Clotting Disorders (Coagulopathies)
1. A 24-year-old woman presents with spontaneous bruising,
recurrent nosebleeds, and heavy menstrual bleeding since
menarche. Her platelet count is normal, but bleeding time is
prolonged. Which is the most likely diagnosis?
A) Hemophilia A
B) von Willebrand disease
C) Immune thrombocytopenic purpura
D) Factor V Leiden
Answer: B) von Willebrand disease
Explanation:
von Willebrand disease characteristically presents with mucocutaneous bleeding
(epistaxis, menorrhagia) and normal platelet counts but prolonged bleeding time due to
defective platelet adhesion.
2. A middle-aged male with a history of deep vein thrombosis is
found to have elevated PTT that does not correct with mixing. Which
disorder is likely?
A) Antiphospholipid syndrome
B) Factor VIII deficiency
C) Hemophilia B
D) von Willebrand disease
Answer: A) Antiphospholipid syndrome
Explanation:
Antiphospholipid antibodies cause a lupus anticoagulant effect, prolonging PTT. Mixing
studies do not correct the PTT as inhibitors are present.
3. A 7-year-old boy with multiple joint bleeds, prolonged aPTT, and
normal PT and platelet count. Which lab finding confirms
hemophilia A?
A) Low factor IX
B) Low factor VIII
C) Low fibrinogen
D) Low von Willebrand factor
Answer: B) Low factor VIII
Explanation:
Hemophilia A is due to factor VIII deficiency, with classic history of hemarthroses and
isolated prolonged aPTT.
4. A woman develops sudden onset breathlessness and hemoptysis.
Workup reveals pulmonary embolism. Family history is significant
for similar episodes. Which mutation is most likely?
A) Prothrombin G20210A
B) Factor V Leiden
C) Protein S deficiency
D) Antithrombin III deficiency
Answer: B) Factor V Leiden
Explanation:
Factor V Leiden is the most common hereditary thrombophilia, causing resistance to
activated protein C and recurrent thrombosis.
5. A neonate bleeds from the umbilical stump and has prolonged PT
and aPTT. Platelet count is normal. Next best step?
A) Vitamin K injection
B) Platelet transfusion
C) Desmopressin
D) Cryoprecipitate
Answer: A) Vitamin K injection
Explanation:
Vitamin K deficiency in newborns presents with prolonged PT and aPTT due to
deficiency of factors II, VII, IX, X.
6. A patient with liver cirrhosis presents with bleeding. Which
coagulation test abnormality is most commonly seen?
A) Isolated prolonged aPTT
B) Isolated thrombocytopenia
C) Prolonged PT
D) Raised D-dimer
Answer: C) Prolonged PT
Explanation:
Liver synthesizes most clotting factors; factor VII (extrinsic pathway) is affected earliest,
leading to prolonged PT.
7. A 35-year-old man presents with a deep muscle bleed after
trauma. Which factor deficiency is unlikely?
A) Factor VIII
B) Factor IX
C) Factor VII
D) Factor XIII
Answer: C) Factor VII
Explanation:
Factor VII deficiency presents with mucocutaneous, not deep muscle or joint bleeds.
8. A prolonged thrombin time suggests a problem with which of the
following?
A) Factor XIII
B) Platelets
C) Fibrinogen
D) Plasminogen
Answer: C) Fibrinogen
Explanation:
Thrombin time measures conversion of fibrinogen to fibrin; prolonged TT indicates
dysfibrinogenemia or hypofibrinogenemia.
9. Which is a feature of Disseminated Intravascular Coagulation
(DIC)?
A) Raised fibrinogen
B) Isolated thrombocytosis
C) Raised D-dimer
D) Shortened PT
Answer: C) Raised D-dimer
Explanation:
DIC is characterized by widespread clot formation and breakdown, raising D-dimer.
Fibrinogen is low, not high.
10. A 23-year-old with heavy bleeding after tooth extraction,
prolonged bleeding time, and platelet aggregation absent with
ristocetin. Diagnosis?
