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STEP 1 > Coagulopathy > Flashcards

Coagulopathy Flashcards

1
Q

Prolonged activated Partial Thromboplastin Time (aPTT)

Genetic

A

Hemophilia A/B

(X-linked)

Hemophilia A prolonged A PTT

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2
Q

Prolonged aPTT

Prolonged Bleeding time

A

vWF deficiency

intrinsic (8, 9, 11, or 12) pathway defect

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3
Q

Prolonged PT, aPTT, Bleed Time

Low Platelets

A

DIC

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4
Q

Prolonged Bleed time

A

Uremic platelet dysfunction

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5
Q

Prolonged aPTT

A

Heparin

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6
Q

Prolonged aPTT

Low Platelets

A

HIT

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7
Q 
Prolonged Prothrombin (PT)
slightly elevated aPTT (if at all)
A

Warfarin

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8
Q

Low Platelets

A

Immune Thrombocytopenia

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9
Q

↓ ADAMTS-13 level →
uncleaved vWF multimers →
platelet trapping & activation

Acquired (autoantibody) or hereditary

A

Thrombotic thrombocytopenic purpura

TTP

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10
Q

↑ bilirubin ↑ LDH, ↓ haptoglobin ↑ bleeding time
↓ Platelets, schistocytes, Petichiae
↑ creatinine

A

Thrombotic thrombocytopenic purpura

TTP

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11
Q

Diffuse microvascular thrombosis, causing microangiopathic hemolytic anemia

A

Thrombotic thrombocytopenic purpura

TTP

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12
Q

Vascular damage & microthrombi formation

From Shiga toxin or Escherichiacoliserotype O157:H7

A

Hemolytic uremic syndrome

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13
Q

↑ bilirubin ↑ LDH, ↓ haptoglobin ↑ bleeding time
↓ Platelets, schistocytes, Petichiae
Acute kidney injury (↑ BUN, ↑ creatinine)

A

Hemolytic uremic syndrome

Preceding bloody diarrhea

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14
Q

DIC is marked by the excessive activation of the _______ coagulation cascade, leading to the generation of thrombin and cross-linked fibrin clots.

______ is then activated to clear the intravascular thrombi; plasminogen is converted to plasmin, which _________ and generates fibrin-degradation products (eg, elevated D-dimer).

Other anticoagulant proteins (eg, protein C, protein S) are also rapidly consumed.

A

extrinsic (tissue factor)

Fibrinolysis

cuts the cross-linked fibrin-fibers
(Plasmin Pierces Fibrin)

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15
Q

Exertional heat stroke (extreme hyperthermia) and seizures increase the risk of ___

A

DIC

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16
Q

vWD is inherited in an autosomal dominant fashion with ________ and is the most common heritable bleeding disorder.

A

variable penetrance

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17
Q

Direct factor Xa inhibitors (eg, apixaban) are anticoagulants that block the ______ of factor Xa, which leads to reduced conversion of ___ to ____.

A

active site

prothrombin to thrombin

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18
Q

Warfarin inhibits vitamin K epoxide reductase, which decreases the _____ form of vitamin K and limits _____ of vitamin K–dependent coagulation factors (II, VII, IX, X).

A

reduced

gamma-carboxylation

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19
Q

Cimetidine, amiodarone, and TMP-SMX are CYP P450 inhibitors which ______, thus increasing the risk of ______.

A

Lowers warfarin metabolism (increases it’s effect)

bleeding

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20
Q

Abnormal bleeding in patients with uremia (Pt on Dialysis or with CKD/ESR disease) is due to a qualitative platelet disorder that causes prolonged ______ only!

A

bleeding time

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21
Q

Absent or ↓ factor ___ (hemophilia A)

Absent or ↓factor ___ (hemophilia B) activity

A

8 (Hemophilia 8-Ate)

9

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22
Q

Slow oozing blood after mild trauma
Hemarthrosis, intramuscular hematomas
GI/GU bleeding
Intracranial hemorrhage

A

Hemophilia A/B
(intrinsic Pathways defect)
Complications: hemophilic arthropathy

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23
Q

Low haptoglobin is a sign of

A

hemolytic anemia

Other associated findings include increased indirect bilirubin and lactate dehydrogenase.

24
Q

Signs of ______ include easy bruisability, petechiae, and mucocutaneous hemorrhage (eg, recurrent epistaxis, gingival hemorrhage).

A

thrombocytopenia

25
Q

PT reflects the _____ clotting pathway, which involves _____, fibrinogen, and factors II, V, VII, and X.

A

extrinsic

tissue factor

26
Q

_____ causes dusky discoloration of the skin (similar to cyanosis), and because it is unable to carry oxygen, a state of functional anemia is induced.

However, the blood ____ of oxygen will be unchanged as it is a measure of oxygen dissolved in plasma and is unrelated to hemoglobin function.

A

Methemoglobinemia

partial pressure of O2

27
Q

_____ is an intracellular iron-storage protein that is used as a serum marker of total body iron stores.

A

Ferritin

28
Q

Hypersegmented neutrophils are characteristic of _______, which can be caused by folate and vitamin B12 deficiency.

A

megaloblastic anemias

29
Q

Etoposide is a chemotherapeutic agent that inhibits the sealing activity of _________.

