Path: Hemodynamics 1

Question 1

What is edema?

Answer 1

Swelling of tissue due to increased fluid in interstitial spaces; can be localized or generalized

Question 2

What is the most common cause of edema?

Answer 2

Heart failure

Question 3

What is effusion?

Answer 3

abnormal excess fluid in a serosal body cavity

Question 4

____ is fluid in a pleural cavity, also called ____ ____.

Answer 4

Hydrothorax; pleural effusion

Question 5

Ascites is what?

Answer 5

fluid in the abdominal cavity, also called peritoneal effusion

Question 6

Fluid in the pericardial cavity is called ____ ____.

Answer 6

Pericardial effusion

Question 7

Pulmonary effusion is what?

Answer 7

fluid in the lung

Question 8

Anasarca is ____ ____.

Answer 8

generalized edema

Question 9

Periorbital edema is frequently the first sign of ____ ____ noticed by mothers of 2-6yr ol children.

Answer 9

nephrotic syndrome

Question 10

If finger pressure on edematous subcutaneous tissue leaves a temporary impression, this is called ____ ____.

Answer 10

pitting edema

Question 11

There are five pathophysiologic categories of edema; what are they?

Answer 11

(1) increased hydrostatic pressure
(2) decreased plasma osmotic pressure
(3) lymphatic obstruction
(4) sodium retention
(5) inflammation

Question 12

What are two places that edema can easily accumulate?

Answer 12

periorbital space and scrotum

Question 13

Edema from increased hydrostatic pressure occurs in the leg due to ____; in the lungs due to ____; and in the lower body due to ____.

Answer 13

DVT; left heart failure; right heart failure

Question 14

Heart failure causes decreased renal blood flow, which activates the ____ system.

Answer 14

renin-angiotensin-aldosterone

Question 15

How does increased aldosterone lead to edema?

Answer 15

it causes increased sodium retention, which means increased water retention

Question 16

Edema from decreased plasma osmotic pressure is a feature of nephrotic syndrome due to ______.

Answer 16

protein loss through the kidneys

Question 17

What is the major protein maintaining plasma oncotic pressure?

Answer 17

albumin

Question 18

True or false: edema due to sodium retention is always generalized.

Answer 18

True

Question 19

Edema due to ____ can be localized (like at the site of infection) or generalized (like in SIRS or sepsis).

Answer 19

inflammation

Question 20

Why is edma transudative in generalized inflammatory edema?

Answer 20

In generalized inflammatory edema, chemokines are few throughout the circulation (compared to site of initiating event), so the outpouring is transudative.

Question 21

What is lymphedema?

Answer 21

edema due to lymphatic obstruction

Question 22

Lymphedema is usually localized and caused by what?

Answer 22

tumor, inflammation, surgery, radiation, or scar

Question 23

Lymphedema due to ____ ____ can cause massive edema of elephantiasis.

Answer 23

parasitic filariasis

Question 24

The major signs/symptoms of pulmonary edema are ____ and ____.

Answer 24

dyspnea (difficulty breathing), and crackles (inspiratory crackling sound on auscultation)

Question 25

What type of heart failure is the most common cause of pulmonary edema?

Answer 25

left heart failure (pressure builds up in the pulmonary vein, eventually in the pulmonary capillaries as well)

Question 26

When pulmonary capillary pressure reaches 20mmHg fluid begins to transudate into ____ and causes ____. When the pressure reaches 25mmHg fluid begins to transudate into ____ causing ____.

Answer 26

the interstitium and causes pulmonary interstitial edema; the alveoli causing pulmonary alveolar edema

Question 27

What do "moist or wet crackles" indicate?

Answer 27

pulmonary alveolar edema

Question 28

Low blood levels of ____ cause water to enter cells; this is especially dangerous to the ____.

Answer 28

sodium; brain

Question 29

Neurons die after ___minutes without oxygen.

Answer 29

4

Question 30

Cerebral edema can be fatal due to ____ of cerebellar tonsils into foramen magnum compressing the _______.

Answer 30

herniation (protrusion); brainstem respiratory center

Question 31

What is hypermia (erythema) and what is the most common cause?

Answer 31

an active increase in arterial blood flow; inflammation

Question 32

What is congestion? (in the context of hemodynamics)

Answer 32

a passive decrease of venous outflow

Question 33

True or false: cyanosis is always caused by congestion?

Answer 33

False - congestion causes cyanosis, but it can also occur without congestion

Question 34

What is central cyanosis?

Answer 34

generalized cyanosis resulting from a failure of the lungs to load the blood with oxygen (either because there's a defect in the lungs, or an anatomic abnormality that prevents the blood from flowing through the lungs)

Question 35

Right heart failure causes passive congestion of what organ?

Answer 35

liver

Question 36

The necrosis causing the nutmeg appearance of the liver is mostly due to ... ?

