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Week 2 Flashcards

1
Q

Global cerebral ischemia caused by

A 
Low perfusion (atherosclerosis of large vessel)
Acute decrease in blood flow (shock)
Chronic hypoxia (anemia)
Repeated hypoglycemia (insulinoma)
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2
Q

Ischemic stroke occurs in

A

focal regions of the brain causing specific deficits

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3
Q

Ischemic strokes are caused by either

A

thrombosis or emboli

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4
Q

Lacunar strokes are most often associated with

A

diabetes and HTN in small blood vessels (from MCA)

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5
Q

Intracerebral hemorrhage is

A

bleeding into the brain parenchyma

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6
Q

Intracerebral hemorrhage is most often due to

A

rupture of Charcot-Bouchard microaneurysms (result of HTN often in lenticulostriate vessels)
Most often in basal ganglia

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7
Q

Subarachnoid hemorrhage associated with

A

Marfan and ADPKD

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8
Q

ITP - immune thrombocytopenia

A

IgG against platelet antigens (GPIIb/IIIa)

Antibodies produced in the spleen and macrophages consume platelets in the spleen

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9
Q

TTP - Thrombotic thrombocytopenic purpura

A

Microangiopathic hemolytic anemia
ADAMS TS13 deficiency
Prevents degradation of vWF, increasing platelet adhesion and creating microthrombi
Microthrombi lead to helmet cells/schistocytes

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10
Q

Bernard Soulier Syndrome

A

Genetic GPIb deficiency
Impairs platelet adhesion to vWF
Enlarged platelets
No agglutination on ristocetin cofactor assay

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11
Q

Glanzmann Thrombasthenia

A

Genetic GPIIb/IIIa deficiency
Impairs platelet aggregation and adhesion to each other
Platelets dont clump on blood smear, but will agglutinate with ristocetin cofactor assay

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12
Q

Primary hemostasis bleeding

A

occurs at mucosal surfaces - skin, gums

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13
Q

Secondary hemostasis bleeding

A

occurs in deep tissues - muscles, joints

Usually after surgical procedurs

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14
Q

PT measures

A

extrinsic and common pathway

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15
Q

PTT measures

A

intrinsic and common pathways

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16
Q

Hemophilia A

A

Genetic factor VIII deficiency
X-linked recessive
Deep tissue bleeding
Increased PTT

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17
Q

Hemophilia B

A

Genetic Factor IX deficiency
X-linked recessive
Deep tissue bleeding
Increased PTT

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18
Q

Hemophilia C

A

Genetic factor XI deficiency

Autosomal recessive

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19
Q

Von Willebrand Disease

A

Genetic vWF deficiency (AD)
increased BT and PTT (carries factor VIII)
Decreased agglutination of ristocetin

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20
Q

Microangiopathic hemolytic anemia with schistocytes

A

TTP, HUS, DIC

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21
Q

Most common inherited coagulation disorder

A

Von Willebrand Disease (AD)

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22
Q

Treat Von Willebrand disease with

A

Desmopressin - increases vWF release from Weibel Palade bodies

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23
Q

Vit K deficiency occurs most often in

A

Newborns, those on long term antibiotics, malabsorption, and with chronic liver disease

