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Pathology > Hemodynamic disorders, thromboemolic disease and shock > Flashcards

Hemodynamic disorders, thromboemolic disease and shock Flashcards

1
Q

Which of the following will cause edema?

A. Hyperalbuminemia
B. Right-sided heart failure
C. Blockage of lymphatics by a neoplastic process
D. Both B and C are correct

A

D

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2
Q

True of edema in inflammation

A. Edema fluid is called a transudate
B. Due to increased capillary permeability
C. Due to renin-angiotensin system activation
D. Both B and C are correct

A

B

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3
Q

A passive process brought about by obstruction in venous blood flow

A. Hemorrhage
B. Congestion
C. Hyperemia
D. Anasarca

A

B

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4
Q

Morphologic evidence of chronic congestion

A. Presence of hemosiderin laden macrophages
B. Constricted vessels with a reddish hue
C. Disintegrated neutrophils
D. Only A and B are correct

A

D

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5
Q

True of petechiae

A. May be due to immunologic disorders
B. Measures > 2 mm
C. May be related to platelet or clotting factor defects
D. Seen in subcutaneous tissues

A

C

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6
Q

Participants in normal hemostasis except

A. Platelets
B. Endothelium
C. Intracellular matrix
D. Coagulation factors

A

C

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7
Q

Primary hemostasis involves

A. Tissue factor
B. Endothelin
C. Fibrin
D. Thrombin

A

B

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8
Q

The phenomenon resulting from obstruction of arterial blood supply or venous drainage and subsequent neurosis of recipient tissues is called

a) haemorrhage
b) congestion
c) infarction
d) hypermia

A

C

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9
Q

A non-inflammatory edema may result from

a) Infection
b) Congestive heart failure
c) Hyperalbuminemia –causes high capillary
osmotic pressure, thus causing
d) DIC

A

B

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10
Q

Extravasation of blood when the vessel wall ruptures is called

a) congestion
b) edema
c) hemorrhage
d) shock

A

C

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11
Q

Hallmark of chronic passive congestion of liver

a) Centrilobular necrosis
b) hemosiderin laden macrophages – Hallmark of CPC of lung
c) fatty changes in hepatocyte
d) neutrophilia

A

A

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12
Q

Edema fluid with a specific gravity of 2 is

a) associated with inflammation – exudate (with proteins, high (>1.012) specific gravity) is a characteristic of inflammatory edema
b) non-inflammatory
c) has low protein contents
d) is a transudate

A

A

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13
Q

Human’s initial response to injury

a) Vasoconstriction
b) vasodilation
c) platelet adhesion
d) activation of coagulation cascade

A

B

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14
Q

The primary hemostastic plug is composed of

a) platelets
b) RBCs –found in the secondary plug
c) WBCs – found in the secondary plug
d) fibrin –secondary plug

A

D

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15
Q

Which of the ff. has a prothrombic property?

a) Prostacyclin
b) Tissue factor
c) Plasmin
d) Thrombomodulin

A

B

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16
Q

In platelet aggregation, platelet to platelet adhesion is mediated by what receptors?

a) Von Willebrand factor
b) Glycoprotein 1b receptor
c) Glycoprotein 2b/3a
d) helper T-cells

A

D

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17
Q

A deficiency of Gp1b receptor results to what condition?

a) Chokes and bends
b) Glanzmann Thrombasthenia
c) Caisson disease
d) Bernard Soulier syndrome

A

D

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18
Q

All factors predisposing to thrombosis except:

a) artherosclerosis
b) hypertension
c) intake of oral contraceptive pills
d) intake of aspirin

A

D

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19
Q

A thrombus, compared to a post mortem clot,

a) is detached
b) has a gelatinous consistency
c) has Lines of Zahn, seen microscopically
d) takes the shape of the vessel wall

A

C

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20
Q

Which of the ff. is a feature of venous thrombus:

a) endothelial injury
b) deep leg veins
c) always occlusive

A

B

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21
Q

True of anemic infarcts

a) in organs with w/ loose connective tissue
b) in organs with dual blood supply
c) wedge-shaped
d) found in the lungs

A

C

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22
Q

The pathogenesis of septic shock starts with which of the following events

a) The binding of lipopolysaccharide capsule (from endotoxin) with leukocytes
b) Activation of cytokines
c) Vasodilation

A

B

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23
Q

A deficiency in Gp1b receptor results to which condition?

a. Chokes and bends
b. Glanzmann Thrombasthenia
c. Caisson Disease
d. Bernard Soulier syndrome

