Hemodynamics I

Question 1

What is an early sign of anasarca?

Answer 1

Periorbital edema

Question 2

What are the three most common causes of cardiogenic pulmonary edema?

Answer 2

1. Left ventricular failure 2. Myocardial infarction 3. Systemic hypertension

Question 3

What are the features of interstitial pulmonary edema?

Answer 3

1. Poorly defined pulmonary vessels 2. Visible lung fissures 3. Septal lines 4. Thick bronchial walls

Question 4

What is the main feature of alveolar pulmonary edema?

Answer 4

Bilateral symmetric perihilar lung consolidation

Question 5

What are the roles of PGI-2 and NO?

Answer 5

Inhibit aggregation

Question 6

What is the role of ADP and TXA-2?

Answer 6

Released by platelets, mediate platelet aggregation

Question 7

What is the role of thrombomodulin?

Answer 7

Converts thrombin to an anticoagulant

Question 8

Which cell makes TPA?

Answer 8

Endothelial cell

Question 9

Which molecules are cofactors for antihrombin?

Answer 9

Heparin-like molecules

Question 10

vWF links platelets to the subendothelium via what surface molecule?

Answer 10

Gp1b

Question 11

What is the role of platelet factor 4?

Answer 11

In platelet granules, binds and inactivates heparin

Question 12

Does serotonin induce vasoconstriction or vasodilation?

Answer 12

Vasoconstriction

Question 13

Prothrombin time tests which arm of the coagulation cascade?

Answer 13

Extrinsic

Question 14

PT is prolonged by what compound?

Answer 14

Warfarin

Question 15

Partial thromboplastin time tests which arm of the coagulation cascade?

Answer 15

Intrinsic

Question 16

PTT is prolonged by what compound?

Answer 16

Heparin, hemophilia, antiphospholipid Ab

Question 17

Which factors are involved in the intrinsic arm?

Answer 17

TENET - 12, 11, 9, 8, 10 (plus calcium and phospholipid)

Question 18

What are the roles of antithrombin III?

Answer 18

1. Directly inactivates thrombin and factors IXa, Xa, XIa, XIIa 2. Potentiated by heparin

Question 19

What are the roles of Protein C?

Answer 19

1. Inhibits (cleaves) cofactors Va and VIIIa 2. Decreases rate of clot formation 3. Requires activation 4. Enhanced by Protein S

Question 20

What is the role of plasmin?

Answer 20

Breaks down fibrin

Question 21

What are the roles of thrombomodulin?

Answer 21

1. Activated by thrombin 2. Binds to thrombin to alter its conformation 3. Complex activates Protein C, which inhibits Va / VIIIa

Question 22

What is the role of tissue pathway factor inhibitor?

Answer 22

Inhibits VIIa-TF complex (extrinsic arm)

Question 23

What molecule inactivates free plasmin?

Answer 23

alpha-2 antiplasmin

Question 24

Which substances can activate plasminogen?

Answer 24

1. TPA (endothelial cells) 2. Urokinase (plasma, various tissues) 3. Streptokinase (bacterial product)

Question 25

Does heparin dissolve clots that have already formed?

Answer 25

No

Question 26

What is the mechanism of action of heparin?

Answer 26

Activates antithrombin III, and inhibits thrombin, factor IXa, and factor Xa

Question 27

What is the mechanism of action of warfarin?

Answer 27

Interferes with vitamin K metabolism, stops blood from clotting within vessels, getting bigger, and breaking off

Question 28

What are the vitamin K dependent clotting factors?

Answer 28

10, 9, 7, 2

Question 29

Does warfarin have more of an effect on the intrinsic or extrinsic pathway?

Answer 29

Extrinsic

Question 30

Which drug is a direct thrombin inhibitor?

Answer 30

Dabigatrin

Question 31

Which drugs are direct factor Xa inhibitors?

Answer 31

Rivaroxaban and apixaban

Question 32

Which drug is a tissue factor pathway inhibitor?

Answer 32

TFPI

Question 33

Most patients with warfarin necrosis have low levels of what compound?

Answer 33

Protein C

Question 34

What is the cause of heparin-induced thrombocytopenia?

Answer 34

Antibodies to heparin bind heparin / platelet factor 4 complex, activation of platelets leads to intravascular coagulation and low platelet counts

Question 35

Bernard Soulier disease

Answer 35

Defect of platelet adhesion, lack of Gp1b

Question 36

Glanzmann's thrombasthenia

Answer 36

Defect of platelet aggregation, lack of GpIIb-IIIa

Question 37

Thrombotic thrombocytopenia purpura

Answer 37

Antibodes directed against vWF cleaving protease ADAMTS-13 - thrombi form in small vasculature

Question 38

Hemophilia A lacks what clotting factor? B? C?

Answer 38

A - VIII B - IX C - XI

Question 39

What is the first step in DIC?

Answer 39

Activation of thrombin systemically

Question 40

How is DIC measured?

Answer 40

1. D-DIMERS - measures plasmin-cleaved insoluble cross-linked fibrin 2. Indirect measurement of plasmin and thrombin activiy