Pathology of Blood Vessels, Hemodynamic disorders and shock

Question 1

Hyperemia and congestion are both due to __

Answer 1

Increased blood volume in tissue

Question 2

___ is an active process and involves vasodilation leading to increased vascular flow

Answer 2

Hyperemia

Question 3

____ and ___ are examples of hypermia

Answer 3

Inflammation and Exercise

Question 4

___ is a passive process where there is decreased blood outflow (deoxygenated blood is backing up)

Answer 4

Congestion

Question 5

This process can be a result of a systemic (cardiac failure) problem or local issue (like blockage), and results in edema

Answer 5

Congestion

Question 6

Vascular congestion leads to a lack of blood flow, which causes ___, leading chronic ischemia. This results in loss of parenchyma, which the body replaces with ___

Answer 6

Vascular congestion leads to a lack of blood flow, which causes hypoxia, leading chronic ischemia. This results in loss of parenchyma, which the body replaces with scarring/scar tissue

Question 7

Typical pathological findings begin with ___ ___, leading to small hemorrhages, which are cleaned up ___ that’ll be laden with ___

Answer 7

Typical pathological findings begin with capillary rupture , leading to small hemorrhages, which are cleaned up by macrophages that’ll be laden with hemosiderin

Question 8

What is the pathology in the image below? What are the cells in the spaces called? (aka heart failure cells)

Answer 8

Mitral stenosis (congestion)

Hemosiderin-laden macrophages

Question 9

A patient with chronic right heart failure has “nutmeg liver”. What condition leads to this nutmeg appearance?

Answer 9

Chronic liver congestion

Question 10

Which area of the body is referred to as the “3rd space”? (hint: holds about 28% or so of the body’s water)

Answer 10

The interstitium

Question 11

Third spacing refers to the collection of fluid in the ___

Answer 11

Third spacing refers to the collection of fluid in the interstitium

Question 12

An abnormal increase in interstitial fluid within tissues is known as ___

Answer 12

Edema

Question 13

Hydrothorax is fluid accumulation in the ___

Answer 13

Peritoneum (lung/chest cavity)

Question 14

___ is fluid accumulation in the pericardium

Answer 14

Hydropericardium

Question 15

___ is fluid collection in the abdomen and is frequently observed with ___ failure

Answer 15

Ascites is fluid collection in the abdomen and is frequently observed with liver failure

Question 16

___ is fluid accumulation all over, like the patient below

Answer 16

Anasarca

Question 17

___ is protein poor fluid caused by increased hydrostatic pressure or reduced plasma protein

Answer 17

Transudate is protein poor fluid caused by increased hydrostatic pressure or reduced plasma protein

Question 18

In heart, renal and hepatic failure as well as malnutrition and other cases of fluid overload, ypu normally see this type of fluid

Answer 18

Transudate

Question 19

___ is protein rich, driven by increased vascular permeability, and is part of the inflammatory response

Answer 19

Exudate

Question 20

In the diagram below, what is the pink fluid shown by the arrow?

Answer 20

Transudate (edema; massive fluid overload)

Question 21

Edema caused by issues in the systemic circulation is known as ___ edema and is characterized by swelling of the ankles and feet (see pic below)

Answer 21

Edema caused by issues in the systemic circulation is known as dependent edema and is characterized by swelling of the ankles and feet

Question 22

The most common cause of dependent edema is ___. You should also consider what other conditions?

Answer 22

The most common cause of dependent edema is heart failure. You should also consider protein-wasting conditions.

Question 23

Ascites can be a result of increased hydrostatic pressure due to __ of liver. It can also result from decreased ___ in liver failure, and ___ failure.

Answer 23

Ascites can be a result of increased hydrostatic pressure due to fibrosis of liver. It can also result from decreased colloid pressure (decreased albumin) component in liver failure, and right heart failure

Question 24

For the case below, what gives away that this is ascites due to liver failure and NOT right heart failure?

