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CPS Exam #2 > Case #5 -- Car Wreck > Flashcards

Case #5 -- Car Wreck Flashcards

1
Q

What are petechiae?

A

1-3 mm red spots caused by bleeding into the skin

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2
Q

What are fibroids?

A

Benign tumors of muscular or fibrous tissues

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3
Q

What do the temperatures 37C and 40C correlate with in Farenheight?

A 
37C = 104 F
37C = 98.6 F
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4
Q

What does the phrase “well-developed”

A

Common in Pediatrics

Comparison of development to average for age group

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5
Q

PT times is a measure of? PTT is a measure of?

A

PT – Extrinsic Pathway

aPTT – Intrinsic Pathway

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6
Q

Loss of von willebrand factor corelated with loss of what other factor?

A

8

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7
Q

What does a Ristocetin cofactor assay assess?

A

Ristocetin needs vW to aggregate

If added and no aggregation, no vW

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8
Q

What does the platelet aggregation to ADP assay indicate?

A

GB2P – It activated the receptor

Decreased levels – Bernard Sollier

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9
Q

DDAVP is also known as…

A

Desmopressin

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10
Q

Common symptoms of vW?

A

Bleeding during operations/trauma
Abnormal Periods
Bruising, Nosebleed, Rash

In type III – Hemearthrosis

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11
Q

What does vW factor do?

A

It helps platelets clump together and stick to the blood vessel

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12
Q

Difference between type I, II, and III

A

I – Reduced vW factor
II – Production of vW that doesn’t work
III – Basically No vW factor

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13
Q

What drugs is it important not to give to vW patients?

A

NSAIDS

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14
Q

What vitamin deficiency should you watch for in bleeding disorders?

A

K

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15
Q

Hemarthresis is characteristic of what type of bleeding disorders?

A

Hemophillia

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16
Q

Components of plugging the blood flow.

A

Activation of platelets that form platelet plug

Stabilization by cross-linked fibrin

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17
Q

Three components of hemostasis? The role of vW?

A

Platelets, Vascular Wall, Coagulation Factor

vW links vascular wall to platelets.

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18
Q

How might hemostasis fail?

A

Too Few Platelets
Dysfunctional Platelets (Heredity, Acquired)
Improper Adhesion (vW, abnormal collagen)
Decreased Coagulation Factors (Heredity, Acquired)

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19
Q

Platelets bind to eachother via…

A

Fibrinogen (GpIIb-IIIa)

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20
Q

Platelets bind to denuded collagen via…

A

vWF (GpIb)

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21
Q

Hereditary causes or improper adhesion of platelets to eachother?

A

Bernard-Soulier

Glanzmann Thrombasthenia

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22
Q

Blood vessel abnormalities that may influence clotting?

A

Ehlers-Danlos Syndrome

Vasculitis

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23
Q

What causes platelet activation (3)?

A

Exposure to collagen
Exposure to Tissue Factor
Exposure to Thrombin

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24
Q

When would you expect platelets to be exposed to collagen?

A

Damaged Vessels

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25
Q

When would you expect platelets to be exposed to tissue factor?

A

Damaged endothelial cells to other tissue

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26
Q

When would you expect platelets to be exposed to thrombin?

A

Activation of coagulation cascade

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27
Q

Common sign of platelet problems?

How to you test for it?

A

Petechiae, easy bruising

Bleeding Time

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28
Q

What do you do in a bleeding time test?

A

Make a small cut and at different time intervals, assess the clot formation.

Abnormally long bleeding time/oozing = platelet problem

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29
Q

Why do hemophiliacs have normal bleeding time?

A

Defects of coagulation factors alone do not prohibit platelet plugging of small fascular holes.

CFs stabilise the plugs and large vascular tears

30
Q

Name the four receptors platelets respond to?

A

Gp Ia-IIa
Gp Ib/V/IX (vW)
Gp VI
Gp IIb-IIIa

31
Q

What is Bernard Soulier?

A

Gp Ib Deficiency

32
Q

Deficiency of
GpIb…
GpIIa-IIIa…

A

Bernard Soulier

Glanzmann thrombasthenia

33
Q

Causes of too few platelets?

A 
Increased Destruction (ITP, hypersplenism)
Decreased Synthesis (Leukemia)
34
Q

Aspirin and NSAIDs inhibit…

A

Thromboxane

Causes contraction and increased clotting

35
Q

Enzyme important in clotting cascase?

A

Serine proteases

36
Q

Alternate names for factor I and II

A

I – Fibrinogen

II – Thrombin

37
Q

Two roles of thrombin?

