Omsii - Path - Hemostasis

Front 1

Factors preventing thrombus formation in small blood vessels.

Back 1

Heparin-like molecules
Prostaglandin (PG) I2
Proteins C and S
Tissue plasminogen activator (tPA)

Front 2

Heparin-like molecules enhance ____ activity

Back 2

enhance ATIII activity

Front 3

ATIII - function?

Back 3

neutralizes activated serine protease coagulation factors

Front 4

PGI2 - two functions?

Back 4

1. vasodilator
2. inhibits platelet aggregation

Front 5

Proteins C and S -- Inactivate factors ____ and ____, enhance ____.

Back 5

inactivate factors V and VII, enhance fibrinolysis

Front 6

tPA: activates ____ to release ____.

Back 6

activates plasminogen to release plasmin

Front 7

Factors enhancing thrombus formation in small vessel injury.

Back 7

Thromboxane A2
Von Willebrand factor
Tissue thromboplastin (factor III)
Extrinsic and intrinsic coagulation systems

Front 8

tPA: activates ____ to release ____.

Back 8

activates plasminogen to release plasmin

Front 9

TXA2 - two functions

Back 9

vasoconstrictor, enhances platelet aggregation

Front 10

vWF = ____ ____ molecule

Back 10

platelet adhesion molecule

Front 11

Factors enhancing thrombus formation in small vessel injury.

Back 11

Thromboxane A2
Von Willebrand factor
Tissue thromboplastin (factor III)
Extrinsic and intrinsic coagulation systems

Front 12

vWF - where is it synthesized?

Back 12

Weibel-Palade bodies in endothelial cells

Front 13

TXA2 - two functions

Back 13

vasoconstrictor, enhances platelet aggregation

Front 14

vWF = ____ ____ molecule

Back 14

platelet adhesion molecule

Front 15

Factor VIII:c - where is it synthesized?

Back 15

synthesized in liver + reticuloendothelial cells

Front 16

Decrease in vWF causes ____ in VIII:c.

Back 16

decrease

Front 17

vWF - where is it synthesized?

Back 17

Weibel-Palade bodies in endothelial cells

Front 18

vWF - two functions

Back 18

1. platelet adhesion
2. prevents degradation of VIII:c in plasma

Front 19

Factor VIII:c - where is it synthesized?

Back 19

synthesized in liver + reticuloendothelial cells

Front 20

Decrease in vWF causes ____ in VIII:c.

Back 20

decrease

Front 21

Tissue thromboplastin: activates factor ____ in the ____ coagulation system

Back 21

factor VII in the extrinsic coagulation system

Front 22

vWF - two functions

Back 22

1. platelet adhesion
2. prevents degradation of VIII:c in plasma

Front 23

Platelet receptor GpIb binds to ____.

Back 23

vWF

Front 24

Tissue thromboplastin: activates factor ____ in the ____ coagulation system

Back 24

factor VII in the extrinsic coagulation system

Front 25

Platelet receptor GpIb binds to ____.

Back 25

vWF

Front 26

Platelet receptor GpIIb-IIIa binds to ____.

Back 26

fibrinogen

Front 27

Ticlopidine, clopidogrel and abciximab interfere with ____ receptor function.

Back 27

GpIIb-IIIa

Front 28

ADO, vWF and fibrinogen are important platelet ____ proteins.

Back 28

platelet storage protiens

Front 29

Platelet function: stabilizes intercellular ____ junctions in ____ endothelial cells.

Back 29

stabilizes intercellular adherens junctions in venular endothelial cells.

Front 30

Extrinsic system: factor ____ activates factors ____ and ____.

Back 30

Extrinsic system: factor VII activates factors IX and X.

Front 31

Intrinsic system factors?

Back 31

XII, XI, IX, VIII

Front 32

Factor XIIa activates the ____ system.

Back 32

kininogen system

Front 33

Final common pathway factors?

Back 33

X, V, II, I

Front 34

Factor ____ crosslinks insoluble fibrin monomers.

Back 34

Factor XIII

Front 35

Vitimin K-dependent factors?

Back 35

procoagulants - II, VII, IX, X

anticoagulants - proteins C and S

Front 36

Vitamin K: liver-activated by ____ ____.

Back 36

epoxide reductase

Front 37

Calcium binds ____ vitamin K-dependent factors.

Back 37

gamma-carboxylated vit K-dependent factors

Front 38

Factors consumed in a clot to produce serum?

Back 38

I, II, V, VIII

Front 39

Plasminogen activators (3)?

Back 39

tPA, streptokinase, urokinase

Front 40

Aminocaproic acid inhibits ____.

Back 40

plasminogen

Front 41

d-Dimers are crosslinked ____ monomers.

Back 41

fibrin

Front 42

Platelet sequence in hemostasis?

