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PH 122 > Fluid & Hemodynamics > Flashcards

Fluid & Hemodynamics Flashcards

0
Q

What kind of shock is this:
due to inadequate blood or plasma volume
hemorrhage, fluid loss (vomiting, diarrhea, burns, trauma) ?

A

Hypovolemic shock

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1
Q

failure of myocardial pump owing to intrinsic myocardial damage, extrinsic pressure or obstruction of outflow

What kind of shock is this?

A

Cardiogenic shock

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2
Q

peripheral vasodilation and pooling of blood; endothelial activation /injury;
AND
- “Kahit pump ka ng pump ng fluid sa katawan ng tao, you’re just losing the fluid into the different parts of the body, but not in the vessel.”

What kind of shock is this?

A

Septic shock

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3
Q

Identify: necrosis resulting from ischemia caused by obstruction of the blood supply

A

Infarction

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4
Q

White infarcts/anemic infarcts: occur in heart, spleen, kidney. How does it come about?

A

Only one artery supplies the organ, once the blood supply is cut, the cells will die; no activation (via blood) of enzymes responsible for liquefaction of the organ

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5
Q

How do red/hemorrhagic infarcts cause pathologic condition?

A

there is more than one vessel that supplies the area –> activation of enzymes will occur. But supply is decreased probably because of hypotension/lack of blood.

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6
Q

Origin of pulmonary embolus

A

Deep venous thromboses (due to lack of mvmt at lower extremities)

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7
Q

What is saddle embolus?

A

When the fragmented thrombi are large enough, it can occlude the main pulmonary artery and straddle the pulmonary artery bifurcation.

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8
Q

What is paradoxical embolism?

A

When embolus passes through interatrial or interventricular defect and gain access to systemic circulation

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9
Q

What is cor pulmonale?

A

occurs when emboli obstruct 60% or more of the pulmonary circulation

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10
Q

What is a mural thrombus?

A

thrombus that adheres to one wall of a heart chamber or major artery

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11
Q

What is Cerebral Infarction?

A

Arterial emboli @ Branches of carotid artery, esp middle cerebral artery

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12
Q

What is fat and marrow embolus?

A

marrow or adipose tissue herniated into the vascular space due to fracture of long bones

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13
Q

Arterial thrombus has alternate dark and light morphology. What do these areas represent?

A

Dark:platelets
Light:Lines of Zahn

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14
Q

What is air embolism?

A

Circulating Gas bubbles that coalesce and obstruct vascular flow

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15
Q

used to stain air embolism into lipid red

A

Sudan stain

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16
Q

__ cc is required to have a clinical effect in pulmonary circulation

A

100

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17
Q

What is decompression sickness?

A

special form of air embolism caused by sudden decrease in atmospheric pressure

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18
Q

Explain the pathophysio of Decompression Sickness

A

Air breathed at high pressure causes increasing amount of gas (particularly nitrogen) to be dissolved in blood and tissues. If the diver then ascends (depressurizes) too rapidly, the nitrogen comes out of solution in the tissues and the blood.

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19
Q

What is Caisson disease?

A

chronic form of decompression sickness; may lead to ischemic necrosis

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20
Q

What causes amniotic fluid embolism?

A

tear in the placental membranes or rupture of uterine veins

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21
Q

Identify: inappropriate activation of blood clotting in an uninjured vasculature, often causing interruption of blood flow

A

Thrombosis

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22
Q

Virchow’s Triad: 3 Primary Influences In Thrombosis Formation
Enumerate!

A

Endothelial Injury
Alterations In Normal Blood Flow
Hypercoagulability

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23
Q

endothelial injury may lead to thrombosis formation, why?

A

It can activate clotting factors.

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24
Q

Consequences of Endothelial Injury include all except:
A)Exposes subendothelial ECM and tissue factor
B)adhesion of platelets
C) increase of prostaglandins
D) none of the above

A

C) increase of prostaglandins

Depletion dapat

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25
Q

Possible consequences of turbulent blood flow include all except
A) Increasing platelet-endothelium contact –>increases chances of platelet activation
B) prevent dilution of activated clotting factors by flowing blood
C) Increase the inflow of clotting inhibitors
D) Atherosclerosis, atrial fibrillation

A

C) Increase the inflow of clotting inhibitors

Decrease dapat.

