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Hematology/Oncology > Hemostasis & Coagulation > Flashcards

Hemostasis & Coagulation Flashcards

1
Q

Which step in the Hemostasis process would be affected most by a von Willebrand disease

A

the 3rd step consisting of the contraction of the platelet plug

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2
Q

What substance would you expect to see missing/defected if their was a problem dissolving clots?

A

the transfer from plasminogen to plasmin

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3
Q

whats the first of 4 steps in the hemostasis process from an injury.

A

vascular constriction limiting blood flow to affected area

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4
Q

describe the process that platelets derive from…

A

pluripotent stem cells-megakaryoblasts-promegakaryocytes-megakaryoctyes-breaking into fragments of platelets

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5
Q

why would you recommend a pt stop taking aspirin about 1 week before surgery?

A

since platelets life span ranges 7-10 days you would want all the effects of aspirin (antiplts) to wear off so they could heal up/clot after cutting/suturing them.

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6
Q

where do your platelets normally reside?

A

1/3 in spleen and 2/3 circulating

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7
Q

How would you expect the platelets to be affected by a pt with cirrhosis and why?

A

Circulating platelet counts may be lowered due to hypersleenomegaly and its resulting eating up of the plts.

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8
Q

This mutation has a defect in which the clotting factor is not inactivated by activated Protein C (APC) hence putting the pt at increased risk for clotting

A

Leiden Factor V

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9
Q

What would you treat a pt presenting with unusual amounts of post-op bleeding with normal PT & PTT’s

A

Desmopressin (stimulates release of vWF from endothelium)

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10
Q

this is the most common inherited bleeding disorder; often found due to surgery follow up with unexplainable levels of bruising

A

von Willebrand disease

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11
Q

why would you add citrate to a “blue top” test tube while checking someone’s blood for PT (prothrombin time)

A

citrate will chelate the Ca++ present; giving the sample time to arrive at lab before clotting since Ca++ will cause it to clot. Once ready, they add Ca++, TF’s & thromboplastin back and measure time

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12
Q

why is the INR paired with PT if it is already controlled with citrate to block calcium

A

Labs use variety of sources of thromboplastin so this helps to normalize the measurement.

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13
Q

what is the D-Dimer test used for?

A

to measure FDP (fibrin degradation products) which result from plasmin dissolving clots; useful to detect DVTs or process’ like DIC

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14
Q

this drug is counterindicated for pregnant women because it is known to have tetragenic effects

A

Warfarin

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15
Q

How could you reverse the effects of heparin

A

adm. protamine

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16
Q

describe the MOA Heparin works to be an anticoagulant

A

increases effectiveness of antithrombin III (an endogenous substance) which inhibits Xa

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17
Q

in a normal healthy endothelium layered vessel, how would you expect the plts

A

inactive

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18
Q

what are factors contributing to the endothelium’s healthy inactive plt environment

A

NO, prostacyclines (PG I2) and endogenous heparin substances

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19
Q

this drug can cause skin necrosis

A

warfarin

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20
Q

this drug can cause blue toe syndrome

A

warfarin

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21
Q

how can you reverse a pt that is bleeding who takes warfarin

A

vitamin K

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22
Q

If you wanted to choose the strongest class of antiplatelets which pathway would you choose to interfere with?

A

inhibiting GPIIB/IIIA

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23
Q

Which factor is deficient with Hemophilia A

A

F. VIII

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24
Q

Which factor is def. in Hemophilia B

A

F IX

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25
Q

which factor is def. in hemophilia C

A

X1

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26
Q

which population is most often affected by Hemophilia C

A

Ashkanazie & iraqi Jewish

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27
Q

what is the cause of Hemophilia disorders

A

X-linked recessive

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28
Q

which gender is most likely affected by Hemophila A

A

Males, females will be asx carriers

29
Q

how would you treat hemophilia A/B

A

Cryoprecipitate; Factors VIII or IX replacement

30
Q

what would you expect to see across the routine labs ordered for Hemophilac patient?

A

Normal plt count & bleeding time, Prolonged aPTT (b/c Factor 8 is only seen in the intrinsic pathway hence no affect on PT which deals wit extrinsic pathway)

31
Q

What is the term consumptive coagulation describe

A

Disseminated intravascular coagulation (DIC)- refers to the using up of coag. factors & plts which leads to systemic bleeding

32
Q

this pt presents with bruising, hemorrhaging, and hemoarthrosis (bleeding into the joint) typically males

A

Hemophiliac

33
Q

What would classify a neutropenic fever

A

1 oral temp. >101 (38.3) OR 2 temps > 100.4 (38.0) separated by 1 hour

34
Q

ANC refers to

A

absolute neutrophil count

35
Q

How would you categorize someone with a ANC < 500

A

severe neutropenic fever

36
Q

whats the most common cause of DIC

A

bacterial sepsis

37
Q

what are some other causes of DIC in addition to bacterial sepsis

A

obstetric complications & malignant d/o

38
Q

which labs would u order to narrow your suspicion of DIC

A

routine : aPTT, PTT, plt count, **FDP most sensitive

39
Q

How would u treat DIC

A

4 main: 1) treat underlying cause, 2) replace coag factors & plts 3) control coag state -heparin 4) support pt -ventilator, dialysis, or transfusion

40
Q

why would you normally not see Vitamin K deficiency due to dietary shortages alone?

