Disorders of Circulation

Question 1

Hematoma

Answer 1

It is a localized collection of blood outside the blood vessels.

Question 2

Hemothorax

Answer 2

It is a type of pleural effusion in which blood accumulates in the pleural cavity.

Question 3

Hemopericardium

Answer 3

Hemopericardium refers to blood in the pericardial sac of the heart.

Question 4

Hemoperitoneum

Answer 4

Hemoperitoneum (sometimes also hematoperitoneum) is the presence of blood in the peritoneal cavity.

Question 5

Hemarthrosis

Answer 5

Hemarthrosis (or haemarthrosis, plural h(a)emarthroses) is a bleeding into joint spaces.

Question 6

Petechiae

Answer 6

It is a red or purple spot on the skin, caused by a minor bleed (from broken capillary blood vessels).

Question 7

Purpura

Answer 7

They are a rash of purple spots on the skin caused by internal bleeding from small blood vessels and are larger that petechiae.

Question 8

Ecchymosis

Answer 8

Nonraised skin discoloration caused by the escape of blood into the tissues from ruptured blood vessels.

Question 9

What is hyperemia and what is the cause?

Answer 9

Hyperemia (active hyperemia) occurs with dilatation of an artery or arteriole and increased blood flow into the capillaries. Hyperemia is caused by sympathetic neurogenic discharge or chemical mediators.

Question 10

What are examples of hyperemia?

Answer 10

Clinical Example: Acute inflammation of tissue, blushing, body’s need to dissipate heat. Hyperemia of the skin appears red (oxygenated blood).

Question 11

What is congestion and what is the cause?

Answer 11

Congestion (passive hyperemia) occurs because of impaired venous drainage. The veins do not dilate because of the active influence of a sympathetic discharge or chemical mediator.

Question 12

What is an example of congestion?

Answer 12

Clinical Example: Chronic passive congestion is a form of long standing congestion which produces characteristic changes in the lungs, liver and spleen. The congestion occurs because of right heart failure.

Question 13

What is edema?

Answer 13

Accumulation of abnormal amounts of fluid in interstitial spaces or body cavities.

Question 14

What are the 2 types of edema?

Answer 14

Inflammatory

Non-inflammatory

Question 15

What is the cause of inflammatory edema?

Answer 15

Tissue injury alters blood flow and vascular permeability as a result of increased interendothelial space. This process is modulated by a variety of chemical mediators.

Question 16

What is the cause of non-inflammatory edema?

Answer 16

Fluid accumulates in the interstitium as a consequence of changes in hydrostatic pressure and colloid osmotic pressure.

Question 17

What is hemorrhage?

Answer 17

Hemorrhage is a flow of blood from a ruptured blood vessel. The blood may flow into tissue, into a body cavity or outside the body.

Question 18

What is thrombosis?

Answer 18

Formation of thrombus (blood clot) within an uninterrupted vascular system. It is considered a pathologic process.

Question 19

What are the 3 mechanisms for thrombosis?

Answer 19

1. Endothelial injury
   Clinical examples: Inflammation; advanced atherosclerosis
2. Altered blood flow: turbulence vs. stasis
   Clinical example: atrial fibrillation, bed rest
3. Hypercoagulable state: Predisposition to easy clot formation
   Clinical examples: Protein C deficiency; woman who smokes and uses oral contraceptives.

Question 20

What is Virchow’s Triad?

Answer 20

1. Endothelial injury
2. Altered blood flow
3. Hypercoagulable state

Question 21

What is an embolism?

Answer 21

An embolus is an intravascular substance (solid, liquid, gas) which is carried by blood from a point of origin to a distant site.

Question 22

What is infarction?

Answer 22

An infarct is an area of ischemic necrosis within tissue or an organ, produced by occlusion of either its arterial supply or venous drainage. The majority of infarcts are associated with thromboembolism and involve arterial occlusions.

Question 23

What is the cause of white infarct?

Answer 23

Ischemic, usually arterial occlusion

Question 24

What is the cause of red infarct?

Answer 24

Hemorrhagic, usually venous occlusion

Question 25

What are some tissues that experience white infarct?

Answer 25

Solid organ with end‐ arterial circulation like heart, liver, spleen and kidney

Question 26

What are some tissues that experience red infarct?

Answer 26

Tissues with dual circulations like lung and small intestine

Question 27

What are the possible fates of a venous thrombus?

Answer 27

• Resolution
• Embolization
• Propagation
• Organization

Question 28

What is Cardiogenic Shock?

Answer 28

Results from low cardiac output due to myocardial pump failure

Question 29

What is Hypovolemic Shock

Answer 29

Results from low cardiac output due to loss of blood or plasma volume

Question 30

What is Septic Shock?

Answer 30

Results from arteriolar vasodilatation and venous blood pooling that stems from systemic immune response to microbial infection.

Question 31

56‐year old woman develops a popliteal venous thrombosis after hip replacement surgery. She recovers and returns to her job as a teacher. Three months later, which of the following term would describe the process mostly likely seen in the popliteal vein?

A. Acute inflammation
B. Granulomatous inflammation
C. Embolization
D. Organization
E. Propagation

Answer 31

D. Organization

Question 32

A 65‐year old previously healthy man is hospitalized for bilateral pneumonia. On hospital day #8 he is found to have swelling and tenderness of his left leg. An ultrasound examination reveals findings consistent with acute left common femoral vein thrombus. Which of the following conditions is most likely to have contributed the most to this finding?

A. Protein C deficiency
B. Prolonged immobilization
C. Hypertension
D. Left ventricle mural thrombus E. Chronic alcohol use

Answer 32

B. Prolonged immobilization

Question 33

On sectioning of an organ from a 69‐year old woman at the time of autopsy, a focal wedge‐shaped area that is firm is accompanied by extensive hemorrhage, giving it a red appearance. The lesion has a base on the surface of the organ. In which of the following situations did this lesion most likely develop?

A. Spleen with embolized mural thrombus
B. Kidney with septic embolus
C. Liver with hypovolemic shock
D. Heart with coronary thrombosis
E. Lung with pulmonary thromboembolism

Answer 33

E. Lung with pulmonary thromboembolism