Bleeding And Thrombosis

Question 1

What does spontaneous hemarthroses indicate?

Answer 1

Factor VII / XI deficiency

Question 2

What does mucosal bleeding indicate?

Answer 2

VWD disease

Question 3

What does epistaxis indicate?

Answer 3

Hereditary hemorrhagic telangectasia

VWD in boys

Question 4

What is heavy menstruated bleeding quantitatively defined as?

Answer 4

Loss of >80 mL of blood per cycle

Question 5

What three things can heavy menstrual bleeding clue you into?

Answer 5

VWD, factor XI deficiency, hemophilia carrier

Question 6

Which drugs can cause excessive bleeding?

Answer 6

NSAIDS
Clopidogrel
Fish oil
Vitamin E

Question 7

Which organs systems can exacerbate bleeding?

Answer 7

Liver
Renal
Hypothyroidism
Bone marrow failure

Question 8

What factors does PT assess?

Answer 8

Factor I (fibrinogen) 
Factor II (prothrombin) 
Factor V 
Factor VII 
Factor X

Question 9

What factors does the aPTT assess?

Answer 9

Factors XI, IX, VIII, X V, II; fibrinogen; prekallikrein, minion gen, and factor XII.

Question 10

What is the Pentad for TTP?

Answer 10

Thrombocytopenic purpura
Microangiopathic hemolytic anemia 
Fever 
Neurological signs 
Renal dysfunction

Question 11

What is ADAMTS13 also known as?

Answer 11

Von Willebrand Factor cleaving protease

Question 12

A mutation in what causes TTP?

Answer 12

ADAMTS13

Question 13

What is the treatment for TTP?

Answer 13

Plasmapheresis

Question 14

How do you treat VWD?

Answer 14

Cryoprecipitate

Desmopressin

Question 15

what disease is characterized by a thinning of vessel walls with telangiectatic formations, arteriovenous malformations, and a aneurysmal dilutions throughout the body?

Answer 15

Hereditary hemorrhagic telangectasia

Question 16

What is the inheritance for hereditary hemorrhagic telangectasia? Mutation?

Answer 16

AD; defect in the gene coding for endoglin (CD 105)

Question 17

What are the two clinical features of hereditary hemorrhagic telangectasia

Answer 17

Telangectasia

Bleeding (epistaxis)

Question 18

Which thrombotic disorder presents with recurrent lower extremity thrombophlebitis and deep vein thrombosis, venous insufficiency and chronic leg ulcers?

Answer 18

Antithrombin III deficiency

Question 19

What is the treatment for AT III Deficiency?

Answer 19

Prophylactic treatment with anticoagulants

Heparin

Question 20

What does protein C do?

Answer 20

Inactivated factors V and VIII

Question 21

What does protein S do?

Answer 21

It’s a cofactors for protein C

Question 22

How do you treat protein C/S deficiency?

Answer 22

Warfarin

Question 23

What part of the coagulation cascade is disrupted in Factor V Leiden disease?

Answer 23

Factor V binding with Protein C to inactivate it

Question 24

What are the four associated features of antiphospholipid syndrome?

Answer 24

Thromboembolic phenomena
Miscarriage
Thrombocytopenia
Cerebral ischemia and recurrent stroke

Question 25

What are three tests/indicators of antiphospholipid syndrome?

Answer 25

Prolonged aPTT Lack of correction in mixing studies using normal plasma Neutralization of inhibitor with excess phospholipid

Question 26

What is the treatment for antiphospholipid syndrome?

Answer 26

Anticoagulation with SC heparin | Hydroxychloroquine

Question 27

Which three antineoplastic drugs can cause malignancy?

Answer 27

Tamoxifen Bevacizumab Thalidomide

Question 28

What is the most common cause of easy bruising?

Answer 28

Thrombocytopenia -decreased platelet numbers

Question 29

What is the term for antibodies interacting with platelet surfaces?

Answer 29

Immune thrombocytopenic purpura

Question 30

How do you treat DIC?

Answer 30

Correct the underlying problem

Question 31

Which disease shows normal aggregation to ADP, collagen, arachidonic acid, epinephrine but absent aggregation to restocetin?

Answer 31

Bernard-soulier syndrome

Question 32

A patient with advanced liver cirrhosis would show what platelet abnormalities? (4)

Answer 32

Thrombocytopenia A prolonged PT A prolonged PTT Low Hgb

Question 33

What is a normal PT?

Answer 33

10-12

Question 34

What is a normal PTT?

Answer 34

30-45

Question 35

What does a mixing study used for?

Answer 35

To evaluated a prolonged aPTT or PT, to distinguish between a factor deficiency and a inhibitor. If there is a isolated factor deficiency, the aPTT will correct with mixing If there is lupus anticoagulant, the mixing and incubation will show no correction Acquired factor VIII inhibitor - mixing will not correct. Mixing will not correct with the presence of other inhibitors such as heparin, fibrin split products and paraproteins

Question 36

What is liskers signs?

Answer 36

Pain with percussion of the anteromedial tibia; not sensitive or specific for DVT

Question 37

What is lowenbergs sign?

Answer 37

Pain when a BP cuff is applied to the mid calf