A

Activated plasmin from plasminogen

Forms fibrin from fibrinogen

38
Q

Plasminogen activators are used in what medical scenario?

A

Dissolving clots in MI or stroke

39
Q

Extrinsic pathway is mediated by….
Starts with Factor….
Tested with….

A

Thromboplastin
Factor VII
PT

40
Q

Intrinsic pathway is triggered by…
Starts with Factor….
Tested with…

A

High MW kininogen and exposure of collagen
Factor XII
aPTT

41
Q

Two factors associated with hemophilia?

A

VIII and IX

42
Q

Mneumonic for PT?

A

You do PT outside at 7AM.

43
Q

Factors in Common Pathway?

A

X, V, and II

44
Q

Bleeding Time, Ristocetin, PT, and aPTT. What’s off in platelet disorders?

A

Bleeding Time

45
Q

Bleeding Time, Ristocetin, PT, and aPTT. What’s off in Hemophillia?

A

aPTT

46
Q

Bleeding Time, Ristocetin, PT, and aPTT. What’s off in Vitamin K deficiency?

A

PT and aPTT

47
Q

Bleeding Time, Ristocetin, PT, and aPTT. What’s off in Liver Failure?

A

PT and aPTT

48
Q

Bleeding Time, Ristocetin, PT, and aPTT. What’s off in vW?

A

Bleeding Time, aPTT, Ristocetin

49
Q

Why does Vitamin K influence PT and aPTT?

A

Vitamin K carboxylates elements of both passages

50
Q

Why does vW disease cause a prolonged aPTT?

A

vW stabilizes and localizes Factor VIII

51
Q

Why can’t a aPTT test distinguish btw hemophilia A and B?

A

Hemophilia A – Factor XIII deficiency
Hemophilia B – Factor IX deficiency

Both deficiencies present in the intrinsic pathway

52
Q

How do you distinguish between Hemophilia A and B?

A

Add the blood to a solution with blood with the respective factors to assess clotting.

If neither works, an inhibitor is present.

53
Q

Inheritance pattern of vW I, II, and III

A

vW I – Autosomal Dominant
II – Autosomal with variable penetrance
III – Autosomal Recessive

54
Q

Why might desmopressin be ineffective against Type II vW?

A

Type II vW is a qualitative defect

55
Q

Common causes of acquired vW? (5)

A 
Cancer
Hypothyroidism
Systemic Lupus erythematosus
Heart Problems
Meds
56
Q

Four sources of Vascular Abnormalities?

A

Ehlers-Danlos Syndrome (Collagen Abnormalities)
Scurvy (Abnormality of cross-linking of collagen)
Vascular Infections (Riskettsia)
Henoch-Schonlein Purpura

57
Q

Genetic inheritance of hemophilia?

A

X-linked inheritance

58
Q

Unexplained pain in hemphilia should be assumed to be…

A

bleeding

59
Q

Hemophilia treatment?

A

Factor Replacement
Pain Control
Rest
Immobilize Joints

60
Q

If low response to factor replacement, probably means…

A

Test for Inhibitor

61
Q

Difference between Concentrates and Cryoprecipitates.

A

Concentrates are Screened and Irradiated.

Cryoprecipitates are screened, but not irradiated

62
Q

What is desmopressin?

A

A synthetic version of vasopressin

63
Q

What does desmopressin do?

A

Increase in vW release from endothelial cell Weibel-Palade bodies

64
Q

Name for intranasal desmopressin?

A

Stimate

65
Q

Side effects of desmopressin?

A

Water conservation with hyponatremia (dilution of Na)

Can cause seizures

66
Q

Why cans highly purified FVIII concentrates be used to treat VWD?

A

They lack VWF

67
Q

When would a cryoprecipitate be an appropriate recommendation?

A

If a concentrate is not available and DDVAp is unavailable or ineffective.

68
Q

What is Epsilon aminocaproic acid?

A

Treatmet used to prevent dissolution of the hemostatic plug, esp. in mucous membrances

69
Q

What topical agents are used to treat bleeding?

A 
GelFoam, Surgicel (Have topical thrombin)
Micronizen Collagen (Avitene)
70
Q

Influence of estrogen on vWD?

A

Increased vWD synthesis

71
Q

What pain treatment might you use for VW patients?

A

Acetaminophen

72
Q

What does multifactorial inheritance mean?

A

Disease is caused by interplay between genetic and environmental factors

CPS Exam #2 (2 decks)

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