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
Q

DIC results in

A

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)

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26
Q

DIC is caused by/secondary to

A

Sepsis, Trauma, Obstetric complications, acute Pancreatitis, Malignancy (leukemia, adenocarcinoma), Nephrotic syndrome, Transfusion
STOP Making New Thrombi

And also rattlesnake bites

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27
Q

tPA converts

A

Converts plasminogen into plasmin to break down fibrinogen and fibrin clots

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28
Q

Thrombomodulin

A

allows thrombin to selectively activate Protein C and S to work as anticoagulants

29
Q

Protein C/S Deficiency

A

Unable to inactivate Factor V and VIII, causing hypercoagulability
Can cause warfarin skin necrosis without a heparin bridge

30
Q

Factor V Leiden

A

Mutated factor V that can’t be cleaved by protein C or S

Excessive activation of coagulation cascade

31
Q

Most common inherited cause of hypercoagulability in whites

A

Factor V Leiden

32
Q

Prothrombin Gene mutation

A

increases production of prothrombin resulting in hypercoagulation
Mutation in 3’ untranslated region

33
Q

Antithrombin III deficiency

A

Decreases inhibition of Factors II and X

34
Q

Antithrombin III deficiency has what effect on PT and PTT?

A

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
Q

Heme is composed of

A

Iron and protoporphyrin

36
Q

Microcytic anemias

A

Iron deficiency anemia (late), anemia of chronic disease (late), Sideroblastic anemia, thalassemia (alpha and beta)

37
Q

Macrocytic anemias

A

Megaloblastic anemia (from B12 and B9 deficiency), anemia due to alcoholism, pancreatitis. alcoholism, liver disease

38
Q

Normocytic Extravascular Hemolytic anemias

A

Hereditary spherocytosis, Sickle cell anemia, Hemoglobin C anemia, and autoimmune anemia (IgG)

39
Q

Normocytic Intravascular Hemolytic anemias

A

Paroxysmal Nocturnal Hemoglobinuria, G6PD deficiency, Autoimmune anemia (IgM), Microangiopathic hemolytic anemia

40
Q

Normocytic Nonhemolytic anemia

A

Aplastic anemia and myelophthisic processes

41
Q

Iron absorption is regulated by

A

enterocytes in the duodenum

42
Q

Microcytic, hypochromic anemia with increased RDW

A

Iron deficiency anemia

43
Q

Iron deficiency anemia lab iron values

A
Decreased ferritin, increased TIBC, decreased serum iron, decreased % saturation
Increased FEP (free protoporphyrin)
44
Q

Anemia of chronic disease differs from iron deficiency anemia in that

A

Ferritin is increased and TIBC is decreased (more stored iron that you can’t get to)

45
Q

Ringed sideroblasts on blood smear

A

Sideroblastic anemia (microcytic)

46
Q

Protoporphyrin synthesis requires

A

ALAS (rate limiting), ALAD, and Vit. B6

47
Q

Final step in heme synthesis

A

Ferrochelatase binds protoporphyrin to iron in the mitochondria to make heme

48
Q

Target cells are seen in

A

Hemoglobin C disease, asplenia, liver disease, and Thalassemia

49
Q

Beta Thalassemia Major on xray

A

Crew cut appearance and thickened facial bones

50
Q

Binds intrinsic factor and carries it to the ileum to be absorbed

51
Q

B12 deficiency presents as

A

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
Q

Increased homocysteine, normal methylmalonic acid

A

Folate deficiency (B12 will have increased methylmalonic acid as well)

53
Q

Crew Cut Xray caused by

A

Sickle cell and B thalassemia major

54
Q

Signs of Sickle cell vaso-occlusion

A

Dactylitis, autosplenectomy with Howell Jolly Bodies, Acute chest syndrome, renal papillary necrosis

55
Q

Sickle cell caused by

A

AR mutation in B chain where glutamic acid is replaced by valine

56
Q

Hemoglobin C caused by

A

AR mutation in B chain where glutamic acid is replaced by lysine

57
Q

Paroxysmal Nocturnal Hemoglobinuria is caused by

A

Acquired defect in myeloid stem cell - impaired synthesis of GPI anchor
Increased incidence of AML

58
Q

GPI anchor holds what to the membrane of RBC’s

A

Decay accelerating factor (DAF) and MIRL to prevent complement destruction

59
Q

PNH confirmatory test

A

Flow cytometry to detect lack of CD55 (DAF)

60
Q

Anemia with intravascular hemolysis shows

A

decreased haptoglobin, hemoglobinemia, hemoglobinuria, and eventually hemosiderinuria

61
Q

Anemia with extravascular hemolysis will show

A

Splenomegaly, jaundice, and increased risk for bilirubin gallstones

62
Q

XR disorder that decreases available glutathione

A

G6PD Deficiency

63
Q

Prevents oxidative stress and damage to RBC’s

A

Glutathione

64
Q

G6PD biproduct

A

NADPH which regenerates glutathione. So without G6PD we dont get NADPH or glutathione

65
Q

G6PD on blood smear

A

Heinz bodies and bite cells (degmacytes)

66
Q

Causes of oxidative stress

A

infection, sulfa drugs, fava beans

67
Q

Diagnose autoimmune hemolytic anemia

A

Coombs test

68
Q

Aplastic anemia caused by

A

damage to hematopoietic stem cell => pancytopenia