Coagulation of blood MCQs With Answer is an essential study resource for B.Pharm students preparing for pharmacology, hematology, and therapeutic exams. This focused introduction covers the coagulation cascade, clotting factors, hemostasis, fibrinolysis, anticoagulant drugs, lab tests (PT, aPTT, INR, thrombin time), and clinical disorders like hemophilia, von Willebrand disease, and DIC. It emphasizes mechanism-based learning—gamma-carboxylation, role of vitamin K, thrombin generation, and platelet interactions—so students can link pharmacotherapy to pathophysiology. SEO keywords included: coagulation of blood, blood coagulation, MCQs, B.Pharm, coagulation cascade, anticoagulants, thrombin, fibrin. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which factor is activated directly by the tissue factor (extrinsic) pathway to start the coagulation cascade?
- Factor VII
- Factor IX
- Factor XII
- Factor XI
Correct Answer: Factor VII
Q2. What is the primary role of vitamin K in coagulation?
- Hydroxylation of prothrombin
- Gamma-carboxylation of glutamic acid residues on clotting factors
- Activation of plasminogen
- Inhibition of thromboxane A2 synthesis
Correct Answer: Gamma-carboxylation of glutamic acid residues on clotting factors
Q3. Which laboratory test is most sensitive to warfarin therapy?
- aPTT
- Bleeding time
- Prothrombin time (PT) / INR
- Thrombin time (TT)
Correct Answer: Prothrombin time (PT) / INR
Q4. Heparin primarily enhances the activity of which endogenous anticoagulant?
- Protein C
- Protein S
- Antithrombin III
- Plasmin
Correct Answer: Antithrombin III
Q5. Which factor deficiency causes Hemophilia A?
- Factor IX deficiency
- Factor VIII deficiency
- Factor VII deficiency
- von Willebrand factor deficiency
Correct Answer: Factor VIII deficiency
Q6. Thrombin converts which soluble plasma protein into insoluble fibrin?
- Fibrinogen
- Plasminogen
- Prothrombin
- Factor XIII
Correct Answer: Fibrinogen
Q7. Which lab test specifically measures the conversion of fibrinogen to fibrin and is prolonged by direct thrombin inhibitors?
- Prothrombin time (PT)
- Activated partial thromboplastin time (aPTT)
- Thrombin time (TT)
- Bleeding time
Correct Answer: Thrombin time (TT)
Q8. Which platelet mediator promotes vasoconstriction and platelet aggregation?
- Prostacyclin (PGI2)
- Nitric oxide (NO)
- Thromboxane A2 (TXA2)
- Plasmin
Correct Answer: Thromboxane A2 (TXA2)
Q9. Which enzyme converts plasminogen to plasmin during fibrinolysis?
- Thrombin
- Tissue plasminogen activator (tPA)
- Factor XIIIa
- Antithrombin
Correct Answer: Tissue plasminogen activator (tPA)
Q10. Which drug is a vitamin K antagonist used as an oral anticoagulant?
- Heparin
- Warfarin
- Argatroban
- Rivaroxaban
Correct Answer: Warfarin
Q11. The intrinsic pathway is classically initiated by activation of which factor?
- Factor VII
- Factor XII
- Factor VIIa-TF complex
- Factor X
Correct Answer: Factor XII
Q12. Which factor cross-links fibrin polymers to stabilize the clot?
- Factor XIIIa
- Factor V
- Factor IV (calcium)
- Factor VIIa
Correct Answer: Factor XIIIa
Q13. Which test is prolonged in hemophilia A but corrected by mixing with normal plasma?
- PT
- aPTT
- Bleeding time
- Platelet aggregation test
Correct Answer: aPTT
Q14. Direct oral anticoagulants (DOACs) include drugs that directly inhibit which targets?
- Vitamin K epoxide reductase
- Thrombin (IIa) and Factor Xa
- Antithrombin III
- Plasminogen activator inhibitor
Correct Answer: Thrombin (IIa) and Factor Xa
Q15. von Willebrand factor has which primary functions in hemostasis?
- Enhances fibrinolysis and inhibits platelet adhesion
- Stores vitamin K and activates protein C
- Promotes platelet adhesion and stabilizes factor VIII
- Cross-links fibrin polymers
Correct Answer: Promotes platelet adhesion and stabilizes factor VIII
Q16. Protamine sulfate is used to reverse the effects of which anticoagulant?