Back 42

1. adhesion
2. release reaction
3. TXA2 synthesis
4. temporary plug

Front 43

TXA2 enhances ____ attachment to ____ receptors

Back 43

enhances fibrinogen attachment to GpIIb-IIIa receptors

Front 44

Temporary platelet plug is held together by ____.

Back 44

fibrinogen

Front 45

Stable platelet plug is held together by ____.

Back 45

fibrin

Front 46

Platelet adhesion to vWF - defective in which two disorders?

Back 46

vWD and Bernard-Soulier disease

Front 47

Platelet synthesis of TXA2 inhibited by ____.

Back 47

aspirin

Front 48

Temporary platelet plug defective in ____ disease

Back 48

Glanzmann's disease

Front 49

Formation of stable platelet plug defective in ____ deficiencies.

Back 49

factor

Front 50

Aspirin or NSAIDS, B-S syndrome, Glanzmann's disease, renal failure, scurvy, thrombocytopenia and vWD are all causes of prolonged ____ ____.

Back 50

prolonged bleeding time

Front 51

Pts taking ASA or NSAIDs will have ____ platelet count.

Back 51

normal platelet count.

Front 52

Glanzmann's disease is a ____ ____ disease (inheritence) characterized by absent ____ fibrinogen receptors and absent thrombosthenin.

Back 52

Autosomal recessive, absent GpIIb-IIIa fibrinogen receptors.

Front 53

Bernard-Soulier syndrome is an autosomal recessive disease characterized by absent ____ platelet receptors for vWF.

Back 53

GpIb platelet receptors for vWF

Front 54

Prolonged bleeding time secondary to renal failure can be reversed with dialysis and ____ ____.

Back 54

desmopressin acetate

Front 55

Scurvy may cause ____ and ____.

Back 55

ecchymoses and hemarthroses

Front 56

Thrombocytopenia -- increased bleeding time when platelet count is < ____ cells/mm^3.

Back 56

<90,000 cells/mm^3

Front 57

Von Willebrand disease is an autosomal dominant disorder characterized by absent or defective ____ and decreased ____.

Back 57

absent or decreased vWF, decreased VIII:c

Front 58

vWD is a combined ____ and ____ ____ disorder

Back 58

combined platelet and coagulation factor disorder

Front 59

BT is a test of platelet function to formation of ____ ____.

Back 59

temporary plug

Front 60

Ristocetin cofactor assay is a test of ____ function.

Back 60

vWF

Front 61

PT evaluates which factors?

Back 61

VII, X, V, II and I

(extrinsic system)

Front 62

INR standardizes PT for ____ therapy.

Back 62

warfarin

Front 63

PTT evaluates which factors?

Back 63

XII, XI, IX, VIII, X, V, II, I

(intrinsic system)

Front 64

Which coagulation test is better in monitoring warfarin therapy?

Back 64

PT

Front 65

Which coagulation test is better in monitoring heparin therapy?

Back 65

PTT

Front 66

FDPs are increased with lysis of ____ and ____ in fibrin thrombi

Back 66

fibrinogen and fibrin

**this test isn't sensitive.

Front 67

D-Dimer assay detects cross-links and is specific for lysis of ____ ____.

Back 67

fibrin thrombi

Front 68

senile purpura is caused by what?

Back 68

vessel instability -- normal finding in elderly patients

Front 69

Chronic iron deficiency, malignancy and splenctomy are common causes of secondary (reactive) ____.

Back 69

thrombocytosis

Front 70

What is the MCC of qualitative platelet dysfunction?

Back 70

ASA

Front 71

Petechiae is only seen with ____.

Back 71

thrombocytopenia

Front 72

Bleeding from superficial scratches and easy bruising are signs of ____ ____.

Back 72

platelet dysfunction (ASA)

Front 73

Petechia, bleeding from superficial scratches and easy bruising are signs of ____.

Back 73

thrombocytopenia

Front 74

Three causes of coagulation disorders?

Back 74

1. decreased production
2. inhibition
3. consumption

Front 75

Late rebleeding and hemarthroses are common signs of ____ ____.

Back 75

coagulation disorders

Front 76

What is the inheritance pattern of hemophilia A?

Back 76

x-linked recessive

Front 77

In pts with Hemophilia A, the % of ____ never changes.

**correlates to severity of disease

Back 77

% VIII:c

Front 78

Hemophilia B is an XR disorder involving factor ____ deficiency.

Back 78

factor IX deficiency

Front 79

In Hemophilia A, pts have ____VIII:c and ____PTT.

Back 79

decreased VIII:c, increased PTT

Front 80

vWD has ____ inheritance.

Back 80

AD

Front 81

MVP, Marfan syndrome and angiodysplasia are associated with which coagulation disorder?

Back 81

vWD

Front 82

What is the MC hereditary coagulation disorder?

Back 82

vWD

Front 83

vWD is a combined ____ and ____ ____ disorder

Back 83

combined platelet and coagulation factor disorder

Front 84

Pts with vWD have ___PTT and ____BT.

