Hemodynamics II

Question 1

What element do the processes of the coagulation pathway depend on? What are they antagonized by?

Answer 1

Depend on Ca2+

Antagonized by coumadin

Question 2

What happens when thrombin encounters NORMAL endothelium?

Answer 2

Changes from procoagulant to anticoagulant so clotting doesn’t extend beyond site of vascular injury

Question 3

What are three limiting factors of coagulation?

Answer 3

1. Dilution - blood flow removes coag factors, which are cleared by liver
2. Need for negatively charged phospholipids - as platelets are used, less of surfaces are available
3. Endothelial secretion of anti-coag factors

Question 4

What protein breaks down fibrin and interferes with its polymerization? What does the breakdown result in?

Answer 4

Plasmin - results in fibrin split products that acts as weak anti-coags

Question 5

How is plasmin generated?

Answer 5

Catabolizing plasminogen by a factor XII-dependent pathway or tissue plasminogen activator (t-PA)

Question 6

How is t-PA synthesized?

Answer 6

Endothelium synthesizes it

Question 7

Name the massive hemorrhagic disorder associated with each:

1. Rupture of aorta
2. Rupture into abdomen
3. Rupture of heart of aorta as a complication

Answer 7

1. Marfan syndrome
2. Aortic abdominal aneurysm
3. MI

Question 8

Name 3 mild bleeding tendencies.

Answer 8

1. vWF deficiency
2. Aspirin consumption
3. Uremia

Question 9

What is epistaxis?

Answer 9

Nosebleeds

Question 10

What is menorrhagia?

Answer 10

Excessive menstruation

Question 11

What bleeding defect is characteristic of hemophilia?

Answer 11

Hemarthrosis

Question 12

What bleeding disorder can result from chronic recurrent blood loss?

Answer 12

Iron deficiency anemia

Question 13

What is Virchow’s triad?

Answer 13

Factors that lead to thrombosis:

1. Endothelial injury
2. Abnormal flow - turbulence or stasis
3. Hypercoagulability

Question 14

What is the adjective to describe normal blood flow?

Answer 14

Laminar

Question 15

What disease is associated with the following alterations in blood flow:

1. Non contractile heart muscle
2. Dilated atrium promoting turbulence
3. Causes small vessel stasis
4. Impedes blood flow in small vessels

Answer 15

1. Acute MI
2. Rheumatic mitral valve stenosis
3. Hyperviscosity (polycythemia vera)
4. Sickle cell

Question 16

What are the two types of hypercoagulability?

Answer 16

Primary - genetic

Secondary - acquired

Question 17

Point mutations in what gene are most common in primary hypercoagulability? Name an additional mutation as well.

Answer 17

Factor V gene - Leiden mutation

Leads to inactivation of protein C and loss of antithrombotic pathway

Could also be prothrombin gene mutation - increases risk of venous thrombosis

Question 18

Elevated levels of what contribute to arterial and venous thrombosis? Deficiency of what can cause this?

Answer 18

Homocyteine

Deficiency of cystathione beta-synthetase

Question 19

What common drug can lead to increased hepatic formation of coag factors?

Answer 19

Oral contraceptives

Question 20

What are two important clinical issues involving secondary hypercoagulability?

Answer 20

1. Heparin-induced thrombocytopenia

2. Antiphospholipid antibody syndrome

Question 21

Antibodies in antiphospholipid antibody syndrome can give a false positive test for what disease?

Answer 21

Syphilis

Question 22

4 steps in fate of a thrombus.

Answer 22

1. Propagation - grows
2. Embolization - breaks off and moves
3. Dissolution - fibrinolysis
4. Organization & recanalization - inflammation & repair, new lumen created