Ace Your PANCE Prep Pearls: 3rd Ed. (2019) Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Physician Assistant (PA) Students
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PANCE Prep Pearls: 3rd Ed. (2019) | Physician Assistant (PA) School Study Aid
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
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
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
Hemolytic Uremic Syndrome (HUS)
- Children
- Pathophysiology
- Preceded by Acute Diarrheal Illness
- Endothelial Damage
- Classic Triad of Symptoms
- Microangiopathic Hemolytic Anemia (MAHA)
- Thrombocytopenia
- Renal Failure
- Labs
- Helmet cells
- LDH
- Treatment
- Dialysis
- Supportive
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
Disseminated Intravascular Coagulation (DIC) Assessment
- Mechanism
- Improper Initiation of Clotting Cascade
- Signs and Symptoms
- Systemic Bleeding
- Petechiae, Purpura, Ecchymosis
- Change in LOC
- Increased PT and PTT
- Cyanosis
- Increased Fibrin Degradation Products (FDP)
- Decreased Platelets and Fibrinogen
2 mins
Disseminated Intravascular Coagulation (DIC) Interventions
- Complications
- Risk for Shock
- Renal Failure
- Interventions
- Treat Underlying Cause
- Manage Bleeding
- Maintain Fluid and Hemodynamic Balance
- Transfusion
- Oxygenation
- Heparin Drip
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
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
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
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