- Warfarin
- Unfractionated heparin
- Rivaroxaban
- Tissue plasminogen activator
Correct Answer: Unfractionated heparin
Q17. A prolonged PT with normal aPTT suggests a deficiency in which pathway?
- Intrinsic pathway
- Extrinsic pathway
- Common pathway only
- Platelet function
Correct Answer: Extrinsic pathway
Q18. Which anticoagulant acts by directly inhibiting factor Xa?
- Apixaban
- Argatroban
- Warfarin
- Heparin (unfractionated)
Correct Answer: Apixaban
Q19. Disseminated intravascular coagulation (DIC) typically presents with which combination?
- Thrombosis only
- Bleeding and microthrombi due to consumption of clotting factors
- Isolated platelet count elevation
- Exclusive extrinsic pathway activation without fibrinolysis
Correct Answer: Bleeding and microthrombi due to consumption of clotting factors
Q20. Which protein is a vitamin K–dependent natural anticoagulant that inactivates factors Va and VIIIa?
- Antithrombin III
- Protein C
- Protein S
- Plasminogen
Correct Answer: Protein C
Q21. Which anticoagulant drug requires antithrombin to exert its effect?
- Unfractionated heparin
- Warfarin
- Dabigatran
- Rivaroxaban
Correct Answer: Unfractionated heparin
Q22. Platelet aggregation studies often measure aggregation in response to which agonist commonly used in the lab?
- tPA
- Arachidonic acid, ADP, or collagen
- Warfarin
- Heparin
Correct Answer: Arachidonic acid, ADP, or collagen
Q23. Which factor is NOT vitamin K dependent?
- Factor II (prothrombin)
- Factor VII
- Factor IX
- Factor V
Correct Answer: Factor V
Q24. Tranexamic acid acts by which mechanism to reduce bleeding?
- Activates plasminogen to plasmin
- Inhibits fibrinolysis by blocking plasminogen binding to fibrin
- Inhibits thromboxane synthesis
- Enhances antithrombin activity
Correct Answer: Inhibits fibrinolysis by blocking plasminogen binding to fibrin
Q25. Which bedside test assesses platelet function and primary hemostasis?
- INR
- Bleeding time
- aPTT
- Thrombin time
Correct Answer: Bleeding time
Q26. Which clotting factor serves as the common pathway activation point leading to thrombin generation?
- Factor VIII
- Factor X
- Factor XII
- Factor VII
Correct Answer: Factor X
Q27. A mixing study corrects a prolonged aPTT—this suggests which cause?
- Presence of a specific factor inhibitor
- Factor deficiency
- Thrombocytopenia
- Hyperfibrinolysis
Correct Answer: Factor deficiency
Q28. Which drug is a recombinant tissue plasminogen activator used for acute ischemic stroke?
- Streptokinase
- Tissue plasminogen activator (alteplase)
- Tranexamic acid
- Heparin
Correct Answer: Tissue plasminogen activator (alteplase)
Q29. Which of the following increases platelet aggregation by inhibiting cyclooxygenase irreversibly?
- Aspirin
- Clopidogrel
- Heparin
- Warfarin
Correct Answer: Aspirin
Q30. Antiphospholipid antibody syndrome commonly prolongs which coagulation test in vitro?
- Bleeding time
- Prothrombin time (PT)
- Activated partial thromboplastin time (aPTT)
- Platelet count
Correct Answer: Activated partial thromboplastin time (aPTT)
Q31. Which coagulation factor is also called Stuart-Prower factor?
- Factor V
- Factor VII
- Factor X
- Factor IX
Correct Answer: Factor X
Q32. Which of the following is a direct thrombin inhibitor used in parenteral anticoagulation?
- Argatroban
- Rivaroxaban
- Warfarin
- Apixaban
Correct Answer: Argatroban
Q33. Which lab parameter is reported as INR to monitor oral anticoagulation?
- aPTT ratio
- Bleeding time standardized
- Prothrombin time standardized to INR
- Thrombin time normalized
Correct Answer: Prothrombin time standardized to INR
Q34. Which platelet receptor is essential for platelet aggregation by binding fibrinogen?
