Pathology Ch 4 - Hemodynamics (Rb)

Front 1

Describe the action of the following endothelial anti-coagulation factors:

Thrombomodulin, Heparin-like molecule, Thrombin receptor, tissue Plasmin activator.

Back 1

Thrombomodulin (receptor)-->binds Thrombin--> + Protein C.

Heparin-like molecule (receptor)-->binds Antithrombin III---| Xa, IXa.

Thrombin receptor --> Endothelial effects--> Prostacyclin (PGI2), NO, ADP --> inhibit aggregation

tPA --> Fibrinolytic cascade

Front 2

A thrombotic mass that forms on a cardiac valve
(less commonly, on cardiac mural endocardium) is known as _____.

Back 2

A vegetation .
(may produce thromboemboli: Rt heart - embolus to lungs, Lt heart - embolus to brain, spleen, kidney)

Frequently seen w/ infective endocarditis

Front 3

What is a paradoxical embolus?

Back 3

When a right-sided cardiac thrombus crosses a patent Foramen Ovale and enters systemic arterial circulation.

Front 4

Define Trouseeaus' syndrome:

Back 4

Hypercoagulable state w/ malignant neoplasms--> arterial & vanous thromboses.
(also seen in some Cancer pts)

Front 5

Define Adenocarcinoma.

Back 5

A malignant neoplams arising from glandular epithelium --> forms a mass lesion
(endocardial metastases rare)

Front 6

Where would you find an atheroma?

Back 6

Typically form in Arteries
(not in heart valves)

Front 7

Define "Chronic passive congestion"

Back 7

capillary, sinusoidal, or venous stasis of blood w/in an organ. (i.e. lung, liver)

Hint 7

Also called "Nutmeg Liver"

Front 8

Define "Mural Thrombus"

Back 8

Thrombi that form on the surfaces of the heart or LARGE arteries.

(not trombotic lesions on cardiac valves)

Hint 8

May include cardiac chamber, dilated aorta, or major aorta branch.

Front 9

Define Petechiae

Back 9

Pin-point hemorrhage.

Remember the scale:
Petechia<Purpura<Echymoses<Hematoma (Dr. Knollman)

Front 10

Where would you likely see "Phlebothromboses"?

Back 10

In Large Veins

(LV stasis --> phlebothrombosis; swelling w/ pain and tenderness of LE)

Front 11

Pulmonary Edema

Back 11

Ccommon clinical problem. Typically from Left-ventricular failure.

Also: Renal failure, acute resp. distess syndrome, P. infections, hypersensitivity rxns.

Front 12

1-3 days following Long bone fracture, pt presents w/ dyspnea & tachycardia.

Name the respiratory complication.

Back 12

Fat embolism.

Microscopic fat globules enter blood (delayed) from fractured long-bone marrow.

(Cause both mechanical & chem damage)

Hint 12

May present w/ thrombocytopenia

Front 13

61 y/o pt presents w/ incr. serum AST, ALT; lower leg swelling; prominent JVD; nut-meg liver. What's underlying condition?

Back 13

Congestive Heart failure = Rt side.

(with liver necrosis & chronic passive congestion

Front 14

Cholestasis can commonly arises from what?

Back 14

Biliary tract obstruction.

(seen w/ icterus)

Front 15

Define Icterus

Back 15

Jaundiced

Front 16

Name the most common cause of DVT.

Back 16

Vascular stasis (from immobility)

Front 17

What is the role of Nitric Oxide (NO) in clotting?

Back 17

Platelet aggregation INHIBITOR

(also a vasodilator... & microbicidal)

Front 18

What is role of Aspirin in clotting?

Back 18

Aspirin INHIBITS platelet functioning.

Front 19

What is role of Calcium in clotting?

Back 19

Calcium is a cofactor in coagulation pathway.

But hypercalcemia --| minimal effect on clotting.