A) Glanzmann thrombasthenia
B) Bernard-Soulier syndrome
C) von Willebrand disease
D) Hemophilia B
Answer: C) von Willebrand disease
Explanation:
von Willebrand factor binds platelets to exposed subendothelium. Ristocetin induces
this binding; absent aggregation with ristocetin confirms vWD.
11. Which transfusion may worsen coagulopathy in massive
hemorrhage?
A) RBCs only
B) Platelets
C) Fresh frozen plasma
D) Cryoprecipitate
Answer: A) RBCs only
Explanation:
Transfusion of only packed RBCs during massive hemorrhage can dilute clotting factors,
worsening coagulopathy.
12. Which condition is associated with a normal coagulation profile
but abnormal platelet function?
A) Hemophilia A
B) Acute leukemia
C) Glanzmann thrombasthenia
D) Vitamin K deficiency
Answer: C) Glanzmann thrombasthenia
Explanation:
Glanzmann’s presents with defective platelet aggregation but normal PT, aPTT, and
platelet count.
13. Hemarthrosis is classical for deficiency of:
A) Factor XIII
B) Platelets
C) Factor VIII
D) Factor V
Answer: C) Factor VIII
Explanation:
Hemophilia A (Factor VIII deficiency) causes recurrent spontaneous joint bleeds
(hemarthrosis).
14. Which inherited disorder causes isolated prolonged aPTT with
normal bleeding time and platelet count?
A) Hemophilia A
B) von Willebrand disease
C) DIC
D) ITP
Answer: A) Hemophilia A
Explanation:
Hemophilia A has isolated prolonged aPTT; platelets and bleeding time are normal.
15. A patient with sepsis develops oozing from venipuncture sites,
thrombocytopenia, prolonged PT, aPTT, and low fibrinogen.
Diagnosis?
A) Hemophilia
B) DIC
C) TTP
D) HUS
Answer: B) DIC
Explanation:
DIC features include bleeding, low platelets, prolonged PT/aPTT, low fibrinogen, and
raised D-dimer in the setting of sepsis.
16. All are features of platelet disorder except:
A) Petechiae
B) Ecchymoses
C) Hemarthrosis
D) Purpura
Answer: C) Hemarthrosis
Explanation:
Hemarthrosis is typical of clotting factor deficiency, not platelet disorders. Platelet
disorders cause mucocutaneous bleeding.
17. A 50-year-old with nephrotic syndrome and recurrent DVTs.
Which measure is likely reduced?
A) Antithrombin III
B) Protein C
C) Platelet count
D) Factor V
Answer: A) Antithrombin III
Explanation:
Nephrotic syndrome causes urinary loss of antithrombin III, predisposing to thrombosis.
18. Which is NOT associated with increased risk of thrombosis?
A) Immobilization
B) Protein C deficiency
C) Oral contraceptives
D) Hemophilia
Answer: D) Hemophilia
Explanation:
Hemophilia increases bleeding risk, not thrombosis. The others are prothrombotic.
19. A 16-year-old develops sudden swelling and pain in a single joint
after minor trauma. Labs show only prolonged aPTT. Most likely
diagnosis?
A) von Willebrand disease
B) Hemophilia A
C) TTP
D) Scurvy
Answer: B) Hemophilia A
Explanation:
Hemophilia presents with hemarthrosis and isolated prolonged aPTT.
20. Which is most likely to cause upper gastrointestinal bleeding due
to vascular malformations and mucocutaneous telangiectasias?
A) Factor VII deficiency
B) Hereditary hemorrhagic telangiectasia
C) Hemophilia B
D) Glanzmann thrombasthenia
Answer: B) Hereditary hemorrhagic telangiectasia
Explanation:
Also called Osler-Weber-Rendu, it presents with recurrent mucocutaneous and GI
bleeding.
21. Fresh frozen plasma can be used to correct deficiency of all
except:
A) Factor VIII
B) Factor V
C) Antithrombin III
D) von Willebrand factor
Answer: A) Factor VIII
Explanation:
Factor VIII concentrations in FFP are inadequate for treating hemophilia A.