- GPIb-IX-V
- GPVI
- GPIIb/IIIa
- P2Y12
Correct Answer: GPIIb/IIIa
Q35. Hemophilia B is caused by deficiency of which factor?
- Factor VIII
- Factor IX
- Factor XI
- Factor XII
Correct Answer: Factor IX
Q36. Which anticoagulant is monitored by anti-Xa levels rather than aPTT in many settings?
- Warfarin
- Low molecular weight heparin (LMWH)
- Dabigatran
- Coumarin
Correct Answer: Low molecular weight heparin (LMWH)
Q37. Which endothelial-derived factor inhibits platelet aggregation and causes vasodilation?
- Thromboxane A2
- Prostacyclin (PGI2)
- Fibrinogen
- von Willebrand factor
Correct Answer: Prostacyclin (PGI2)
Q38. Which test is least affected by hypofibrinogenemia?
- Thrombin time (TT)
- Fibrinogen assay
- Bleeding time
- Prothrombin time (PT)
Correct Answer: Bleeding time
Q39. Which protein inhibits fibrinolysis by inactivating plasmin?
- Alpha-2 antiplasmin
- Protein C
- Antithrombin III
- Factor V Leiden
Correct Answer: Alpha-2 antiplasmin
Q40. Factor V Leiden mutation causes a resistance to which anticoagulant pathway?
- Antithrombin pathway
- Protein C–mediated degradation of Factor Va
- Vitamin K–dependent gamma-carboxylation
- Fibrinolysis by plasmin
Correct Answer: Protein C–mediated degradation of Factor Va
Q41. Which medication is an antiplatelet that irreversibly blocks the P2Y12 ADP receptor?
- Clopidogrel
- Aspirin
- Heparin
- Warfarin
Correct Answer: Clopidogrel
Q42. Which coagulation test is prolonged by deficiency of fibrinogen?
- Bleeding time only
- Thrombin time (TT)
- INR only
- Platelet aggregation
Correct Answer: Thrombin time (TT)
Q43. Streptokinase as a thrombolytic agent works primarily by which mechanism?
- Directly converting fibrin to FDPs
- Forming a complex with plasminogen to generate plasmin
- Inhibiting platelet aggregation
- Enhancing antithrombin activity
Correct Answer: Forming a complex with plasminogen to generate plasmin
Q44. Which factor acts as a cofactor for the activation of factor X by factor IXa in the intrinsic tenase complex?
- Factor V
- Factor VIII
- Factor XIII
- Protein S
Correct Answer: Factor VIII
Q45. In vitamin K deficiency, which clotting tests are typically prolonged first?
- aPTT due to intrinsic factor deficiency
- Bleeding time due to platelet dysfunction
- PT/INR due to reduced factors II, VII, IX, X
- Thrombin time due to low fibrinogen
Correct Answer: PT/INR due to reduced factors II, VII, IX, X
Q46. Which molecular event converts prothrombin (II) to its active form thrombin (IIa)?
- Cleavage by factor Xa in the prothrombinase complex
- Gamma-carboxylation by vitamin K
- Activation by plasmin
- Cross-linking by factor XIIIa
Correct Answer: Cleavage by factor Xa in the prothrombinase complex
Q47. Thromboelastography (TEG) assesses which aspect of coagulation?
- Only PT value
- Global viscoelastic properties of whole blood clot formation and lysis
- Only platelet count
- Only fibrinogen concentration
Correct Answer: Global viscoelastic properties of whole blood clot formation and lysis
Q48. Which factor deficiency typically prolongs bleeding time?
- Factor VIII deficiency
- Von Willebrand disease due to decreased vWF
- Factor X deficiency
- Prothrombin deficiency
Correct Answer: Von Willebrand disease due to decreased vWF
Q49. Which lab finding is characteristic of hyperfibrinolysis?
- Low D-dimer
- Elevated fibrin degradation products (FDPs) and low fibrinogen
- Normal fibrinogen and prolonged PT only
- Isolated thrombocytosis
Correct Answer: Elevated fibrin degradation products (FDPs) and low fibrinogen
Q50. Which drug is a monoclonal antibody that inhibits platelet GPIIb/IIIa and is used in acute coronary interventions?
- Abciximab
- Clopidogrel
- Aspirin
- Ticagrelor
Correct Answer: Abciximab
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