is now part of standard PPH treatment bundles. It did not
increase mortality.
9. Platelets for transfusion are stored at room temperature with a short shelf life, which means:
A. They are always available in unlimited quantities
B. They can be frozen for years
C. Smaller hospitals may have limited supplies and need advance planning or transfer
D. They need no compatibility consideration
Correct Answer: C. Smaller hospitals may have limited supplies and need advance planning
or transfer
Rationale: Platelets last about 5 to 7 days and require agitation at room temperature, so supply varies.
Hospitals arrange rapid delivery or transfer for high-risk patients. They cannot be frozen routinely.
, 10. Fibrinogen concentrate offers an advantage over cryoprecipitate because it:
A. Has a standardized dose, rapid preparation, and pathogen inactivation
B. Contains red cells
C. Raises platelets
D. Requires blood typing
Correct Answer: A. Has a standardized dose, rapid preparation, and pathogen inactivation
Rationale: Concentrate can be given quickly without thawing or ABO matching, though availability and
cost vary. It contains fibrinogen only. Cryoprecipitate requires thawing and pooling.
11. Dilutional coagulopathy develops during massive hemorrhage when:
A. Only plasma is transfused
B. Bleeding stops early
C. Large volumes of crystalloid or red cells alone are given without plasma, platelets, or fibrinogen
D. No fluids are given
Correct Answer: C. Large volumes of crystalloid or red cells alone are given without plasma,
platelets, or fibrinogen
Rationale: Replacing lost blood with fluids that lack clotting factors dilutes the remaining factors,
worsening bleeding. Balanced transfusion ratios and early fibrinogen prevent this. Limiting crystalloid is
part of modern resuscitation.
12. In a woman with significant coagulopathy, an epidural catheter should:
A. Be removed immediately regardless of labs
B. Not be removed until coagulation has normalized, to reduce the risk of spinal epidural hematoma
C. Be flushed with heparin
D. Be left in place indefinitely without assessment
Correct Answer: B. Not be removed until coagulation has normalized, to reduce the risk of
spinal epidural hematoma
Rationale: Both placement and removal of neuraxial catheters carry hematoma risk when platelets or
clotting factors are abnormal, so timing follows coagulation recovery and guidelines. Heparin flushes are
inappropriate. Ongoing assessment is required.
