Test 74 Flashcards
Thrombotic thrombocytopenic purpura
Due to acquired autoantibodies against the metalloprotease ADAMTS13, which cleaves ultralarge chains of von Willebrand factor off the vascular endothelium. Uncleaved chains trap and activate platelets, resulting in severe thrombocytopenia and microangiopathic hemolytic anemia (schistocytes, elevated indirect bilirubin). Urgent treatment with plasma exchange removes the autoantibody and replenishes ADAMTS13.
Splenic vein thrombosis
Splenic vein thrombosis, which commonly occurs in association with pancreatitis, may be asymptomatic or present with variceal bleeding due to isolated gastric varices, the disease’s hallmark. Varices develop due to redirection of blood flow to the collateral gastroepiploic system and short gastric veins.
Male circumcision
Postprocedural bleeding is a common complication of circumcision and typically resolves with direct pressure (compressive elastic dressing). A comprehensive dressing should be used for only a short time and must be removed prior to discharge to prevent necrosis.
Nonmelanoma skin cancer
When cutaneous cancer is suspected, the first step is to obtain a biopsy to verify the diagnosis and to determine the histologic characteristics. This information will help with planning the best course of treatment.
Ischemic stroke
Stroke patients, particularly those with dysarthria, are at risk for oropharyngeal dysphasia and aspiration. In the setting of acute stroke, patients should be given nothing by mouth, including medications, until a rapid bedside dysphagia screening can be performed.
Ischemic stroke
DVT and pulmonary embolism are common causes of morbidity and mortality in acute ischemic stroke, particularly in patients with hemiparesis. DVT prophylaxis should include intermittent pneumatic compression in all patients. In most patients receiving aspirin therapy only (no thrombolytics, therapeutic anticoagulation, or dual antiplatelet therapy), subQ prophylactic-dose heparin is also recommended.