Treatment causes chromosomal breaks to accumulate in dividing cells, as double stranded DNA fragments, ultimately causing cell death.

A

topoisomerase 2

30
Q

Prolonged Bleed time

Low Platelets

A

TPP

31
Q

warfarin-induced ______, a rare complication that can occur in individuals with underlying protein C or S deficiency shortly after starting warfarin.

A

skin necrosis

*result in thrombotic occlusion of the microvasculature with skin necrosis.

32
Q

warfarin-induced skin necrosis a rare complication that can occur in individuals with underlying ________ shortly after starting warfarin.

A

protein C or S deficiency

33
Q

Many Caucasians have ____, which is modified to resist activated protein C. The resulting hypercoagulable state predisposes to deep vein thromboses

A

factor V Leiden

34
Q

Many Caucasians have factor V Leiden which is modified to resist activated protein C. Consequences of the hypercoagulable state predisposes to ____ & ____

A

deep vein thromboses
&
PE

35
Q

_____ is a plasma cell neoplasm associated with the overproduction of monoclonal immunoglobulins.

A

Multiple myeloma

36
Q

Serum protein electrophoresis demonstrates a monoclonal spike in the gamma globulin region
and abnormal plasma cells. Diagnosis

A

Multiple myeloma

37
Q

Multiple myeloma is treated with medications that block _____ activity (eg, bortezomib) or increase _______ of specific transcription factors like Lenalidomide.

A

proteasome
ubiquitination

Lenalidomide increases E3 ubiquitin ligase binding to transcription factors overexpressed causing increased transcription factor destruction by the proteosome and cancer cell death.

38
Q

Give a pregnant women, _________ if she has thrombosis since it can’t cross placenta. pregnancy makes you hypercoagulable

A

LMW Heparin (Enoxaparin)

39
Q

_______ rapidly reverses warfarin’s effects whereas vitamin K requires time for clotting factor re-synthesis.

A

Fresh frozen plasma

40
Q

A normal bleeding time indicates adequate _______ function.

A

platelet hemostatic

41
Q

A normal activated partial thromboplastin time (aPTT) indicates an intact ______ coagulation system.

A

intrinsic

42
Q

Prolonged prothrombin time in the setting of normal aPTT indicates a defect in the extrinsic coagulation system at a step that is _______-.

A

not shared with the intrinsic system

aka Factor 7 deficiency

43
Q

Factor XI deficiency results in a rare autosomal recessive disorder called ______.
Affected patients are at increased risk for bleeding following surgery or trauma.

prolonged aPTT
normal PT.

A

hemophilia C

44
Q

How is desmopressin able to stop prolonged bleeding in Hemophilia A and Type-1 vWb Disease (2)

A

Increases circulating factor VIII

Increases endothelial secretion of vWF to stop bleeding

45
Q

Hemophilia B must be treated with

A

factor 9 replacement

46
Q

The thrombin time (TT) is prolonged with medications that directly or indirectly inhibit ______.

A

thrombin

47
Q

________ inhibitors prolong both aPTT and PT with no effect on TT.

A

Direct factor Xa

48
Q

_________ inhibitors directly inhibit platelet activity and have little overall effect on aPTT, PT, or TT.

A

Cyclooxygenase (Asprin)

49
Q

_____ prevent the formation of thrombin (factor IIa), resulting in prolongation of aPTT, PT, and TT.

A

Direct thrombin inhibitors

dabigatran

50
Q

Factor 2a is also known as

Factor 2 is aka

A

Thrombin

Prothrombin

51
Q

_________ binds to antithrombin and causes inactivation of several coagulation factors, most significantly factor IIa (thrombin) and factor Xa.

aPTT and TT are prolonged

A

Unfractionated heparin

52
Q

Unfractionated heparin binds to antithrombin and causes inactivation of several coagulation factors, most significantly _____ and ______.

A 
factor IIa (thrombin)
factor Xa
53
Q

Patients with cystic fibrosis are at risk for fat-soluble vitamin (ie, A, D, E, K) deficiency due to fat malabsorption from pancreatic insufficiency which can cause a_____PT and ______aPTT

A

Vitamin K deficiency thus

prolonged PT
normal aPTT

54
Q

Total body vitamin K does not contribute to a delay in warfarin efficacy.
However, increased intake of _______ can lead to subtherapeutic INR due to increased vitamin K availability in the liver.

A

foods rich in vitamin K (eg, green leafy vegetables)

55
Q

Nephrotic syndrome is a hypercoagulable state which can cause renal vein thrombosis. Loss of _____, is responsible for the thrombotic complications

A

antithrombin III

56
Q

_________- is a protein released from the alpha granules of platelets that plays a role in platelet aggregation. It also binds heparin and helps inactivate the molecule.

A

Platelet factor 4 (PF4)

57
Q

Heparin-induced thrombocytopenia and thrombosis results from the production of IgG antibodies against _______.

The Fc component of these antibodies binds to platelets, resulting in widespread platelet activation (prothrombotic state) & splenic destruction of these platelets (Thrombocytopenia)

A

complexes of heparin and platelet factor 4.

STEP 1 (88 decks)

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