Neoplasia 5

Question 1

in the non progressive stage of shock, what are some of the compensatory mechanisms

Answer 1

cutaneous and peripheral vasoconstriction –> cool, pale skin; to maintain BP and supply to vital organs

• sympathetic stimulation
• ADH, RAA, etc

Question 2

if the patient is warm then it is more indicative of what kind of shock?

Answer 2

septic

Question 3

what is the underlying situation in the progressive stage of shock?

Answer 3

impaired tissue perfusion but there it is still sufficient to prevent cell injury and death
will see low pH due to anaerobic glycolysis
↓ Cardiac output leading to anoxic endothelial cell injury and leads to DIC

Question 4

what is the effect of low pH in the progressive stage

Answer 4

blunts vasomotor response leading to dilation of arterioles

Question 5

at the irreversible stage of shock, it is characterized by ________

Answer 5

multi organ failure

Question 6

how can hypovolemic shock lead to septic shock?

Answer 6

at the stage of decompensation (irreversible), the ischemic bowel can leak bacteria and lead to septic shock

Question 7

gram ________ bacterial are the most common cause of septic shock

Answer 7

positive

Question 8

with endothelial activation more ___________ thrombotic factors are produced

Answer 8

pro-thrombotic (↑ clot formation) specifically procoagulants and anti-fibrinolytics

Question 9

septic shock patients have ↑ gluconeogenesis due to TNF and IL-1 and stress hormones and leads to _______

Answer 9

insulin resistance, ↓ insulin release and hyperglycemia

Question 10

what are the two effect of hyperglycemia on the inflammatory cells?

Answer 10

• suppresses the phagocytic activity of PMN’s

- ↑ the expression of adhesion molecules on endothelial cells

Question 11

DIC occludes the ________ vessel leading to _________ syndrome

Answer 11

adrenal;

Waterhouse friedrichsen

Question 12

what are metabolic abnormalities seen in septic shock?

Answer 12

• hyperglycemia
• insulin resistance
• initial surge in glucocorticoid release and later depression (waterhouse friedrichsen syndrome)

Question 13

__________ is more resistant to hypoxic injury in shock because they have dual blood supply

Answer 13

lungs

Question 14

most sensitive neurons to hypoxia

Answer 14

pyramidal cells of hippocampus and purkinje cells of the cerebellum

Question 15

watershed infarcts of the brain

Answer 15

region where the ACA meets w/ MCA and it is the first region to die

Question 16

what are some morphological changes seen in ischemic encephalopathy

Answer 16

• edema, mottled discoloration in grey matter
• grey/white junction blurred
• neuronal necrosis
• hemorrhages

Question 17

_______ necrosis is a morphological feature seen in an ischemic heart

Answer 17

contraction band necrosis

Question 18

define thrombosis

Answer 18

inappropriate activation of the formation of a thrombus in an injured vessel or thrombotic occlusion of a vessel after a relatively minor injury

Question 19

what are the three components of Virchow’s Triad

Answer 19

• endothelial injury
• hypercoagulable state
• abnormal blood flow
  all three lead to thrombosis

Question 20

endothelial cell injury in the main cause of ________ thrombi

Answer 20

arterial

Question 21

hereditary causes of hypercoagulability of blood and it is due to a lack of _______

Answer 21

lack of: anticoagulants

• Factor V (Leiden) mutation (most common)
• anti thrombin III deficiency
• Protein C deficiency
• Protein S deficiency