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PEDO Midterm (Fall) > 3. Medically Complex Patients > Flashcards

3. Medically Complex Patients Flashcards

1
Q

Describe the difference between primary and secondary hemostasis

A

Primary Hemostasis

  • Injury to Blood vessel –>Platelet plug formation
  • Platelets and coagulation factors in plasma and vessel wall interact to form platelet plug at injury site

Secondary Hemostasis
-Coagulation and clotting factors lead to production of fibrin which is deposited to form blood clot

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2
Q

What happens when primary or secondary hemostasis is disrupted

A

prolonged bleeding

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3
Q

People with inherited coagulation disorders results in a decrease in what

A

factors in coagulation cascade

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4
Q

Hemophilia A is a decrease in factor….

A

VIII

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5
Q

Hemophilia B is a decrease in factor _

A

IX

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6
Q

Hemophilia B is also called

A

christmas disease

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7
Q

Von Willebrands Diseases is a decrease in

A

VW factor

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8
Q

What is the role of VW factor

A

-Binds VIII then the complex binds platelets for activation of coaggulation cascade

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9
Q

What happens to factor VIII in the absence of VW factor

A

it is degraded

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10
Q

What cells produce factor VIII

A

endothelial cells

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11
Q

Describe the two components of Factor VIII

A

Von- Willebrand component –> initial platelet aggregation

Factor VIII component –> activates factor X in the intrinsic coagulation pathway

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12
Q

What is the role of factor IX

A

Also activates factor X in the intrinsic coaggulation pathway

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13
Q

What is the inheritance pattern of hemophilia A

A

X-linked recessive (only seen in men- females are carriers )

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14
Q

30% of Hemophilia A cases are a result of what

A

spontaneous mutation

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15
Q

Which is more common hemophilia A or B

A

A (85% hemophiliacs are Hemophilia A)

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16
Q

The classification of hemophilia is based on what

A

the % procoagulant present

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17
Q

Severe, Moderate, Mild hemophilia is defined as…

A
  • Severe= <1% factor VIII non detectable in plasma spontaneous bleeding in joints and muscles
  • Moderate= 1-4% Factor VIII. Less severe bleeding after small trauma
  • Mild (5-25% Factor VIII) may not manifest until after trauma or surgery
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18
Q

What is the normal % of factor VIII in the blood (aka non-hemophiliacs)

A

55-100%

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19
Q

IS there a cure for hemophilia

A

no

20
Q

What should be done to minimize the health consequences of hemophilia

A
  • Avoid injury and meds that promote bleeding
  • Good nutrition
  • Good oral hygiene
  • IV administration of deficient clotting agent
21
Q

What are signs of hemophilia

A
  • Intracranial hemorrhage
  • Prlonged nose bleeds
  • Bruise easily
  • Warm, Painful swollen joints with decreased movement
  • GI hemorrhage
22
Q

Inheritance pattern for hemophilia B is

A

X-linked recessive (same as hemophilia A)

23
Q

What is the inheritance pattern of Von Willebrand’s disease

A

autosomal dominant (can also be aquired)

24
Q

How can von willebrand’s disease be acquired

A
  • Via thrombocytopenia

- Via autoantibodies against VWF

25
Q

Classification of VW disease is based on

A
  • Inherited v.s acquired
  • Depends on platelet and factor defects
  • As mild as nosebleeds, gingival bleeding and bruising to severe internal bleeding
26
Q

What bleeding disorders can only boys get

A

Hemophilia A and B

27
Q

Blood screening tests for these three bleeding disorders tests the ability of the _ clotting pathway with the _ test

A

Intrinsic pathway… Activated Partial thromboplastin time (APTT)

28
Q

What is the blood test that measures the function of the extrinsic clotting pathway

A

Prothombin time (PT)

29
Q

If coagulation test results are _ seconds more than the control this is considered abnormal

A

2 sec

30
Q

The time required to stop bleeding is a measure of what

A

the platelet function

31
Q

What is the normal APTT and PT times

A

APTT=24-38 sec

PT= 11-17 sec

32
Q

Which of the three bleeding disorders will have a prolonged APTT

A

All of them

33
Q

Which of the three bleeding disorders will have a prolonged PT

A

None of them

34
Q

What bleeding disorders will have a decreased factor VIII

A

Hemophilia A and Von willebrands

35
Q

Which diseases will have an increased bleeding time

A

only Von Willebrand’s because of the impaired platelet function

36
Q

Platelet counts in Von Willebrands disease will be (decrease/normal)

A

Could be either depends on the type

37
Q

Platelet counts in hemophilia will be (decreased/normal)

A

normal

38
Q

What are the clinical hallmarks of hemophilia

A
  • Easy bruising
  • Prolonged/fatal bleeding after surgery or trauma
  • Will NOT necessarily have excessive bleeding after minor cuts and abrasions
  • Joint/muscle hemorrhages (Hemarthroses and hematomas in muscle)
  • Painful arthritis (degenerative joint disease)
  • Pseudotumors (hemorrhagic pseudocysts may occur) in the jaw
  • Bloodborne viral infections more common from transfusions (HIV and Hepatitis)
39
Q

Possible sequelae of a hematoma in the muscle could be what

A

compression of nerves (paralysis) or lead to vascular/airway obstruction

40
Q

What are the oral manifestations of bleeding disorders

A
  • Petechiae
  • Ecchymosis
  • Generalized gingival hemorrhage
  • Purpura
41
Q

As a dentist if you suspect a bleeding disorder what should you do

A
  • Refer to pediatrician for blood screen
  • If pediatrician is suscpicious the patient is refered to a hematologist
  • Consultation with the hematologist must be obtained before performing invasive dental care
42
Q

(T/F) Patients with a bleeding disorder can often receive basic outpatient care

A

t

43
Q

Is premedication required for supragingival scaling in mild/moderate cases? Subgingival scaling?

A

no… MAYBE

44
Q

In order to avoid extractions _ should be done with the teeth to avoid a platelet transfusion

A

endodontics

45
Q

Patients should be treated with what before invasive dentistry

A
  • their deficient factor

- Amicar (from the hematologist) 1 hr prior

46
Q

What meds should be avoided in people with bleeding disorders

A

aspirin and ibuprofen (these decrease platelet function- blood thinners) Use acetaminophen

PEDO Midterm (Fall) (8 decks)

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