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26
Q

Turbulent blood flow most common in ___

A

Vessels that bifurcate (carotid artery, for example)

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27
Q

IDENTIFY

A

Embolus

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28
Q

IDENTIFY
(1)usually arise from a mural thrombus (2) can travel to a wide variety of sites 3) in general, outcome is tissue infarction

A

Arterial embolus

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29
Q

False about arterial embolus:
A) normal: thrombi in the left heart chamber settle in the lungs; B)paradoxical: thrombi in the right heart chamber settle in a hole in the heart affecting circulation
C)both are false
D)both are true

A

(A)

Imbes na left, right dapat

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30
Q

False about thrombophilia
A. Also called hypocoagulation
B.disruption of balance bet coagulation & anti-coagulation
C. May be caused by gene mutations (Factor V Leiden), anticoagulant deficiencies
D. May also be caused by oral contraceptives, hyperestrogenic state of pregnancy, malignancies and autoimmune diseases

A

A

Hypercoagulation dapat

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31
Q

Sequence the steps of thrombus fate
A. Dissolution by fibrinolytic activity
B. Organization and Recanalization, reestablishing flow by ingrowth of endothelial cells, smooth muscle cells, and fibroblasts to create vascular channels
C. Propagation causing complete vessel obstruction
D. Embolization to other sites in the vasculature

A

C D A B

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32
Q

False about fibrinolysis
A.Thrombus formation and thrombus dissolution occursin chronologic order. B. Concurrent with thrombogenesis and modulates coagulation
C.Restores blood flow in vessels occluded by thrombus and facilitates healing after inflammation and injury
D. None of the above

A

A.

Once the activation of the clotting cascade occurs, fibrinolysis also occurs.

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33
Q

False about arterial thrombi
A. formed in areas of less active blood flow
B. when mature, demonstrate the alternate dark gray layers of platelets (and RBCs) interspersed with lighter layers of fibrin
C. eventually liquefy and disappear or are organized with fibrous tissue formation
D. None of the above

A

A. formed in areas of less active blood flow

Less –> more

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34
Q

It can be determined if a clot is pre-mortem or postmortem based on the ___

A

Lines of Zahn (lighter layers of fibrin at thrombus)

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35
Q

Identify

A

Venous thrombi

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36
Q

Thrombophlebitis. What is it?

A

inflammation of veins with thrombus formation (when you stay very long in bed)

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37
Q

False about superficial leg veins’ thrombosis
A)usually in varicose saphenous veins B)causes local congestion and pain
C) embolize often
D) local edema and impaired venous drainage, i.e. skin infections, varicose ulcers

A

C) embolize often

Rarely dapat

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38
Q

False about venous thrombosis at deep leg veins
A.in larger veins above the knee (popliteal, femoral and iliac)
B.may cause pain and edema
C.cannot be asymptomatic
D.Prone to develop pulmonary emboli

A

C. Cannot be asymptomatic

May be Asymptomatic in 50% of patients

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39
Q

Deep venous thromboses may occur in all except
A) Advanced age, bed rest, or immobilization
B)Congestive heart failure
C)trauma, surgery and burns
D)puerperal and postpartum states
E)none of the above

A

E)none of the above

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40
Q

False about Migratory Thrombophlebitis
A. Also called Rousseau Syndrome
B. Commonly seen in patients with pancreatic cancer
C. Both are false

A

A. Also called Rousseau Syndrome

Trousseau dapat

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41
Q

False about Disseminated Intravascular Coagulation
A)Both the procoagulant and the anticoagulant are activated at the same time but are not balanced.
B) Separate illness
C)causing activation of clotting cascade.
D)Widespread fibrin microthrombi in the microcirculation.
E)occur most likely at eye, mucosa

A

B) Separate illness

It is an effect of illness, like cancer/sepsis

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42
Q

What is Consumption Coagulopathy?

A

Platelets & coagulation factors consumed

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43
Q

False about postmortem clots
A)attached to vessel wall
B)two-layered appearance:
C)Currant jelly appearance – red cell-rich layer
D)Chicken fat appearance – cell-poor upper layer

A

A)attached to vessel wall

Hindi siya attached sa vessel wall.

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44
Q

refers to blood extravasation following vessel rupture, defects in platelets or coagulation factors

Identify

A

Hemorrhage

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45
Q

capillary bleeding can occur with chronic congestion, true or false?