A

Vit. K is synthesized in our gut by colonic flora

41
Q

In what few instances would u suspect Vit K defieciency due to dietary causes….

A

alcoholics, malnourished, those on parenteral nutrition without a Vit K supplement

42
Q

What are some main causes of Vit. K deficiency

A

iatrogenic: either surgical interventions alter GI making it ineffective to absorb or long term abx use wiping out normal colonic flora; chronic liver dz such as primary biliary cirrhosis; otherwise warfarin

43
Q

what would you suspect in a low plt count in an otherwise normal healthy ind.

A

pseudothrombocytopenia

44
Q

vasodilator substances such as NO and PG I2 (prostacyclin) are normally functioning how

A

inhibit platelets

45
Q

What tumor marker is associated with hepatpcellular cancer; germ cell cancers.

A

Alphafetoprotein (AFP)

46
Q

What cancer is associated with the carcinoembryonic antigen (CEA) tumor marker

A

bowel & breast; used to cx if colorectal ca has spread & recurrence/tx response of breast.

47
Q

what cancer is associated with the CA-125 tumor marker

A

ovarian cancer (used 4 diagnosis, assess response to tx, evaluate 4 recurrence)

48
Q

what marker is used to check for prostate cancer

A

prostate specific antigen (PCA)

49
Q

which tumor marker is associated with breast cancer; used to determine whether tx w/ hormonal therapy (tamoxifen) is appropriate

A

estrogen receptor

50
Q

what cancer(s) is associated with the tumor marker HER2/neu

A

breast & gastric; (assess tx with trastuzumab)

51
Q

What is the Ann Arbor Staging system used for…

A

certain cancers don’t follow TNM staging like leukemia, lymphoma, & myeloma

52
Q

Describe the 4 stages of Ann Arbor staging system

A

I- one lymph node II-2 or > same side diaphragm III-nodes on both side and IV-spread to organs (spleen/liver)

53
Q

What is the Gleason score most often associated with

A

prostate cancer

54
Q

How would you distinguish Class A and B for Ann Arbor

A

A is asx vs. B-fever, night sweats

55
Q

What signs/sx would you expect to find with Superior Vena cava syndrome tht would indicate an oncologic emergency

A

neck & face swelling, dilated neck viens, edema of face, cyanosis as obstruction results in impaired venous return

56
Q

Tumor Lysis syndrome (a tx-related emergency) is identified with what findings:

A

hyperuricemia, hyperkalemia, hyperphosphatemia, & hypocalcemia

57
Q

pt presents with pain that is colicky in nature (comes & goes) Upon PE you find **High pitched bowel sounds, abd distenstion w/ tympany, ascities, and visible peristatsis….. what is the diagnosis? How would you treat this pt?

A

Most likely a tumor obstruction in the intestine, this is an Emergency & should intervene surgically.

58
Q

how would you describe cauda equine syndrome

A

low back pain, diminished sense of sensation over butt, saddle sign (numbness in perineal area), rectal & bladder dysf. lower ext. weakness

59
Q

what oncological emergency would you worry about with the symptoms associated with the cauda equine syndrome

A

malignant spinal cord compression

60
Q

what is the most common neoplastic syndrome resulting from an overproduction of PTHrP (parathyroid hormonone related protein)

A

hypercalcemia

61
Q

this pt presents with hyperparathyroidism, (osteoporosis, kidney stones, excessive urination, abd pain, weakness, N&V, or loss appetite)

A

hypercalcemia due to a tumor calling for medical emergency

62
Q

What two things would an aPTT be useful for

A

heparin & hemophiliacs

63
Q

what two things would be useful for PT time

A

warfarin & liver disases

64
Q

how would you tx a high risk neutropenic fever pt

A

Admit, start on anti-pseudomonal cephalosporins

65
Q

how would u tx a low risk pt with suspected neutropenic fever

A

tx: oral cipro with augmentin or if PCN allergy=cipro with clindamycin… OBSERVE 4 hours b4 dx and f/u 24hrs

66
Q

what are two caveats to high risk neutropenic fever pts that would indicate the need for adding aminoglycoside

A

pneumonia or evidene of gram - bacteria (klebsiella)

67
Q

if a pt with neutropenic fever are suspected to have abd sxs or Cdiff. what medication could be given to help

A

metronidazole

68
Q

Vancomycin can be used for neutropenic pts with certain cases:

A

resistnce to or prior use of cipro/cephalosporin TMP/SMX PCN allergy, hypotenstion. indwelling catheters/lines, mucositis

Hematology/Oncology (4 decks)

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