Exertional Heat Stroke Quiz

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Questions and Answers

Which organ is most affected in exertional heat stroke?

  • GI tract
  • Kidneys
  • Liver
  • Brain (correct)

Which condition can exertional heat stroke trigger?

  • Hypothermia
  • Hypertension
  • Hypoglycemia
  • Disseminated intravascular coagulation (DIC) (correct)

What happens to tissue oxygen demand and metabolic rate in exertional heat stroke?

  • They decrease
  • They increase (correct)
  • They stay the same
  • They fluctuate

What can severe hyperthermia in exertional heat stroke lead to?

<p>Increased tissue oxygen demand (D)</p> Signup and view all the answers

What can the release of procoagulant proteins in exertional heat stroke trigger?

<p>Disseminated intravascular coagulation (DIC) (A)</p> Signup and view all the answers

Which coagulation cascade is excessively activated in DIC?

<p>Extrinsic coagulation cascade (D)</p> Signup and view all the answers

What is generated in DIC as a result of the excessive activation of the coagulation cascade?

<p>Cross-linked fibrin clots (C)</p> Signup and view all the answers

What happens to plasminogen in DIC?

<p>It is converted to plasmin (A)</p> Signup and view all the answers

Which laboratory finding is characteristic of acute DIC?

<p>Prolonged PT/PTT and elevated D-dimer (B)</p> Signup and view all the answers

What is a common clinical manifestation of acute DIC?

<p>Tachycardia (B)</p> Signup and view all the answers

What is the underlying cause of thrombocytopenia in acute DIC?

<p>Increased platelet Consumption (A)</p> Signup and view all the answers

Which factor do direct factor Xa inhibitors block to reduce conversion of prothrombin to thrombin?

<p>Activated Factor X (A)</p> Signup and view all the answers

How are direct factor Xa inhibitors administered?

<p>Orally (C)</p> Signup and view all the answers

Do direct factor Xa inhibitors require drug level monitoring?

<p>No (A)</p> Signup and view all the answers

What converts plasminogen to plasmin?

<p>Tissue plasminogen activator (D)</p> Signup and view all the answers

What is the primary use of tissue plasminogen activator?

<p>To dissolve blood clots in acute ischemic strokes (B)</p> Signup and view all the answers

What is the role of tissue plasminogen activator in fibrinolysis?

<p>To increase plasmin levels (B)</p> Signup and view all the answers

Which clotting factors are prevented from gamma carboxylation by the action of warfarin?

<p>Factor VII (A)</p> Signup and view all the answers

How long does it take for the therapeutic effect of warfarin to occur?

<p>3-5 days (C)</p> Signup and view all the answers

What is the primary site of action of warfarin?

<p>Liver (C)</p> Signup and view all the answers

How long does it take for the therapeutic effect of warfarin to occur?

<p>3-5 days (C)</p> Signup and view all the answers

What is the mechanism of action of warfarin?

<p>Blocks the activation of NEW clotting factors (C)</p> Signup and view all the answers

Which patient population is at increased risk for developing lower extremity deep venous thrombosis (DVT)?

<p>Nonambulatory hospitalized patients (B)</p> Signup and view all the answers

When is DVT prophylaxis usually initiated in patients undergoing certain orthopedic procedures such as hip and knee replacement?

<p>Within hours of wound closure (C)</p> Signup and view all the answers

Which type of heparin does not require laboratory monitoring when given therapeutically?

<p>Low molecular weight heparin (B)</p> Signup and view all the answers

What is the primary target of LMWH when it activates antithrombin III (AT III)?

<p>Factor Xa (D)</p> Signup and view all the answers

What is the mechanism of action of unfractionated heparin when it binds to antithrombin III (AT III)?

<p>Inhibits factor Xa PRIMARILY (D)</p> Signup and view all the answers

Which medication is useful for inhibiting ADP-mediated platelet aggregation?

<p>Clopidogrel (D)</p> Signup and view all the answers

What is the primary use of clopidogrel and ticlopidine?

<p>Inhibiting platelet aggregation (B)</p> Signup and view all the answers

Which factor does low-molecular-weight heparin (LMWH) primarily act on?

<p>Factor Xa (C)</p> Signup and view all the answers

What is the main function of antithrombin III (AT III) when activated by Enoxaparin?

<p>Binds to factor Xa (D)</p> Signup and view all the answers

How does Enoxaparin differ from heparin in terms of molecular weight?