A

D

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24
Q

What is prothromic?

a. Prostacyclin
b. Tissue Factor
c. Plasmin
d. Thrombomodulin

A

B

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25
Q

What results from the rupture of blood vessel walls?

a. Hyperemia
b. Congestion
c. Hemorrhage
d. Hematoma

A

C

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26
Q

What cell comprises primary hemostasis?

a. RBC
b. WBC
c. Platelet

A

C

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27
Q

What is the common cause of increase vascular permeability?

a. Endothelial injury
b. Leukocyte mediated injury
c. Increase in interendothelial space

A

C

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28
Q

The following is true about nitric oxide

a. Promotes vasodilation
b. Also known as your endothelial derived relaxation factor
c. Inhibits platelet adhesion and aggregation
d. AOTA

A

D

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29
Q

Most important cells in hemostasis

a. RBC
b. Lymphocytes
c. Endothelial cells
d. Epithelial cells

A

C

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30
Q

Mechanism of edema in a child with kwashiorkor.

A. Decrease in albumin/protein synthesis
B. Albuminuria
C. Nephrotic Syndrome
D. Chronic passive congestion of the liver

A

C

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31
Q

Cardiac failure cells in chronic pulmonary congestion in the lungs is due to:

A. old hemorrhage
B. predisposition to mural thrombi
C. deceased myocytes
D. cardiac hypertrophy

A

A

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32
Q

The following are causes of edema EXCEPT

A. lymphatic obstruction
B. Na+/H2O retention
C. Congestive Heart Failure
D. Excess albumin production

A

D

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33
Q

What characteristics differentiate a thrombus from a thromboembolus?

A. The thrombus is adherent to the vessel wall
B. The thromboembolus is adherent to the vessel wall
C. Lines of Zahn are seen only in the thrombus
D. Only the thrombus can cause vascular obstruction

A

A

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34
Q

Which of the ff is the incorrect pair:

A. sudden and rapid ascent of scuba divers - air embolism
B. exposure of the lungs due to trauma - air embolism
C. femoral fracture - air embolism
D. complicated gynecological and obstetric procedures - air embolism

A

C

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35
Q

Not seen in lines of zahn

A. Fibrin
B. Erythrocytes
C. Platelets
D. Foam cells

A

*

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36
Q

Hyperemia can be seen in the following except:

A. After a strenuous activity
B. In blushing
C. In menopausal hot flushes
D. In migrating thrombophlebitis

A

*

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37
Q

The common denominator in shock regardless of the underlying cause is:

A. vascular stasis
B. systemic hypoperfusion
C. coagulopathy in intact blood vessels
D. vascular dilation

A

B

38
Q

Case: A 19 year old boy was rushed to the ER due to multiple stab wounds. He had a hypotensive BP and a respiratory rate of 32. Scenario 1: The patient dies on the operating table due to blood loss despite massive blood transfusions. What caused this?

A. Cardiogenic shock
B. Septic shock
C. Anaphylactic shock
D. Hypovolemic shock
E. Neurogenic shock
A

E

39
Q

Scenario 2: The patient survived the operation but they next day experienced severe infection and peripheral vasodilation. Within hours the patient was dead. What caused this?

A. Cardiogenic shock
B. Septic shock
C. Anaphylactic shock
D. Hypovolemic shock
E. Neurogenic shock
A

B

40
Q

During the operation, the patient’s heart stopped beating, the surgeon opened the pericardial sac and noticed large amounts of blood compressing the heart. He drained the blood and started massaging the patient’s heart. The patient survived. What could have been the cause of death if the patient died?

A. Cardiogenic shock
B. Septic shock
C. Anaphylactic shock
D. Hypovolemic shock
E. Neurogenic shock
A

D

41
Q

What is the mechanism of death of a patient who had diarrhea and vomiting due to food poisoning?

A. Cardiogenic shock
B. Septic shock
C. Anaphylactic shock
D. Hypovolemic shock
E. Neurogenic shock
A

D

42
Q

What cells produce the clinical symptoms of anaphylactic shock?

A. Neutrophils
B. Mast Cells
C. Macrophages
D. Lymphocytes

A

B

43
Q

What is the most common clinical manifestation of shock?

A. Fever
B. Difficulty of breathing
C. Tachycardia
D. Hypotension

A

D

44
Q

Respiratory Distress Syndrome is a common complication of shock, presenting clinically as dyspnea, and radiologically as white-out lungs. Which is a characteristic of it?

