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PPOM1 Block 4 > Lecture 161 > Flashcards

Lecture 161 Flashcards

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1
Q

What is considered the most important factor in Virchow’s Triad?

A

Endothelial injury

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2
Q

What are the three components of Virchow’s triad?

A

Endothelial injury, abnormal blood flow, hypercoagulability

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3
Q

Severe endothelial injury can expose underlying ____ and ____ triggering thrombosis.

A

vWF and tissue factor

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4
Q

What is slow blood flow referred to as?

A

Stasis

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5
Q

What is disrupted, non-laminar blood flow called?

A

Turbulence

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6
Q

What is the danger in disrupting laminar blood flow?

A

Brings platelets in contact with the endothelium

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7
Q

What are the characteristic features of thrombi formed in flowing blood?

A

Lines of Zahn

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8
Q

What type of clots are gelatinous and have a dark red dependent portion with a yellow ‘chicken fat’ upper portion?

A

Postmortem clots

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9
Q

What type of thrombi are typically caused by endothelial injury or turbulence?

A

Arterial thrombi

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10
Q

What direction do arterial thrombi tend to grow?

A

Retrograde (against the direction of blood flow)

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11
Q

What type of thrombi are typically formed in the coronary, cerebral, and femoral arteries?

A

Arterial thrombi

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12
Q

What is the term for venous thrombi?

A

Phlebothrombosis

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13
Q

What direction do venous thrombi tend to grow?

A

Extend in the direction of blood flow, toward the heart

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14
Q

What veins are most commonly involved in venous thrombi?

A

Veins of the lower extremities

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15
Q

What are thrombi occurring in the heart chambers or the aortic lumen called?

A

Mural thrombi

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16
Q

What condition can cause atrial mural thrombi due to atrial dilation and fibrillation?

A

Rheumatic heart disease

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17
Q

Both cardiac and aortic mural thrombi are prone to ____.

A

Embolization

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18
Q

What is the inheritance pattern of Factor V Leiden?

A

Autosomal dominant with incomplete penetrance

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19
Q

Factor V is typically cleaved and inactivated by activated ____.

A

Activated Protein C (APC)

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20
Q

What is the result of a single nucleotide mutation in the Factor V gene?

A

Makes Factor V resistant to cleavage and inactivation by APC

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21
Q

Patients under ____ with thrombotic events should be evaluated for clotting disorders.

A

50 years old

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22
Q

How is Factor V Leiden diagnosed?

A

Activated Protein C (APC) resistance assay

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23
Q

A single nucleotide change in the 3’-untranslated region of the prothrombin gene causes what downstream effect?

A

Elevated prothrombin (Factor II) levels

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24
Q

What is the action of thrombin?