Cryoprecipitate is preferred.
22. Which test result is diagnostic in Bernard-Soulier syndrome?
A) Decreased glycoprotein IIb/IIIa
B) Absent platelet aggregation with ADP
C) Absent aggregation with ristocetin
D) Megaloblastic anemia
Answer: C) Absent aggregation with ristocetin
Explanation:
Bernard-Soulier syndrome features defective GPIb, required for ristocetin-induced
aggregation.
23. Which is not a feature of DIC?
A) Prolonged PT
B) Low fibrinogen
C) Raised D-dimer
D) Isolated increased platelet count
Answer: D) Isolated increased platelet count
Explanation:
DIC leads to low platelet count due to consumption.
24. Which finding is suggestive of platelet rather than clotting-factor
disorder?
A) Hematuria
B) Petechiae
C) Hemarthrosis
D) Deep muscle bleed
Answer: B) Petechiae
Explanation:
Petechiae are typical for platelet disorders; clotting factor disorders cause deep bleeding
like hemarthrosis.
25. Which clotting factor is not synthesized in the liver?
A) Factor VIII
B) Factor V
C) Factor IX
D) Factor X
Answer: A) Factor VIII
Explanation:
Factor VIII is primarily made by endothelial cells, not hepatocytes.
26. Which best assesses intrinsic pathway activity?
A) Prothrombin time
B) Bleeding time
C) Activated partial thromboplastin time (aPTT)
D) Thrombin time
Answer: C) Activated partial thromboplastin time (aPTT)
Explanation:
aPTT measures activity of factors XII, XI, IX, VIII (intrinsic pathway).
27. A patient on warfarin develops heavy bleeding. Which factor is
decreased first?
A) Factor X
B) Factor IX
C) Factor VII
D) Factor II
Answer: C) Factor VII
Explanation:
Factor VII has the shortest half-life, so PT is prolonged first.
28. A 12-year-old with congenital afibrinogenemia. All are true
except:
A) Prolonged PT
B) Prolonged aPTT
C) Normal thrombin time
D) Prolonged bleeding time
Answer: C) Normal thrombin time
Explanation:
Fibrinogen absent, so thrombin time is also prolonged; all clotting screens are affected.
29. Haemostatic defect in immune thrombocytopenia is due to:
A) Platelet destruction
B) Platelet production defect
C) Clotting factor deficiency
D) Fibrinogen defect
Answer: A) Platelet destruction
Explanation:
ITP involves immune-mediated platelet destruction. Bleeding time is prolonged, but
PT/aPTT are normal.
30. A 6-year-old child with acute lymphoblastic leukemia develops
gum bleeding. Platelet count: 12,000/mm³, PT and aPTT normal.
Reason for bleeding?
A) Platelet dysfunction
B) Thrombocytopenia
C) Clotting factor deficiency
D) Hyperfibrinolysis
Answer: B) Thrombocytopenia
Explanation:
Severe thrombocytopenia (<20,000/mm³) leads to spontaneous mucocutaneous
bleeding.
31. All of the following are vitamin K-dependent factors except:
A) II
B) VII
C) IX
D) VIII
Answer: D) VIII
Explanation:
Factors II, VII, IX, X, protein C and S are vitamin K-dependent; VIII is not.
32. Acquired hemophilia (autoantibody against factor VIII) is
confirmed by:
A) Mixing study fails to correct aPTT
B) Platelet aggregation study
C) Thrombin time
D) D-dimer
Answer: A) Mixing study fails to correct aPTT
Explanation:
Acquired inhibitors do not correct aPTT with mixing; congenital deficiencies do.
33. Which best distinguishes between DIC and primary fibrinolysis?
A) PT
B) Platelet count
C) Fibrin split products
D) D-dimer
Answer: D) D-dimer
Explanation:
D-dimer is raised in DIC due to clot breakdown but not in primary fibrinolysis.
34. Why does chronic renal failure cause increased bleeding
tendency?