A. Neutrophils within alveolar cells
B. Proteinaceuos fluid in alveolar spaces
C. Hyaline membrane lining alveolar walls
D. AOTA

A

C

45
Q

Acute Renal Failure is a common complication of shock. Characteristic of increased blood levels of BU and creatinine with red cell cast in urine. Which microscopic finding is most specific to this condition?

A. Mononuclear cells in interstitium
B. Red cells in tubular lumen
C. Mononuclear cells in glomeruli
D. Focal necrosis of tubular epithelial cells

A

D

46
Q

The most common origin of pulmonary embolism

A. Deep leg vein
B. Femoral Vein
C. Aorta
D. Right ventricle

A

A

47
Q

Which of the ff. statements is true for paradoxical embolus?

A. The embolus originates in the arterial system and obstructs the venous flow
B. The embolus originates in the heart and obstructs the arterial flow
C. The embolus originates in the venous system and
obstructs the arterial flow
D. The embolus originates in the heart and obstructs
the venous flow

A

C

48
Q

What must exist for paradoxical embolism to occur?

A. left-sided valvular defect
B. ventricular septal defect
C. foramen ovale
D. all of the above

A

D

49
Q

A 32 y/o woman gave birth after prolonged labor. After which, she experienced difficulty in breathing. After 10 minutes, she died. What embolic material could have caused this?

A. amniotic fluid
B. thrombolytic material
C. air
D. fat

A

A

50
Q

Bends is caused by what embolic material?

A. thrombus
B. amniotic fluid
C. air
D. fat

A

C

51
Q

Elderly people with hip fracture are predisposed to ______ embolism.

A. fat
B. air
C. amniotic fluid
D. tumor

A

A

52
Q

Pale infarcts are usually seen in

A. spleen
B. small intestine
C. lungs
D. brain

A

A

53
Q

Necrosis in myocardial infarction is due to:

A. coagulation necrosis
B. caseation necrosis
C. liquefactive necrosis
D. fat necrosis

A

A

54
Q

Myocardial infarcts may either be pale or red depending on whether this condition occurred or not

A. repair by fibrosis
B. healing
C. reperfusion
D. infiltration by hemosiderin-laden macrophages

A

C

55
Q

Mechanism behind edema formation in filariasis

A. inflammation
B. lymphatic obstruction
C. electrolyte imbalance from worm load
D. decreased protein due to worm load

A

B

56
Q

The mechanism behind bipedal edema due to congestive heart failure is

A. increased oncotic pressure
B. decreased oncotic pressure
C. increased hydrostatic pressure
D. decreased hydrostatic pressure

A

C

57
Q

Fluid in the peritoneal space is termed

A. anasarca
B. hemoperitoneum
C. ascites
D. hydrothorax

A

C

58
Q

Which is a symptom that is more of LHF than RHF:

a. pulmonary edema congestion
b. bipedal edema
c. CPC of liver
d. CPC of spleen

A

A

59
Q

Which is a symptom that is more of LHF than RHF:

a. ascites
b. nutmeg liver
c. orthopnea
d. splenomegaly

A

C

60
Q

What is the mechanism of edema in neoplastic syndrome?

a. increase oncotic pressure
b. decrease oncotic pressure
c. increase hydrostatic pressure
d. decrease hydrostatic pressure

A

B

61
Q

The histological finding on CPC of lungs:

a. fluid in the alveoli
b. microhemorrhages
c. hemosiderin-laden macrophages
d. proteinaceous exudate

A

C

62
Q

The characteristic gross finding of chronic passive congestion in liver is

a. hepatomegaly
b. nutmeg liver
c. hemorrhagic necrosis
d. cirrhosis

A

B

63
Q

Iron- and calcium-containing fibrotic areas in CPC of the spleen:

a. Rokitansky Aschoff nodules
b. Rohr bodies
c. Gamna-Gandy bodies
d. granulomata

A

C

64
Q

The mechanism in formation of a thrombus in an aortic aneurysm:

a. endothelial cell injury
b. turbulent blood flow
c. slow blood flow
d. hypercoagulability of the blood

A

B

65
Q

The primary mechanism in formation of a thrombus in disseminated cancer:

a. endothelial cell injury
b. turbulent blood flow
c. slow blood flow
d. hypercoagulability of the blood

A

D

66
Q

The mechanism in formation of thrombus in coronary artery disease:

a. endothelial cell injury
b. turbulent blood flow
c. slow blood flow
d. hypercoagulability of the blood

A

A

67
Q

What is the characteristic of a thrombus that is not found in a post-mortem clot?