A

True

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46
Q

conditions or abnormalities that may increase tendency/risk of having hemorrhage from insignificant injuries

Identify

A

Hemorrhagic diatheses

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47
Q

Enumerate the 3 types of superficial hemorrhages. How are they classified?

A

Petechiae
Purpura
Ecchymosis

(According to size)

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48
Q

Arrange accdg to increasing size: purpura, petechiae, ecchymosis?

A

Petechiae, purpura, ecchymosis

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49
Q

In which diseases can you see petechiae?

A

Dengue hemorrhagic fever, platelet disorders

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50
Q

In which diseases can you see purpura?

A

Autoimmune disorders

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51
Q

True or false: ecchymosis may be seen in patients with hemophilia

A

True

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52
Q

localized blood volume increase in capillaries and small vessels

Identify

A

Hyperemia

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53
Q

Differentiate active fr passive hyperemia

A

Active Hyperemia (Hyperemia) - results from localized arterial dilatation Passive Hyperemia (Congestion) -resulting from obstructed venous return or increased pressure form CHF

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54
Q

congestion and distention of alveolar capillaries leading to capillary rupture and passage of RBCs into the alveoli; usually due to left heart failure

Identify

A

Chronic passive congestion of the lungs

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55
Q

Another name for heart failure cells

A

intraalveolar hemosiderin-laden macrophages

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56
Q

Location of heart-failure cells

A

Lungs

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57
Q

due to combination of dilated, congested central veins and the surrounding brownish-yellow liver cells

A

Nutmeg Liver

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58
Q

Nutmeg liver’s main cause

A

Right heart failure

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59
Q

defined simply as the process by which blood clots form at sites of vascular injury

A

Hemostasis

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60
Q 
Sequence the steps of hemostasis
A)Formation of platelet plug
B)Deposition of fibrin
C)Arteriolar vasoconstriction 
D)Clot stabilization and resorption
A

C A B D

61
Q

Hemorrhagic disorders are characterized by __

A

characterized by excessive bleeding, hemostatic mechanisms are either blunted or insufficient to prevent abnormal blood loss

62
Q

Thrombotic disorders are characterized by __

A

blood clots (thrombi) form within intact blood vessels or within the chambers of the heart

63
Q

False about transudate
A)non-inflammatory edema fluid
B)high filtration rate but no inflammation; intact vessel wall
C)low protein content, specific gravity of

A

D)results from dec. intravascular hydrostatic or osmotic pressure

Increased

64
Q

False about exudate
A)edema fluid from increased vascular permeability as a result of inflammation B)always occurs in an inflammatory setting
C)damage in vessel wall results to exit of protein
D)low protein content, specific gravity

A

D)low protein content, specific gravity

65
Q

What is anasarca?

A

generalized edema

66
Q

What are effusions?

A

excess fluids in body cavities

67
Q 
All are causes of edema except
A)Increased Hydrostatic Pressure 
B)Decreased Capillary Permeability 
C)Decreased Oncotic Pressure 
D)Increased Sodium Retention 
E)Blockage of Lymphatics
A

B)Decreased Capillary Permeability

Increased dapat

68
Q

True or false: Edema caused by increased hydrostatic pressure is manifested by Congestive Heart Failure.

A

True

69
Q

Identify

A

Peripheral edema

70
Q
A

Pulmonary edema

71
Q

True or false. One can only have either pulmonary edema or peripheral edema.

A

False. Because as the left sided failure increases, the fluid also back clogs into the right ventricle. If it worsens, it also back clogs into the peripheral system

72
Q

physiology of inflammation depends on the status of the blood vessel, true or false?

A

True

73
Q

Oncotic pressure refers to the __ content of the plasma

A

Protein

74
Q

How does decreased oncotic pressure increase possibility of edema?

A

The fluid is not maintained within the vessel, but is flushed out because there is no oncotic pressure pulling the water towards the lumen. What you only have is the hydrostatic pressure transmitted from the heart, which pushes the fluid away from the lumen.

75
Q

How does increased sodium retention lead to edema?

A

Excessive salt intake with renal insufficiency impaired venous repair or arterial dilation –> Increased water retention, aldosterone secretion and hydrostatic pressure

76
Q

Differentiate hemorrhagic infarct from ischemic infarct

A

Ischemic infarct has clotting

77
Q

Identify: necrosis resulting from ischemia caused by obstruction of the blood supply

A

Infarction

78
Q

White infarcts/anemic infarcts: occur in heart, spleen, kidney. How does it come about?

