Test 2 Flashcards by Katie Tate

What type of shock results from pump failure of the heart? Most often SECONDARY to an infarction that destroys a large part of the functioning myocardium.

Cardiogenic Shock

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In Cardiogenic Shock, the loss of contractile elements decreases the ability of the heart to pump blood which leads to what?

Arrhythmia (similar consequences may result from myocarditis, valvular heart disease or CHF)

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The loss of circulatory volume results in?

Hypovolemic Shock

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What 2 things mentioned in the slides can hypovolemic shock be attributed to?

massive hemorrhage

2. water loss due to burns, vomiting, or diarrhea

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In hypovolemic shock, you have the loss of vascular tone and pooling of blood in dilated peripheral blood vessels. What are 2 other causes of this mentioned in class?

Anaphylactic shock -> caused by exposure to an allergen

2. Neurogenic stimuli -> pain caused by trauma or spinal cord injury

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The major cause of Septic Shock?

Severe G- endotoxin (LPS) bacteremia (shock resulting from the spread of bacteria from a severe localized infection into the bloodstream)

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What is currently the most common cause of death in ICUs?

Septic Shock

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What are 6 examples of G- bacteria that can cause septic shock?

E. coli
Proteus
Serratia
Pseudomonas
K. pneumoniae
Bacteroides

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Once LPS binds to macrophages, what 3 things does the macrophage release?

TNF alpha
IL-1
MMP

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What is defined as a state of hypoperfusion of tissues with blood which results in tissue hypoxia and multiple organ failure.

Shock

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_______: freely moveable, intravascular mass that is carried from one anatomic site to another by blood

Embolism

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__________: Fragments of thrombi carried by venous or arterial blood. Accounts for most the emboli in clinical practice.

Thromboemboli

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Infected ______ give rise to septic emboli. Classified on basis of the _________ through which they are carried.

Thrombi

Vessels

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______ ______: these include fat emboli that occur after bone fracture and _____ ______ emboli caused by the entry of amniotic fluid into the uterine veins during delivery

Liquid Emboli

Amniotic Fluid

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_____ _____: an air embolism can be produced by injecting air into veins. Air is liberated under pressure, as in decompression sickness

Gaseous Emboli

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What happens to cause a solid particle emboli?

Cholesterol crystals detach from atherosclerotic plaques or tumor cells, or bone marrow emboli, or bullets

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Venous emboli originate where?

Where do they typically lodge?

Originate in veins

Lodge in Pulmonary artery

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_______ emboli are venous emboli that reach the ______ circulation through the _____ _____ or an interventricular septal defect that can cause symptoms similar to those of an ______ emboli (including infarction)

Paradoxical
arterial
foramen ovale
arterial

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Where do arterial emboli originate?

The left atrium or ventricle, aorta and the major arteries

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How can an arterial emboli cause infarction?

carried by arterial blood, the embolism can occlude the peripheral arteries

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What 2 things are found with true bone marrow emboli in the lungs at time of autopsy?

Hematopoietic cells

2. Fat

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What forms a meshwork of thin filaments that bind together the cellular elements of the blood seen in a thrombus. (adhesion molecules)

Fibrin (polymerized fibrinogen)

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What are the 4 fates of a thrombus?

Lysis and resolution
Organization -> inflammatory cells to granulation tissue to collagen
Recanalization
Embolism

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What is another name for heart failure cells?

Alveolar “hemosiderin-laden” macrophages

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What does chronic passive congestion of the lungs lead to?

formation of edema and extravasation of the RBCs into the alveoli which are taken up by alveolar macrophages and the hemoglobin is degraded into a brown (hemosiderin) pigment which, which accumulates in the lysosomes of macrophages -> heart failure cells are formed

How do venous emboli become pulmonary emboli?

venous emboli typically originate in the deep veins of the lower extremities and are carried by venous blood to the vena cava through the right atrium and ventricle and then into the pulmonary artery

What is the name of an emboli that straddles the branching of an artery blocking both branches? -Often lethal bc they prevent the entry of blood into the lungs and cause acute anoxia.

Saddle Embolus | amniotic fluid and air emboli may also block pulmonary circulation

What emboli is usually a direct result of trauma with fat (from bone marrow) entering ruptured capillaries at the site of the fracture.

Fat Embolism - usually appears 1-3 days after injury

What is the most severe form of fat embolism syndrome?

Seen in the lungs with respiratory failue (ARDS) | -also with numerous fat globules within microvasulature

What 4 things happen when a fat emboli reaches the brain?