<p>Enoxaparin has a lower molecular weight (D)</p> Signup and view all the answers

Which fat-soluble vitamin deficiency is most likely causing the patient's symptoms?

<p>Vitamin K (A)</p> Signup and view all the answers

What is the primary cause of increased risk of vitamin K deficiency in patients with CF?

<p>Reduced secretion of pancreatic enzymes (D)</p> Signup and view all the answers

Which of the following symptoms is NOT consistent with EARLY vitamin K deficiency in patients with CF?

<p>Prolonged aPTT (B)</p> Signup and view all the answers

Which of the following statements about Andexanet alfa is correct?

<p>Andexanet alfa is a factor Xa decoy that has no proteolytic effect. (A)</p> Signup and view all the answers

Which of the following is a use for Andexanet alfa?

<p>To reverse the anticoagulation effect of factor Xa inhibitors (B)</p> Signup and view all the answers

Which of the following medications is commonly reversed by Andexanet alfa?

<p>Rivaroxaban (B)</p> Signup and view all the answers

Which enzyme is specifically targeted by direct oral anticoagulants?

<p>Factor Xa (C)</p> Signup and view all the answers

What is the primary target of heparin when it activates antithrombin III (AT III)?

<p>Factor Xa (C)</p> Signup and view all the answers

What is the effect of heparin on thrombin time/partial thromboplastin time?

<p>Prolonged (C)</p> Signup and view all the answers

Which laboratory finding is commonly seen in patients with antiphospholipid antibody syndrome?

<p>Positive RPR test (D)</p> Signup and view all the answers

What is a characteristic feature of antiphospholipid antibody syndrome?

<p>Recurrent pregnancy loss (C)</p> Signup and view all the answers

What can antiphospholipid antibodies in systemic lupus erythematosus cause?

<p>Elevated PTT (B)</p> Signup and view all the answers

Which laboratory finding is commonly seen in patients with disseminated intravascular coagulation (DIC)?

<p>Elevated prothrombin time (PT) (D)</p> Signup and view all the answers

What is the primary cause of disseminated intravascular coagulation (DIC)?

<p>Sepsis (C)</p> Signup and view all the answers

Which of the following is a characteristic sign of disseminated intravascular coagulation (DIC)?

<p>Bleeding from venipuncture sites (D)</p> Signup and view all the answers

Which of the following medications is a potent enhancer of the cytochrome P-450 pathway and can decrease the efficacy of warfarin?

<p>Phenobarbital (C)</p> Signup and view all the answers

Which of the following medications can inhibit warfarin metabolism and increase the risk of bleeding?

<p>Cimetidine (B)</p> Signup and view all the answers

Which of the following medications does NOT affect the metabolism or efficacy of warfarin?

<p>Amiodarone (A)</p> Signup and view all the answers

Which of the following is a manifestation of vitamin C deficiency?

<p>Gingival bleeding (B)</p> Signup and view all the answers

What is the main role of vitamin C in the body?

<p>Production of collagen (C)</p> Signup and view all the answers

Which of the following is/are characteristics of vitamin C deficiency?

<p>Perifollicular keratosis (B)</p> Signup and view all the answers

Which of the following is a symptom of scurvy?

<p>Poor wound healing (C)</p> Signup and view all the answers

Which of the following is a hemorrhagic complication of scurvy?

<p>Gingival bleeding (B)</p> Signup and view all the answers

Which vitamin deficiency can cause perifollicular hyperkeratosis?

<p>Vitamin C (D)</p> Signup and view all the answers

Which vitamin K-dependent coagulation factor has the shortest half-life?

<p>Factor VII (A)</p> Signup and view all the answers

What does failure of prothrombin time to correct with vitamin K supplementation in liver disease indicate?

<p>Factor VII deficiency (B)</p> Signup and view all the answers

What is the most common cause of factor VII deficiency?

<p>Liver disease (C)</p> Signup and view all the answers

Which condition can lead to high-output heart failure in patients with severe cirrhosis?

<p>Development of mesenteric and intrahepatic arteriovenous shunts (D)</p> Signup and view all the answers

What is the primary cause of high-output heart failure in severe cirrhosis?

<p>Development of mesenteric and intrahepatic arteriovenous shunts (A)</p> Signup and view all the answers

Which of the following is a potential complication of starting patients on warfarin?

<p>Skin necrosis (A)</p> Signup and view all the answers

What factor can further exacerbate the hypercoagulability seen in patients started on warfarin?

<p>Protein C deficiency (B)</p> Signup and view all the answers

What is the primary cause of thrombotic occlusion in patients started on warfarin?

