Pathology

Question 1

What is the difference between a blood clot and a thrombosis?

Answer 1

clots are extravascular coagulation

thrombosis is intravascular coagulation- static

Question 2

Excess intravascular coagulation results in what?

Answer 2

Thrombosis

Question 3

What is the end point of coagulation?

Answer 3

Aggregate of platelets, RBCs and fibrin

Question 4

What cascade is associated with inflammation?

Answer 4

Complement cascade

Question 5

What cascade is associated with apoptosis?

Answer 5

caspase cascade

Question 6

What cascade is associated with thrombosis?

Answer 6

Coagulation cascade

Question 7

what is the most common pathway of the coagulation cascade?

Answer 7

The extrinsic pathway

Question 8

what would you measure Intrinsic coagualtion pathway with?

Answer 8

prothrombin time

Question 9

what would you measure extrinsic coagulation pathway with?

Answer 9

Activated partial thromboplastin time

Question 10

what are the 2 end reactions of the coagulation cascade?

Answer 10

Prothrombin- thrombin

Fibrogen- fibrin

Question 11

What is Virchow’s triad?

Answer 11

Locations where thrombosis is favoured

1. sites of endotheial injury
2. turbulent blood flow
3. hypercoaguable blood

Question 12

what is present at sites of endothelial injury?

Answer 12

Increased exposure to tissue factor
Weak vessel walls
Atheroma
Aneurysms
Surface thrombosis

Question 13

what can cause endothelial injury?

Answer 13

toxins
infectious agents
smoking
autoimmune disease
primary vasculitis

Question 14

what can cause turbulence?

Answer 14

Endothelial cell injury

Stasis

Question 15

what can cause Hypercoaguability?

Answer 15

lots of inherited disorders
e.g. factor V Lieden, protein C deficency, antithrombin III deficiency
Prolonged immobility
Significant tissue injury

Question 16

How does cancer effect coagulation?

Answer 16

Predisposes thrombosis
Some produce tissue factor- stimulated thrombosis
Also, chemotherapy can increase thrombosis risk

Question 17

What is an embolism?

Answer 17

A thrombus that has been transported through the vasculature to a point where it gets stuck

Question 18

what characteristic on an x-ray indicates a PE?

Answer 18

White wedge shape

Question 19

what is ischaemia?

Answer 19

Insufficient blood supply

Question 20

what is infarction?

Answer 20

death of tissue as a result of ischaemia

Question 21

What are some emboli other than PE?

Answer 21

Air
Amniotic Fluid
Fat
Tumour
Septic

Question 22

What is another word for atheroma?

Answer 22

Atherosclerosis
Hardening of the arteries
Coronary artery disease
Ischaemic heart disease

Question 23

What is the underlying principle of atheroma?

Answer 23

Endothelial cell injury

Question 24

Where does haemodynamic injury occur?

Answer 24

Sites of turbulent blood flow

Question 25

How does hypertension contribute to atheroma?

Answer 25

Damages endothelium

Question 26

How is hyperlipidaemia a risk factor?

Answer 26

lots of low density lipoproteins can lead to hypercholesterolaemia, which can cause atheroma on it's own

Question 27

how is diabetes a risk factor?

Answer 27

``` Increases cholesterol levels Advanced Glycation end products Abnormal cross linking in vessel walls Loss of elasticity Trapping of cholesterol ```

Question 28

What are the stages of atheroma formation?

Answer 28

1. Primary endothelial injury 2. Accumulation of lipids and macrophages 3. Migration of smooth muscle cells 4. Increase in size

Question 29

What happens after endothelial injury?

Answer 29

Increased permeability & white cell adhesion Increased VCAM-1 So monocytes attach and migrate through wall & become macrophages

Question 30

What happens with fat after endothelial injury?

Answer 30

Macrophages engulf cholesterol Initially cholesterol volume is low LDL is deposited HDL is "shuttled" back to the liver

Question 31

What happens to smooth muscle after endothelial injury?

Answer 31

Migrated from tunica media to intima Gets stuck and takes on cholesterol Produce extracellular matrix- collagen Changes lesion from fatty streak to fibrofatty plaque

Question 32

Small changes in patency of a vessel have what effect on the flow?

Answer 32

Large reduction

Question 33

What happens as atheromatous plaques enlarge?

Answer 33

blood flow is compromized

Question 34

what is the progress of atheromatous plaques?

Answer 34

Fatty streak Fibrofatty plaque Complicated plaque with overlying thrombus

Question 35

What are three factors that would make atherosclerosis critical?

Answer 35

1. If its the only artery supplying an organ/tissue 2. If the artery diameter is small (eg. coronary artery) 3. Overall blood flow is reduced

Question 36

What are some complications of atheroma?

Answer 36

Stenosis Aneurysm Dissection Thrombosis and embolism

Question 37

What is arterial stenosis?

Answer 37

Narrowing of the arterial lumen Reduced elasticity Reducced flow in systole Tissue ischaemia

Question 38

What are some effects of cardiac ischaemia?

Answer 38

``` Reduced exercise tolerance Angina Unstable angina Myocardial Infarction cardiac failure ```

Question 39

What is cardiac fibrosis?

Answer 39

Loss of cardiac myocytes Replacement by fibrous tissue Loss of contractility Reduced elasticity & filling

Question 40

What is the impact of arterial stenosis on carotid arteries?

Answer 40

TIA Stroke Vascular dimentia

Question 41

What is the impact of arterial stenosis on renal arteries?

Answer 41

Hypertension | Renal failure

Question 42

What is the impact of arterial stenosis on peripheral arteries?

Answer 42

Claudication | Foot/leg ischaemia

Question 43

what is the most common site of aneurism formation?

Answer 43

abdominal aorta

Question 44

What are some aneurysm complications?

Answer 44

``` Rupture Thrombosis Embolism Pressure erosion of adjacent structure Infection ```

Question 45

what is arterial Dissection?

Answer 45

Splitting within the media by flowing blood False lumen filled with blood within the media Sudden collapse and high mortality

Question 46

Other associations with aortic dissection?

Answer 46

``` Atheroma Hypertension Trauma Coarctation Marfan's Pregnancy ```