Hemodynamic Disorders

Question 1

___ is the increased interstitial fluid which produces swelling and is initially painless

Answer 1

edema

Question 2

___ is the accumulation of fluid in the body cavities

Answer 2

effusion

Question 3

What are the 4 causes of edema?

Answer 3

1-too much leakage–increased vascular permeability
2-too little reabsorption–lymphatic obstruction
3-increased capillary hydrostatic pressure
4-reduced plasma oncotic pressure

Question 4

Retention of sodium and thus water like in kidney disease results in what cause of edema?

Answer 4

increased hydrostatic pressure

Question 5

___ determines extracellular fluid volume and osmolarity

Answer 5

sodium

Question 6

Hydrostatic pressure from arterioles results in an outflow of ___ of fluid into extracellular space normally

Answer 6

14 ml/min

Question 7

Oncotic pressure in venules results in inflow of ___ of fluid into vasculature

Answer 7

12 ml/min

Question 8

What accounts for the extra 2ml/min of fluid not involved in hydrostatic or oncotic pressure?

Answer 8

lymphatics

Question 9

What increases hydrostatic pressure? 3 things

Answer 9

1-increased venous pressure (thrombosis, clot, CHF)
2-hypervolemia-sodium retention, acute renal failure
3-arteriolar dilation-inflammation, heat

Question 10

What causes decreased oncotic pressure?

Answer 10

hypoproteinemia-nephrotic syndrome, cirrhosis, malnutrition

Question 11

What are the causes of localized edema? 3

Answer 11

1- DVT
2- lymphatic obstruction
3- acute inflammation

Question 12

What are the causes of generalized edema? 5

Answer 12

• cardiogenic
• nephrogenic
• cirrhosis
• hypoalbumininemia
• steroids

Question 13

___ is extreme generalized edema

Answer 13

anasarca

Question 14

___ is an active process with increased diameter or number of vessels typically due to increased blood supply such as in inflammation

Answer 14

hyperemia

Question 15

___ is a passive process and is due to outflow of blood from an area and it presents blue/red

Answer 15

congestion

Question 16

___ is seen with inflammation and infection, is protein rich, and is seen with increased vascularity and hyperemia

Answer 16

exudate

Question 17

__ is seen with CHF and hypoalbumininemia, is non-inflammatory and is a filtrate of plasma seen with congestion

Answer 17

transudate

Question 18

___ are minute hemorrhages caused by rupture of capillaries or arterioles or low platelet counts

Answer 18

petechiae

Question 19

___ are larger hemorrhages that are caused by rupture of capillaries or arterioles, low platelet counts, trauma, vasculitis, and increased fragility of vessels

Answer 19

purpura

Question 20

___ are bruises

Answer 20

ecchymoses

Question 21

a ___ is a rounded mass hemorrhage with a mass effect on tissue surrounding

Answer 21

hematoma

Question 22

initiation and formation of the platelet plug occur in ___ hemostasis

Answer 22

primary

Question 23

propagation of the coagulation cascade occurs in ___ hemostasis

Answer 23

secondary

Question 24

Fibrinolysis is very important to minimize ___ of tissue distal to the clot

Answer 24

ischemia

Question 25

coumadin affects the ____ pathway of the coagulation cascade

Answer 25

extrinsic

Question 26

heparin affects the ___ pathway of coagulation cascade

Answer 26

intrinsic

Question 27

both heparin and coumadin affect the ___ pathway of coagulation cascade

Answer 27

common

Question 28

Factor ___ is part of the extrinsic pathway

Answer 28

VII

Question 29

Factor ___ is part of the intrinsic pathway

Answer 29

XII

Question 30

___ is the most important coagulation factor

Answer 30

Thrombin

Question 31

The intrinsic pathway is measured by the ____ lab test

Answer 31

PTT

Question 32

The extrinsic pathway is measured by the ___ lab test

Answer 32

PT

Question 33

a ___ is a stationary intravascular blood clot

Answer 33

thrombus

Question 34

___ is an intravascular blood clot that travels

Answer 34

embolus

Question 35

an ___ blood clot causes ischemia and infarction in tissue distal to it

Answer 35

arterial

Question 36

a ___ blood clot causes emboli somewhere else

Answer 36

venous

Question 37

Virchow's triad refers to the classic causes/predispositions for ___ formation; what are the 3 factors?

