STROKE REHABILITATION
QUESTIONS AND COMPREHENSIVE
ANSWERS
metabolic causes of bruising ANSW✅✅Cushing's
hypothyroidism
brief investigations of bruising ANSW✅✅history
examination
investigations
clotting tests
safeguarding - consider NIA
history of bruising ANSW✅✅Site (trunk suggests bleeding disorder is more likely), or can appear
below an injury
Anything similar before
Petechiae or purpura present?
Spontaneous
Family history of medical conditions
Elderly?
Exercising a lot or manual job?
Pale skin? Bruising is more obvious
examination of bruising ANSW✅✅Distribution
Site
Size
Petechiae, purpura, ecchymoses
Systemic - pallor, hair or nail problems
Delayed healing
Hepatosplenomegaly
,Lymphadenopathy
Joint defects
investigations (bloods) of bruising ANSW✅✅FBC - Hb, platelets (low = thrombocytopenia), WBC
(low = bone marrow issue)
RBC
Platelets size and shape - large in ITP (immune thrombocytopenia)
U&E
LFTs
Clotting screen - PTT, APTT, fibrinogen, INR
Coagulation factor assays
Platelet function tests
Screening for von Willebrand disease
prothrombin time - PT clotting test ANSW✅✅assesses extrinsic pathway and final common
pathway (factors VII, I, V, II, and fibrinogen)
how to remember function of prothrombin time - PT clotting test ANSW✅✅I Play Tennis OUTSIDE
- PT = extrinsic
activated partial thromboplastin time - APPT clotting test ANSW✅✅intrinsic pathway plus final
common pathway (factors XII, XI, IX, X, V, II and fibrinogen)
how to remember activated partial thromboplastin time - APPT clotting test ANSW✅✅I Play Table
Tennis INSIDE - APTT = intrinsic
INR clotting test ANSW✅✅compares PT with normal value as a ratio
Used to monitor warfarin and risk of bleeding
Different conditions will have different INR targets
thrombotic thrombocytopenic purpura - TTP ANSW✅✅Decrease in function of ADAMTS13 gene
Normally cuts von Willebrand factors into smaller pieces to regulates its interaction with platelets
, failure of this process leads to easy bruising / bleeding
non-Hodgkins lymphoma ANSW✅✅Younger male patients
Platelets autoantibodies - usually IgG from a B lymphocyte
Premature removal of platelets from circulation by macrophages, especially by spleen
Platelet life falls to only a few hours
what is Cullen's sign? ANSW✅✅periumbilical (under belly button) ecchymoses
when is Cullen's sign seen? ANSW✅✅haemorrhagic pancreatitis
Ruptured ectopic pregnancy
Retroperitoneal bleeding
what is Grey Turner's sign ANSW✅✅flank ecchymoses in a vertical line
development and cause of Cullen's and Grey Turner's signs ANSW✅✅Both develop 3 days after
event
Caused by retroperitoneal haemorrhage that has dissected through facial planes to get to skin
Can also extravasate into perineum causes scrotal haematoma of inguinal swelling
High mortality rate - 1/3
process of haemostasis ANSW✅✅Exposure of subendothelial material causes platelet activation
Platelets change shape & produce pseudopodia
They rapidly stick to damaged area via receptors
Platelets interact with von Willebrand factors & exposed collagen
Von Willebrand factor = protein synthesised by endothelial cells & megakaryotes
VW factors bind to coagulation factor 8 in plasma
Platelets aggregate & interact via receptor sites using fibrinogen - factor 1
Platelets contract & release granules - promote aggregation
Fibrin generation occurs due to release of tissue factor (factor 3) from damaged tissue - activates
extrinsic pathway
QUESTIONS AND COMPREHENSIVE
ANSWERS
metabolic causes of bruising ANSW✅✅Cushing's
hypothyroidism
brief investigations of bruising ANSW✅✅history
examination
investigations
clotting tests
safeguarding - consider NIA
history of bruising ANSW✅✅Site (trunk suggests bleeding disorder is more likely), or can appear
below an injury
Anything similar before
Petechiae or purpura present?
Spontaneous
Family history of medical conditions
Elderly?
Exercising a lot or manual job?
Pale skin? Bruising is more obvious
examination of bruising ANSW✅✅Distribution
Site
Size
Petechiae, purpura, ecchymoses
Systemic - pallor, hair or nail problems
Delayed healing
Hepatosplenomegaly
,Lymphadenopathy
Joint defects
investigations (bloods) of bruising ANSW✅✅FBC - Hb, platelets (low = thrombocytopenia), WBC
(low = bone marrow issue)
RBC
Platelets size and shape - large in ITP (immune thrombocytopenia)
U&E
LFTs
Clotting screen - PTT, APTT, fibrinogen, INR
Coagulation factor assays
Platelet function tests
Screening for von Willebrand disease
prothrombin time - PT clotting test ANSW✅✅assesses extrinsic pathway and final common
pathway (factors VII, I, V, II, and fibrinogen)
how to remember function of prothrombin time - PT clotting test ANSW✅✅I Play Tennis OUTSIDE
- PT = extrinsic
activated partial thromboplastin time - APPT clotting test ANSW✅✅intrinsic pathway plus final
common pathway (factors XII, XI, IX, X, V, II and fibrinogen)
how to remember activated partial thromboplastin time - APPT clotting test ANSW✅✅I Play Table
Tennis INSIDE - APTT = intrinsic
INR clotting test ANSW✅✅compares PT with normal value as a ratio
Used to monitor warfarin and risk of bleeding
Different conditions will have different INR targets
thrombotic thrombocytopenic purpura - TTP ANSW✅✅Decrease in function of ADAMTS13 gene
Normally cuts von Willebrand factors into smaller pieces to regulates its interaction with platelets
, failure of this process leads to easy bruising / bleeding
non-Hodgkins lymphoma ANSW✅✅Younger male patients
Platelets autoantibodies - usually IgG from a B lymphocyte
Premature removal of platelets from circulation by macrophages, especially by spleen
Platelet life falls to only a few hours
what is Cullen's sign? ANSW✅✅periumbilical (under belly button) ecchymoses
when is Cullen's sign seen? ANSW✅✅haemorrhagic pancreatitis
Ruptured ectopic pregnancy
Retroperitoneal bleeding
what is Grey Turner's sign ANSW✅✅flank ecchymoses in a vertical line
development and cause of Cullen's and Grey Turner's signs ANSW✅✅Both develop 3 days after
event
Caused by retroperitoneal haemorrhage that has dissected through facial planes to get to skin
Can also extravasate into perineum causes scrotal haematoma of inguinal swelling
High mortality rate - 1/3
process of haemostasis ANSW✅✅Exposure of subendothelial material causes platelet activation
Platelets change shape & produce pseudopodia
They rapidly stick to damaged area via receptors
Platelets interact with von Willebrand factors & exposed collagen
Von Willebrand factor = protein synthesised by endothelial cells & megakaryotes
VW factors bind to coagulation factor 8 in plasma
Platelets aggregate & interact via receptor sites using fibrinogen - factor 1
Platelets contract & release granules - promote aggregation
Fibrin generation occurs due to release of tissue factor (factor 3) from damaged tissue - activates
extrinsic pathway
