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24 Cards in this Set
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Case 1: 20 month year old boy Refused to walk for past 2 days Bleeding into joints Which of these is the most likely? Acute lympgoblastic leukaemia Osteomyelitis Von willerbramd Disease Haemophilia |
Ans: Haemophilia *cant be Von Willerbrands because it doesnt preset with bleeding into joints, more mucocutaneous bleeding (unless it is type 3 disease)* |
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How do you differentiate between haemophilia A and B? What tests would you run to confirm a diagnosis of Haemophilia? Measure the APP Measure the PT Measure the factor VIII Measure the platelet count |
Unlikely to be B, A is 5 times more common than B) Ans: Measure the factor VIII |
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How is heamophillia inherited? Autosomal Xlinked Y linked Autosomal dominant |
Ans: X-linked |
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The father tells you the boys maternal grandfather has heamophillia A, what are the chances of any further child having haemophilia A? e.g wifes father had haemophilia A e.g normal man with carrier wife. |
1 in 4 chance of child having disease. *The daughters of men with haemophilia are obligate carriers* |
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What is the treatment of choice? Recombinant Factor VIII Fresh frozen plasma - not going to get enough of the factors in a high enough concentration. DDAVP and tranexamic acid Plasma derived factor VIII |
Ans: Recombinant Factor VIII - indépendant of blood donors so no infection risk *not fresh frozen plasma because to won't get enough of the factors in a high enough concentration* *not DDAVP and Tranexmic acid - not an option in severe heamophillia, seems to bind to the heamophullia cell and release VWF into the circulation so doesnt work for people who have no factor 8 becuase it isnt strong enough* *not plasma derived factor VIII because it comes with a high risk of infection* |
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Which of these is not a complication of planma derived therapy? Hepatitis B HIV Hepatitis C Hepatitis A |
Ans: Hep A - most rare v uncommon |
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What is the other main complication of the treatment of heamopbhillia A with factor VII concentrates? Development of antibodies Allergic reactions - occasionally Addiction to factor VIII Increased risk of thrombosis |
Ans: Development of Antibodies - because the immune system has never seen factor 8 if you have severe haemophilia. If these antibodies develop then it will inhibit the factor 8 and make the treatment futile. |
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What is the best treatment regime for these patients? Treat the patietns as soon as possible after bleed Give factor VIII once a week Give factor VIII at least 3 times a week Bone marrow transplant |
Ans: Give factor VIII at least 3 times a week *cant be give once a week because half life of factor VIII is too short and so would disappear* *treating the patient soon after the bleed is all well and good but it isnt a long term solution* |
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Case 2: 24 year old females student Presents with 4 day historyy of easy bruising and small red spots on ankles No previous history of bleeding after tonsilectomy and dental extraction. Recently been off colour with flu. On the combined oral pill. What are the non-blanching spots on her arms? Spider nevi Brusises Petechiae Telangectasia |
Ans: Petechia (basically just small bruises) *might be spider nevi - most common cause is oestrogen - so can be seen in those taking the combined pill* |
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Which of these symptoms is she unlikely to have? Mennorrhagia Swollen, hot painful legs Epistaxis Buccal bleeding |
Ans: Swollen, hot painful legs |
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What is the likely cause of her symptoms? Thrombocytopenia Scurvy Vit K deficiency Liver failure |
Ans: Thrombocytopenia *liver failure can result in heamostatic failure (due to redced fibrinogenn and reduced platelet count)* |
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Which of the following is not a cause of thrombocytopeniania? Acute myeloid leukaemia Vit K deficiency Aplastic anaemia ITP (idopahthaticy thrombocytepenic pupiura) |
Ans: Vit K deficiency - are, not the typical patter of bleeding - tend to see coagulation bleeding into head muscles, organs and joints |
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The patient has spontaneous bruising and petechia formation, which platelet count is most likely? |
Answer is 10 *if platelet count is mild low then just bruising, if really low then they would be spontaneously bleeding* |
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Which underlying illness is not associated with ITP? (autiomimune condition - breakdown of immune regulation which results in the removal of platelets from the circulation) HIV Vit C deficiency (scurvy) SLE Glandular fever - often see ITP follow viral infection |
Ans: Vit C deficiency (scurvy) - presents with corkscrew hairs and abnormal gums *SLE always associated with anything to do with auto immunity* *Glandular fever - often see ITP follow viral infection* |
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Case 3: 70 year old, excessive bleeding from colectomy He has bleeding from is adbomlas wound but not from his drain. He has had surgery in the past but no abnormal bleeding. What is the most likely cause? Severe haemophilia A Von willerbrands LMWH prophylaxis Poor surgical technique |
Ans: Poor surgical technique *won't be heamophillia or von willerbrands because it would have been picked up before he reached this age* *LMWH prophylaxis would have more systemic bleeding* |
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Which of the following was NOT a reason the patient was given LMWH? Surgery Old age Hypertension thromboembolism Active cancer |
Ans: Hypertension - not a risk factor for VTE |
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Case 4: 65 year old man takes aspirin for previous history of TIA. How does aspirin work? Inhibits thrombin It reduces platelet aggregation - inhibits COX pathway Inhinbits coagulation factor production Inhibits Vit D |
Ans: It reduces platelet aggregation - inhibits COX *Aspirin is an antiplatelet, anticoagulants are better for venous thromboembolisms* |
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Which of these drugs does not inhibit platelet function? Clopidogrel Dagibiatran Amximimab Ticagrelor |
Ans: Dagibiatran - it is an anticoagulant *the rest are anti platelets* |
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Case 5: 21 year old medical student on combined pill Which is true? She has an increased risk of stroke She has a reduced risk of PE She may bleed more easily She has a family history of a mother and sister of mother with PE - contraindication |
Ans: She has an increased risk of stroke *PE risk is increased not reduced* *Blood is thicker so bleeds less easily* *family history wouldn't exist because doctor would have never prescribed pill if this was the case* |
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She has an increased risk of stroke and VTE (venous thromboembolism) Her reactive risk of VTW is 5 X But her absolute risk is low - how is this? |
Absolute risk is low compared to older patient because she is young. So even with the 5X increase she is young so still v low risk of stroke. |
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Which of the following could be present and contribute further to her VTE risk? Hypercholesteroleamia Factor V Leiden Von willerbrands factor deficiency Diabetes mellitus |
Ans: Factor V Leiden - increased risk of VTE (doesnt increase risk of stroke though), Factor V Leidein increased VTE 5X In combination with pill which increases overall risk of 30 *diabetes increase for for arterial thrombosis not venous* |
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She has an episode of proximal DVT Which of the following are not risk factors for arterial thromboembolism? Smoking Diabetes Factor V Leiden
Arterial fibrillation |
Ans: Factor V Leiden - - factor for venous but not for arterial |
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Chose incorrect answer. Arterial thrombus is? Platlete rich May cause pulmonary embolism |
Ans: May cause pulmonary embolism (that is venous not arterial) |
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Venous thrombosis incorrect answer: Is fibrin rich Is participated by circular stasis Occurs most commonly in upper limb May cause pulmonary infaaction |
Ans: Occurs most commonly in upper limb |