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PATHPROS > HEMODYNAMIC DISEASE, THROMBOEMBOLIC DISORDERS AND SHOCK > Flashcards

HEMODYNAMIC DISEASE, THROMBOEMBOLIC DISORDERS AND SHOCK Flashcards

1
Q

List 2 possible causes for the findings shown in the gross specimen photograph attached.

A

The image shows a mural thrombus in the aortic lumen.

Causes include:

  • ulcerated atherosclerotic plaque
  • aneurysmal dilation
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2
Q

imaging test of choice in pulmonary embolism

A

CT pulmonary angiography

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3
Q

How do septic infarcts occur?

A

occur when infected cardiac valve vegetations embolize or when microbes seed necrotic tissue

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4
Q

See the attached image. List 2 other conditions associated with edema due to the same underlying mechanism responsible for the finidngs seen in the image.

A

Th image depicts lymphedema in filariasis

Underlying mechanism: Lymphatic obstruction

2 other conditions:

Lymphedema after a modified radical mastectomy and radiation therapy

Breast lymphedema (inflammatory carcinoma), due to blockage of subcutaneous lymphatics by malignant cells

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5
Q

See the attached image.

Cause and mechanism?

A

Acute LVF: blood backs up into the lungs –>transudate in alveoli–>pulmonary edema

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6
Q

2 differences between an antemortem thrombus and a postmortem clot

A

An antemortem thrombus is adherent to the vessel wall and is composed of Lines of Zahn.

A postmortem clot is not attached to the vessel wall and does not exhibit lines of Zahn.

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7
Q

See attached image.

List 3 possible causes

A

Diagnosis: Fat embolism

Causes:

a. fractures of long bones
b. soft tissue trauma
c. burns

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8
Q

What word best fits the description provided?

Accumulation of fluid within tissues when the net rate of fluid movement exceeds the rate of lymphatic drainage

A

Edema

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9
Q

2 consequences of acute decompression sickness

A
  1. bends- rapid formation of gas bubbles within skeletal muscles and supporting tissues in and about joints
  2. chokes - respiratory distress due to formation of gas bubbles in the pulmonary vasculature leading to edema, hemorrhage, and focal atelectasis or emphysema
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10
Q

Morphology of lung in shock

A
  1. diffuse alveolar damage
  2. alveolar hyaline membranes
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11
Q

two of the most important causes for arterial thrombosis

A

Atherosclerosis

Endocardial injury

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12
Q

Why do patients with Hashimotos and Grave’s disease develop myxedema?

A

T cell cytokines –>stimulate fibroblasts–>synthesize excess hyaluronic acid

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13
Q

Virchow’s triad of Thrombosis

A

(1) endothelial injury
(2) stasis or turbulent blood flow
(3) hypercoagulability of the blood

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14
Q

Is this an arterial or venous thrombus?

  • Predominant component: friable meshwork of platelets, fibrin, red cells, and degenerating leukocytes.
  • begin at sites of turbulence or endothelial injury
  • tend to grow retrograde
A

Arterial thrombosis

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15
Q

What is the mechanism responsible for the findings shown?

History of chronic alcohol abuse

See attached image

LIver biopsy: Bridging fibrosis

A
  1. Decreased oncotic pressure
  2. Increased hydrostatic pressure within the portal vein due to extensive fibrosis

Forgot the 2nd one, didn’t ya? Gotcha!

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16
Q

What do you mean by organization of a thrombus?

A

ingrowth of endothelial cells, smooth muscle cells, and fibroblasts into a thrombus and eventual incorporation into the vessel wall.

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17
Q

How does turbulent blood flow lead to thrombosis?

A
  1. Disrupts laminar flow –>platelets come in contact with endothelium
  2. Prevents dilution and washout of activated clotting factors
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18
Q

Give one term that best fits the description provided below:

Venous thrombus passage through an Inter atrial or inter ventricular septal defect–> venous embolus–>passes through the defect–> reaches systemic circulation

A

Paradoxical embolism

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19
Q

Give one word that best fits the description

Passage of any material that can lodge in a blood vessel and obstruct its lumen through venous or arterial circulation

A

Embolism

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20
Q

Predominant component of venous thrombi

A

More enmeshed red cells (and relatively few platelets) – hence aka red/stasis thrombi as they mainly occur at sites of stasis

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21
Q

In which condition would you be likely to see the findings shown in the attached image?

