Parsa - Hemodynamic Disorders

Question 1

What are the cellular components that are most frequently damaged by injurious stimuli?

Answer 1

1. mitochondria
2. cell membranes
3. the machinery of protein synthesis and packaging
4. DNA in nuclei

Question 2

What are the components that contribute to thrombosis

Answer 2

1. sub endothelial collagen
2. platelets
3. coagulation system

Question 3

what is endothelial injury due to

Answer 3

hypercholesterolemia or

1. inflammation bc if exposure of sub endothelial collagen
2. platelet adhesion and aggregation at the site of injury to form a primary platelet plug

Question 4

what are the lab findings of endothelial injury

Answer 4

1. inflammation: c -reactive protein
2. infection: sepsis
3. massive tissue destruction:

Question 5

what does platelet adhesion and aggregation depend on

Answer 5

1. von wildebrand factor that functions as an adhesion bridge between sub endothelial collagen and the glycoprotein lb platelet receptor
2. fibrinogen bridging Gplb-illa receptors on diff platelets accomplishing aggregation.

Question 6

What is the clinical assessment of platelets

Answer 6

1. spontaneous mucosal bleeding.

2. petechiae and ecchymoses

Question 7

how is clotting initiated in the lab via the intrinsic way?

Answer 7

1. adding phospholipids, calcium, and either a negative charged substance such as glass beads
   * factor 12

Question 8

how is clotting initiated in the lab via the extrinsic pathway

Answer 8

via tissue factor, a membrane bound glycoprotein that is expressed by sub endothelial cells. Activates factor VII

Question 9

how is clotting initiated in the lab via the extrinsic pathway

Answer 9

via tissue factor, a membrane bound glycoprotein that is expressed by sub endothelial cells.

Question 10

Which assay assesses the function of the protein in the extrinsic pathway

Answer 10

PT (Prothrombin time) *factor 7

Question 11

Which assay assesses the function of the protein in the extrinsic pathway

Answer 11

PT (Prothrombin time)

Question 12

Among the coagulation factor which is the most important?

Answer 12

thrombin

Question 13

Among the coagulation factor which is the most important?

Answer 13

thromin

Question 14

What are the lab and clinical assessment for the the coagulation system

Answer 14

1. severe liver disease inteferes with production of fibrinogen factors: 2, 5, 7-11
2. patients on anticoagulant hterapy
3. patients with vitamin K deficiency

Question 15

What are factor deficiencies for the coagulation system

Answer 15

1. hemophilia A: factor 7 deficiency

2. Hemophilia B: factor 9 deficiency

Question 16

What are the two types of gaining hypercoagulability

Answer 16

1. primary (genetic)

2. secondary (acquired)

Question 17

Point mutaiton in Factor ____ is in people who have genetic hyper coagulability. Also the G20210A mutation increases _____ levels.

Answer 17

V; Leiden. ; prothrombin

Question 18

what are secondary hyper coagulability states

Answer 18

1. Prolonged bedrest/immbolization
2. Myocardial infarction
3. atrial fibrillation
4. tissue injury
5. cancer
6. DIC
7. heparin induced thrombocytopenia
8. antiphospholipid antibody syndrome
9. SCA, smoking, contraceptives

Question 19

how do we prevent thrombosis?

Answer 19

aspirin

Question 20

what are the substances in the endothelium that inhibit platelet aggregation

Answer 20

1. PGI2 (prostaglandin)
2. NO (nitric oxide)
3. ADP
4. vasodilation

Question 21

what dose aspirin block

Answer 21

thromboxane A2

Question 22

what is the principle anticoagulant that regulates protein responsible for inactivating some of the clotting proteins

Answer 22

antithrombin III

Question 23

When antithrombin III binds to _____ it becomes 1000 fold more effective as an inhibitor of thrombin

Answer 23

heparin

Question 24

what does HIT stand for

Answer 24

heparin induced thrombocytopenia

Question 25

The most devastating side effect of heparin is its ability to form a complex with ____ that can generate formation of heparin/PF4 antibodies. in some pts, IgG Ab can bind to the Fc receptor on the platelets which leads to activation, aggregation and consumption of platelets and thrombus formation.

Answer 25

PF4 (platelet factor 4)

Question 26

warfarin acts by antagonizing Vitamin ____

Answer 26

K

Question 27

if there is excessive thrombin formation, we give ____ and urokinase which are plasminogen activators that promote breakdown of thrombin once its formed

Answer 27

streptokinase

Question 28

what does DIC stand for

Answer 28

1. Disseminated Intravascular coagulation

Question 29

what is DIC

Answer 29

when patients develop numerous micro thrombi throughout their circulation and get excessive bleeding.

Question 30

what are two major mechanisms that activate DIC

Answer 30

1. release of thermoplastic substances into the circulation

2. widespread injury to endothelial cells (sepsis)

Question 31

the major mechanisms that trigger DIC by release of thermoplastic substances include:

Answer 31

1. endotoxin in gram - sepsis
2. obstetric complications
3. malignant tumors
4. traumatized or necrotic tissue

Question 32

the major mechanisms that trigger DIC by widespread injury to endothelial cells include

Answer 32

1. endotoxin in gram - sepsis
2. Ag/Ab complexes
3. Temperature extremes

Question 33

what does embolism refer to

Answer 33

impaction of blood vessel by an embolus which becomes lodged within a vessel and prevents further blood flow past this point

Question 34

what is an embolus

Answer 34

a detached Intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its origin.

Question 35

What are the different types of emboli

Answer 35

1. Thromboemboli
2. paradoxical emboli
3. fat emboli
4. atheroma emboli
5. amniotic fluid emboli
6. gas emboli