Back 84

increased PTT, increased BT

**also, decreased vWF and VIII:c

Front 85

Rx for vWD?

Back 85

desmopressin acetate, oral contraceptive pills (estrogen)

Front 86

With circulating anticoagulant, PT and/or PTT (are/are not) corrected with mixing study.

Back 86

ARE NOT

** indicates immune destruction

Front 87

What are the vitamin K-dependent factors?

Back 87

II, VII, IX, X, protein C and S

**gamma-carboxylation activates them.

Front 88

Why can't newborns synthesize vitamin K?

Back 88

lack bacterial colonization in bowel

Front 89

What is the MCC of vitamin K deficiency in a hospitalized pt?

Back 89

broad spectrum antibiotics

Front 90

Rat poison contains ____.

Back 90

warfarin

Front 91

Warfarin inhibits ____ ____, rendering Vitamin K nonfunctional.

Back 91

epoxide reductase

Front 92

In pts with cirrhosis, ____ synthesis of vitamin K-dependent factors, ____ activation of vitamin-K.

Back 92

decreased synthesis of vitamin K-dependent factors, decreased activation of vitamin K

Front 93

MCC DIC?

Back 93

1. sepsis

2. malignancy
3. crush injury

Front 94

DIC: ____ of coagulation factors

Back 94

consumption

Front 95

DIC is a ____ disorder.

Back 95

thrombohemorrhagic

Front 96

DIC lab findings?

Back 96

inc PT, PTT, D-dimers, BT

dec platelets

Front 97

Most sensitive screen for DIC?

Back 97

D-dimers

Front 98

DIC Rx

Back 98

Treat underlying causes!!!

component replacement until underlying cause resolved

Front 99

Open heart surgery, prostatectomy and diffuse liver disease are common causes of ____ ____.

Back 99

primary fibrinolysis

Front 100

Primary fibrinolysis lab findings?

Back 100

+FDPs, -D-dimers,

normal platelet count

inc PT, PTT

Front 101

Secondary fibrinolysis lab findings?

Back 101

+FDPs, +D-dimers

dec platelet count

inc PT, PTT

Front 102

Secondary fibrinolysis is a compensatory reaction in the presence of ____.

Back 102

DIC

Front 103

MC hereditary thrombosis syndrome?

Back 103

Factor V Leiden

**mutant form of factor V cannot be degraded by protein C and S

Front 104

Hemorrhagic skin necrosis is associated with ____ therapy in protein C deficiency.

Back 104

warfarin

Front 105

Clinical sign of ATIII deficiency -- ____ PTT after standard dose of heparin.

Back 105

normal PTT -- require greater dose of heparin to activate whatever ATIII is present

Front 106

MCC thrombocytopenia in children 2-6 yo.

Back 106

Acute idiopathic thrombocytopenic purpura (ITP)

Front 107

MCC thrombocytopenia in adults.

Back 107

Chronic idiopathic thrombocytopenic purpura (ITP)

Front 108

Newborns infants of mothers with ITP may have transient thrombocytopenia due to transplacental passage of ____ antibodies.

Back 108

IgG

Front 109

Neonatal alloimmune thrombocytopenia is caused by feto-maternal incompatibility for ____ ____ ____.

Back 109

platelet specific antigens.

Front 110

Post-transfusion purpura primarily occurs in ____ women.

Back 110

multiparous

Front 111

MCC thrombocytopenia in hospitalized pts.

Back 111

Heparin-induced thrombocytopenia

**occurs 5-14 days after Rx

Front 112

Thrombotic thrombocytopenic purpura (TTP) is an acquired or genetic deficiency in vWF-cleaving metalloprotease in endothelial cells that occurs in ____ ____.

Back 112

adult females

Front 113

TTP - clinical pentad

Back 113

1. fever
2. thrombocytopenia
3. renal failure
4. microangiopathic hemolytic anemia with shistocytes
5. CNS deficits

Front 114

MCC renal failure in kids.

Back 114

Hemolytic uremic syndrome (HUS)

Front 115

MCC of HUS is endothelial damage at areteriole-capillary junctions due to Shiga-like toxin of which bacteria?

Back 115

E. coli (O157:H7 serotype)

**undercooked beef

Front 116

HUS triad

Back 116

1. thrombocytopenia
2. acute renal failure
3. microangiopathic hemolytic anemia

Front 117

Thrombocytopenia ITP, TTP, HUS

lab findings

Back 117

decreased platelet count, increased bleeding time

Front 118

vWD - lab findings

Back 118

inc BT, PTT

Front 119

Hemophilia A - lab findings

Back 119

inc PTT

Front 120

DIC - lab findings

Back 120

dec platelet count

inc BT, PT, PTT

Front 121

Primary fibrinolysis - lab findings

Back 121

inc BT, PT, PTT

Front 122

ASA or NSAIDS - lab findings

Back 122

Inc BT

Front 123

Warfarin or Heparin - lab findings

Back 123

inc PT, PTT