NBME COMSAE Exam Latest Update 2026 | Exam Prep |
High-Yield Review Guide
1. Describe the role of Factor XIII in the coagulation cascade and how it differs
from the roles of Protein C and Thrombomodulin.
Factor XIII stabilizes fibrin clots by cross-linking fibrin strands, while
Protein C and Thrombomodulin are involved in regulating
coagulation and preventing excessive clotting.
Factor XIII is involved in platelet aggregation, whereas Protein C and
Thrombomodulin stabilize fibrin clots.
Factor XIII is responsible for initiating the coagulation cascade, while
Protein C and Thrombomodulin are involved in fibrinolysis.
Factor XIII is a pro-coagulant, while Protein C and Thrombomodulin
are anticoagulants with no role in clot stabilization.
2. Describe how tissue factor (TF) contributes to hemostasis after an injury.
Tissue factor (TF) activates the extrinsic pathway of coagulation,
leading to the formation of a fibrin clot.
Tissue factor (TF) prevents blood loss by dilating blood vessels.
Tissue factor (TF) directly stimulates the production of red blood cells.
Tissue factor (TF) enhances the breakdown of clots to prevent
excessive coagulation.
3. A 12-year-old girl consults you for prolonged menstrual bleeding for more
than 3 weeks now. CBC, PT, PTT are normal but bleeding time is prolonged at
15 minutes and easy bruisability. You suspect she may have:
Von Willebrand Disease
Acute ITP
, Leukemia
Glanzmann Thrombasthenia
4. If the 17-year-old male continues to play tennis without addressing the
inflammation of the wrist flexors, what potential long-term consequence
might he face?
Increased range of motion in the elbow
Chronic elbow pain and potential tendon injury
Complete recovery without intervention
Improvement in flexibility and strength
5. In a clinical scenario where a patient presents with wrist drop and difficulty in
elbow flexion, which nerve injury could be responsible for these symptoms?
Radial nerve injury
Median nerve injury
Ulnar nerve injury
Musculocutaneous nerve injury
6. Which clotting factor mechanically stabilizes fibrin to help protect it from
fibrinolysis?
Factor XIII
Protein C
Tissue factor
von Willebrand Factor
7. The HELLP syndrome is characterized by:
, Elevated liver transaminases, thrombocytopenia, and consumptive
coagulopathy
Upper liver transaminases and RR > 160/110
Increased liver transaminases, thrombocytopenia and RR >
Increased hepatic transaminases, thrombocytopenia and hemolysis
8. Which factor is known for its role in stabilizing fibrin clots during the
coagulation process?
Factor XIII
Thrombomodulin
Protein C
Von Willebrand factor
9. A 30-year-old woman presents to hematology for evaluation after a recent
postpartum hemorrhage. She states that she has always had heavy menstrual
bleeding and bruised easily. She also states that she had nosebleeds lasting
longer than 10 minutes as a child. Her platelet count, prothrombin time, and
activated partial thromboplastin time are all normal. Which of the following is
the most likely diagnosis?
von Willebrand disease
Hemophilia B
Factor V Leiden
Hemophilia A
10. What does the acronym HELLP stand for in the context of HELLP syndrome?
Hemorrhage, Elevated Lipids, Low Platelets
High Enzymes, Low Platelets, Elevated Liver
High-Yield Review Guide
1. Describe the role of Factor XIII in the coagulation cascade and how it differs
from the roles of Protein C and Thrombomodulin.
Factor XIII stabilizes fibrin clots by cross-linking fibrin strands, while
Protein C and Thrombomodulin are involved in regulating
coagulation and preventing excessive clotting.
Factor XIII is involved in platelet aggregation, whereas Protein C and
Thrombomodulin stabilize fibrin clots.
Factor XIII is responsible for initiating the coagulation cascade, while
Protein C and Thrombomodulin are involved in fibrinolysis.
Factor XIII is a pro-coagulant, while Protein C and Thrombomodulin
are anticoagulants with no role in clot stabilization.
2. Describe how tissue factor (TF) contributes to hemostasis after an injury.
Tissue factor (TF) activates the extrinsic pathway of coagulation,
leading to the formation of a fibrin clot.
Tissue factor (TF) prevents blood loss by dilating blood vessels.
Tissue factor (TF) directly stimulates the production of red blood cells.
Tissue factor (TF) enhances the breakdown of clots to prevent
excessive coagulation.
3. A 12-year-old girl consults you for prolonged menstrual bleeding for more
than 3 weeks now. CBC, PT, PTT are normal but bleeding time is prolonged at
15 minutes and easy bruisability. You suspect she may have:
Von Willebrand Disease
Acute ITP
, Leukemia
Glanzmann Thrombasthenia
4. If the 17-year-old male continues to play tennis without addressing the
inflammation of the wrist flexors, what potential long-term consequence
might he face?
Increased range of motion in the elbow
Chronic elbow pain and potential tendon injury
Complete recovery without intervention
Improvement in flexibility and strength
5. In a clinical scenario where a patient presents with wrist drop and difficulty in
elbow flexion, which nerve injury could be responsible for these symptoms?
Radial nerve injury
Median nerve injury
Ulnar nerve injury
Musculocutaneous nerve injury
6. Which clotting factor mechanically stabilizes fibrin to help protect it from
fibrinolysis?
Factor XIII
Protein C
Tissue factor
von Willebrand Factor
7. The HELLP syndrome is characterized by:
, Elevated liver transaminases, thrombocytopenia, and consumptive
coagulopathy
Upper liver transaminases and RR > 160/110
Increased liver transaminases, thrombocytopenia and RR >
Increased hepatic transaminases, thrombocytopenia and hemolysis
8. Which factor is known for its role in stabilizing fibrin clots during the
coagulation process?
Factor XIII
Thrombomodulin
Protein C
Von Willebrand factor
9. A 30-year-old woman presents to hematology for evaluation after a recent
postpartum hemorrhage. She states that she has always had heavy menstrual
bleeding and bruised easily. She also states that she had nosebleeds lasting
longer than 10 minutes as a child. Her platelet count, prothrombin time, and
activated partial thromboplastin time are all normal. Which of the following is
the most likely diagnosis?
von Willebrand disease
Hemophilia B
Factor V Leiden
Hemophilia A
10. What does the acronym HELLP stand for in the context of HELLP syndrome?
Hemorrhage, Elevated Lipids, Low Platelets
High Enzymes, Low Platelets, Elevated Liver