A) Increased urea interferes with platelet function
B) Decreased platelet count
C) Coagulation factor deficiency
D) Thrombocytosis
Answer: A) Increased urea interferes with platelet function
Explanation:
Uremia leads to abnormal platelet function and prolonged bleeding time.
35. Which anticoagulant inhibits both thrombin and factor Xa?
A) Heparin
B) Warfarin
C) Dabigatran
D) Aspirin
Answer: A) Heparin
Explanation:
Heparin potentiates antithrombin III, inhibiting both thrombin and factor Xa.
36. Neonatal purpura fulminans is due to deficiency of:
A) Protein C
B) Protein S
C) Factor V
D) Fibrinogen
Answer: A) Protein C
Explanation:
Congenital protein C deficiency manifests as purpura fulminans in neonates with
extensive thrombosis.
37. The earliest laboratory abnormality in DIC is:
A) Thrombocytosis
B) Prolonged PT
C) Prolonged aPTT
D) Low fibrinogen
Answer: B) Prolonged PT
Explanation:
PT is prolonged earliest due to factor VII consumption in DIC.
38. Which is the most sensitive indicator of DIC?
A) Platelet count
B) PT
C) D-dimer
D) Fibrinogen
Answer: C) D-dimer
Explanation:
D-dimer is reliably elevated in DIC, indicating fibrin breakdown.
39. All the following are features of hemophilia except:
A) Delayed wound healing
B) Hemarthrosis
C) Male predominance
D) Normal bleeding time
Answer: A) Delayed wound healing
Explanation:
Hemophilia presents with hemarthrosis, male predominance, and normal bleeding time;
delayed healing is not typical.
40. A known hemophilia A patient is given desmopressin before
dental extraction. Mechanism of action?
A) Stimulates factor IX release
B) Stimulates von Willebrand factor release
C) Stimulates thrombopoietin
D) Inhibits fibrinolysis
Answer: B) Stimulates von Willebrand factor release
Explanation:
Desmopressin releases stored factor VIII and vWF, which helps in mild hemophilia A.
41. Which clotting factor does not have a corresponding clinical
bleeding disorder if deficient?
A) Factor XII
B) Factor XI
C) Factor IX
D) Factor VII
Answer: A) Factor XII
Explanation:
Factor XII deficiency prolongs aPTT but does not cause bleeding.
42. Which test is used to monitor unfractionated heparin therapy?
A) PT
B) aPTT
C) TT
D) Fibrinogen
Answer: B) aPTT
Explanation:
aPTT is used for monitoring unfractionated heparin.
43. Which feature differentiates primary vs secondary hemostasis
disorders?
A) Hematuria
B) Mucocutaneous bleeding
C) Recurrent miscarriages
D) Thrombosis
Answer: B) Mucocutaneous bleeding
Explanation:
Primary hemostasis (platelet related) disorders present with mucocutaneous bleeding;
secondary (clotting factors) present with deep bleeds like hemarthrosis.
44. A 32-year-old woman with easy bruisability has normal PT, aPTT,
platelet count, and bleeding time. Likely diagnosis?
A) Ehlers-Danlos syndrome
B) von Willebrand disease
C) ITP
D) Glanzmann thrombasthenia
Answer: A) Ehlers-Danlos syndrome
Explanation:
Connective tissue disorders can cause bruising despite normal coagulation and platelet
studies.
45. In a patient with vitamin K deficiency, which factor is NOT
reduced?
A) Factor II
B) Factor VII
C) Factor V
D) Factor IX
Answer: C) Factor V
Explanation:
Factor V is not vitamin K dependent, so not reduced in deficiency.
46. Warfarin-induced skin necrosis is due to:
A) Increased platelet aggregation
B) Rapid drop in protein C
C) Inhibition of factor V
D) Fibrinogen consumption
Answer: B) Rapid drop in protein C
Explanation:
Protein C is a natural anticoagulant. Warfarin causes its rapid decline, leading to
microvascular thrombosis and skin necrosis.
