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First Aid for the USMLE Step 2 CK (10th Ed.) | Medicine (MD/DO) School Study Aid
Coagulation Cascade
- Secondary Hemostasis
- Intrinsic Pathway
- Partial Thromboplastin Time (PTT)
- Heparin
- Extrinsic Pathway
- Prothrombin Time (PT)
- Warfarin
- Common Pathway
- Thrombin
- Convert Fibrinogen to Fibrin
- Stabilizes the Platelet Plug
2 mins
Clotting Overview
- Characteristics
- Endothelial Cells are Damaged
- Platelets Respond to Exposed Collagen and Stick
- Platelets Release Recruiting Factors
- More Platelets are Attracted
- Soluble Fibrinogen Turns to Insoluble Fibrin
- Fibrin Seals the Clot
- Clot Dissolves
- Liver Produces Clotting Factors
2 mins
Heparin Mechanisms
- Mechanism of Action
- Short Half-life
- Antithrombin Activation Cofactor
- Decrease Thrombin, Factor Xa
- Side Effects
- Bleeding
- Heparin Induced Thrombocytopenia (HIT)
- Antidote
- Protamine Sulfate
2 mins
Heparin Indications
- Indications
- Acute Coronary Syndrome (ACS)
- Prophylaxis
- Pulmonary Embolism
- Atrial Fibrillation
- Used during Pregnancy
1 min
Heparin Induced Thrombocytopenia (HIT)
- Pathophysiology
- 5-10 Days After Heparin Exposure
- Heparin-Platelet Factor 4 Complex
- Autoantibodies Form Against Complex
- Heparin-Platelet Factor 4-Antibody Complex Binds Platelets
- Platelet Aggregation
- Procoagulant Release
- Symptoms
- Thrombocytopenia
- Diagnosis
- Serotonin Release Assay (SRA)
- Treatment
- Stop Heparin, Start Direct Thrombin Inhibitor
2 mins
Warfarin
- Mechanism of Action
- Interferes with Vitamin K-dependent Clotting Factors
- Extrinsic Pathway
- Bridge with Heparin
- Indications
- Chronic Anticoagulation
- Side Effects
- Bleeding
- Necrosis
- Cytochrome P450
- Contraindications
- Pregnancy
- Antidote
- FFP + Vitamin K
2 mins
Warfarin Antidotes
- Antidotes
- Vitamin K
- Fresh Frozen Plasma
59 secs
Alteplase
- Mechanism
- Tissue Plasminogen Activator
- Indications
- Thrombosis
- Side Effects
- Bleeding
- Contraindications
- Intracranial Hemorrhage
- Internal Hemorrhaging
- Considerations
- Minimize Bleeding
- Monitor for Shock
- Antidote
- Aminocaproic Acid
2 mins
Factor Xa Inhibitors
- Characteristics
- Inhibit Factor Xa
- -xaban
- Drugs
- Apixaban
- Rivaroxaban
- Indications
- Pulmonary Embolism
- Nonvalvular Atrial Fibrillation
- Deep Vein Thrombosis
- Considerations
- Andexanet Alfa
2 mins
Enoxaparin (Lovenox)
- Mechanism of Action
- Inhibits Clotting Factors
- Factor Xa
- Indications
- Clot Formation Prevention
- Side Effects
- Heparin Induced Thrombocytopenia (HIT)
- Bleeding
- Considerations
- Medication Education
- Subcutaneous Injection
- 2 Inches from Umbilicus or Incisions
- Antidote
- Protamine Sulfate
2 mins
Abciximab and Tirofiban (GP IIb/IIIa Inhibitors)
- Mechanism
- IIb/IIIa Receptor Inhibitors
- Inhibits Platelet Aggregation
- Indications
- Thrombotic Event Prevention
- Acute Coronary Syndrome (ACS)
- Percutaneous Coronary Intervention (PCI)
- Side Effects
- Bleeding
