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Terms in this set (34)
which clotting factors are dependent on vit K in coag cascade?
Facotr II (prothrombin)
VII, IX, X
and also essential production of proteins C,S
which exxam findings are most consistent with thrombocytopenia?
a) delayed procedural bleeding
c) large soft tissue hematoma
d) wet purpura
D) WET PURPURA
(blood blisters, or purpura on mucosal surface)
a,b,c: clotting factor def
what type of inherited d/o is hemophilia C
autosomal recessive d/o
what is tx of von Willebrand dz
hemophilia A and B are what type of inheritied d/o
which of following is MC location of bleeding in pts with von Willebrand dz?
a) joint spaces
b) mucosal surfaces
c) muscle groups
B) MUCOSAL SURFACES
(GI and GU tracts)
a,c: hemophilias a,b,c
d: serious complication of sickle cell
63y F h/o etoh abuse and gastric bypass p/w unsteady gait. reports increase in falls over past 8mos. tripping over rugs. exam: wide base ataxic gait c diminished prooprioception and vibration sense below knees blt; reflexes increased in LEs but symmetric. MRI of brain: no cerebellar atrophy; nerve conduction pending. labs: increased MCV, decreased serum vit B12, nml folate, elevated MMA and homocysteine.. most appropriate intervention?
a) gabapentin daily
b) IM cyanocobalmin weekly
c) IVIG monthly
d) PO vit B12 daily
B) IM CYANOCOBALAMIN WEEKLY
(b/c prev surgery)
a: symptomatic tx for neuropathic pain
c: aquired inflammatory demyelinating neurpathies (GBS, CIDP)
d: need parenteral or IM
what blood cell morphology would be expected on peripheral smear of pt with vit B12 def?
elevated fibrin degration products is seen in what dz?
(fibrin degradation products seen when clot is being dissolved by plasmin)
how does infectious parotits present
parotid gland swelling, tenderness, +/- fevers
how does Ludwig angina present?
submandibular and sublingual swelling and fluctuance + difficulty swallowin and submandibular erythema
9y immigrant boy from Ethiopia has large painless facial mass involving jaw and has ipsilateral lower facial numbness.. most likely dx?
a) Burkitt lymphoma
b) infectious parotits
c) ludwig angina
d) thyroglossal duct cyst
b) mass would be painfull
c) would have submandibular and sublingual swelling and fluctuance + difficulty swallowing
d) duct cyst usually in neck not jaw
Facotr II deficiency lab
PT prolonged b/c is prothrombin deficiency
vit K deficency labs
more prolonged PT > aPTT
von Willebrand dz lab
bleeding time prolonged
(def in von willie factor used in clotting)
18y boy p/w marked hemarthrosis of knee after tripping, has happened before. activated partial thromboplastin time is prolonged. prothrombin and thrombin time are nml... most likely dx?
a) factor II def
b) hemophilia B
c) vit K def
d) von willie dz
B) HEMOPHILIA B
minor trauma -> hemarthrosis
aPTT prolonged, PT and thomrbin nml
which type of antibodies is responsible for autoimmune destruction of platelets?
clinical picture of 1ry ITP?
recent viral illness
c/o red spot or easy bleeding
petechiar, purpura, gingival bleeding on exam
platelets < 100k
MC cause is antiplatelet antibodies
tx obs, steroids, IVIG
when are schistocytes seen on peripheral blood smear (4 things)?
artificial heart valves
what is big difference between DIC and ITP, TTP
DIC is ill-appearing with schistocytes but increased PT(INR), PTT, D-dimer, fibrinogen degradation and DECREASED fibrinogen
what is big difference between TTP and ITP, DIC?
TTP is ill-appearing, schistocytes on smear, but nml fibrinogen and everything else nml or slight increase
what is big difference between ITP and TTP, DIC?
ITP pt isn't ill-appearing, everything is pretty nml lab wise
what is hallmark lab finding in ITP?
decreased platelet count
Hyperuricemia is most likely in wich of following pts?
a) HIV taking indinavir
b) Tb taking rifampin
c) Burkitt lymphoma and chemo
d) breast ca and radiation
c) chemo pt
(chemo for high grade kymphomas , like Burkitts, -> tumor lysis syndrome
Anemia of chronic dz p/w (Fe and ferritin)?
5y boy h/o sickle cell anemia p/w dyspnea + fatigue. 1 wk prior had fever, HA, bright red rash o cheeks which has since resolved. labs show decrease in baseline hgb by 30%. name that virus?
pt undergoing TEE suddenly develops profound hypoxemia + cyanosis. RR is 18, o2 sat remains 80% despite adequate supplemental 02 via nonrebreather.. med list includes benzocaine, fentanyl, midazolam, propoful during procedure.. what substance should you administer to tx underlying condition?
- methemoglobinemia d/t benzocaine.. pulse ox remaining ~80-85%
which organ regulated body concentration of Fe?
80y F c/o fatigue and sluggishness, numbness in hands recently. on exam has glossitis and appears slightly jaundiced; labs show macrocytic anemia; autoantibodies to intrinsic factor are detected; what is tx?
monthly parenteral cyanocobalamin
what does B12 def have that folate def doesn't?
glossitis and neuro symptoms are more common in B12 def
methylmalonic acid is elevated in which vit def that causes macrocytic anemia?
(homocysteine is elevated in both folate and B12)
universal donor for RBC transfusion?
(lack of A,B, Rh factor antigens)
universal plasma donor blood type?
MC location for spontaneous bleeding in children w hemophilia A?
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