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24
Q

DIC

A

Pathologic activation of the entire coag cascade

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25
DIC results in
consumption of platelets and factors Results in bleeding, especially from IV sites and mucosa Decreased platelets and clotting factors, and fibrinogens Increased BT, PT, PTT, and D DIMER Schistocytes on smear due to microthrombi (like TTP and HUS)
26
DIC is caused by/secondary to
Sepsis, Trauma, Obstetric complications, acute Pancreatitis, Malignancy (leukemia, adenocarcinoma), Nephrotic syndrome, Transfusion STOP Making New Thrombi And also rattlesnake bites
27
tPA converts
Converts plasminogen into plasmin to break down fibrinogen and fibrin clots
28
Thrombomodulin
allows thrombin to selectively activate Protein C and S to work as anticoagulants
29
Protein C/S Deficiency
Unable to inactivate Factor V and VIII, causing hypercoagulability Can cause warfarin skin necrosis without a heparin bridge
30
Factor V Leiden
Mutated factor V that can't be cleaved by protein C or S | Excessive activation of coagulation cascade
31
Most common inherited cause of hypercoagulability in whites
Factor V Leiden
32
Prothrombin Gene mutation
increases production of prothrombin resulting in hypercoagulation Mutation in 3' untranslated region
33
Antithrombin III deficiency
Decreases inhibition of Factors II and X
34
Antithrombin III deficiency has what effect on PT and PTT?
Little to no direct effect but diminishes the effect of Heparin (Heparin won't increase PTT as much as you would expect it to)
35
Heme is composed of
Iron and protoporphyrin
36
Microcytic anemias
Iron deficiency anemia (late), anemia of chronic disease (late), Sideroblastic anemia, thalassemia (alpha and beta)
37
Macrocytic anemias
Megaloblastic anemia (from B12 and B9 deficiency), anemia due to alcoholism, pancreatitis. alcoholism, liver disease
38
Normocytic Extravascular Hemolytic anemias
Hereditary spherocytosis, Sickle cell anemia, Hemoglobin C anemia, and autoimmune anemia (IgG)
39
Normocytic Intravascular Hemolytic anemias
Paroxysmal Nocturnal Hemoglobinuria, G6PD deficiency, Autoimmune anemia (IgM), Microangiopathic hemolytic anemia
40
Normocytic Nonhemolytic anemia
Aplastic anemia and myelophthisic processes
41
Iron absorption is regulated by
enterocytes in the duodenum
42
Microcytic, hypochromic anemia with increased RDW
Iron deficiency anemia
43
Iron deficiency anemia lab iron values
``` Decreased ferritin, increased TIBC, decreased serum iron, decreased % saturation Increased FEP (free protoporphyrin) ```
44
Anemia of chronic disease differs from iron deficiency anemia in that
Ferritin is increased and TIBC is decreased (more stored iron that you can't get to)
45
Ringed sideroblasts on blood smear
Sideroblastic anemia (microcytic)
46
Protoporphyrin synthesis requires
ALAS (rate limiting), ALAD, and Vit. B6
47
Final step in heme synthesis
Ferrochelatase binds protoporphyrin to iron in the mitochondria to make heme
48
Target cells are seen in
Hemoglobin C disease, asplenia, liver disease, and Thalassemia
49
Beta Thalassemia Major on xray
Crew cut appearance and thickened facial bones
50
Binds intrinsic factor and carries it to the ileum to be absorbed
B12
51
B12 deficiency presents as
Macrocytic anemia w/ hypersegmented neutrophils, glossitis, and subacute combined degeneration of the spinal cord (methylmalonic acid cant be converted and builds up in the cord)
52
Increased homocysteine, normal methylmalonic acid
Folate deficiency (B12 will have increased methylmalonic acid as well)
53
Crew Cut Xray caused by
Sickle cell and B thalassemia major
54
Signs of Sickle cell vaso-occlusion
Dactylitis, autosplenectomy with Howell Jolly Bodies, Acute chest syndrome, renal papillary necrosis
55
Sickle cell caused by
AR mutation in B chain where glutamic acid is replaced by valine
56
Hemoglobin C caused by
AR mutation in B chain where glutamic acid is replaced by lysine
57
Paroxysmal Nocturnal Hemoglobinuria is caused by
Acquired defect in myeloid stem cell - impaired synthesis of GPI anchor Increased incidence of AML
58
GPI anchor holds what to the membrane of RBC's
Decay accelerating factor (DAF) and MIRL to prevent complement destruction
59
PNH confirmatory test
Flow cytometry to detect lack of CD55 (DAF)
60
Anemia with intravascular hemolysis shows
decreased haptoglobin, hemoglobinemia, hemoglobinuria, and eventually hemosiderinuria
61
Anemia with extravascular hemolysis will show
Splenomegaly, jaundice, and increased risk for bilirubin gallstones
62
XR disorder that decreases available glutathione
G6PD Deficiency
63
Prevents oxidative stress and damage to RBC's
Glutathione
64
G6PD biproduct
NADPH which regenerates glutathione. So without G6PD we dont get NADPH or glutathione
65
G6PD on blood smear
Heinz bodies and bite cells (degmacytes)
66
Causes of oxidative stress
infection, sulfa drugs, fava beans
67
Diagnose autoimmune hemolytic anemia
Coombs test
68
Aplastic anemia caused by
damage to hematopoietic stem cell => pancytopenia

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