Front 20

25 y/o woman presents w/ m.status change w/in 24 hrs; rt temporal hemorrhagic infarction (mid Cerebral A occluded). Hx includes pulmonary embolism, miscarriage, false-pos test for syphilis. Also: increased PTT; normal platelets. Likely cause?

Back 20

A hypercoagulability. Pt has anti-phospholipid-protein antibodies (lupus anticoagulant). Seen both with and w/o SLE. Ab binds cardiolipin (syphilis indicator).

Sx: recurrent arterial, venous thrombosis & miscarriages.

Front 21

Define Von Willebrand disease.

Back 21

Platelet adhesion deficit Gp1b receptor on platelet has nothing to bind to --> minimal platelet aggregation -->tendancy to bleed

(not thrombotic)
--vWF produced by normal endothelium (NOT post injury)--

Hint 21

vWF produced by normal endothelium (NOT post injury)

Front 22

Define: Factor V (Leiden)Mutation

Back 22

Coagulation problem.
(PT, PTT normal) Not cleaved; by Protein C.

Front 23

Name mechanism of Tissue plasminogen activator.

Back 23

Thrombolytic agent: generates Plasmin -> cleaves fibrin to dissolve clots.

Front 24

Name Heparin's mechanism of action on clotting

Back 24

Heparin prevents thrombosis by activating anti-thrombin III...

Front 25

49 y/o man stablized following ant. left ventricle infarction. 3 days later, develops severe SOB and decreased Ejec Fraction; dies 2 hrs later. Which microscopic changes likely seen in lungs?

Back 25

See congestion of alveolar capillaries w/ transudate in alveoli.

(acute Left heart failure-->backed up pulmonary vein --> incr. hydrostatic pressure in capillaries)

Hint 25

a- fibrin+neutrophils in lungs?
b- congestion in alv. capillaries w/ transudate in alveoli
c- alveolar fibrosis w/ hemosiderin macrophages
d-purulent exudate in pleural space

Front 26

What happens (expected) in "Decompression Sickness"

Back 26

dissolution of Nitrogen (ascending from deep scuba dive) in blood--> forms gas bubbles--> occludes arterioles.

Hint 26

the bends

Front 27

39 y/o woman presents w/ 3-cm carcinoma in left breast. Left breast is slightly enlarged & overlying skin is thickened, reddish-orange, and pitted. What's with the skin?

Back 27

Lymphatic obstruction. w/ "peau d'orange" appearance

Hint 27

venous thrombosis?
lymphatic obstruction?
Ischemia?
Chronic passive congestion?
Chronic inflammation?

Front 28

Pt presents w/ hx of frequent nose-bleeds and increased menstural flow. petechiae & purpura present on skin of lower extemities. Normal PT, PTT, platelet count. Decreased vonWillebrand Factor activity.
Which clotting step affected?

Back 28

Platelet adhesion.

Decr vWF affects adhesion step only.

Hint 28

where's that picture from lecture?

Front 29

Define Factor V (leiden) mutation; list incidence.

Back 29

Most common genetic hypercoagulability.(2-15% population)

=Factor V mutation resistant to cleavage (Va) by Protein C. --> unchecked coagulation= freq. emboli.

(Disorder of 50% of DVT pts)

Hint 29

(Disorder of 50% of DVT pts)

Front 30

How does cigarette smoking affect clotting?

Back 30

Forms atherosclerotic plaques on Arterial walls.

Front 31

Describe DIC

(Disseminated Intravascular Coagulation)

Back 31

Sudden onset of widespread fibrin thrombi in microcirculation...eventually reverses (fibrolytic) --> severe systemic bleeding.

(consumption coagulopathy; present w/ thrombocytopenia)

Front 32

What is simple causes of gangrene?

Back 32

ARTERIAL Obstruction

(not venous)

Front 33

Describe interplay between Thromboxane (TxA2) and prostacyclin (PGI2) in platelet aggregation.