Answer 37

thrombus formation; hypercoaguable state, endothelial injury, altered blood flow (usually stasis)

Question 38

a venous thrombus usually starts at the ___

Answer 38

valves

Question 39

A ___ thrombus restricts the lumen but does not occlude it

Answer 39

parietal

Question 40

a red thrombus is from ___

Answer 40

venous

Question 41

a white thrombus is from ___

Answer 41

arterial

Question 42

What are Virchow's triad factors in venous blood clots?

Answer 42

1-endothelial injury from trauma or surgery 2-abnormal blood flow-stasis 3-hypercoagulability-OCPs and older folks

Question 43

What are Virchow's triad factors in arterial blood clots?

Answer 43

1-endothelial injury from atherosclerosis 2-abnormal blood flow-turbulence 3-hypercoagulability

Question 44

What are the 3 consequences of arterial occlusion?

Answer 44

1-infarction or dysfunction of tissue perfused by that artery 2-infarcted tissue will undergo scarring and atrophy 3-can embolize to next capillary bed

Question 45

What are the 4 consequences of venous occlusion?

Answer 45

1-edema and pain 2-infarction from embolism to next capillary bed, 3-infarction from back pressure of arterial supply 4-leakage of fibrin that retards oxygen perfusion

Question 46

Venous emboli are usually from the deep veins of ___ and ___ system that go into the pulmonary arteries

Answer 46

thigh and popliteal

Question 47

a ___ embolus gets to systemic circulation through an abnormal communication between the venous and arterial systems at the level of the heart

Answer 47

paradoxical embolism

Question 48

What are the risk factors for arterial thrombi/emboli? 4

Answer 48

atrial fibrillation, endocarditis, MI, valve abnormalities

Question 49

The arterial thrombi usually arise in what 3 places?

Answer 49

1-arteries complicated with atherosclerotic plaques 2-heart chambers 3-site of atherosclerosis/aneurysm

Question 50

Arterial thrombi may embolize to arteries in almost any part of the body with ____ and ___ most common

Answer 50

lower extremities and brain

Question 51

a ___ emboli is a special form of emboli resulting from bone fracture especially in the pelvis which usually affects the pulmonary and CNS

Answer 51

fat

Question 52

a ___ emboli is a special form of emboli from atheromas--atherosclerotic debris--and may resemble a fat embolus

Answer 52

cholestrol

Question 53

a ___ embolus is a special form of emboli that is usually iatrogenic--from injections or surgery--often from acute decompression sickness

Answer 53

gas

Question 54

____ embolus is a special form of emboli in which fetal cells and debris enter the maternal circulation--it is often seen at the end of labor and is often catastrophic--can cause DIC

Answer 54

amniotic fluid

Question 55

___ like talc and cement can also cause special forms of emboli

Answer 55

foreign materials

Question 56

What are the 5 causes of arterial obstruction?

Answer 56

``` 1-atherosclerosis 2-arteriosclerosis 3-arterial spasm 4-compartment syndrome 5-torsion ```

Question 57

arterial spasm is caused by

Answer 57

intense vasoconstriction

Question 58

____ is when an arteriole cannot relax in absence of endothelium due to lack of NO

Answer 58

Furchgott phenomenon

Question 59

Raynaud's phenomenon is often seen in the fingers and is an example of ____

Answer 59

arterial spasm

Question 60

What is the path of compartment syndrome?

Answer 60

perfusion pressure falls below tissue pressure in closed anatomic site --> veins are affected first --> arteries are then affected --> leads to tissue necrosis or functional deficits

Question 61

What are the 5/6 'P's of compartment syndrome?

Answer 61

``` Pain Paresthesia Pallor Paralysis Pulselessness Polar/poikilothermia ```

Question 62

____ is a deformation of forearm with flexion at the wrist that follows muscle infarction and replacement with fibrous tissue

Answer 62

Volkmann's contracture

Question 63

___ can cause infarction--it is a twisting that first causes venous obstruction and with further twisting causes arterial obstruction

Answer 63

torsion

Question 64

____ is similar to torsion but usually occurs due to a hernia or in the colon or small bowel

Answer 64

strangulation

Question 65

___ is decreased blood supply to organ

Answer 65

ischemia

Question 66

damage from infarction depends on what 4 things?

Answer 66

1-type of vascular supply--terminal, dual 2-rate of development of occlusion (acute or chronic) 3-vulnerability of tissue to hypoxia 4-oxygen content of blood

Question 67

Acute infarcts are often ___ due to damage to the endothelium

Answer 67

red

Question 68

___ infarcts are often seen in the heart, kidneys, and spleen from arterial occlusion of terminal arteries

Answer 68

white

Question 69

___ infarcts may be due to either arterial or venous blood system and hemorrhage into the infarct

Answer 69

red

Question 70

___ is a kind of cardiovascular collapse where the blood supply to the body is insufficient to meet the body's demands

Answer 70

shock

Question 71

What are two factors for decreased cardiac output?