Answer 24

The patient’s skin is yellow-orangish, indicating jaundice, which suggests liver failure and NOT right heart failure

Question 25

\_\_\_ is fluid accumulation in the pleura and can cause lung compression

Answer 25

Pleural effusion is fluid accumulation in the pleura and can cause lung compression

Question 26

Fluid accumulation in the lymphatics is called \_\_\_

Answer 26

Lymphedema (lymphatic obstruction)

Question 27

The most common causes of fluid accumulation in the lymphatics are radiation, surgery, ___ infection, \_\_\_, cellulitis and ___ (thoracic duct obstruction)

Answer 27

The most common causes of fluid accumulation in the lymphatics are **radiation**, **surgery**, **parisitic infection**, **neoplasms**, **cellulitis** and **chylothorax** (thoracic duct obstruction)

Question 28

\_\_\_ is the formation of intravascular blood clot that may obstruct blood flow and result in hypoperfusion / infarction

Answer 28

**Thrombosis** is the formation of intravascular blood clot that may obstruct blood flow and result in hypoperfusion / infarction

Question 29

Below is the sequence of thrombotic events: Endothelial injury \>\> \_\_\_ (to control bleeding) \>\> \_\_\_ adherence and aggregation \>\> Coagulation cascade (tissue factors), __ \_\_ formation (made by platelets and endothelium) \>\> Fibrinolysis / thrombosis equilibrium

Answer 29

Endothelial injury \>\> **Vasoconstriction** (to control bleeding) \>\> **Platelet adherence and aggregation** \>\> **Coagulation cascade** (tissue factors), **fibrin clot** formation (made by platelets and endothelium) \>\> **Fibrinolysis / thrombosis** equilibrium

Question 30

Virchow's triad (i.e. the 3 key factors in thrombosis) consists of: endothelial injury, ___ and \_\_\_

Answer 30

**endothelial injury**, **abnormal blood flow (aka stasis)**, and **hypercoagulability**

Question 31

Endothelial injury can occur due to ___ (aka the primary evolutionary drive for hemostasis), and ___ (e.g. diabetes, hypertension, atherosclerosis)

Answer 31

Endothelial injury can occur due to **trauma** (aka the primary evolutionary drive for hemostasis), and **chronic endothelial damage** (e.g. diabetes, hypertension, atherosclerosis)

Question 32

How did the owner of this coronary artery die suddenly? ## Footnote A.Thrombosis due to stasis B.Acute myocardial infarction due to plaque rupture C.Rupture at an aneurysm D.Cocaine induced coronary vasospasm

Answer 32

**B. Acute myocardial infarction due to plaque rupture**

Question 33

Another word for abnormal blood flow is \_\_\_, which can happen in both veins and arteries; if it happens in arteries, it mainly happens in areas of \_\_\_. It can also occur in ___ heart chambers

Answer 33

Another word for abnormal blood flow is **stasis**, which can happen in **both veins and arteries**; if it happens in arteries, it mainly happens in areas of **aneurysms**. It can also occur in **dilated heart chambers** (e.g. aneurysms from healed infarcts, valve disease, cardiomyopathies)

Question 34

In the image below, what is the most likely cause of thrombosis? A.Atherosclerosis inside the ventricle B.Coagulopathy C.Old MI -\> decreased motility -\> stasis inside ventricle D.Metastatic cancer

Answer 34

C.Old MI -\> decreased motility -\> stasis inside ventricle

Question 35

For the patient below, what is the most likely outcome? ## Footnote A.Diabetes B.Coronary artery disease C.Metabolic syndrome D.Systemic thromboembolism

Answer 35

D. Systemic thromboembolism (The problem with thrombi in the ventricles is that they can leave through the L ventricle to the systemic circulation and go lodge somewhere else)

Question 36

The two types of hypercoagulable/prothombotic states are ___ and \_\_

Answer 36

Primary and secondary/acquired

Question 37

A primary prothrombotic state is due to __ in the coagulation cascade, whereas aquired can be due to \_\_\_, carcinomas, heparin induced thrombocytopenia, low risk: smoking, OCPs, nephrotic syndrome, and \_\_\_

