Thrombosis/Embolism/Infarction/Shock

Question 1

A ______ is an intravascular clot, often impeding or preventing blood flow.

Answer 1

thrombus

Question 2

What is thrombosis?

Answer 2

the formation or presence of a thrombus (may result in infarction)

Question 3

______ Triad = endothelial injury + Alterations in blood flow + hypercoagulability

Answer 3

Virchow’s

Question 4

True or False: Virchow’s Triad includes hypocoagulability.

Answer 4

False: HYPERcoagulability

Question 5

Endothelial injury (loss of barrier) will _____ prothrombotic activity.

Answer 5

increase

Question 6

Alterations in blood flow are commonly of what two types?

Answer 6

1. turbulence

2. stasis

Question 7

What is turbulence?

Answer 7

hyper-coagulative state = increased flow = endothelial activation

Question 8

What is stasis?

Answer 8

peripheral displacement of platelets or concentration of clotting factors results in decreased flow = endothelial activation

Question 9

True or False: Thrombosis can occur due to inherited or acquired conditions.

Answer 9

True

Question 10

What are the three mentioned inherited conditions of hypercoagulability?

Answer 10

Factor V Leiden (Va cannot be cleaved)
AT III deficiency
Prothrombin mutation

Question 11

In what situations would there be an acquired condition that results in hypercoagulability (and thrombosis)?

Answer 11

prolonged bed rest
cancer
pregnancy
extensive tissue injury
anti-PL ab

Question 12

Is a homozygote of Factor V Leiden at higher or lower risk for developing thrombosis?

Answer 12

Homo = 50% risk
Hetero = ~5% risk

Question 13

Thrombosis can either be arterial or venous. What are the colors associated with each?

Answer 13

arterial = white
venous = red

Question 14

Describe arterial thrombosis.

Answer 14

incorporation of fibrin = makes it WHITE
sites of turbulence (endothelial injury)
occlusive or mural
on heart valves (NBTE)
DISTINCT LINES OF ZAHN (layering of red blood cells)

Question 15

Describe venous thrombosis.

Answer 15

sites of stasis (ex. deep leg veins/bed rest)

INDISTINCT lines of zahn (slower flow rate)

Question 16

_____ thrombosis is associated with turbulence, whereas, ______ thrombosis is associated with stasis.

Answer 16

arterial

venous

Question 17

True or False: In an aortic thrombus, there would be distinct lines of zahn.

Answer 17

True.

arterial thrombis = DISTINCT lines

Question 18

Thrombi form _______ the heart.

Answer 18

toward

Question 19

What are the four fates of thrombi?

Answer 19

Propagation
Embolization
Dissolution (resolution)
Organization (recanalization)

Question 20

What is DIC?

Answer 20

Disseminated Intravascular Coagulation

- widespread activation of both the coagulation cascade and the fibrinolytic systems

Question 21

Why is “consumptive coagulopathy” sometimes used to describe DIC?

Answer 21

coagulation factors and platelets are depleted (causing bleeding problems) while fibrin split products are elevated (microthrombi)
its a big mess of clotting and bleeding issues occuring simultaneously

Question 22

True or False: Disseminated Intravascular Coagulation is a dangerous disease.

Answer 22

False: it is a CONDITION not a disease

Question 23

What are the possible etiologies of D.I.C.?

Answer 23

• infection (gram negative bacteria)
• obstetric complications (placental abruption, retained dead fetus)
• neoplasm
• shock
• massive tissue injury

Question 24

What are the treatment options for DIC?

Answer 24

HIGHLY VARIABLE (but usually you treat the bleeding aspect of the condition preferentially)
-depends on the management of underlying disorder

Question 25

What is an embolus?

Answer 25

an INTRAvascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin

Question 26

The majority of emboli are dislodged thrombus material and are known as ____________.

Answer 26

thromboembolism

Question 27

What is the common origin for a Pulmonary Thromboembolism?

