Test 1: 10-14 Hemodynamics II

Question 1

1. Give the defect and glycoprotein for Bernard-Soulier Disease and Glanzmann’s Thombasthenia

Answer 1

a. Bernard-Soulier Disease
i. Defect of platelet adhesion
ii. Glycoprotein Ib

b. Glanzmann’s thrombastenia
i. Defect of platelet aggregation
ii. Glycoprotein IIb/IIIa

Question 2

2. Thrombotic Thrombocytopenic Purpura (TTP) has what antibodies for which protease?

Answer 2

Von Willebrand factor cleaving protease, ADAMTS-13

Question 3

3. In Hemorrhagic disorders – coagulopathies, von Willebrand’s disease is a deficiency of?

Answer 3

Von Willebrand’s antigen

Question 4

4. Give 4 clinical presentations of von Willebrand’s disease

Answer 4

i. Easily bruised
ii. Nosebleeds
iii. Gingival bleeding
iv. Menorrhagia (heavy period)

Question 5

5. What is the difference between hemophilia A and B?

Answer 5

Hemophilia A: factor VIII deficiency, more common

Hemophilia B: factor IX deficiency, more rare

Question 6

6. Give 5 characteristics of hemophilia

Answer 6

i. Deep internal bleeding leading to swelling
ii. Joint damage (harmarthrosis/haemophillic arthropathy)
iii. Transfusion transmitted infection
iv. Adverse reactions to clotting factor treatment
v. Intracranial hemorrhage

Question 7

7. What pathways can be activated to produce deleterious effects?

Answer 7

The same pathways that stop hemorrhaging

Question 8

8. In Virchow’s triad what leads to thrombosis?

Answer 8

Endothelial injury, abnormal blood flow (or circulatory stasis), hypercoagulable state

Question 9

9. In heparin-induced thrombocytopenia, platelet factor 4 is released by? What does it bind to and what are results of this?

Answer 9

Released by platelets and binds heparin, thus blocking its action and promoting coagulation

Question 10

11. Antiphospholipid antibody syndrome is most associated with what disorder? May cause a false positive test for?

Answer 10

Systemic lupus erythematosus (SLE)

Syphilis

Question 11

12. Turbulence causes what kind of damage? How does it cause local pockets of stasis? Give four things turbulence does

Answer 11

a. Causes endothelial injury or dysfunction
b. By forming countercurrents causing local pockets of stasis
c. Turbulence:
i. Disrupts laminar fluid
ii. Prevents dilution of clotting factors
iii. Prevents inflow of clotting inhibitors
iv. Promote endothelial cell activation

Question 12

13. Give 7 causes of turbulence

Answer 12

i. Ulcerated atherosclerotic plaque
ii. Aneurysms
iii. Hyperviscosity syndrome
iv. Sickle cell anemia
v. Myocardial infarctions
vi. Mitral valve stenosis
vii. Atrial fibrillation

Question 13

14. Thrombi morphology
    Arterial thrombi usually occur at sites of?
    Venous thrombi usually occur as a?
    Thrombi have a point of?

Answer 13

a. Sites of endothelial injury
b. Consequence of stasis
c. Firm attachment to the vessel

Question 14

15. What are Lines of Zahn?

Answer 14

In a thrombus, it is alternating bands of mostly fibrin and mostly RBC

Question 15

16. Mural thrombi are?

Answer 15

Arterial thrombosis in cardiac chambers due to myocardial infarction, ulcerated atherosclerotic plaque or aneurysmal dilatation

Question 16

17.	Artery thrombi are usually occlusive. What is their path in the arterial system?
How do they appear? 
What are they made of? 
May cause? 
Risk factors?

Answer 16

a. Coronary artery > cerebral artery > femoral artery
b. Grey-white and friable. Composed of platelets, fibrin, erythrocyte, and leukocytes
c. May cause local obstruction or distant embolization
d. Risk factors include
i. Myocardial infarction
ii. Rheumatic heart disease
iii. Atherosclerosis

Question 17

18. Venous thrombi are usually due to?
    What is their color and why?
    Mostly involve where on the body?

Answer 17

a. Usually due to stasis
b. They contain more erythrocytes and therefore are red
c. Mostly lower extremity veins but may involve other sites

Question 18

20. Risk factors for venous thrombosis include?

Answer 18

CHF 
Trauma 
Surgery 
Pregnancy 
Cancer 
Trosseau syndrome

Question 19

21. What happens in trousseau syndrome/migratory thrombophlebitis?

Answer 19

A serine protease released by malignant tumor cells activates factor 10
Tumor cells release plasma membrane vesicles exhibiting procoagulant activity. Tissue thromboplastin is released from necrotic tumor

Question 20

22. What is an embolus?

Answer 20

A detached intravascular solid liquid or gaseous mass that is carried by the blood to a site distant from its point of origin

Question 21

23. Where do all emboli originate from? How long do the emboli travel? Unless otherwise specified an embolus is assumed to be a?