1. Cerebral edema 2. Red petechiae 3. microinfarcts 4. fat globules form in microvasculature

What is the clinical expression for arterial emboli with the end location being cerebral?

lodge in the middle cerebral artery and cause infarcts of the basal ganglia

What is the clinical expression for arterial emboli with the end location being spleen?

sharp subcostal pain

What is the clinical expression for arterial emboli with the end location being renal?

hematuria

What is the clinical expression for arterial emboli with the end location being intestines?

results from embolus that lodges in one of the major intestinal arteries, causing gangrene and necrosis of the bowel

Define Waterhouse-Freidrichsen syndrome and its clinical features associated with sepsis

Shock due to bilateral adrenal hemorrhage caused by severe bacterial infection

Red infarcts are caused by what?

typical of venous obstruction -> venous congestion -> local ischemia -> necrosis

What 4 (discussed) organs do red infarcts involve?

Involving: (typical of organs with dual blood supply) 1. intestines (twisting of the sigmoid colon) 2. testes (maybe the result of twisting) 3. Liver 4. Lungs

What are white (pale) infarcts typically caused by and where do they occur?

Arterial occlusion in solid organs (HEART/KIDNEY)

Why are white infarcts rimmed by a thin red zone?

Contains extravasated blood that was destined to reach the ischemic zone from surrounded anastomotic blood vessels.

T/F After ischemic necrosis in the brain, cells cannot be replaced so fibrous scars form as regeneration

False - The brain does NOT form fibrous scars, it becomes liquefied and is ultimately reabsorbed leaving behind a fluid filled cyst that later undergoes gliosis. The heart forms fibrous scars.

Septic infarcts may transform into an _______ that tends to heal ______ due to an inadequate blood supply to the infarcted area.

Abscess | poorly

What 2 things are abscesses associated with?

1. Inflammation | 2. Bacterial infections (G-)

Best prevention against thrombosis?

Heparin

What is it called when amniotic fluid containing fetal cells and debris enters into the maternal circulation through a tear in the placental membrane and rupture of the open uterine and cervical veins? Often catastrophic

Amniotic fluid emboli seen in the mothers lungs

What are 5 signs/symptoms of amniotic fluid emboli?

1. Sudden severe dyspnea 2. Cyanosis 3. Hypotensive shock 4. Seizures 5. Coma

Another name for shock lung syndrome

adult respiratory distress syndrome (ARDS) -> left ventricular insufficiency raises the intapulmonary venous pressure, causin stagnation of blood in the pulmonary circulation , and favors the formation of pulmonary edema

Another name for a bruise

contusion

Name for blood released by internal hemorrhage fills body cavities

Hematoma

Name for small hemorrhages into the skin and mucosa less than 1mm in diameter

petechiae

Name for small hemorrhages into the skin and mucosa between 1mm to 1cm

purpura

Name for larger blotchy bruises

Ecchymosis

During an autopsy, sternum, thorax, and rib fractures are seen this indicates what?

Cardiac resuscitation (seen in bone marrow emboli patients)

_________ is defined as a consequence or dilation of the arterioles and mediated by neural signals that lead to the relaxation of arteriolar smooth muscle

Active hyperemia

Congestive or congestion is caused by an increased venous back pressure and most often occurs in chronic form. Typically a consequence of CHF, where the stangnation of venous deoxygenated blood contributes to cyanosis and is associated with peripheral or pulmonary edema. This is descriptive of?

Passive hypermia - chronic passive congestion of the lungs leads to edema, extravasation of RBCs into alveoli and the "heart failure cells are seen.

What 2 things is chronic passive congestion accompanied by?

1. anoxia | 2. pulmonary fibrosis

General features of oral carcinomas 1. _______ tumors are the most ______ tumor of the oral cavity, originating from the ______ cells within the mouth 2. Affects men __ women 3. ____ ____ _____ accounts for over 95% of oral cancers. 4. Unusual if seen under the age of ____ 5. Single most common cancer in men in _____ due to chewing _____ (combo of betel leaves and areca nuts)

1. Epithelial - common - surface 2. > 3. Squamous Cell Carcinoma 4. 40 5. India

8 Risk factors for oral carcinomas

1. Tobacco 2. Alcohol (potentiates the carcinogenic effect of tobacco 3. Sunlight/UV light (cancer of the lips) 4. Dental irritation/poor OH 5. Immunosuppression 6. Leukoplakia & erythroplakia 7. HPV 8. EBV (due to hairy leukoplakia)

Cancer of the tongue is ____% of all oral cancers. It is the most common site in oral cavity. The most common location is ______ & _____ aspect of anterior 2/3. Main etiology is ______ & _____ when cancer is found in the anterior part. Most common clinical appearance is painless ________ or exophytic mass.