- Considerations
- Expensive
- Combination Drug Therapy
2 mins
Hemophilia
- Cause/Mechanism
- Genetic Mutation
- Assessment
- Prolonged Bleeding
- Pain
- Hemarthrosis
- Interventions
- Clotting Factor Replacement Therapy
- DDAVP (Desmopressin Acetate)
- Antifibrinolytic Therapy
- Analgesics
- Considerations
- Genetic Counseling
- Prevent Injury
3 mins
Von Willebrand Disease
- Mixed platelet and coagulation disorder
- Mechanism
- Autosomal Dominant Condition Leading to Reduced vWF
- Defect in platelet plug formation
- Labs
- Increased Bleeding Time
- PTT increased
- Factor VIII decreased
- Normal platelet count
- Treatment
- DDAVP (synthetic vasopressin)
1 min
Factor V Leiden Thrombophilia
- Pathophysiology
- Most Common Genetic Clotting Disorder in Caucasians
- Genetic Point Mutation
- Glutamine Replaces Arginine
- Mutant Factor V
- Resistant to Degradation by Activated Protein C
- Symptoms
- Hypercoagulability
- Recurrent DVT (Increased Risk of Thromboembolism)
- Considerations
- Avoid Oral Contraceptives
- Caution During Pregnancy
2 mins
Antiphospholipid Syndrome
- Characteristics
- Antiphospholipid Antibodies
- Hypercoagulability
- Clinical Features
- Recurrent Thromboembolisms
- Recurrent Miscarriages
- Diagnosis
- Anticardiolipin Antibodies
- Anti-Beta-2-Glycoprotein Antibodies
- Lupus Anticoagulant
- Management
- Anticoagulation
2 mins
Disseminated Intravascular Coagulation (DIC)
- Pathophysiology
- Bleeding State
- Activation of Clotting Factors
- Deficiency of Clotting Factors
- Causes
- Sepsis
- Trauma
- Obstetric Complications
- Acute Pancreatitis
- Malignancy
- Nephrotic Syndrome
- Transfusion
2 mins
Thrombotic Thrombocytopenic Purpura (TTP)
- Inhibition or deficiency of ADAMTS 13
- vWF Multimers are Not Degraded
- Microthrombi (and Emboli)
- Symptoms
- FAT RN Pentad
- Fever
- Anemia
- Thrombocytopenia
- Renal Dysfunction
- Neurologic Abnormalities (Altered Mental status)
- Treatment
- Plasmapheresis
- Corticosteroids
- Splenectomy
2 mins
Primary Immune Thrombocytopenia
- Characteristics
- Preceding Infection or Vaccination
- Antiplatelet Antibodies
- Clinical Features
- Often Asymptomatic
- Bleeding
- Petechiae
- Diagnosis
- Thrombocytopenia
- Increased Megakaryocytes
- Management
- Corticosteroids
- Intravenous Immunoglobulin (IVIG)
- Rituximab
- Splenectomy
4 mins
Deep Vein Thrombosis (DVT) Characteristics
- Mechanism
- Virchow's Triad
- Venous Stasis
- Endothelial Damage
- Hypercoagulability
- Symptoms
- Tenderness
- Homan's Sign
- Warmth
- Redness
- Swelling
- Asymptomatic
1 min
Deep Vein Thrombosis (DVT) Management
- Diagnosis
- Compression Ultrasound (CUS) with Doppler
- D-Dimer
- Contrast Venography
- Treatment
- IVC Filter
- Heparin for Acute Management
- Warfarin for Long-term Management
- Thrombectomy/Thrombolysis
- Stockings
- Walking
4 mins
Wells' Criteria for Pulmonary Embolism
- Scoring
- Clinical Symptoms of DVT (+3)
- Pulmonary Embolism Most Likely Diagnosis (+3)
- Tachycardia (+1.5)
