AG-ACNP board study guide Questions
and Answers
Dx of ITP Correct Ans-bone marrow biopsy, CBC, platelet count, the platelets they do have
are larger than normal
Rule out other causes of thrombocytopenia
Tx of ITP Correct Ans-management may not be necessary until PLT < 20,000
IVIG (to distract the autoimmune)
steroids- help increase PLT count
refractory- splenectomy
Gamma globulin is preferred in HIV ITP
ITP vs SLE Correct Ans-bone marrow biopsy
Disseminated Intravascular Coagulation (DIC) Correct Ans-activation of thrombin (that
converts fibrinogen to fibrin) to form clot.
- amniotoic fluid embolus
- trauma (exposure of endothelial tissue factor)
- infection/sepsis
- malignancy
,- extensive burns
- leukemia
fibrinogen, prothrombin, PLT F V/VIII reduced due to consumption
circulating thrombin also breaks down clot and produces FDP (fibrin degradation products)
Hemorrhage results from the anticoagulant action of FDP's and the depletion of coagulation
factors. (It really is a nasty trick. it uses up your clotting factors, then produces bleeding by
breaking down the clot that was built with the clotting factors. sort of a pathologic pyramid
scheme)
It really is a rampant activation of thrombin (a thrombin problem). the thrombin activate
fibrinogen, clots ensue, fibrinogen gets used up, PLTS get used up and the body goes on breaking
down the clots.
since the endpoint of the coagulation cascade is fibrin and all of the fibrinogen is being
consumed, lab values such as the INR can be "infinite" and PTT can be massive elevated because
there is no "end point" (fibrin clot) for those values
Thrombotic Thrombocytopenic Purpura (TTP) Correct Ans-ADAMSTS13 deficiency or
autoantibody
Normal PT/PTT
Can't cleave vWF into monomers
Microthrombi creating schistocytes (MAHA microangiopathic hemolytic anemia)
,CNS abnormalities
renal failure
Tx of TTP and HUS Correct Ans-Plasmapheresis (or FFP)
DO NOT GIVE PLATELETS
indications for pharmacologic revascularization in MI Correct Ans-1. unrelieved chest pain >
30 min and < 6 hrs
WITH
2. ST elevation of > 0.1 mv in 2 or more CONTIGUOUS leads
TIBC (total iron binding capacity) Correct Ans-Normal 250-450
MCHC (mean corpuscular hemoglobin concentration) Correct Ans-32 - 36 g/dL
Concentration of hemoglobin per RBC
Metanephrine levels in pheochromocytoma Correct Ans-Metanephrine > 1.4
Normetanephrine > 2.5
free plasma measurement is the fastest test for Pehochromocytoma diagnosis
, Medicare Part B Correct Ans-The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and other services and
supplies.
Medicare Part A(Inpatient) Correct Ans-automatic at age 65 if the person paid the premiums.
if the person never paid the premiums(full time house wife) the person is not eligible for
Medicare coverage) Also covers person with end stage diseases at any age.
Medicare part A will pay for the following "medically necessary " services:
-inpatient hospitalization(including inpatient psych)
-hospice care
-home health care
-skilled nursing facility
Medicare Part A will not pay for custodial care(nursing homes, retirement homes)
Medicare Part C (Medicare Advantage) Correct Ans-•Replaces and covers expenses found in
Part A and B
•Medicare private fee-for-service plans (PFFS)
•Medicare managed care plans (HMOs and PPOs)
•Medicare specialty plans
Medicaid Correct Ans-A federal and state assistance program that pays for health care
services for people who cannot afford them.
Tx of H. pylori Correct Ans-Triple tx for 14 days
and Answers
Dx of ITP Correct Ans-bone marrow biopsy, CBC, platelet count, the platelets they do have
are larger than normal
Rule out other causes of thrombocytopenia
Tx of ITP Correct Ans-management may not be necessary until PLT < 20,000
IVIG (to distract the autoimmune)
steroids- help increase PLT count
refractory- splenectomy
Gamma globulin is preferred in HIV ITP
ITP vs SLE Correct Ans-bone marrow biopsy
Disseminated Intravascular Coagulation (DIC) Correct Ans-activation of thrombin (that
converts fibrinogen to fibrin) to form clot.
- amniotoic fluid embolus
- trauma (exposure of endothelial tissue factor)
- infection/sepsis
- malignancy
,- extensive burns
- leukemia
fibrinogen, prothrombin, PLT F V/VIII reduced due to consumption
circulating thrombin also breaks down clot and produces FDP (fibrin degradation products)
Hemorrhage results from the anticoagulant action of FDP's and the depletion of coagulation
factors. (It really is a nasty trick. it uses up your clotting factors, then produces bleeding by
breaking down the clot that was built with the clotting factors. sort of a pathologic pyramid
scheme)
It really is a rampant activation of thrombin (a thrombin problem). the thrombin activate
fibrinogen, clots ensue, fibrinogen gets used up, PLTS get used up and the body goes on breaking
down the clots.
since the endpoint of the coagulation cascade is fibrin and all of the fibrinogen is being
consumed, lab values such as the INR can be "infinite" and PTT can be massive elevated because
there is no "end point" (fibrin clot) for those values
Thrombotic Thrombocytopenic Purpura (TTP) Correct Ans-ADAMSTS13 deficiency or
autoantibody
Normal PT/PTT
Can't cleave vWF into monomers
Microthrombi creating schistocytes (MAHA microangiopathic hemolytic anemia)
,CNS abnormalities
renal failure
Tx of TTP and HUS Correct Ans-Plasmapheresis (or FFP)
DO NOT GIVE PLATELETS
indications for pharmacologic revascularization in MI Correct Ans-1. unrelieved chest pain >
30 min and < 6 hrs
WITH
2. ST elevation of > 0.1 mv in 2 or more CONTIGUOUS leads
TIBC (total iron binding capacity) Correct Ans-Normal 250-450
MCHC (mean corpuscular hemoglobin concentration) Correct Ans-32 - 36 g/dL
Concentration of hemoglobin per RBC
Metanephrine levels in pheochromocytoma Correct Ans-Metanephrine > 1.4
Normetanephrine > 2.5
free plasma measurement is the fastest test for Pehochromocytoma diagnosis
, Medicare Part B Correct Ans-The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and other services and
supplies.
Medicare Part A(Inpatient) Correct Ans-automatic at age 65 if the person paid the premiums.
if the person never paid the premiums(full time house wife) the person is not eligible for
Medicare coverage) Also covers person with end stage diseases at any age.
Medicare part A will pay for the following "medically necessary " services:
-inpatient hospitalization(including inpatient psych)
-hospice care
-home health care
-skilled nursing facility
Medicare Part A will not pay for custodial care(nursing homes, retirement homes)
Medicare Part C (Medicare Advantage) Correct Ans-•Replaces and covers expenses found in
Part A and B
•Medicare private fee-for-service plans (PFFS)
•Medicare managed care plans (HMOs and PPOs)
•Medicare specialty plans
Medicaid Correct Ans-A federal and state assistance program that pays for health care
services for people who cannot afford them.
Tx of H. pylori Correct Ans-Triple tx for 14 days
