2018 Start

Question 1

Used in times of starvation or stress

Answer 1

Gluconeogenesis(mechanism by which lactic acid and amino acids converted to glucose)

Question 2

Catalyze the formation of thrombin

Answer 2

Prothrombin complex

Question 3

Vitamin K dependent factors

Answer 3

II, VII, IX, and X, protein C and S (2, 7, 9, and 10)

Question 4

Long bleeding time (ristocetin test)

Answer 4

von Willebrand’s disease

Question 5

von Willebrand’s disease treatment

Answer 5

I - reduced quantity most common; DDAVP
II - defect in vWF;
Cryoprecipitate, DDAVP
III - complete vWF deficiency;
Cryoprecipitate

Question 6

Hemophilia A

Answer 6

Sex-linked recessive, most common symptom hemarthrosis, prolonged PTT, factor VIII crosses placenta so newborns might not bleed at circumcision;
Cryoprecipitate

Question 7

Treatment for bleeding in uremic patients

Answer 7

1st - Hemodialysis
2nd - DDAVP (acute reversal)
3rd - Cryoprecipitate

Question 8

Heparin induced thrombocytopenia (HITT)

Answer 8

Secondary to anti-heparin antibodies treat with stopping heparin and starting argatrogan (direct thrombin inhibitor)

Question 9

Stop ASA ___ days preop

Answer 9

7 days

Question 10

Stop plavix ___ days preop

Answer 10

7 days

If needed, bridge with Integrilin (eptifibatide)

Question 11

Stop Coumadin ___ days preop

Answer 11

7 days

Consider heparin bridge; tx bleeding with PCC, Vit K and FFP

Question 12

Goal platelet count

Answer 12

> 50K preop and >20K postop

Aminocaproic acid

Question 13

Bleeding after circumcision

Answer 13

Hemophilia (?)

Question 14

99% of bleeding disorders identified this way:

Answer 14

Abnormal bleeding with tooth extraction or tonsillectomy

Question 15

IVC Filter indications

Answer 15

Contra indications to anticoagulation
PE while on anticoagulation
Free-floating IVC, iliofemoral, or deep femoral DVT
Recent PE
Pl. IV see below the renal veins

Question 16

Best diagnostic study for PE

Answer 16

CTPA (?)

Question 17

Used in DIC, persistent bleeding following Cardio pulmonary bypass, or thrombolytic overdoses

Answer 17

Aminocaproic acid (Amicar) - Inhibits fibrinolysis by inhibiting plasmin

Question 18

MOA for dabigatran, apixiban, argatroban, and rivaroxaban

Answer 18

DOACs - direct thrombin inhibitors

Use argatroban with HITT

Question 19

LMWH (Lovenox, enoxaparin)

Answer 19

Vines and activates anti-thrombin III but increases neutralization of just factor XA not reversible with protamine

Question 20

Treatment for thrombolytic overdose

Answer 20

Aminocaproic acid

Question 21

Back pain, chills, tachycardia, fever during transfusion

Answer 21

Acute hemolytic reaction

Tx: Stop transfusion, fluids, diuretics, bicarb, pressors

Question 22

Best way to avoid blood transfusion reactions

Answer 22

Type and cross

Question 23

Electrolyte abnormality with massive transfusion

Answer 23

Hypocalcemia

Question 24

Effector cells in cell mediated immunity

Answer 24

Macrophages, cytotoxic T cells, natural killer cells

Question 25

Primary effector cells in cell-mediated immunity

Answer 25

Cytotoxic T cells (?)

Question 26

What medicines cause degranulation of mast cells? Which do not?

Answer 26

IgE complexes, complement components, mechanical trauma, endotoxins, and free radicals. Not degranulated by corticosteroids (?)

Question 27

Most common anaerobe in the colon?

Answer 27

Bacteroides fragilis

Question 28

Most common aerobic bacteria in the colon

Answer 28

E coli

Question 29

Most common bacteria overall in the colon?

Answer 29

Bacteroides fragilis (?)

Question 30

C Diff treatment

Answer 30

PO Vanc or flagyl; IV flagyl

Question 31

___% of abscess have anaerobes | ___% of abscess have anaerobes and aerobes

Answer 31

90% of abscess have anaerobes | 80% of abscess have anaerobes and aerobes