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Clinical Skills > CS Exam 2 > Flashcards

CS Exam 2 Flashcards

1
Q

Meds that increase PT

A

warfarin

salicylates (aspirin, pepto bismol)

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2
Q

Meds that decrease PT

A

Estrogen/OCPs

Vitamin K

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3
Q

Conditions that lead to decreased Vitamin K

A
  • bile duct obstruction
  • drugs: abx
  • diarrhea
  • malabsorption syndromes
  • dietary deficiency
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4
Q

Warfarin/Coumadin MOA

A
  • decreases Vitamin K production, thereby inhibiting vitamin K dependent factors
  • affects PT
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5
Q

Meds that increase PTT

A

*Heparin
Antihistamines
Ascorbic acid
Salicylates

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6
Q

Heparin MOA

A
  • activates factor II (Antithrombin)
  • effect = immediate and short-lived
  • affects PTT
  • can cause drug-induced thrombocytopenia
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7
Q

Normal platelet count

A

150,000-450,000

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8
Q

Vitamin K-dependent clotting factors

A

II, VII, IX, X

also Protein C & S

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9
Q

Factor IV (Calcium) MOA

A
  • required for coagulation factors to bind to phospholipids

- necessary for activation of many factors

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10
Q

Factor V Leiden MOA

A
  • clotting disorder

- inherited mutation in which protein C cannot inhibit Factor V

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11
Q

Factor VIII: what are the 2 components?

A
  • Antihemophilic factor (factor VIII)

- VWF (inactivates/stabilizes VIII) (also promotes platelet adhesion to collagen)

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12
Q

Where is Factor III found?

A
  • Tissue factor
  • membrane protein on cells surrounding BV
  • exposed when vessels ruptured
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13
Q

Factor V MOA

A

helps Factor Xa convert prothrombin to thrombin

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14
Q

Where is Factor VIII produced?

A
  • liver, but also
  • endothelial cells
  • RES
  • megakaryocytes
  • therefore: #s not decreased in severe liver dysfunction
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15
Q

Factor XIII: MOA

A
  • Fibrin Stabilizing Factor
  • stabilizes clot
  • activated by thrombin
  • binds to fibrin, crosslinks fibrin units
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16
Q

Explain the thrombin time lab test

A
  • asses fibrinogen deficiency
  • excess thrombin added to sample to assess whether fibrinogen>fibrin step is rate limiting
  • non-improvement= qualitative or quantitative fibrinogen issue
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17
Q

Thrombocytopenia: platelet count

A

<150,000

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18
Q

DIC: Lab values

A
  • prolonged PT and PTT*
  • decreased fibrinogen
  • increased D-dimer
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19
Q

ITP: labs

A
  • large platelets

- antibodies to platelets

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20
Q

Aspirin: MOA

A
  • irreversibly blocks arachidonic acid, affecting platelets aggregation
  • d/c: 7-10 days until platelet restoration
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21
Q

NSAIDS: MOA

A
  • reversibly inhibit COX

- d/c: 24-48 hours until platelet restoration

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22
Q

Von Willebrand Dz: MOA

A
  • inherited deficiency, now antihemophilic factor is not kept stabilized by VWF
  • affects ligands that adhere platelets to endothelium
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23
Q

Mild-moderate liver dz: PT and PTT expected labs

A

PT prolonged, PTT normal

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24
Q

Severe liver disease: PT and PTT expected labs

A

both prolonged

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25
Q

What does Protein C do?

A
  • combines with Thrombomodulin
  • complex activated by Protein S
  • inactivates factors Va and VIIIa
  • outcome: decreased thrombin production
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26
Q

aPL syndrome: MOA

A
  • antiphospholipid antibody
  • autoimmune attack of Apolipoprotein H
  • Apo-H normally inhibits platelet agglutination, therefore aPL syndrome leads to clotting
27
Q

Labs to test for antiphospholipid antibody

A
  • anticardiolipin ab’s (IgM and IgG)
  • Anti-B2 glycoprotein I ab’s (IgM and IgG)
  • Lupus anticoagulant (specific lupus-associated ab)
28
Q

Homocysteine levels: interfering factors

A
  • renal impairment (decreased filtration)
  • lack of dietary B vitamins
  • smoking (increases)
  • levels increase w/ age
  • men > women
29
Q

Antithrombin: MOA

A
  • endogenous inhibitor of Factor X and Thrombin

- activated by heparin

30
Q

Arterial thrombotic workup: indications

A
  • arterial thrombosis prior to age 55 w/o other risk factors

- 2 months after episode (acute phase reactants may alter results)