47. All cause hypercoagulable state except:
A) Antithrombin III deficiency
B) Protein C deficiency
C) Factor V Leiden
D) Hemophilia B
Answer: D) Hemophilia B
Explanation:
Hemophilia B increases bleeding, not clotting. Others are prothrombotic states.
48. The diagnosis of deep vein thrombosis is best confirmed by:
A) PT/INR
B) Duplex ultrasonography
C) D-dimer
D) Venography
Answer: B) Duplex ultrasonography
Explanation:
Ultrasound is the first-line diagnostic tool for DVT.
49. Which is NOT a component of Virchow’s triad?
A) Hypercoagulability
B) Vessel wall injury
C) Hemolysis
D) Venous stasis
Answer: C) Hemolysis
Explanation:
Hemolysis does not contribute to thrombosis; hypercoagulability, vessel wall injury, and
stasis do.
50. The gold standard for hemophilia A diagnosis is:
A) Platelet function assay
B) Factor VIII assay
C) aPTT
D) PT
Answer: B) Factor VIII assay
Explanation:
Specific factor assay confirms diagnosis of hemophilia type and severity.
51. Which therapy is NOT effective in TTP?
A) Plasma exchange
B) Platelet transfusion
C) Steroids
D) Rituximab
Answer: B) Platelet transfusion
Explanation:
Platelet transfusions increase risk of thrombosis and are avoided unless life-threatening
bleeding.
52. Which is the only clotting factor not decreased in liver disease?
A) Factor V
B) Factor VII
C) Factor VIII
D) Factor X
Answer: C) Factor VIII
Explanation:
Factor VIII levels may be normal or increased; others are decreased in liver disease.
53. A young woman develops hemolytic anemia, thrombocytopenia,
fever, renal failure, and neurological deficits. Diagnosis?
A) ITP
B) TTP
C) DIC
D) HUS
Answer: B) TTP
Explanation:
The pentad suggests thrombotic thrombocytopenic purpura (TTP).
54. Which test is prolonged in hemophilia A?
A) Bleeding time
B) PT
C) aPTT
D) Platelet count
Answer: C) aPTT
Explanation:
Isolated prolonged aPTT due to factor VIII deficiency in hemophilia A.
55. Which type of vWD is characterized by a qualitative defect of
vWF?
A) Type 1
B) Type 2
C) Type 3
D) None
Answer: B) Type 2
Explanation:
Type 2 vWD has normal or near-normal vWF level, but defective function.
56. A patient with prosthetic heart valve on warfarin develops
headache, confusion, and a high INR. First step?
A) Stop warfarin
B) Give vitamin K
C) Platelet transfusion
D) Immediate neurosurgery
Answer: A) Stop warfarin
Explanation:
Immediate step is cessation of anticoagulant to prevent worsening of bleeding.
57. Which is the mainstay of therapy in DIC?
A) Platelet transfusion
B) Antifibrinolytics
C) Treat underlying cause
D) Heparin
Answer: C) Treat underlying cause
Explanation:
DIC is secondary to another trigger; management focuses on this while supporting
coagulation as needed.
58. Massive transfusion protocol aims to prevent:
A) Dilutional coagulopathy
B) Thrombosis
C) Hemochromatosis
D) Hemolysis
Answer: A) Dilutional coagulopathy
Explanation:
Balance between RBCs, plasma, and platelets is essential to prevent coagulopathy after
massive transfusion.
59. Which is the test of choice for diagnosis of platelet function
disorders?
A) PT/INR
B) aPTT
C) Bleeding time
D) Platelet aggregation studies
Answer: D) Platelet aggregation studies
Explanation:
Specific agonists are used to assess platelet function in vitro.
60. Which is the safest blood component for a hemophilia patient
needing factor VIII?
A) Platelets
B) Fresh frozen plasma
C) Cryoprecipitate
D) Whole blood
Answer: C) Cryoprecipitate
Explanation:
Cryoprecipitate is rich in factor VIII and fibrinogen; FFP is less concentrated for factor VIII
needs.