Answer 37

A primary prothrombotic state is due to **genetic errors** in the coagulation cascade, whereas aquired can be due to **immobilization**, **carcinomas**, **heparin induced thrombocytopenia**, low risk: **smoking, OCPs, nephrotic syndrome**, and **pregnancy**

Question 38

Examples of venous thrombosis syndromes include ___ (DVT), ___ (on differential for pt w/ ripping chest pain) which can be acute or chronic, ___ and ___ (Budd-Chiari syndrome)

Answer 38

Examples of venous thrombosis syndromes include **deep venous thrombosis (DVT)**, **pulmonary thromboembolism** (on differential for pt w/ ripping chest pain) which can be acute or chronic, **IVC thrombosis** and **Hepatic vein thrombosis** (Budd-Chiari syndrome)

Question 39

The movement of physiologic or foreign material within an artery or vein, that lodges elsewhere is known as an \_\_\_

Answer 39

Embolism

Question 40

Examples of components that can embolize are __ (most common), fat, __ fluid, tumors, air and ___ materials

Answer 40

Examples of components that can embolize are **thrombus** (most common), **fat**, **amniotic fluid**, **tumors**, **air** and **iatrogenic** materials (medical devices/drugs left in body therapeutically or unintentionally)

Question 41

The types of emboli include systemic, ___ and ___ (crosses foramen ovale to reach systemic circulation)

Answer 41

The types of emboli include s**ystemic** (source usually **cardiac (valves, ventricles) or Iatrogenic)**,**pulmonary**(source usually in**leg veins**) and **paradoxical** (**venous source**) (involves hole in one's heart)

Question 42

Pulmonary embolisms usually come from __ veins and the biggest risk factors include ___ (I have **trauma** to my **veins** and I **just had surgery** so I **can't move** coz I have **cancer**)

Answer 42

Pulmonary embolisms usually come from **leg** veins and the biggest risk factors include **DVT**, **trauma**, **post-operative**, **immobilization**, and **malignancy**

Question 43

In the pt below, what is the most likely cause of death? ## Footnote A.Budd-Chiari syndrome B.Gunshot wound C.Congestive heart failure D.Paradoxical embolus E.Saddle embolus of pulmonary trunk bifurcation

Answer 43

Saddle embolus of pulmonary trunk bifurcation (Saddle emboli look like you’re sitting on a saddle between right and left)

Question 44

How can you tell ante-morterm vs post-morterm saddle emboli?

Answer 44

Antemorterm: lines of Zahn – there’s organization which obstructs blood flow, whereas post morterm would look like chicken fat

Question 45

An ___ is irreversible ischemic injury secondary to hypoxia, resulting in coagulative necrosis (except in \_\_\_, where it’s liquefactive necrosis). It's usually the result of a thrombus or embolus.

Answer 45

An **infarction** is irreversible ischemic injury **secondary to hypoxia**, resulting in **coagulative necrosis** (except in **brain**, where it’s liquefactive necrosis). It's usually the result of a thrombus or embolus.

Question 46

Histologically, you can date an infarct using the scheme below: Minutes to hours: \_\_\_ \_\_\_ hours: necrosis \>1-2 days: \_\_\_

Answer 46

Histologically, you can date an infarct using the scheme below: Minutes to hours: **nothing** **4 - 12** hours: **necrosis** \>1-2 days: **scar**

Question 47

Shock is defined as \_\_, and may be due to decreased cardiac contractility, decreased ___ (as in DIC), or decreased ___ (vasodilation)

Answer 47

Shock is defined as **systemic hypotension** resulting in tissue **hypoperfusion,** **hypoxia +** **ischemia** , and may be due to **decreased cardiac contractility**, **decreased intravascular volume** (as in DIC), or **decreased peripheral vascular resistance** (vasodilation)

Question 48

The types of shock are \_\_, hypovolemic, neurogenic, __ and \_\_\_

Answer 48

Cardiogenic Hypovolemic Neurogenic Septic Anaphylactic

Question 49

Fill in the table below

Answer 49