Back 33

TxA2 (synthesized -COX- from platelets) vasoconstricts and favors platelet aggregation. PGI2 vasodilates and inhibits platelet aggregation.

Front 34

What are the 4 stages of normal hemostasis?

Back 34

1) Reflex Vasoconstriction
2) Primary Hemostasis (platelet recruitment, adhering)
3) Secondary hemostasis =coagulation cascade. (Thrombin activation)
4) Thrombus/Antithrombotic events (tPA, thrombomodulin release)

Front 35

Describe Shock (cardiovascular collapse)

List the 3 categories

Back 35

Systemic hypoperfusison & Hypotension. Decr Cardiac output or blood volume. Affects ==> Brain, Heart, Lungs, Kidney, Adrenals, GI.

1) Cardiogenic - heart "pump failure"
2)Hypovolemic shock - blood/plasma loss
3) Septic shock - mostly by gram-neg infections > gram-pos / fungal

Front 36

Most common cause of Arterial Thrombosis?

Of Venous thrombosis?

Back 36

Arterial Thrombosis = Atherosclerotic damage to v endothelium.

Venous = Stasis of blood

Front 37

Dense alpha granules in Platelets contain/release what?

Back 37

Primarily ADP. Also: fibrinogen, factor V, extra vWF (besides that on healthy endothelial cells), and factor IV (recruit more platelets)

Front 38

Describe Glanzmann's thromboasthenia.

Back 38

Deficieny of GPIIb-IIIa: the platelet receptor that binds/cross-links fibrinogen forming platelet aggregates.

"Fibrinogen Glanzes off platelets" lol.

Front 39

What is the function of Thrombomodulin?

Back 39

Present on intact endothelium, it binds thrombin & activates Protein C (to inhibit coagulation by cleaving Va & VIIIa)

Front 40

What is the role (if any) between diabetes and atherosclerosis?

Back 40

Diabetes mellitus accelerates and worsens atherosclerosis.

Front 41

Define "Organization & Recanalization" as it pertains to hemostasis.

Back 41

The boring of new channels/lumens through a non-dissolved thrombus to allow some blood flow.

Front 42

Describe the clinical terms for sizes of hemorrage.

Back 42

Petechia (pinpoint)
Purpura (3 mm)
Echymosis (1-3 cm)
Hematoma (space/cavity-filling)
Congestion - occurs w/ vascular dilation/pooling within an organ.

Front 43

A pt w/ 15 yr hx of recurrent thromboses develops septicemia; dies of multiple organ failure. Which organ is spared ischemic injury? (Brain, liver kidney, heart, spleen)

Back 43

Liver: it has a dual blood supply (hepatic artery + portal vein)

Front 44

In which organs could a "hemorrhagic infarct" be seen?

Back 44

Those with dual blood-supply: Lungs, Liver, GI tract...

Front 45

What is Aspirin's mechanism of action on clotting?

Back 45

Aspirin --| COX --> TxA2 --> platelet aggregation

Aspirin blocks cyclooxygenase pathway of AA metabolism & eicosanoid production --including Thromboxane A2, which causes vasoconstriction, promotes platelet aggregation.

Front 46

Define: anasarca

Back 46

generalized edema into subQ connective tissue

Front 47

An otherwise healthy woman delivering her full-term infant suddenly turns dyspnic, cyanotic, hypotensive. Seizure & coma follow. What happened? Expected findings?

Back 47

Amniotic Fluid Embolism; placental/uterine vein tears at delivery;

Amniotic fluid--> maternal circulation; embolus -->lungs.
May see fetal squam. cells, lanugo in maternal pulmonary microcirculation.

Front 48

Describe what PTT tests.

Back 48

Patial trhromboplastin time. Screens INTRINSIC path & adequacy of all factors except XIII & VII.
(25-30 sec =normal); Panic >60 sec.

Incr w/: lupus anticoagulant, inhibitors (heparin), vWF disease (sometimes), hemophilia A/B, DIC.