A

Only one artery supplies the organ, once the blood supply is cut, the cells will die. The area stays white because there will be no activation (via blood) of enzymes responsible for liquefaction of the organ

79
Q

How do red/hemorrhagic infarcts cause pathologic condition?

A

there is more than one vessel that supplies the area, and so activation of enzymes will occur. But supply is decreased probably because of hypotension/lack of blood.

80
Q

IDENTIFY

A

Embolus

81
Q

False about Pulmonary Embolus

(1) Originate from deep venous thromboses (DVTs)
(2) least common form of thromboembolic disease
(3) important cause of sudden death, usually occurring in immobilized post-operative patients and those with CHF
(4) immobilization leads to venous thrombosis in lower extremities (usually deep vein thrombosis)

A

(2) least common form of thromboembolic disease

Most dapat

82
Q

What is saddle embolus?

A

fragmented thrombi from DVT are carried eventually into the pulmonary arterial vasculature. When the fragmented thrombi are large enough, it can occlude the main pulmonary artery and straddle the pulmonary artery bifurcation.

83
Q

What is paradoxical embolism?

A

When embolus passes through interatrial or interventricular defect and gain access to systemic circulation

84
Q

What is cor pulmonale?

A

occurs when emboli obstruct 60% or more of the pulmonary circulation

85
Q

What is a mural thrombus?

A

thrombus that adheres to one wall of a heart chamber or major artery

86
Q

IDENTIFY
(1)usually arise from a mural thrombus (2) can travel to a wide variety of sites 3) in general, outcome is tissue infarction

A

Arterial embolus

87
Q

False about arterial embolus:
A) normal: thrombi in the left heart chamber settle in the lungs; B)paradoxical: thrombi in the right heart chamber settle in a hole in the heart affecting circulation
C)both are false
D)both are true

A

(A)

Imbes na left, right dapat

88
Q

What is Cerebral Infarction?

A

Arterial emboli @ Branches of carotid artery, esp middle cerebral artery

89
Q

IDENTIFY
(1) Fractures of long bones (rarely in setting of tissue trauma and burns) rupture vascular sinusoids in the marrow or small venules, allowing marrow or adipose tissue to herniate into the vascular space and travel to the lung (2) lodge in lungs, brain, kidneys and other organs

A

Fat and Marrow embolus

90
Q

Identify

symptomatic fat embolism characterized by pulmonary insufficiency, neurologic symptoms, anemia, and thrombocytopenia

A

Fat embolism syndrome

91
Q

Identify
Gas bubbles within the circulation can coalesce to form frothy masses that obstruct vascular flow and cause distal ischemic injury

A

Air embolism

92
Q

used to stain air embolism into lipid red

A

Sudan stain

93
Q

__ cc is required to have a clinical effect in pulmonary circulation

A

100

94
Q

What is decompression sickness?

A

special form of air embolism caused by sudden decrease in atmospheric pressure

95
Q

Explain the pathophysio of Decompression Sickness

A

6) Air breathed at high pressure causes increasing amount of gas (particularly nitrogen) to be dissolved in blood and tissues. If the diver then ascends (depressurizes) too rapidly, the nitrogen comes out of solution in the tissues and the blood.

96
Q

What is Caisson disease?

A

chronic form of decompression sickness; may lead to ischemic necrosis

97
Q

IDENTIFY

(1) Caused by the infusion of amniotic fluid or fetal tissue into the maternal circulation via a tear in the placental membranes or rupture of uterine veins
(2) can activate the coagulation process and components of innate immunity

A

Amniotic fluid embolism

98
Q

Identify: inappropriate activation of blood clotting in an uninjured vasculature, often causing interruption of blood flow

A

Thrombosis

99
Q

Virchow’s Triad: 3 Primary Influences In Thrombosis Formation
Enumerate!

A

Endothelial Injury
Alterations In Normal Blood Flow
Hypercoagulability

100
Q

endothelial injury may lead to thrombosis formation, why?

A

It can activate clotting factors.