25-30% lateral & vental tobacco & alcohol ulcerated

Cancer of the lower lip is ______% of all oral cancers. ____ % also present with cancer on the upper lip. Less common in _______ which might relate to the protective effect of _____ from the sun. Higher survival rates due to earlier _______?

``` 20-25% 10% women lipstick diagnosis ```

Cancer of the floor of the mouth is _____% of all oral cancers. Most common site is along the ______ aspect of the floor, near ______ ______. Etiology linked to ______ & ______. Presents as ______ mass with pain, ______, and excessive ________. Chance of invasion into underlying mandibular bone ______%

``` 20% anterior lingual frenulum tobacco & alcohol ulcerated bleeding salivation 15-30% ```

Cancer of the gingiva and alveolar ridge makes up ___% of all oral cancers. _________ gingiva involvement is more common than _______ gingiva. ________ areas are most commonly affected. Presents with nonspecific findings, including ____ _____ & difficulty _____ the mouth. Most common clinical appearance is an ulcerated or __________ mass.

``` 6% Mandibular Maxilla Edentulous Sore throat opening exophytic ```

Cancer of the hard palate makes up ____% of all oral cancers. Rarest in _____ more common in _____ due to reverse smoking. Etiology linked to ______ & ______ use. Presents as ulcerative or exophytic lesion w/ or w/o _____ and or ________. _____ of cases present with underlying bone invasion.

``` 3% USA India Tobacco & alcohol pain bleeding 1/3 ```

Cancer of the buccal mucosa makes up ___% of oral cancers. Early lesions appear as ulcerative and _____ exophytic masses. Majority aries in the middle to ______ portion of the cheek with spread to ______ ridge, upper and lower jaw, _____ and _____. Etiology liked to ______ & ______.

``` 2% infiltrative posterior alveolar tonsils and palate Tobacco & alcohol ```

List the most common to least common sites of oral cancer related to tobacco & alcohol. (6 total)

1. Tongue 2. Lower lip 3. Floor of mouth 4. Gingiva/edentulous alveolar ridge 5. Hard palate 6. Buccal Mucosa

The the most common site of oral cancer related to HPV? (4 total)

1. Tonsils 2. Back of tongue 3. back of throat (oropharynx) 4. uvula (more posterior regions)

What are the 2 pre-cancerous lesions that lead to oral cancer?

1. Leukoplakia - white plaques | 2. Erythroplakia - red/velvety eroded area AKA dysplastic leukoplakia

What type of leukoplakia is described as asymptomatic white patch on surface of mucous membrane (not a tumor) that can result in malignant transformation to squamous cell carinoma. Equal frequency in both sexes. More common after 3rd decade. Not a diagnosis.

Precancerous Leukoplakia

What type of leukoplakia is found on the buccal mucosa, tongue, and floor of the mouth. It can be solitary or multiple, varies in size. Cannot be removed by scraping.

Cancerous Leukoplakia 10% superficial 8% invasive 20% become malignant

3 risk factors for leukoplakia and erythroplakia

1. Smoking 2. Chewing tobacco 3. Alcohol use

Erythroplakia is more ______ and less _______ than leukoplakia.

precancerous | less common

T/F With erythroplakia, epithelial changes are atypical and have higher risk of malignant transformation

True

Oral HPV tumors occur in _____ age groups and in _____ males and in ___-____. HPV group is the fastest-growing segment of ____ cancer population due to increase in oral ____. More _______ to radiation therapy than tobacco related oral cancer which equals better outcome and ________. Most cases of oral cancer due to HPV also have a history of ______ use.

``` young white non-smokers oral sex susceptible survivability tobacco ```

Oral cancer lesions can be described as?

Raised, firm, pearly-white with central necrosis and rolled mucosal borders.

Main sites of metastais of oral cancers?

1. Submandibular 2. Superficial 3. deep cervical lymph nodes (common metastasis causing death: liver, lungs, GI, bone)

Small oral cancer lesions =_______ Large oral cancer lesions = local or referred _____, difficulty ______/speaking/_____/ opening mouth, may exhibit bleeding and cause _________

``` asymptomatic pain swallowing chewing anemia ```

Test 2 Flashcards

(75 cards)