Exam 1; Thrombosis/Embolism/Infarction/Shock

Question 1

This is an intravascular clot, often impeding blood flow

Answer 1

thrombus

Question 2

This is the formation or presence of a thrombus, which may result in infarction

Answer 2

thrombosis

Question 3

What is the “Virchow’s” triad that leads to thrombosis

Answer 3

endothelial injury
alterations in blood flow
hypercoagulability

Question 4

What two things can cause the endothelial injury leading to thrombosis

Answer 4

loss of barrier

increased pro-thrombin activity caused by many things

Question 5

What three things can cause the alteration in blood flow leading to thrombosis

Answer 5

turbulence
stasis; allowing the concentration of clotting factors, activates endothelial cells
aneurysms/atherosclerotic plaques

Question 6

What type of conditions can cause hypercoaguability

Answer 6

inherited

acquired

Question 7

What are the three inherited conditions that can cause hypercoaguability

Answer 7

factor V leiden
AT III deficiency (anticoagulant protein)
prothrombin mutation

Question 8

What are some acquired conditions that can cause hypercoaguability

Answer 8

prolonged bed rest
extensive tissue injury
pregnancy
cancer
anti-PL antibodies (phospholipid)

Question 9

This is also known as a white thrombi and it tends to occur at sites of turbulence or endothelial injury and loss; may be occlusal or mural, typically lodging in small arterioles or heart valves

Answer 9

arterial thrombi

Question 10

What kind of lines of Zahn does a white thrombi have

Answer 10

distinct

Question 11

This is also known as a red thrombi and is often found in the deep veins of the legs

Answer 11

venous thrombi

Question 12

What kind of lines of Zahn does a red thrombi have

Answer 12

indistinct

Question 13

This fate of a thrombi is when it can enlarge by additional fibrin/platelet deposition

Answer 13

propagation

Question 14

This fate of a thrombi is when the entire thrombus dislodges or a piece breaks loose

Answer 14

embolization

Question 15

This fate of a thrombi is when it lyses by fibrinolytic activity

Answer 15

dissolution

Question 16

This fate of a thrombi is an ingrowth of fibroblasts and smooth muscle cells, leading to deposition of collagen and recanalization, which may re-establish flow through the thrombus

Answer 16

organization

Question 17

This is the widespread activation of the coagulation cascade and fibrinolytic system leading to depletion of coagulation factors and platelets and accumulation of fibrin split products

Answer 17

disseminated intravascular coagulation (DIC)

Question 18

What can DIC be associated with

Answer 18

widespread formation of micro thrombi and risk of hemorrhage

conditions associated are infection, obstetric complications, neoplasm, shock, massive injury, etc.

Question 19

What is the treatment for DIC

Answer 19

highly variable
dependent upon management of the underlying disorder
potentially life-threatening

Question 20

What is the origin of a pulmonary thromboembolism

Answer 20

thromboemboli that lodges in pulmonary arteries usually arising from deep veins in the legs

Question 21

What are the five consequences of a pulmonary thromboemboli

Answer 21

no clinical manifestation
pulmonary hemorrhage and hematemesis
pulmonary infarction
sudden death due to large emboli obstructing the large pulmonary artery or straddling the bifurcation as a saddle
gradual obstruction of many small pulmonary arteries resulting in pulmonary hypertension

Question 22

This is an embolism that arises in a systemic vein and crosses a communication from the venous side to the arterial side of circulation; usually through the foramen ovale

Answer 22

paradoxical embolus

Question 23

This is an embolism that originates usually from the left atrium, left ventricle or ulcerated atherosclerotic plaque; they can travel to any systemic artery

Answer 23

systemic embolism

Question 24

This type of emboli may arise from a fracture of a large long bone, soft tissue injury

Answer 24

fat

Question 25

This type of emboli may arise from a chest wall injury or decompression sickness

Answer 25

air

Question 26

This type of embolism is a rare complication of pregnancy, associated with DIC

Answer 26

amniotic fluid

Question 27

This type of embolism is from debris from the central core of an atherosclerotic plaque

Answer 27

atherosclerotic

Question 28

This is an ischemic necrosis involving all cell types in a segment of an organ or the entire organ

Answer 28

infarction

Question 29

Infarction is usually due to what

Answer 29

arterial obstruction, less often due to vessel twisting, venous obstruction or slow flow from the cause such as shock

Question 30

What are some conditions that lead to hemorrhagic infarcts

Answer 30

venous occlusion loos tissue dual circulation or extensive arterial supply overlap previos congestion infarction followed by a re-flow of blood to the area

Question 31

What are some conditions that lead to white (pale) infarcts

Answer 31

arterial occlusion in solid organs (like kidney where there is only one way in) where tissue density limits blood seepage from adjacent vascular beds

Question 32

Infarcts tend to be which shape

Answer 32

wedge shaped with the point of the lede at the site of arterial obstruction

Question 33

Infarction is followed by which kind of response

Answer 33

acute inflammatory response that begins within several hours | healing occur by granulation tissue ingrowth followed by scar formation

Question 34

Infarctions of the brain result in what

Answer 34

liquefactive necrosis and heal with formation of cystic space

Question 35

What are four factors that influence infarction development

Answer 35

nature of the blood supply (dual vs single) rate of development of occlusion; slow occlusion allows time for opening of collateral vessels vulnerability to hypoxia; some tissue are more vulnerable oxygen carrying capacity of the blood

Question 36

This is "systemic hypoperfusion" - low blood perfusion to the tissues

Answer 36

shock

Question 37

What are the five different type of shock

Answer 37

``` cardiogenic hypovolemic septic anaphylactic neurogenic ```

Question 38

What are the four associated pathogenicities of septic shock

Answer 38

PAMPs (like LPS) bind to TLRs on monocytes and neutrophils mediating the release of IL-1 and TNF secondary release of cytokines vasodilation, hypotension, endothelial cell activation, reduced myocardial contractility

Question 39

This stage of shock is when compensatory mechanisms maintain tissue perfusion by tachycardia, renal conversation of water, redistribution of the blood to vital organs.

Answer 39

non-progressive

Question 40

This stage of shock is when inadequaate perfusion with metabolic imbalances such as acidosis and increased lactic acid leads to pooling of blood and reduced perfusion. Hypoxic injury to endothelium results in DIC

Answer 40

progressive

Question 41

This stage of shock is when tissue injury cannot be reversed by re-perfusion

Answer 41

irreversible

Question 42

What are some clinical manifestations of shock

Answer 42

``` tachycardia/tachypnea (rapid breathing) hypotension cold, clammy skin pallor/cyanosis confusion low urine output acidosis; high lactic acid ```