101
Q

Consequences of Endothelial Injury include all except:
A)Exposes subendothelial ECM and tissue factor
B)adhesion of platelets
C) increase of prostaglandins
D) none of the above

A

C) increase of prostaglandins

Depletion dapat

102
Q

Possible consequences of turbulent blood flow include all except
A) Increasing platelet-endothelium contact –>increases chances of platelet activation
B) prevent dilution of activated clotting factors by flowing blood
C) Increase the inflow of clotting inhibitors
D) Atherosclerosis, atrial fibrillation

A

C) Increase the inflow of clotting inhibitors

Decrease dapat.

103
Q

Turbulent blood flow most common in ___

A

Vessels that bifurcate (carotid artery, for example)

104
Q

False about thrombophilia
A. Also called hypocoagulation
B.disruption of balance bet coagulation & anti-coagulation
C. May be caused by gene mutations (Factor V Leiden), anticoagulant deficiencies
D. May also be caused by oral contraceptives, hyperestrogenic state of pregnancy, malignancies and autoimmune diseases

A

A

Hypercoagulation dapat

105
Q

Sequence the steps of thrombus fate
A. Dissolution by fibrinolytic activity
B. Organization and Recanalization, reestablishing flow by ingrowth of endothelial cells, smooth muscle cells, and fibroblasts to create vascular channels
C. Propagation causing complete vessel obstruction
D. Embolization to other sites in the vasculature

A

C D A B

106
Q

False about fibrinolysis
A.Thrombus formation and thrombus dissolution occursin chronologic order. B. Concurrent with thrombogenesis and modulates coagulation
C.Restores blood flow in vessels occluded by thrombus and facilitates healing after inflammation and injury
D. None of the above

A

A.

Once the activation of the clotting cascade occurs, fibrinolysis also occurs.

107
Q

False about arterial thrombi
A. formed in areas of less active blood flow
B. when mature, demonstrate the alternate dark gray layers of platelets (and RBCs) interspersed with lighter layers of fibrin
C. eventually liquefy and disappear or are organized with fibrous tissue formation
D. None of the above

A

A. formed in areas of less active blood flow

Less –> more

108
Q

It can be determined if a clot is pre-mortem or postmortem based on the ___

A

Lines of Zahn (lighter layers of fibrin at thrombus)

109
Q

Identify

A

Venous thrombi

110
Q

Thrombophlebitis. What is it?

A

inflammation of veins with thrombus formation (when you stay very long in bed)

111
Q

False about superficial leg veins’ thrombosis
A)usually in varicose saphenous veins B)causes local congestion and pain
C) embolize often
D) local edema and impaired venous drainage, i.e. skin infections, varicose ulcers

A

C) embolize often

Rarely dapat

112
Q

False about venous thrombosis at deep leg veins
A.in larger veins above the knee (popliteal, femoral and iliac)
B.may cause pain and edema
C.cannot be asymptomatic
D.Prone to develop pulmonary emboli

A

C. Cannot be asymptomatic

May be Asymptomatic in 50% of patients

113
Q

Deep venous thromboses may occur in all except
A) Advanced age, bed rest, or immobilization
B)Congestive heart failure
C)trauma, surgery and burns
D)puerperal and postpartum states
E)none of the above

A

E)none of the above

114
Q

False about Migratory Thrombophlebitis
A. Also called Rousseau Syndrome
B. Commonly seen in patients with pancreatic cancer
C. Both are false

A

A. Also called Rousseau Syndrome

Trousseau dapat

115
Q

False about Disseminated Intravascular Coagulation
A)Both the procoagulant and the anticoagulant are activated at the same time but are not balanced.
B) Separate illness
C)causing activation of clotting cascade.
D)Widespread fibrin microthrombi in the microcirculation.
E)occur most likely at eye, mucosa

A

B) Separate illness

It is an effect of illness, like cancer/sepsis

116
Q

What is Consumption Coagulopathy?

A

Platelets & coagulation factors consumed

117
Q

False about postmortem clots
A)attached to vessel wall
B)two-layered appearance:
C)Currant jelly appearance – red cell-rich layer
D)Chicken fat appearance – cell-poor upper layer

A

A)attached to vessel wall

Hindi siya attached sa vessel wall.

118
Q

refers to blood extravasation following vessel rupture, defects in platelets or coagulation factors

Identify

A

Hemorrhage

119
Q

capillary bleeding can occur with chronic congestion, true or false?