A

Cleaves fibrinogen to fibrin

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25
What amino acid metabolite contributes to atherosclerosis and both arterial and venous thrombosis?
Homocysteine
26
Prothrombotic effects in elevated homocysteine may be due to ____ linkages formed between homocysteine metabolites and protein like fibrinogen.
Thioester linkages
27
Acquired causes of elevated homocysteine include deficiencies of what three things?
Vitamin B6, vitamin B12, and folic acid
28
Vitamin B6, B12, and folic acid are necessary for ____ metabolism.
Homocysteine
29
What natural coagulant inhibits thrombin (Factor IIa), Factor Xa, and other serine proteases in the coagulation cascade?
Antithrombin III
30
What is the most common inheritance pattern of antithrombin III deficiency?
Autosomal dominant
31
What is the result of antithrombin III deficiency?
Increased thrombin activity and a reduced response to heparin
32
What type of antithrombin III deficiency is caused by insufficient ATIII produced by the liver?
Type I
33
What type of antithrombin III deficiency is caused by defective ATIII protein?
Type II
34
How is antithrombin III deficiency treated?
Direct thrombin or Xa inhibitors, warfarin, and supplemental ATIII
35
What vitamin K-dependent natural anticoagulant is synthesized in the liver?
Protein C
36
Protein C inactivates what two Factors?
Factor Va and Factor VIIIa
37
Protein C inactivates Factor Va and Factor VIIIa, resulting in reduced ____.
Thrombin generation
38
What is the inheritance pattern of Protein C deficiency?
Autosomal dominant
39
What clotting disorder is caused by an inability to inactivate Factors Va and VIIIa, resulting in increased thrombin formation?
Protein C deficiency
40
Protein C deficient individuals are at an increased risk of thrombotic skin necrosis when starting ____.
Warfarin therapy
41
What additional pharmaceutical is necessary to use as a 'bridge' when initiating warfarin therapy in patients with Protein C deficiency?
Heparin
42
The action of Protein C is dependent on what cofactor?
Protein S
43
What vitamin-K dependent protein synthesized in the liver serves as a cofactor for activated Protein C (APC) in the inactivation of Factors Va and VIIIa?
Protein S
44
What is the inheritance pattern of Protein S deficiency?
Autosomal dominant
45
What inherited deficiency has a similar clinical presentation and risks as Protein C deficiency?
Protein S deficiency
46
What condition can disseminated cancers lead to?
Migratory thrombophlebitis
47
What effect does estrogen have on coagulation factors?
Increases coagulation factors and decreases Antithrombin III
48
What coagulation risk factor is associated with decreased endothelial prostacyclin (PGI2) production?
Old age
49
What formation occurs with IgG antibodies against complexes of heparin and platelet factor 4 (PF4)?
Heparin-induced thrombocytopenia
50
Platelet factor 4 is released from what kind of platelet granules?
Alpha granules
51
What is the most serious complication of HIT?
Thrombosis
52
What HIT type is non-immune mediated and is often asymptomatic?
HIT type I
53
What HIT type is immune-mediated and clinically serious?
HIT type II
54
What autoimmune disorder is characterized by the presence of one or more antiphospholipid (aPL) autoantibodies?
Antiphospholipid antibody syndrome (APS)
55
aPL antibodies are directed against ____.
Anionic membrane phospholipids
56
What prolonged PTT in vitro that does not correct with a mixing study and false-positive serological syphilis test could suggest?
Antiphospholipid antibody syndrome (APS)
57
Where do superficial venous thrombi typically occur?
Saphenous veins
58
Where do deep vein thrombi typically occur?
Larger leg veins (popliteal, femoral, iliac)
59
Why are 50% of DVTs asymptomatic?
Venous collateral channels of the leg
60
What makes older thrombi more resistant to lysis?
Extensive fibrin deposition and cross-linking
61
What therapeutic administration is usually effective only if given within the first few hours of a thrombotic event?
Fibrinolytic agents (t-PA)
62
What occurs when capillary channels eventually form within the thrombus?
Recanalization
63
What is a detached intravascular solid, liquid, or gaseous mass carried by the blood called?
Embolus
64
What type of embolism presents as dyspnea, pleuritic chest pain, cough, and hemoptysis?
Pulmonary thromboembolism
65
Where in the heart are fragmented emboli deposited to before traveling into the pulmonary vasculature?
Right side
66
What is an embolus between the pulmonary artery bifurcation called?
Saddle embolus
67
Obstruction of ____ sized arteries can result in pulmonary hemorrhage but usually not pulmonary infarction.
Medium-sized
68
What are emboli that arise in or affect the arterial system called?
Systemic thromboembolism
69
Most systemic emboli originate from ____.
Intracardiac mural thrombi
70
What is the most common destination for an arterial emboli?
Lower extremities
71
What are venous emboli that pass from the venous system into the arterial system through an atrial or ventricular septal defect called?
Paradoxical emboli
72
What do atherosclerotic emboli often occlude?
Small caliber vessels
73
What do atherosclerotic emboli characteristically show?
Needle-shaped empty spaces called cholesterol clefts
74
How do fat emboli cause biochemical injury?
Free fatty acids released from the fat globules are toxic to endothelium and can activate platelets and granulocytes
75
What condition is characterized by pulmonary insufficiency, neurological symptoms, anemia, and thrombocytopenia developing 1 to 3 days after an injury?
Fat embolism syndrome
76
What symptoms can indicate fat embolism syndrome?
Sudden onset of tachypnea, dyspnea, tachycardia, delirium, diffuse petechial rash, and thrombocytopenia
77
What classic presentation includes sudden collapse, neurologic symptoms mimicking a stroke, apnea, and cardiovascular collapse?
Air embolism
78
What is the rapid formation of gas bubbles within skeletal muscles and supporting tissues in and around joints called?
The Bends
79
What do gas bubbles in the pulmonary vasculature cause?
Edema, hemorrhage, and focal atelectasis or emphysema
80
What is a chronic form of decompression sickness characterized by the persistence of gas emboli in the skeletal system?
Caisson disease
81
What can sudden severe dyspnea, cyanosis, and shock, followed by neurologic impairment and DIC in a woman who has just given birth indicate?
Amniotic fluid embolism

PPOM1 Block 4 (44 decks)

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