- Immobilization > 3 Days (+1.5)
- Previous DVT or PE (+1.5)
- Hemoptysis (+1)
- Malignancy (+1)
- Probability
- > 6 = High
- 2-6 = Moderate
- < 2 = Low
3 mins
Protein C or S Deficiency
- Pathophysiology
- Autosomal Dominant
- Inability to Inactivate Factor Va and VIIIa
- Symptoms
- Hypercoagulable State
- Recurrent DVTs or DVTs at Young Age
- Treatment
- Begin Heparin
- Slowly Bridge to Warfarin
- Hemorrhagic Skin Necrosis
2 mins
Pulmonary Embolism Causes
- Causes
- FAT BAT Mnemonic
- Fat
- Air
- Deep Vein Thrombosis (DVT)
- Bacteria
- Amniotic Fluid
- Tumor
- Risk Factors
- Hypercoagulable
- Central Venous Lines
- Immobilized
1 min
Chronic Venous Insufficiency (Venous Stasis Ulcer) Assessment
- Venous Stasis Ulcer
- Uneven Edges
- Dull Persistent Pain
- Medial Malleolus
- Necrotic
- Normal Pulses
- Lower Leg Edema
- Bronze-Brown Pigmentation
- Warm
- Pruritus
2 mins
Chronic Venous Insufficiency (Venous Stasis Ulcer) Interventions
- Frequently Elevate Legs
- Avoid Standing/Sitting for Long Periods of Time
- Elastic Compression Stockings
- Bilayer Artificial Skin
- Daflon
- Wound Dressings
- Proper Foot and Leg Care
2 mins
Varicose Veins Assessment
- Cause
- Increased Venous Pressure
- Incompetent Valves
- Assessment
- Telangiectasias
- Small Reticular Veins
- Dilated and Tortuous Veins
1 min
Superficial Thrombophlebitis
- Cause/Mechanism
- IV Catheter Irritation
- Assessment
- Erythema
- Cord-like Vein
- Edema
- Interventions
- Remove IV Catheter
- Elevate
- Warm Compress
- Considerations
- Rotate Sites Q3 Days
- Aseptic Technique
2 mins
Snake Bite Injury
- Local Findings
- Edema
- Erythema
- Tissue Necrosis
- Systemic Findings
- Neurotoxicity
- Distributive Shock
- Disseminated Intravascular Coagulation (DIC)
- Diagnosis
- Diagnosis by Clinical Impression
- Management
- Antivenom
- Closely Monitor Patient
2 mins
Essential Thrombocythemia
- Characteristics
- JAK2 Mutation
- Presentation
- Often Asymptomatic
- Thromboembolic Events
- Spontaneous Abortion
- Erythromelalgia
- Gout
- Diagnosis
- Thrombocytosis
- Megakaryocyte Hyperplasia
- Management
- Aspirin
- Hydroxyurea
2 mins
Direct Thrombin Inhibitors
- Indications
- Heparin Induced Thrombocytopenia (HIT)
- Nonvalvular Atrial Fibrillation
- Venous Thromboembolism
- Drug Names
- Dabigatran
- Bivalirudin
- Argatroban
- Mechanism of Action
- Inhibition of Thrombin
- Antidotes
- Idarucizumab
- Activated Prothrombin Complex Concentrate
- Side Effects
- Bleeding
3 mins
Antithrombin Deficiency
- Characteristics
- Autosomal Dominant
- Increased Thrombin and Factor X
- Heparin Resistance
- Hypercoagulability
- Diagnosis
- Family History
- Normal PT, PTT, and Bleeding Time
- Antithrombin-Heparin Cofactor Assay
- Management
- Factor Xa Inhibitors
- Direct Thrombin Inhibitors
- Low Molecular Weight Heparin
- Antithrombin Replacement
3 mins
Thrombopoietin
- Mechanism
- Increases Megakaryocyte Proliferation
- Indication
- Autoimmune Thrombocytopenia
- Drugs
- Romiplostim
- Eltrombopag
1 min