31
Q

Arterial thrombotic workup labs

A
  • tPA antigen
  • C-reactive protein
  • Lupus Anticoagulant panel (lupus inhibitor, antiphospholipid)
  • Plasma homocysteine
32
Q

Venous thrombotic workup: timing

A
  • 2 months after episode (acute phase reactants may alter results)
  • allow for completion of anticoagulation therapy (off for 7-10 days prior to testing)
33
Q

Venous thrombotic workup labs

A
  • APC resistance test
  • Protein C activity
  • Protein S free antigen
  • Antithrombin activity
  • Lupus inhibitor assay
  • If all negative… prothrombin DNA screen, Factor VII, Factor VIII, CRP
  • if APCR + , check Factor V DNA screen
34
Q

Microcytic anemia

A
  • Fe def
  • AI/CD (normo or micro)
  • Thalassemia
  • Sideroblastic
  • Copper deficiency/zinc poisoning
35
Q

Reasons for falsely elevated retic counts

A

pregnancy

Howell-Jolly bodies

36
Q

How do you tell if RPI is adequate?

A

< 2 = inadequate

> 3 = definitely adequate

37
Q

Basophilic stippling: associated conditions

A 
visible ribosomes
visible when Wright stained
-lead poisoning
-other heavy metal poisoning
-alcohol
-reticulocytosis
38
Q

Howell-Jolly bodies

A

leftover DNA fragments

-underperforming/nonfunctional/missing spleen

39
Q

Tear drop cells: associated conditions

A

myelofibrosis

thalassemia

40
Q

Burr cells

A
  • commonly an artifact of EDTA use

- seen in uremia, liver disease, severe burns

41
Q

Iron-deficiency anemia: transferrin saturation value

A

<15%

42
Q

Most sensitive test to determine Fe def anemia

A

serum ferritin

43
Q

Which drugs increase transferrin/TIBC?

A

fluorides

OCPS

44
Q

Which drugs decrease transferrin/TIBC?

A

ACTH

chloramphenicol

45
Q

Sideroblastic anemia: iron panel lab results

A
  • normal or high across the board

- bone marrow bx

46
Q

If Hbg >9 and normal RDW with known chronic disease, we presume which dz?

A

AI/CD

47
Q

What ANC value is considered severe immuncompromisation and warrants protective isolation?

A

<100

48
Q

Values:

  • critical leukocytosis
  • leukocytosis
  • leukopenia
  • critical leukopenia
A

> 30,000
10,000
<4,000
<2,500

49
Q

Clinical manifestations of critically LOW Hgb levels

A
  • angina
  • MI
  • CHF
  • CVA
50
Q

Clinical manifestations of critically HIGH Hgb levels

A
  • CVA

- organ failure

51
Q

Drugs that increase RBC and Hgb

A

EPO

anabolic steroids

52
Q

When do we transfuse pt?

A

Hgb < 6 almost always appropriate
Hgb <7-8 maybe, depends
Hgb <10 almost never appropriate

53
Q

Neutrophils: production time and lifespan

A

produced in 7-14 days

in circulation of 6 hours

54
Q

Basophils: function

A
  • allergic rxn and parasitic infx
  • phagocytosis of antigen-antibody complexes
  • do NOT respond to bacterial/viral infx
  • heighten inflammatory response (heparin, histamine, peroxidase)
55
Q

Eosinophils: function

A
  • allergic rxn and parasitic infx
  • phagocytosis of antigen-antibody complexes
  • do NOT respond to bacterial/viral infx
56
Q

Monocytes (macrophages): function

A
  • phagocytic cells similar to neutrophils
  • produced more quickly and circulate longer in blood stream than neutrophils
  • produce interferon* (immunostimulant)
57
Q

Monocytosis: conditions

A
  • chronic inflammatory disorders
  • viral infx
  • parasites
58
Q

Basopenia: conditions

A

acute allergic rxns

59
Q

Neutropenia: conditions

A

aplastic anemia

60
Q

platelets: lifespan

A

7-9 days

61
Q

Antiplatelet agents: examples

A

aspirin

clopidogrel

62
Q

What factors does thrombin induce?

A

1, 5, 8, 11, 13, thrombomodulin

63
Q

Conditions which exhibit acquired Factor VIII deficiency

A

pregnancy
autoimmune disorders
malignancies

64
Q

Define: warfarin necrosis

A
  • tissue necrosis occurs because of a deficiency in Protein C
  • occurs b/c inhibition of Protein C is initially stronger than inhibition of other Vitamin K dependent coag factors

Clinical Skills (1 decks)

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