CCS Hemostasis and Coagulation Management 3

Question 1

In the coagulation cascade, which pathway is initiated by tissue factor exposure at the site of vascular injury?

Accepted Answer

Extrinsic pathway

Answer

Intrinsic pathway

Answer

Common pathway

Answer

Fibrinolytic pathway

Question 2

Which topical hemostatic agent works by providing a physical matrix that activates the intrinsic coagulation pathway and is derived from bovine or human thrombin?

Accepted Answer

Fibrin sealant (Tisseel)

Answer

Gelatin foam (Gelfoam)

Answer

Oxidized cellulose (Surgicel)

Answer

Bone wax

Question 3

Which point-of-care viscoelastic test provides information about clot formation, clot strength, and fibrinolysis and is commonly used to guide transfusion in cardiac surgery?

Accepted Answer

Thromboelastography (TEG) or ROTEM

Answer

Bleeding time

Answer

Activated clotting time (ACT)

Answer

Platelet aggregation assay

Question 4

Which coagulation factor is activated by thrombin and serves as the final enzyme in converting fibrinogen to fibrin?

Accepted Answer

Thrombin (Factor IIa)

Answer

Factor Xa

Answer

Factor XIIIa

Answer

Factor VIIa

Question 5

A patient with known heparin-induced thrombocytopenia (HIT) requires cardiac surgery with CPB. Which anticoagulant is the preferred alternative to heparin?

Accepted Answer

Bivalirudin

Answer

Low molecular weight heparin (LMWH)

Answer

Fondaparinux

Answer

Argatroban

Question 6

During cardiac surgery, epsilon-aminocaproic acid (EACA) reduces bleeding by which mechanism?

Accepted Answer

Competitively inhibiting plasminogen binding to fibrin

Answer

Inhibiting platelet aggregation

Answer

Binding and inactivating heparin

Answer

Activating thrombin generation

Question 7

Which fibrinogen level is generally considered the threshold below which fibrinogen replacement (cryoprecipitate or fibrinogen concentrate) should be considered in a bleeding cardiac surgery patient?

Accepted Answer

Below 200 mg/dL

Answer

Below 400 mg/dL

Answer

Below 100 mg/dL

Answer

Below 50 mg/dL