A

True

120
Q

conditions or abnormalities that may increase tendency/risk of having hemorrhage from insignificant injuries

Identify

A

Hemorrhagic diatheses

121
Q

Enumerate the 3 types of superficial hemorrhages. How are they classified?

A

Petechiae
Purpura
Ecchymosis

(According to size)

122
Q

Arrange accdg to increasing size: purpura, petechiae, ecchymosis?

A

Petechiae, purpura, ecchymosis

123
Q

In which diseases can you see petechiae?

A

Dengue hemorrhagic fever, platelet disorders

124
Q

In which diseases can you see purpura?

A

Autoimmune disorders

125
Q

True or false: ecchymosis may be seen in patients with hemophilia

A

True

126
Q

localized blood volume increase in capillaries and small vessels

Identify

A

Hyperemia

127
Q

Differentiate active fr passive hyperemia

A

Active Hyperemia (Hyperemia) - results from localized arterial dilatation Passive Hyperemia (Congestion) -resulting from obstructed venous return or increased pressure form CHF

128
Q

congestion and distention of alveolar capillaries leading to capillary rupture and passage of RBCs into the alveoli; usually due to left heart failure

Identify

A

Chronic passive congestion of the lungs

129
Q

Another name for heart failure cells

A

intraalveolar hemosiderin-laden macrophages

130
Q

Location of heart-failure cells

A

Lungs

131
Q

due to combination of dilated, congested central veins and the surrounding brownish-yellow liver cells

A

Nutmeg Liver

132
Q

Nutmeg liver’s main cause

A

Right heart failure

133
Q

defined simply as the process by which blood clots form at sites of vascular injury

A

Hemostasis

134
Q 
Sequence the steps of hemostasis
A)Formation of platelet plug
B)Deposition of fibrin
C)Arteriolar vasoconstriction 
D)Clot stabilization and resorption
A

C A B D

135
Q

Hemorrhagic disorders are characterized by __

A

characterized by excessive bleeding, hemostatic mechanisms are either blunted or insufficient to prevent abnormal blood loss

136
Q

Thrombotic disorders are characterized by __

A

blood clots (thrombi) form within intact blood vessels or within the chambers of the heart

137
Q

False about transudate
A)non-inflammatory edema fluid
B)high filtration rate but no inflammation; intact vessel wall
C)low protein content, specific gravity of

A

D)results from dec. intravascular hydrostatic or osmotic pressure

Increased

138
Q

False about exudate
A)edema fluid from increased vascular permeability as a result of inflammation B)always occurs in an inflammatory setting
C)damage in vessel wall results to exit of protein
D)low protein content, specific gravity

A

D)low protein content, specific gravity

139
Q

What is anasarca?

A

generalized edema

140
Q

What are effusions?

A

excess fluids in body cavities

141
Q 
All are causes of edema except
A)Increased Hydrostatic Pressure 
B)Decreased Capillary Permeability 
C)Decreased Oncotic Pressure 
D)Increased Sodium Retention 
E)Blockage of Lymphatics
A

B)Decreased Capillary Permeability

Increased dapat

142
Q

True or false: Edema caused by increased hydrostatic pressure is manifested by Congestive Heart Failure.

A

True

143
Q

Identify

A

Peripheral edema

144
Q
A

Pulmonary edema

145
Q

True or false. One can only have either pulmonary edema or peripheral edema.

A

False. Because as the left sided failure increases, the fluid also back clogs into the right ventricle. If it worsens, it also back clogs into the peripheral system

146
Q

physiology of inflammation depends on the status of the blood vessel, true or false?

A

True

147
Q

Oncotic pressure refers to the __ content of the plasma

A

Protein

148
Q

How does decreased oncotic pressure increase possibility of edema?

A

The fluid is not maintained within the vessel, but is flushed out because there is no oncotic pressure pulling the water towards the lumen. What you only have is the hydrostatic pressure transmitted from the heart, which pushes the fluid away from the lumen.

149
Q

How does increased sodium retention lead to edema?

A

Excessive salt intake with renal insufficiency impaired venous repair or arterial dilation –> Increased water retention, aldosterone secretion and hydrostatic pressure

150
Q

Differentiate hemorrhagic infarct from ischemic infarct

A

Ischemic infarct has clotting

PH 122 (17 decks)

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