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Heme/Onc 5 (Clots)
Step-2
| Question | Answer |
|---|---|
| A 45 y/o man presents with acute onset flank pain and hematuria. What is the most likely etiology? | nephrolithiasis |
| What is the most likely cause of aortic stenosis in a 50 y/o patient? | congenital bicuspid aortic valve |
| Which type of bias is introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death? | Lead time bias |
| What is the mechanism of action of the following drug: streptokinase | cleaves fibrin clots |
| What is the mechanism of action of the following drug: ASA | inhibits COX/platelet aggregation |
| What is the mechanism of action of the following drug: Clopidogrel | ADP receptor blocker |
| What is the mechanism of action of the following drug: Abciximab | GP IIb/IIIa inhibitor |
| What is the mechanism of action of the following drug: Tirofiban | GP IIb/IIIa inhibitor |
| What is the mechanism of action of the following drug: Ticlopidine | ADP blocker |
| What is the mechanism of action of the following drug: Enoxaparin | LMWH (binds factor Xa) |
| What is the mechanism of action of the following drug: Eptifibatide | GP IIb/IIIa inhibitor |
| What is the classic pentad for TTP? | hemolytic anemia, thrombocytopenia, uremia, neurologic dz, fever |
| What lab test is used to monitor warfarin? | PT/INR |
| What lab test is used to monitor Heparin? | PTT |
| What lab test is used to monitor LMWH? | Anti-factor Xa |
| What is the treatment for the mc inherited bleeding d/o? | Von Willebrand factor deficiency. Treatments include DDAVP(first line for acute bleeding), Cryoprecipitate or factor 8 concentrates for severe or refractory bleeding, OCPs for menorrhagia, Avoid ASA. |
| What are the mcc of DIC? | "STOP Making new Thrombi": Sepsi, trauma, OB complications, pancreatitis, malignancy, transfusions |
| A patient comes in with a DVT/PE, you can not find an easy explanation for this. What should be on the differential dx? | Inherited diseases of hypercoagulation such as factor 5 leiden mutation(mc), antithrombin deficiency, Protein C or S deficiency, Prothrombing gene mutation. Also some less common are hyperhomocysteinemia, dysfibrogenemia, plasminogen deficiency. |
| T/F You incidentally find a Factor 5 Leiden deficiency in a pt who is asymptomatic. You should immediately start the patient on anti-coagulation therapy to prevent any clotting. | False. You only anti-coagulate the patient once they have had a DVT. |
| What lab changes would you see in the following disease (Platelet count, Bleed time, PT, PTT): HUS or TTP | decrease platelets, increase BT, Normal PT and PTT |
| What lab changes would you see in the following disease (Platelet count, Bleed time, PT, PTT): hemophilia A or B | normal platelets, BT, PT and increased PTT |
| What lab changes would you see in the following disease (Platelet count, Bleed time, PT, PTT): Von Willebrand dz | normal platelets, increase BT, normal PT, increase PTT |
| What lab changes would you see in the following disease (Platelet count, Bleed time, PT, PTT): DIC | normal platelets, increased BT, PT and PTT |
| What lab changes would you see in the following disease (Platelet count, Bleed time, PT, PTT): warfarin use | normal platelets and BT, increased PT and PTT |
| What lab changes would you see in the following disease (Platelet count, Bleed time, PT, PTT): end stage liver dz | low/nL platelets, high/normal BT, increased PT and PTT |
| What lab changes would you see in the following disease (Platelet count, Bleed time, PT, PTT): ASA use | normal platelets, increase BT, normal PT and PTT |
| What is the mc mutation that disposes to venous thrombosis in white patients? | Factor 5 Leiden |
| A patient has a sudden decrease (>50%) in platelet levels after being started on heparin. What disease is this? | HIT. Heparin induced thrombocytopenia. |
| What causes HIT (pathology asociated)? | development of antiplatelet antibodies that cause widespread platelet destruction in response to heparin therapy |
| What causes Idiopathic thrombocytopenia (pathology associated)? And which population is it most common in? | Autoimmune B cell directed production of antiplatelet antibodies. Platelets usually <50,000. Common in children |
| What is the tx for ITP? | self-limited in children. Adults require corticosteroids, delayed splenectomy, IV IG, plasmapheresis, or recobinant factor 7a |
| Which disease is causing the following thrombocytopenia: diffuse platelet aggregation due to autoantibodies against a preventative enzyme; associated with E. coli 0157:H7 infection | TTP-HUS |
| What is the treatment for TTP-HUS? | corticosteroids, plasmapheresis, FFP |
| Which 2 clotting factors are the only ones not synthesized by the liver? | vWF and factor 8 |
| Green leafy veggies are a good source of vitamin ______. | K |
| Patients with end stage liver dz are on prophy vitamin _______ to optimize clotting factor production. | K |
| Hemophiliacs tend not to develop significant bleeds unless they have ______ clotting activity. | <5% |
Created by:
shelybel
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