Answer 21

a. Dislodged thrombus
b. Until they are stuck in a vessel too small
c. Thromboembolus

Question 22

24. Most pulmonary thromboembolism arises from?

Answer 22

Deep leg vein thrombi above knee

Question 23

25. A pulmonary embolus may occlude in what two spaces? Where can it be lodged?

Answer 23

occlude main pulmonary artery
lodge across bifurcation
occlude smaller branching arterioles

Question 24

26. Two sources of arterial emboli are?

Answer 24

Mural thrombi in heart or aorta

Paradoxical emboli

Question 25

27. When are fat globules common in circulation?

Answer 25

After: Fractures of long bones Soft tissue trauma Burns

Question 26

28. What happens if there is a rapid decrease in pressure (decompression)? What two disorders are in this category? What is the treatment?

Answer 26

a. Air bubbles form in the circulation b. The bends: Formation of gas bubbles in skeletal muscles and supporting tissues in and around joints The chokes: Gas emboli in lungs cause edema, hemorrhage atelectasis, and emphysema causing respiratory distress c. Treatment: Slow decompression allows gradual resorption and exhalation of the gases

Question 27

29. Caisson disease occurs in people who? What happens with persistence of gas?

Answer 27

Persons who worked in caissons had atmospheric pressure for long periods Persistence of gas emboli in skeletal system results in multiple foci if ischemic necrosis

Question 28

30. What does Amniotic emboli consist of?

Answer 28

Epithelial cells from fetal skin Lanugo hair Fat from venix caseosa mucin from fetal respiratory and gastrointestinal tract

Question 29

31. What is an infarction? In addition to thrombosis and emboli, what are its causes?

Answer 29

a. Infarction -- Death of tissue due to interruption in blood supply b. Causes in addition to thrombosis and emboli: i. Vasospasm ii. Hemorrhage within atherosclerotic plaque iii. Extrinsic compression of vessel iv. Torsion of vessel

Question 30

32. In infarct development, what cell type has the least, medium, or fibroblast?

Answer 30

Neuron 3-4 minutes Myocardium 20-30 minutes Fibroblast Hours

Question 31

33. Red infarction occurs in what 5 examples?

Answer 31

i. Venous occlusions ii. Loose tissues iii. Tissues with dual circulation iv. Tissues previously congested due to sluggish flow v. Reestablished blood flow to a site of previous arterial occlusion and necrosis

Question 32

34. What are white infarcts?

Answer 32

Arterial occlusions in solid organs with limitations of flow into areas of ischemic necrosis

Question 33

35. Infarcts tend to be what shape? Where do they occlude in a vessel?

Answer 33

Infarcts tend to be wedge-shaped | Occluded vessel at apex

Question 34

36. A septic infarct occurs when? | The major source of septic emboli is?

Answer 34

A septic infarct occurs when the origin of an embolus is infected tissue. The major source of septic emboli is vegetation formed by bacteria growing on heart valves in bacterial endocarditis

Question 35

37. What is shock AKA? What is shock caused by? Results in what 3 symptoms?

Answer 35

a. Cardiovascular Collapse b. Shock is caused by a reduction in cardiac output or effective circulating volume c. Results in hypotension, impaired tissue perfusion and cellular hypoxia

Question 36

38. What is neurogenic shock? Anaphylactic shock?

Answer 36

a. Neurogenic dysfunction causes loss of vascular tone and peripheral pooling of blood b. Generalized IgE mediated hypersensitivity response associated with vasodilatation and increased vascular permeability

Question 37

39. In the progressive stage of shock, what are signs of this?

Answer 37

i. Widespread tissue hypoxia ii. Lactic acidosis iii. Decreased vasomotor responses iv. Confusion and decreased urinary output v. Irreversible Stage vi. Widespread cell injury vii. Subsequent decrease in urine output and severe fluid/electrolyte disorders occur

Question 38

40. In shock decreased vasomotor responses include?

Answer 38

Arterioles dilate Pooling in microcirculation worsens cardiac output Anoxic endothelial cell injury

Question 39

41. Shock causes widespread cell injury. Give 3 examples

Answer 39

Widespread cell injury Lysosmal enzyme leakage Decreased Myocardial Contraction Acute tubular necrosis renal failure

Question 40

42. Give the shock morphology of the following: brain, heart, kidneys

Answer 40

Morphology Brain: ischemic encephalopathy Heart: coagulation necrosis/subendocardial hemorrhage, contraction band necrosis Kidneys: acute tubular necrosis

Question 41

43. Give the shock morphology of the following: lungs, adrenal gland, gastrointestinal tract, and liver?

Answer 41

Lungs: diffuse alveolar damage Adrenal Gland: Cortical cell lipid depletion Gastrointestinal tract: Mucosal hemorrhage and necrosis Liver: Fatty change, central hemorrhagic necrosis