passmedicine 2 Flashcards
(119 cards)
1
Q
PT measures what pathway
A
extrinsic (shorter pathway, shorter name)
2
Q
PTT measure what pathway
A
intrinsic (longer pathway, longer name)
3
Q
central molecule in coagulation cascade
A
Xa
4
Q
INR measures what pathway
A
extrinsic pathway (PT)
5
Q
unfractionated heparin inhibits what factors
A
thrombin and Xa
6
Q
unfractionated heparin has what risk
A
can develop heparin induced thrombocytopenia
7
Q
how do you give heparin
A
IV (can give sub-cut as DVT prophylaxis)
8
Q
warfarin inhibits what factors
A
2, 7, 9, 10, protein C, protein S
9
Q
LMWH inhibits what factor
A
Xa
10
Q
rivoroxiban inhibits what
A
Xa
11
Q
problem with rivoroxiban
A
does not have a reversal drug
12
Q
PT measures what pathway
A
extrinsic and common pathway
13
Q
normal INR
A
0.8 - 1.2
14
Q
what can cause an increase INR
A
- anticoagulants
- reduced clotting factors
15
Q
what can cause reduce clotting factors (and in turn in increased INR)
A
- liver disease
- low vit K
- DIC
- sepsis
16
Q
how do PT and PTT tests differ in regards to process
A
PT - thromboplastin added, has tissue factor
PTT - no tissue factor, add silica instead
17
Q
PTT measures what pathways
A
intrinsic and common
18
Q
what can cause in increase PTT
A
- some anticoagulants
- Von willibrand disease
- haemophilia
- antiphospholipid syndrome
19
Q
what is the final product in the coagulation cascade
A
fibrin
20
Q
when will you see low fibrinogen
A
liver disease and DIC
21
Q
when will you see high fibrinogen
A
acute phase protein - so anything like that
22
Q
what causes high D-dimer
A
VTE arterial clot malignancy DIC severe sepsis liver disease
23
Q
what features indicates platelet problems
A
petechia (non blanching)
excessive bleeding following minor trauma
small bruises
immediate bleeding during/after surgery
24
Q
what features indicate coagulation problems
A
large bruises
delayed bleeding in surgery
spontaneous haemoarthrosis/muscle haematomas
25
endothelial cells use 5 mechanisms to prevent thrombus formation. name 2 secreted things
```
nitric oxide (NO)
prostacyclin (PGI2)
```
26
endothelial cells use 5 mechanisms to prevent thrombus formation. name the 3 expressed things
heparin sulphate
thrombomodulin
tissue factor pathway inhibitor
27
vWF binds what
factor VIII (8) this stops it being broken down
28
activated platelet secrete what
vWF
ADP
thromboxane A2
fibrinogen
29
what causes platelets to change to activated shape
Calcium
30
aspirin is a Cox-___ inhibitor
1
31
what converse prothrombin to thrombin
Xa/Va complex
32
what converts X to Xa in intrinsic
IXa/VIIIa complex
33
what converts X to Xa in extrinsic
TF/VIIa complex
34
what does thrombin do
converts fibrinogen into fibrin
35
what does antithrombin inhibit
thrombin
| VIIa, IXa, Xa, XIIa (7,9,10,11)
36
3 naturally occurring things that prevent run away coagulation
anti-thrombin
protein C pathway
tissue factor pathway inhibitor
37
what does thrombomodulin do
stops thrombin from working and activates protein C which (along with factor S) inhibits factors VIIIa and Va
38
what does tissue factor pathway inhibitor do
reversibly inhibits Xa and VIIa/TF complex
39
clot breakdown pathway
plasminogen --> plasmin --> plasmin breaks down fibrin into fibrin degradation products (D-dimer)
40
what can cause low Vit K in body
is fat soluble, so need bilirubin
41
vit k is co-enzyme to which clotting factors
2 (thrombin),7, 9, 10, C and S
42
what vitamin are babies short in and needs to be given
Vit K
43
2 examples of anti platelets
aspirin and clopidogrel
44
what does warfarin do
inhibits vit K epoxide reductase which is responsible for recycling Vit K that has been used as a co enzyme
45
what does unfractionated heparin do
activates antithrombin (which deactivates thrombin and Xa)
46
what does fractionated heparin do
inactivates Xa
47
what test used to monitor unfractionated heparin
PTT
48
what from of heparin requires monitoring
unfractionated
49
which stays in system longer UFH or LMWH
LMWH (coz only given sub-cut)
50
which form of heparin can you give in renal failure
UFH (can't give LMWH)
51
drug used to reverse heparin
protamine
52
what drug can cause thrombocytopenia
heparin (particularly UFH)
53
haemophilia A is deficiency in
factor VIII
54
haemophilia B is deficiency in
factor IX
55
another name for haemophilia B
christmas disease
56
anaemia: microcytosis disproportionately low to slightly low Hb
thalasaemia
57
HbA2
thalasaemaia trait
58
very low MCV, mild anaemia
thalasaemia trait
59
HbA2 levels that will suggest thalasaemia
> 3.5%
60
haemophilia A is deficiency in what factor
VIII
61
haemophilia B (christmas disease) is deficiency in what factor
