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Clinical Haematology > Chapter 27 : Thrombosis 1 > Flashcards

Chapter 27 : Thrombosis 1 Flashcards

1
Q

What is the function of Platelet derived Growth Factor?

A

It stimulates the migration and proliferation of smooth muscle cells and fibroblasts in the arterial intima.

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2
Q

What are the two important pathogenesis factors for Arterial Thrombosis?

A

Platelet deposition and thrombus formation

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3
Q

What are the risk factors for Arterial Thrombosis?

A
  • Positive family history
  • Male sex
  • Hyperlipidaemia
  • Hypertension
  • Diabetes mellitus
  • Gout
  • Polycythaemia
  • Cancer
  • Hyperhomocysteinaemia
  • Cigarette smoking
  • ECG abnormalities
  • Elevated CRP, IL6, fibrinogen, lipoprotein-associated phospholipase A2
  • Lupus anticoagulant
  • Collagen vascular diseases
  • Behçet’s disease
  • Malignancy
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4
Q

What are the components of Virchrow’s Triad?

A

1 Slowing down of blood flow.
2 Hypercoagulability of the blood.
3 Vessel wall damage.

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5
Q

What is the most common inherited cause of an increased risk of Venous Thrombosis?

A

Factor V Leiden (FVL) gene mutation

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6
Q

True or False? In Factor V Leiden (FVL) gene mutation, There is failure of activated protein C (APC) to prolong the activated partial thromboplastin time (APTT) test when added to plasma of patients with FVL, so the phenotype is sometimes referred to as ‘activated protein C resistance’.

A

TRUE!!

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7
Q

True or False? Factor V Leiden (FVL) gene mutation increases the risk of Arterial Thrombosis.

A

FALSE!! It does not increase the risk of arterial thrombosis.

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8
Q

What is the genetic mutation associated with Factor V Leiden deficiency ?

A

In the factor V Leiden mutation the Arg506Gln polymorphism leads to glutamine at position 506, with less efficient inactivation of factor V by APC and increased risk of thrombosis.

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9
Q

True or False? Antithrombin deficiency is Autosomal recessive.

A

FALSE!! It is Autosomal Dominant

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10
Q

True or False? In Antithrombin deficiency there are recurrent venous thromboses, usually starting in early adult life, and arterial thrombi may occur.

A

TRUE!!

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11
Q

Fill in the blanks. “ Infants may be born with homozygous Protein C deficiency and characteristically present with _____________.”

A

Disseminated intravascular coagulation (DIC) or purpura fulminans in infancy.

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12
Q

True or False? G20210A is a mutation in the promoter region of the prothrombin gene that has a prevalence of 2–3% in the population.

A

TRUE!!

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13
Q

What is a characteristic feature of Protein C and S deficiency?

A

Many patients develop SKIN NECROSIS as a result of dermal vessel occlusion when treated with warfarin alone, thought to be caused by a further reduction of protein C levels in the first day or two of warfarin therapy.

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14
Q

Fill in the blanks. “ In Prothrombin allele G20210A, there is an ____________ production of prothrombin

A

INCREASED

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15
Q

Fill in the blanks. “ The risk of venous thrombosis due to High Hyperhomocysteinaemia is only in the case of patients with _________.”

A

A deficiency of cystathione β-synthase (CBS).

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16
Q

Fill in the blanks. “ Homocysteine is derived from the dietary _________.”

A

Methionine

17
Q

How is homocysteine normally removed?

A

It is normally removed by either either remethylation to methionine or conversion to cysteine via a trans-sulphuration pathway.

18
Q

True or False? Classic homocystinuria is a rare autosomal recessive disorder caused by deficiency of CBS.

A

TRUE!!

19
Q

What are the clinical features of CBS deficiency?

A
  1. Vascular disease
  2. Thrombosis
  3. Mental Retardation
  4. Lens Dislocation
    5.Long slender fingers
20
Q

What are the acquired risk factors for Hyperhomocysteinaemia?

A
  1. Deficiency of Vitamin B6 & folate 2. Drugs (e.g. ciclosporin)
  2. Renal damage
  3. Smoking
    5 . Men and Post-menopausal women ( not acquired but mentioned)
21
Q

Fill in the blanks. “ ____________is responsible for up to 50% of cases of Deep Vein Thrombosis and Pulmonary Embolism. “

A

Hospital-acquired thrombosis (HAT)

22
Q

What is the time period of hospitalisation associated with Hospital- Acquired Thrombosis ( HAT) aka venous thromboembolism (VTE)?

A

90 days

23
Q

Which patients are at risk for Post Operative venous thrombosis?

A
  1. Obese patients
    2.Elderly
  2. Patients with previous or family history of venous thrombosis.
  3. Patients with major abdominal or hip operations that were performed.
24
Q

Fill in the blanks. “ Patients with carcinoma of the _____,_______ & ________ have increased risk of developing venous thrombosis.”

A

Ovary, brain and pancreas

25
Q

Fill in the blanks. “ Oestrogen therapy, particularly high-dose therapy, is associated with increased plasma levels of factors ________.”

A

II
VII
VIII
IX
X

26
Q

True or False? Oestrogen therapy is associated wit depressed levels of protein S and C and Tissue plasminogen activator in vessel wall.

A

TRUE!!

27
Q

What is Antiphospholipid Syndrome?

A

The antiphospholipid syndrome (APS) can be defined as the occurrence of venous or arterial thrombosis and/or recur- rent miscarriage in association with laboratory evidence of persistent antiphospholipid antibody

28
Q

What is the Antiphospholipid associated with Antiphospholipd syndrome APS ?

A

Lupus anticoagulant (LA)

29
Q

How is Lupus Anticoagulant (LA ) identified?

A

It is identified by a prolonged plasma APTT which does not correct with a 50 : 50 mixture with normal plasma.

Dr. Lowe says prolonged PTT

30
Q

Which test is used to confirm diagnosis oof Antiphospholipid syndrome?

A

Dilute Russell’s viper venom test ( DRVVT)

31
Q

What are the important signs of Deep Vein Thrombosis?

A
  • Unilateral thigh or calf swelling or tenderness
  • Putting oedema
  • The presence of collateral superficial non-varicose veins.
32
Q

What is Homan’s sign?

A

Pain in the calf on flexing the ankle

33
Q

What are the clinical features of Pulmonary embolism?

A
  • Pleuritic chest pain
  • Tachycardia
  • Cough
  • Dizziness
  • Light- headedness
    *Previous history of DVT
  • Immobilization for more than 2 days or recent (<4 weeks) surgery
  • Haemoptysis
  • Cancer
34
Q
A

Clinical Haematology (26 decks)

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