A

Waterhouse Friedrichsen syndrome assoc with meningococcal septicemia

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22
Q

3 important clinical consequences of an arterial thrombus

A

a. Critical vessel occlusion
b. formation of a mural thrombus
c. Embolization

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23
Q

Identify the pattern of shock described below:

CVP- Decreased

PCWP- Decreased

CO-Increased

SVR - Decreased

mVO2 - Increased

A

Septic shock

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24
Q

List 4 important possible consequences of a pulmonary embolism​

A
  1. Acute right heart failure–>sudden cardiac death (cor pulmonale)
  2. pulmonary hemorrhage
  3. pulmonary infarction
  4. Chronic thromboembolic pulmonary hypertension
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25
Q

Identify the pattern of shock described below:

CVP- Increased

PCWP- Increased

CO-Decreased

SVR - Increased

mVO2 - Decreased

A

Cardiogenic shock

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26
Q

What pattern of infarction is likley to occur in the organs listed below?

Spleen, kidney, heart

A

Pale/ white

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27
Q

Why is pulmonary infarction a rare occurrence following pulmonary embolism?

A

The lung is supplied by both the pulmonary arteries and the bronchial arteries, and the intact bronchial circulation is usually sufficient to perfuse the affected area. Understandably, if the bronchial arterial flow is compromised (e.g., by left-sided cardiac failure), infarction may occur.

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28
Q

Arterial or venous thrombosis?

calf tenderness associated with forced dorsiflexion of the foot

Clinical image attached

A

Venous thrombosis

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29
Q

4 fates of a thrombus

A
  1. Propagation
  2. Embolization
  3. Dissolution
  4. Organization and recanalization
30
Q

Which condition is this radiographic finding associated with?

A

Saddle embolism – Occlusion of the main pulmonary artery by an embolus that straddles the pulmonary artery bifurcation

31
Q

List 3 examples for edema developing due to decreased oncotic pressure

A
  1. Liver cirrhosis
  2. Protein malnutrition
  3. Nephrotic Syndrome
  4. Protein losing gastroenteropathy
32
Q

How do you establish the diagnosis of protein losing gastro-enteropathy?

A

Increase in alpha 1 antitrypsin clearance

33
Q

What is the mechanism responsible for the morphologic findings shown in the attached image?

A

Increased hydrostatic pressure in the pulmonary capillaries

34
Q

Morphologic features of chronic passive lung congestion

A

alveolar septal fibrosis

hemosiderin-laden macrophages aka “heart-failure cells.”

brown induration

35
Q

Give one microscopic term that best fits this appearance of the liver biopsy in a patient with acute right ventricular failure

  1. central vein and sinusoids are distended.
  2. centrilobular hepatocytes may undergo ischemic necrosis
  3. Periportal hepatocytes – fatty change
A

Acute liver congestion

36
Q

Most frequent cause of septic shock

A

gram-positive bacterial infections

37
Q

Identify the pattern of shock described below:

CVP- Decreased

PCWP- Decreased

CO-Decreased

SVR - Increased

mVO2 - Decreased

A

Hypovolemic shock

38
Q

Hyperemia or congestion?

a. passive process
b. results from reduced outflow of blood from a tissue
c. Affected tissues take on a dusky reddish-blue color (cyanosis) due to red cell stasis and the presence of deoxygenated hemoglobin

A

Congestion

39
Q

Why does edema develop in right heart failure?

A

Increased PH in the venacava–>transudate enters the interstitial tissue around the ankle and lower legs–>pitting edema

40
Q

Microscopic morphology of kidney in shock

A

acute tubular necrosis

41
Q

When does transudation occur in a vessel (with reference to PH and PO ) ?

A

When PH >PO

42
Q

What is the mechanism of development of edema in a person with cellulitis?

A

Increased permeability of venules due to inflammation

43
Q

Consequence of thrombosis of the superior mesenteric vein

A

hemorrhagic small-bowel infarction

44
Q

Gross morphologic appearance of chronic passive congestion of the liver

A

centrilobular regions are grossly red-brown and slightly depressed (because of cell death) and are accentuated against the surrounding zones of uncongested tan liver (nutmeg liver)

45
Q

Hyperemia or congestion?

  1. active process
  2. arteriolar dilation –> increased blood flow
  3. Affected tissues turn red (erythema) because of increased delivery of oxygenated blood.
A

Hyperemia

46
Q

Pathophysiologic mechanism of amniotic fluid embolism

A

tear in the placental membranes or rupture of uterine veins–>infusion of amniotic fluid/fetal tissue into the maternal circulation

47
Q

Cerebral atrophy or cerebral edema?

Gross specimen of brain showing narrowed sulci and widened gyri

A

Cerebral edema

48
Q

Consequence of chronic decompression sickness

A

multiple foci of ischemic necrosis

49
Q

Identify the pattern of shock described below:

CVP- Decreased

PCWP- Decreased

CO-Decreased

SVR - Decreased

mVO2 - Decreased

A

Neurogenic shock

50
Q

What term best fits the description provided?