Answer 71

1-pump failure--LV is not pumping out enough blood | 2-decreased effective circulating volume--volume is remaining in periphery instead of returning to central

Question 72

In early shock, skin is cold and clammy--why?

Answer 72

the heart tries to compensate by vasoconstricting peripheral blood vessels to shunt blood to necessary organs

Question 73

Later on in shock the skin returns to warm and pink--why?

Answer 73

the pt has reached the point of no return where the compensatory mechanisms fail and vasodilation returns peripheral blood

Question 74

When the kidneys are not perfused the patient becomes ___ which damages the heart further

Answer 74

acidotic

Question 75

___ shock is due to myocardial pump failure as in MI, arrhythmias, cardiac tamponade, PE

Answer 75

cardiogenic

Question 76

___ shock is due to reduced amounts of blood volume as may happen with bleeding, dehydration, burns, and diarrhea

Answer 76

hypovolemic

Question 77

___ shock is due to peripheral vasodilation and increased permeability as well as microbial infection

Answer 77

septic

Question 78

___ shock is due to Type 1 IgE mediated hypersensitivity

Answer 78

anaphylactic

Question 79

___ shock is due to severe brain or spinal cord injury which impairs vasomotor control---can't vasoconstrict

Answer 79

neurogenic

Question 80

sepsis is "_____"--a systemic response to infection

Answer 80

SIRS plus signs of infection

Question 81

The leading cause of septic shock is now considered to be

Answer 81

gram positive bacteria, followed by gram negative bacteria, and then fungi

Question 82

What happens in septic shock?

Answer 82

1-bacteria have structural components of cell walls that cause immune and endothelial cell activation which release cytokines and activate complement which causes a hyperinflammatory state with leaky blood vessels

Question 83

Induction of a procoagulant state in septic shock leads to systemic activation of ___ and deposition of fibrin-rich thrombi in small vessels which leads to ___

Answer 83

thrombin; DIC

Question 84

Death of alveolar cells, acute tubular necrosis of the kidney, liver failure, myocardial cell death, bowel necrosis, and brain ischemia are all consequences of ____

Answer 84

multiple organ dysfunction syndrome

Question 85

In general, how is multi-system organ failure caused?

Answer 85

- -microbial product starts it - -an inflammatory response is activated globally - -cytokines, etc. cause vasodilation, increased permeability and decreased perfusion

Question 86

the ____ stage of shock has a compensatory mechanism that is activated and perfusion of vital organs is maintained

Answer 86

nonprogressive

Question 87

the ___ stage of shock has tissue hypoperfusion which leads to worsening circulatory and metabolic imbalances including lactic acidosis

Answer 87

progressive

Question 88

the ___ stage of shock is when there is so much cell and tissue injury that survival is not possible

Answer 88

irreversible

Question 89

In shock the ____-____-___ system is activated which leads to sodium and water retention; then ___ and ___ cause selective constriction of peripheral vessels to shunt blood to vital organs (heart and brain)

Answer 89

renin-angiotensin-aldosterone; norepinephrine and angiotensin 2

Question 90

How do the vessels respond to norepinephrine and angiotensin 2?

Answer 90

the vessels constrict

Question 91

The vasoconstriction induced by compensatory mechanisms of shock require ATP and when the ATP is depleted there is a switch to anaerobic glycolysis which produces lactic acidosis---what does that result in?

Answer 91

acidosis blunts the vasomotor response and the sodium/potassium pump doesn't function and there is a point of no return where blood pressure can no longer be raised

Question 92

____, released from the posterior pituitary gland, is rapidly poured out and leads to increased water retention and decreased urine output

Answer 92

vasopressin

Question 93

Hypotension, tachycardia, cool clammy skin, tachypnea, oliguria, change in mental status, metabolic acidosis, and multi-system organ failure are all clinical signs of

Answer 93

shock

Question 94

___ is a systematic hypersensitivity involving basophils and mast cells that release cytokines and things like histamine

Answer 94

immediate, type 1 hypersensitivity

Question 95

____ is an autosomal dominant disease with a C1 esterase inhibitor deficiency---can cause asphyxiation and death, follows mild trauma or stress

Answer 95

hereditary angioedema