Answer 27

Deep leg veins

Question 28

True or False: A pulmonary thromboembolism may have no manifestations or consequences.

Answer 28

True - often blood can be re-routed through other vasculature - however, some CAN cause sudden death (saddle embolus)

Question 29

What is a "saddle embolus?"

Answer 29

A large emboli obstructing a large pulmonary artery or straddling the bifurcation of the pulmonary arterial trunk

Question 30

Systemic embolization usually originates in _______.

Answer 30

the left atrium - almost always it's ARTERIAL - could also originate from the left ventricle or atherosclerotic plaque

Question 31

What is a "paradoxical systemic embolization?"

Answer 31

an embolus that arises in a vein before CROSSING into the arterial side of circulation; often passes through a patent foramen ovale

Question 32

What is the common passageway for a paradoxical systemic embolus?

Answer 32

the patent foramen ovale

Question 33

Name the five types of embolism.

Answer 33

1. Thrombus * 2. Fat (not common- may occur with bad bone breaks) 3. Air ("bends" and caisson disease) 4. Amniotic Fluid (can be associated with DIC) 5. Atherosclerotic Plaque Material

Question 34

_______ is an area of ischemic necrosis secondary to occlusion of arterial supply or venous drainage.

Answer 34

Infarction

Question 35

Infarction is an area of ischemic _________ that is _______ to occlusion of arterial supply or venous drainage.

Answer 35

necrosis | secondary

Question 36

Name a major contributor to mortality associated with cardiovascular disease.

Answer 36

Infarction

Question 37

What are the two types of infarction?

Answer 37

Red or White

Question 38

______ infarction is hemorrhagic.

Answer 38

Red

Question 39

_______ infarction is pale.

Answer 39

White

Question 40

_______ infarction occurs following ARTERIAL occlusion in a solid organ.

Answer 40

White

Question 41

______ infarction occurs following VENOUS occlusion.

Answer 41

Red

Question 42

True or False: "White infarction" can be associated with loose tissues, previous congestion, and reflow of blood to infarcted area.

Answer 42

False....that is all "red"

Question 43

Arterial blockage in the spleen would be of which type of infarction?

Answer 43

White

Question 44

True or False: The rate of occlusion influences infarct development.

Answer 44

True

Question 45

A decreased oxygen carrying capacity of the cardiovascular system would _____ the vulnerability for infarct development.

Answer 45

increase

Question 46

"Systemic HypoPerfusion" is better known as _____.

Answer 46

shock

Question 47

What are the Pathophysiologic categories of shock?

Answer 47

1. cardiogenic 2. hypovolemic (lots of bleeding) 3. Septic (endotoxin) 4. Anaphylactic 5. Neurogenic

Question 48

_______ is the #1 cause of death in intensive care units.

Answer 48

Septic Shock

Question 49

What is septic shock associated with?

Answer 49

gram-positive or gram-negative bacteria

Question 50

In septic shock, there is an activation of _______ on monocytes and neutrophils with release of IL-1, TNF, and other mediators.

Answer 50

toll-like receptors

Question 51

Activation of mediators in a situation of septic shock would result in ________ and decreased _______

Answer 51

vasodilation and decreased perfusion

Question 52

What are the three stages of shock?

Answer 52

1. Nonprogressive 2. Progressive 3. Irreversible

Question 53

In ____ shock, tissue injury is unrecoverable and multiple organ failure can lead to death.

Answer 53

irreversible

Question 54

In _____ shock, inadequate perfusion leads to anaerobic metabolism, lactic acidosis, and sometimes DIC.

Answer 54

Progressive

Question 55

In _____ shock, compensatory mechanisms maintain perfusion.

Answer 55

Nonprogressive

Question 56

What are the clinical manifestations of shock?

Answer 56

- tachycardia (increased HR) - tachypnea (shallow breathing) - hypotension - cool clammy skin (except "septic" is warmer) - pallor/cyanosis - confusion - low urine output - acidosis - high lactic acid