Acute

Question 1

what is the ECG finding in PE with right heart strain?

Answer 1

S1 Q3 T3

large S and Q waves 1 and 3 and inverted T waves in 3

Question 2

causes of hypovolaemic shock

Answer 2

bleeding
pancreatitis (necrotising then fluid lost into body cavity)
AAA
adrenal failure
burns

Question 3

causes of ear bleeding

Answer 3

infection with perforation
barotrauma
head trauma

Question 4

what causes DIC?

Answer 4

obstetric complications (eclampsia, pre eclampsia, abruptio placenta, saline abortion, retained products of conception)
snake bites
incompatible drug transfusion

Question 5

why does DIC happen?

Answer 5

continuous thrombin production, used up so bleeding occurs, clotting factors are triggered by endotoxin from bacteria or by viruses

Question 6

what are platelets inhibited by?

Answer 6

NO (which is in intact endothelium)

Question 7

how are platelets activated?

Answer 7

thrombin and exposed endothelial collagen

Question 8

how long do platelets last?

Answer 8

8 days

Question 9

what is ecchymosis?

Answer 9

bleeding into soft tissue (not necessarily trauma as haematoma is)

Question 10

how is the coagulation cascade set off?

Answer 10

VII contact with vascular endothelium

Question 11

what is the function of fibrinolysis?

Answer 11

prevents blood clots getting too big and prepares site of inflammation for the next stage of healing

Question 12

how does plasmin come about?

Answer 12

cleaved from plasminogen by urokinase and tissue plasminogen activator

Question 13

what does plasmin do?

Answer 13

degrades fibrin

Question 14

when in fibrinolysis used clinically?

Answer 14

MI
ischaemic stroke
PE

Question 15

give some examples of fibrinolytics

Answer 15

streptokinase
alteplase
reteplase

Question 16

define major bleed

Answer 16

loss of 50% blood volume in 3 hours or 100% in 24 hours or >150ml/min
or if it has led to shock <90mmHg/>110bpm

Question 17

what is dilutional coagulopathy

Answer 17

when major bleeding with transfusion leads to thrombocytopenia, bleeding uses up the platelets and coat factors

Question 18

what is prioritised in DIC?

Answer 18

platelet transfusion

Question 19

what is ITP?

Answer 19

autoimmune-low platelets with normal bone marrow-an autoimmune response to platelet surface antigens

Question 20

treat ITP?

Answer 20

conservative, if a major bleed>transfuse platelets+steroids

Question 21

what causes TTP?

Answer 21

pregnancy
drugs
cancer
autoimmune-autoantibody mediated inhibition of vWF breakdown so platelets get used up

Question 22

what makes up TTP?

Answer 22

5 things
fever
renal failure
neuro sx
haemolytic anaemia
thrombocytopenia

Question 23

how do you treat thrombotic thrombocytopenic purpura?

Answer 23

plasmapheresis

corticosteroids

Question 24

complications of haemophilia

Answer 24

haemoarthosis
cerebrovascular accident
internal bleeding
blood infections

Question 25

what does vWF do?

Answer 25

platelet adhesion

Question 26

what happens in vWF

Answer 26

lots of small vessels in uterus, skin, GI tract, bleeding from these areas as platelets don’t get activated

Question 27

how is aspirin an anticoagulant

Answer 27

prevents COX1 more than it does COX2 so thromboxane reduced

Question 28

how does clopidogrel prevent platelet aggregation?

Answer 28

prevent ADP binding to p2y12 receptor

Question 29

what is haemorrhagic disease of the newborn?

Answer 29

alloimmune condition, maternal IgG>foetus attack RBC>foetal anemia may>hydrops fetalis

Question 30

what must you not do for someone with facial trauma

Answer 30

put an NG tube in-fracture and tube may cause CSF leak