<p>Transient hypercoagulable state (B)</p> Signup and view all the answers

Which of the following is a characteristic of acute disseminated intravascular coagulation (DIC)?

<p>Elevation of D-dimer levels (D)</p> Signup and view all the answers

What is the most common cause of bleeding complications in acute disseminated intravascular coagulation (DIC)?

<p>Consumption of platelets and clotting factors (A)</p> Signup and view all the answers

Which of the following is a consequence of widespread formation of microvascular thrombi in acute disseminated intravascular coagulation (DIC)?

<p>Consumption of coagulation factors (D)</p> Signup and view all the answers

Which type of anticoagulant is used to treat heparin-induced thrombocytopenia (HIT)?

<p>Direct thrombin inhibitors (DTIs) (A)</p> Signup and view all the answers

What should be avoided in patients with heparin-induced thrombocytopenia (HIT)?

<p>Low molecular weight heparin (LMWH) (C)</p> Signup and view all the answers

What is the primary treatment for heparin-induced thrombocytopenia (HIT)?

<p>Direct thrombin inhibitors (DTIs) (C)</p> Signup and view all the answers

Flashcards

Organ Affected in Exertional Heat Stroke

The brain is the organ most affected by exertional heat stroke.

Exertional Heat Stroke Trigger

Exertional heat stroke can trigger disseminated intravascular coagulation (DIC).

Tissue Oxygen Demand in Heat Stroke

In exertional heat stroke, tissue oxygen demand and metabolic rate increase.

Hyperthermia Consequence

Severe hyperthermia in exertional heat stroke can lead to increased tissue oxygen demand

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Procoagulant Proteins Trigger

The release of procoagulant proteins in exertional heat stroke can trigger disseminated intravascular coagulation (DIC).

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Coagulation Cascade in DIC

The extrinsic coagulation cascade is excessively activated in DIC.

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Product of Excessive Coagulation

Cross-linked fibrin clots are generated in DIC due to excessive activation of the coagulation cascade.

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Plasminogen Conversion in DIC

In DIC, plasminogen is converted to plasmin.

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Lab Finding in Acute DIC

Prolonged PT/PTT and elevated D-dimer is characteristic of acute DIC.

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Clinical Sign of Acute DIC

Tachycardia is a common clinical manifestation of acute DIC.

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Thrombocytopenia Cause in DIC

Thrombocytopenia in acute DIC is due to increased platelet consumption.

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Direct Factor Xa Inhibitors

Direct factor Xa inhibitors block activated Factor X to reduce conversion of prothrombin to thrombin.

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Direct Factor Xa Inhibitors Route

Direct factor Xa inhibitors are administered orally.

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Factor Xa Monitoring

Direct factor Xa inhibitors do not require drug level monitoring.

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tPA Function

Tissue plasminogen activator converts plasminogen to plasmin.

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tPA Use

The primary use of tissue plasminogen activator is to dissolve blood clots in acute ischemic strokes.

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tPA Role in Fibrinolysis

Tissue plasminogen activator increases plasmin levels, which promotes fibrinolysis.

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Warfarin Target

Warfarin prevents gamma carboxylation of clotting factor VII, among others.

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Warfarin Onset

The therapeutic effect of warfarin occurs in 3-5 days.

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Warfarin Site of Action

The primary site of action of warfarin is the liver.

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Warfarin Action

Warfarin blocks the activation of new clotting factors.

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DVT Risk Factor

Nonambulatory hospitalized patients are at increased risk for developing lower extremity deep venous thrombosis (DVT).

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DVT Prophylaxis Timing

DVT prophylaxis is initiated within hours of wound closure in patients undergoing certain orthopedic procedures such as hip and knee replacement.

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Heparin Without Monitoring

Low molecular weight heparin (LMWH) does not require laboratory monitoring when given therapeutically.

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LMWH Target

The primary target of LMWH when it activates antithrombin III (AT III) is Factor Xa.

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Unfractionated Heparin Mechanism

Unfractionated heparin, when it binds to antithrombin III (AT III), primarily inhibits factor Xa.

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Clopidogrel Function

Clopidogrel is useful for inhibiting ADP-mediated platelet aggregation.

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Clopidogrel Use

The primary use of clopidogrel and ticlopidine is inhibiting platelet aggregation.

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LMWH Action

Low-molecular-weight heparin primarily acts on Factor Xa.

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Vitamin Deficiency in CF

Vitamin K deficiency is likely the cause of the patient's symptoms due to CF.

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