IX
62
prolonged bleeding, prolonged APTT, prothrombin time normal
haemophilia A
63
if no obvious cause for DVT what other investigations must be done
Investigate for underlying malignancy + check anti-phospholipid antibodies
64
what causes febrile reaction following transfusion
- due to white blood cell HLA antibodies
| - often the result of sensitization by previous pregnancies or transfusions
65
which infection can be spread through transfusion because it can't be tested for
variant creultzeldt-jaokobs disease (vCJD) - prion disease
66
IgM paraprotein
waldenstroms marcoglobulinurea
67
investigations for myeloma
electrophoresis looking for Ig bands
68
Tear-drop poikilocytes
myelofibrosis
69
target cells can indicate what 2 things
hyposplenism and iron deficiency
70
Reed-Sternberg cell
Hodgkin's lymphoma
71
lacunar cells
Nodular sclerosing hodgkins lymphoma
72
C-myc gene translocation
burkitts lymphoma
73
which lymphoma associated with EBV
Burkitts lymphoma (especially endemic (african) form)
74
2 forms of burkitts lymphoma
endemic (African) form: typically involves maxilla or mandible
sporadic form: abdominal (e.g. ileo-caecal) tumours are the most common form. More common in patients with HIV
75
type of cels in burrkits
B cell
76
microscopy: starry sky
burkitts lymphoma
77
treatment for burrkits
chemo
78
most common cause of thrombophilia
factor V leiden
79
activated protein C resistance also called
factor V leiden
80
what does protein C do
inactivates Va and VIIIa
81
ESR in Polycythaemia rubra vera will be
low
82
if a patient is deficiency in both B12 and folate, how do you treat them
treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord, then give folate once B12 levels are back up
83
what can happen following chemo for Burkkits
Tumour lysis syndrome: releases a large quantity of intracellular components such as potassium, phosphate and uric acid. Get confusion, and muscle cramp
84
parvo virus causes what in people with sickle cell
aplastic crisis (sudden fall in Hb)
85
parvo virus bad for which people
sickle cell and spherocytosis
86
t(8;14)
burkitts
87
dalteparin is
LMWH
88
unfractionated heparin blocks several factors, LMWH works by INCREASES something, what?
antithrombin activity on Xa
89
which leukaemia is associated with an over active tyrosine kinase
chronic myeloid leukaemia
90
imatinib is used to treat what and why
chronic myeloid leukaemia, it is associated with over active tyrosine kinase
91
what leukaemia in 40-50 yrs
chronic myeloid leukemia
92
what leukaemia do very old people get
chronic lymphocytic leukemia
93
auer rods
acute myeloid leukaemia
94
high HbS, no HbA
sickle cell remember "S" for sickle
95
high HbA2
beta thalassaemia trait
96
red cells with loss of central pallor.
spherocytosis
97
HbS and HbA
sickle cell trait
98
get anaemia with sickle trait?
No
99
normal blood count but neuropathy
B12 deficiency
100
excess platelet production
essential thrombocythaemia
101
word for high platelet count
thronbocytosis
102
word for clotting tendency
thrombophilia
103
Normal prothrombin time, prolonged partial thromboplastin time, normal platelet count, normal fibrinogen.
Factor VIII deficiency (AKA Haemophilia A)
104
2 things that will cause an increased PTT
factor VIII deficiency (haemophilia A or vWF disease)
| antiphospholipid syndrome
105
Prolonged prothrombin time, normal partial thromboplastin time, normal platelet count, normal fibrinogen.
Factor VII deficiency (extrinsic pathway)
106
common pathway factors
II, V and X
107
What will cause prolongation of both the prothrombin and activated partial thromboplastin time.
Deficiencies of common pathway factors (II,V and X), can be due to low Vit K or liver disease
108
Prolonged prothrombin time, prolonged partial thromboplastin time, low platelet count, low fibrinogen.
DIC
109
Rituximab targets what
CD20, expressed on B cells and B cell lymphomas.
110
use rituximab to treat what
non-Hodgkin’s lymphoma
111
chronic myeloid leukaemia is treated with
imatinib
112
Aspirin is an irreversible inactivator of
cyclooxygenase
113
aspirin inhibits cyclooxyrgenase, what does cyclooxyrgenase do
required for the production of prostaglandins and thromboxanes for platelet aggregation.
114
horse shaped nucleus, steel-grey cytoplasm and vacuoles
monocyte
115
treatment for autoimmune haemolytic anaemia
steroids
116
treatment for symptomatic drug induced (usually chemo) pancytopenia
RBC transfusion
117
hypothyroidism and anaemia
pernicious anaemia
118
treatment for acute sickle crisis
exchange transfusion
119
excretion of clonal (kappa or lama only) light chains suggest
myeloma (these are bence jones proteins)
