Surgery: Hemostasis, Wound Healing And SSIs

Question 1

Refers to platelet plug formation and aggregation.

Answer 1

Primary hemostatsis

Question 2

Refers to the deposition of insoluble fibrin generated by proteolytic coagulation cascade.

Answer 2

Secondary hemostasis

Question 3

What are the coagulation factors tested in prothrombin time?

Answer 3

VII, X, V, II (prothrombin) and Fibrinogen

Question 4

Primary inciting factor in extrinsic pathway?

Answer 4

Tissue factor release (Factor III) / Endothelial damage

Question 5

The treatment for the most common congenital bleeding disorder categorized under partial quantitative deficiency type is ______.

Answer 5

Von Willebrand Disease
Type I: partial quantitative deficiency
Type II: qualitative deficiency
Type III: Total deficiency

Treatment:
Humate P which contains vWF and VIII
Desmopressin which raised endogenous vWF by triggering release of factor from endothelial cells.

Question 6

A patient with hemophila has a factor level of 6%. This is considered to be?

a. Mild
b. Moderately severe
c. Severe
d. Extremely severe

Answer 6

A. Mild hemophilia

<1% severe
1-5 % moderately severe
>5 lesser than 30%: severe

Question 7

Hemophilia C is caused by a deficiency of what factor?

Answer 7

Factor XI

Hemophilia A: VIII
Hemophilia B: IX

Question 8

Thrombasthenis or Glanzmann thrombasthenia is an autosomal recessive disorder in which platelet glycoprotein IIb/IIIa complex is either lacking or present but dysfunctional. Patients with this disease can be treated with _____.

Answer 8

Platelet transfusion

Question 9

What is the defect in Bernard Soulier syndrome?

Answer 9

Glycoprotein Ib/IX/V receptor for vWF

Tx: Platelet transfusion

Question 10

Most common intrinsic platelet defect.

Answer 10

Storage pool disease

Question 11

Partial albinism and loss of dense granules

Answer 11

Hermansky-Pudlak syndrome

Question 12

First line treatment in adult with ITP

Answer 12

IV immunoglobulin and corticosteroids

Question 13

Third line treatment for ITP which is an anti-CD20 monoclonal antibody

Answer 13

Rituximab

Question 14

Diagnosis of heparin-induced thrombocytopenia is through what two assays?

Answer 14

Serotonin release assay
-highly specific but not sensitive

ELISA
-low specificity

Question 15

In addition to stopping the heparin, a patient with heparin induced thrombocytopenia should be treated with 
A. Lepirudin
B. LMWH
C. Warfarin
D. Aspirin

Answer 15

Initial tx for HIT would be stopping the heparin and use of primarily thrombin inhibitors such as Argatroban, Bivalirudin, and Lepirudin

Question 16

Most effective treatment for bleeding secondary to TTP

Answer 16

Plasmapharesis

Question 17

Hallmark of antiphospholipid syndrome

Answer 17

Prolonged aPTT in vitro but an increased risk of thrombosis in vivo

Question 18

Which of the following increases effect of warfarin thereby decreasing the dose given for anticoagulation?
A. Barbiturates
B. Corticosteroids
C. Cephalosporins
D. Oral contraceptive pills

Answer 18

C. Cephalosporins

“BarOCA decreases warfarin effect”
Barbs, oral contraceptives, corticosteroids and ACTH

Increases warfarin effect
Phenylbytazone
Anabolic steroids
Clofibrate
Cephalosporins
L thyroxine
Aminodarone
Glucagon

Question 19

This measures the viscoelastic properties of blood/ clot stregth

Answer 19

Thromboelastogram

Question 20

Autologous transfusion

Answer 20

Up to five units with administration of recombinant human erythropoietin.

40 days prior to surgery as first procurement then last one at 3-4 days prior to surgery.

Hgb > 11g/dL
Hct > 34%

Question 21

Percentage of blood loss in terms of total blood volume where addition of PRBC and FFP is indicated.

Answer 21

Blood loss >20% of total blood volume