Accumulation of fluid within the body cavity when the net rate of fluid movement exceeds the rate of lymphatic drainage

A

Effusion

51
Q

Diagnosis?

History of prolonged immobilization following surgery

Sudden onset dyspnea, Pleuritic chest pain, Tachypnea,Tachycardia

EKG: “S1Q3T3” pattern

A

Pulmonary embolism

52
Q

What is the mechanism of development of edema common to all the clinical conditions listed below?

  1. Congestive heart failure
  2. Constrictive pericarditis
  3. Ascites (liver cirrhosis)
  4. Venous obstruction or compression
  • Thrombosis
  • External pressure (e.g., mass)
  • Lower extremity inactivity with prolonged dependency
A

Increased hydrostatic pressure

53
Q

When does reabsorption occur in a vessel (with reference to PH and PO ) ?

A

When PO > PH

54
Q

Trace the route taken by a thrombus arising in the deep veins and causing pulmonary embolism

A

DVT–>fragmented thrombus–>larger veins–>right heart–>pulmonary arterial tree

55
Q

Most common site for venous thrombi

A

lower extremity veins (90%)

56
Q

List 2 clinical conditions assoc with sodium and water retention, leading to edema

A

Chronic renal failure

Congestive heart failure

57
Q

Why does edema develop in left heart failure?

A

Increased PH in the pulmonary capillaries——> transudate enters the alveoli & interstitium of the lungs–> pulmonary edema

58
Q

What’s your diagnosis?

lungs are two to three times their normal weight

Sectioning yields frothy, blood-tinged fluid

A

Pulmonary edema

59
Q

How does pulmonary edema cause deleterious clinical consequences?

A

impede oxygen diffusion, creates a favorable environment for bacterial infection

60
Q

Give one word that best fits the description provided below:

grossly and microscopically apparent laminations

pale platelet and fibrin deposits alternating with darker red cell–rich layers

A

Lines of Zahn

61
Q

List important conditions favoring deep vein thrombosis

A
  1. Vascular stasis
  2. Injury and inflammation
  3. Hypercoagulability
  4. Advanced age
  5. Sickle cell disease
62
Q

Morphologic feature of amniotic fluid embolism

A

presence of squamous cells shed from fetal skin, lanugo hair, fat from vernix caseosa, and mucin derived from the fetal respiratory or gastrointestinal tract in the maternal pulmonary micro­vasculature

63
Q

5 underlying possible mechanisms for red/hemorrhagic infarct

A
  1. venous occlusion
  2. in loose, spongy tissues
  3. tissues with dual circulations
  4. in tissues previously congested by sluggish venous outflow
  5. when flow is reestablished to a site of previous arterial occlusion and necrosis
64
Q

What is the pathophysiology?

  • sudden onset of tachypnea
  • dyspnea
  • tachycardia

diffuse petechial rash

Microscopic image of lung attached

A

Diagnosis: Fat embolism

Pathophysiology: Injuries–>rupture vascular sinusoids in the marrow/small venules–>marrow/adipose tissue herniates into the vascular space–>lung

65
Q

Give one word that best fits the description provided

an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage

A

Infarct

66
Q

What’s the most likely underlying mechanism?

A

arterial occlusion in a solid organ with end-arterial circulation resulting in a pale infarct

67
Q

List 2 possible causes for the findings shown in the gross specimen photograph attached.

A

The image shows a mural thrombus in the heart chambers.

Causes include:

  1. Arrhythmias
  2. dilated cardiomyopathy
  3. myocardial infarction
  4. myocarditis
68
Q

What’s the diagnosis?

sudden onset of dyspnea

tachypnea

pleuritic chest pain

and hemoptysis

see attached clinical image

A

Pulmonary infarction (hemorrhagic/red infarct)

69
Q

What pattern of infarction is likley to occur in the organs listed below?

Testes, ovaries, lung, small bowel

A

Red/hemorrhagic infarct

70
Q

List 2 conditions where turbulent flow may be encountered

A
  1. Ulcerated atherosclerotic plaque
  2. Aneurysms
  3. Mitral stenosis secondary to RHD assoc with LA dilation and atrial fibrillation
  4. Polycythemia vera
  5. Sickle cell anemia
71
Q

What is meant by recanalization of a thrombus?

A

Formation of capillary channels that help re-establish continuity of a vessel that has been occluded by a thrombus.

72
Q

Why do you get Cortical cell lipid depletion in the adrenal gland in shock?

A

Because of conversion of the relatively inactive vacuolated cells to metabolically active cells that utilize stored lipids for the synthesis of steroids

PATHPROS (36 decks)

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