a. currant jelly and chicken fat combination
b. lines of Zahn
c. both
d. neither

A

B

68
Q

Manifestation of shock in the lungs:

a. proliferation of type 2 pneumocytes
b. neutrophils present in alveolar space
c. pulmonary congestion and edema
d. hyaline membrane line the alveoli

A

A/D

69
Q

Shock in the kidney is manifested by:

a. Acute glomerulonephritis
b. Nephritic syndrome
c. Acute tubular necrosis
d. Renal infarct

A

C

70
Q

Lymphatic obstruction is a pathogenetic mechanism behind the localized edema seen in:

a. Liver cirrhosis
b. Nephritic syndrome
c. Elephantiasis
d. Kwashiorkor

A

C

71
Q

Which of the following is not a manifestation of right-sided heart failure?

a. distended jugular vein
b. bipedal edema
c. ascites
d. enlarged spleen

A

A

72
Q

In hemorrhagic necrosis of the liver, which is the most affected area?

a. Centrilobular
b. Peripheral
c. Portal vein
d. Hepatic artery

A

A

73
Q

Which of the following organs has dual blood supply?

a. spleen
b. kidney
c. intestine
d. AOTA

A

C

74
Q

Thrombus that breaks off or travels through the vascular channel:

a. propagating thrombus
b. organizing thrombus
c. emboli
d. infarct

A

C

75
Q

Blushing is a result of:

a. Neurogenic stimulus
b. Hormonal stimulus
c. Cytokines

A

A

76
Q

Passive congestion occurs in:

a. arteriolar system
b. venous system
c. capillary system
d. AOTA

A

B

77
Q

Cause of primary right-sided heart failure:

a. idiopathic pulmonary hypertension
b. pulmonary tuberculosis
c. herpes
d. Left-sided heart failure

A

D

78
Q

Extravasation of blood to connective tissue to form mass-like tissue:

a. petechiae
b. purpura
c. contusion
d. hematoma

A

D

79
Q

Hemarthrosis is the filling of blood in:

a. peritoneum
b. pericardium
c. pleural cavity
d. joints

A

D

80
Q

What is the main pathogenesis of thrombus formation in aortic aneurysm?

a. direct endothelial damage
b. turbulent flow of blood
c. slowed flow of blood
d. thickening of blood

A

C

81
Q

Thrombus fate characterized by invasion by connective tissue and has become firmer and paler.

a. Organization
b. Recanalization
c. Embolization
d. Lysis

A

A

82
Q

Mural thrombus formed after left ventricular wall infarct is primarily due to:

a. Endothelial damage
b. Fast blood flow
c. Slow blood flow
d. Coagulability of blood

A

A/C

83
Q

What is the most common site of deep venous thrombosis?

a. Hepatic veins
b. Pelvic veins
c. Leg veins
d. Mesenteric veins

A

C

84
Q

Homan’s Sign is a characteristic physical finding in:

a. Pulmonary infarction
b. DVT
c. Superior mesenteric artery
d. Mural thrombosis

A

B

85
Q

Expected type of myocardial infarct:

a. Red infarct
b. Pale infarct
c. Both
d. Neither

A

B

86
Q

Type of infarct seen in kidney?

a. Red infarct
b. Pale infarct
c. Either of the above
d. Neither of the above

A

B

87
Q

What is the main pathogenesis of generalized edema in nephrotic syndrome?

a. Poor albumin production due to liver failure
b. Low protein production
c. Increased secretion of albumin
d. Lymphatic obstruction

A

C

88
Q

What is the pathophysiology of forward heart failure in congestive heart failure due to any cause?

a. Venous obstruction
b. Decreased glomerular filtration rate
c. Increased sodium retention
d. AOTA

A

C

89
Q

A 7-year old girl suffered 2nd and 3rd degree burns. She was admitted to the hospital but died 2 days later after presenting with hypotension responsive to fluid intake. Carbon monoxide level not significantly elevated and bacterial culture of her blood negative of organism. What is the probability of the mechanism of death?

a. Hypovolemic shock
b. Septic shock
c. Cardiogenic shock
d. Neurogenic shock

A

A

90
Q

58 year-old obese female had a stroke, became bedridden. Stable for one month suddenly died. On day of death, she had difficulty breathing. Upon autopsy, pathologist found a large pulmonary embolus. What is the most probable mechanism of death?

a. Hypovolemic shock
b. Septic shock
c. Cardiogenic shock
d. Neurogenic shock

A

C

Pathology (6 decks)

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