Answer 36

inadequate arterial perfusion of the liver due to passive congestion caused by right heart failure

Question 37

True or False: In the context of hemodynamic, both hyperemia and congestion are common but not serious.

Answer 37

True

Question 38

What are "heart failure cells"?

Answer 38

the appearance of hemophages accumulated in pulmonary alveoli with iron from blood that has leaked into the alveoli due to capillary burst from the high pressure; this is caused by chronic sublethal left heart failure

Question 39

What is the difference between hemorrhage and hematoma?

Answer 39

A hemorrhage is extravasation of blood due to blood vessel rupture. Hematoma is when a hemorrhage is enclosed within tissue.

Question 40

What are petechiae?

Answer 40

tiny (1-2mm) hemorrhages due to platelet deficiency

Question 41

What are purpura?

Answer 41

medium (3-10mm) hemorrhages due to vasculitis or vessel fragility

Question 42

What are ecchymoses?

Answer 42

larger (>1cm) subcutaneous hemorrhages that go from red-blue to blue-green to gold-brown as the hemoglobin breaks down; frequently called bruises but bruise carries the connotation of trauma - ecchymosis not always due to trauma

Question 43

____ is hemorrhage into a pleural cavity.

Answer 43

Hemothorax

Question 44

____ is hemorrhage into a joint.

Answer 44

Hemarthrosis

Question 45

Two big factors that affect the lethality of hemorrhages include:

Answer 45

location & timing

Question 46

What is hemostasis?

Answer 46

formation of a blood clot to "plug" the site of vascular injury

Question 47

What three components regulate hemostasis?

Answer 47

1. vascular wall (endothelium) 2. platelets 3. coagulation cascade

Question 48

What are the four stages of hemostasis at the site of vascular injury?

Answer 48

1) vasoconstriction 2) primary hemostasis 3) secondary hemostasis 4) thrombus and antithrombotic events

Question 49

In stage 1 of hemostasis, there is a brief arteriolar vasoconstriction mediated by ____ ____ mechanisms augmented by local secretion of vasoconstrictors such as ____.

Answer 49

reflex neurogenic mechanisms; endothelin

Question 50

In stage 2 of hemostasis (primary hemostasis) what takes place?

Answer 50

patelet adhesion to thrombogenic ECM

Question 51

What factor mediates platelet adhesion to ECM in stage 2 of hemostasis, and what does it bind to?

Answer 51

von Willebrand factor, binds to the GpIb receptors on platelets

Question 52

What are 2 cytokines released from platelet granules that are associated with platelet activation?

Answer 52

ADP and thromboxane A2

Question 53

In secondary hemostasis, or stage 3, what happens with regard to the coagulation cascade?

Answer 53

activated by tissue factor and platelet factors, the cascade culminates in the conversion of fibrinogen to fibrin by activated thrombin

Question 54

What are the major jobs of thrombin in the coagulation cascade?

Answer 54

- converts fibrinogen to fibrin - stimulates endothelial cells to adhere to neutrophils - stimulates platelets to release TXA2 - activates monocytes and lymphocytes * Plus - later in hemostasis will stimulate endothelial cells to release NO, t-PA, and PC

Question 55

What is the character of the plug or clot formed in stage 4 of hemostasis?

Answer 55

semi-permanent plug of aggregated platelets and polymerized fibrin

Question 56

Counter-regulatory mechanisms limit the hemostatic plug to the site of injury. Describe some of these mechanisms.

Answer 56

- expression of thrombomodulin on endothelial cells (works to activate protein C) - fibrinolytic system (includes t-PA, plasmin, tissue factor pathway inhibitor, antithrombin III, heparin-like molecules, protein S, and urokinase)

Question 57

What is seen in a patient with a deficiency of von Willebrand factor?

Answer 57

a tendency to bleed excessively with surgery/menstruation

Question 58

What is seen in a patient with overactivity of von Willebrand factor? (For bonus points: what is this disorder called?)

Answer 58

a tendency to clot in small blood vessels and then bleed from having used up too many platelets and clotting factors --called thrombotic thrombocytopenic purpura

Question 59

Deficiency of what causes the rare Bernard-Soulier syndrome?

Answer 59

deficiency of platelet GpIb receptors for von Willebrand factor; results in bleeding tendency

Question 60

Deficiency of what causes the rare Glanzmann thrombasthenia syndrome?

Answer 60

deficiency of platelet GpIIb/IIIa receptors; results in bleeding tendency due to deficient platelet aggregation

Question 61

What is eptifibatide (brand Integrilin)?

Answer 61

medication that binds GpIIb/IIIa receptors to inhibit platelet aggregation; used IV for patients who are clotting coronary arteries, or IA for patients with intracerebral clots

Question 62

What is clopidogrel (brand Plavix)?

Answer 62

medication that blocks platelet ADP receptors thereby preventing the conformational change that ADP would induce in the GpIIb/IIIa receptors that would allow them to bind fibrinogen for platelet aggregation