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48 Cards in this Set

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

Thrombomodulin, Heparin-like molecule, Thrombin receptor, tissue Plasmin activator.
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
A thrombotic mass that forms on a cardiac valve
(less commonly, on cardiac mural endocardium) is known as _____.
A vegetation .
(may produce thromboemboli: Rt heart - embolus to lungs, Lt heart - embolus to brain, spleen, kidney)

Frequently seen w/ infective endocarditis
What is a paradoxical embolus?
When a right-sided cardiac thrombus crosses a patent Foramen Ovale and enters systemic arterial circulation.
Define Trouseeaus' syndrome:
Hypercoagulable state w/ malignant neoplasms--> arterial & vanous thromboses.
(also seen in some Cancer pts)
Define Adenocarcinoma.
A malignant neoplams arising from glandular epithelium --> forms a mass lesion
(endocardial metastases rare)
Where would you find an atheroma?
Typically form in Arteries
(not in heart valves)
Define "Chronic passive congestion"
capillary, sinusoidal, or venous stasis of blood w/in an organ. (i.e. lung, liver)
Also called "Nutmeg Liver"
Define "Mural Thrombus"
Thrombi that form on the surfaces of the heart or LARGE arteries.

(not trombotic lesions on cardiac valves)
May include cardiac chamber, dilated aorta, or major aorta branch.
Define Petechiae
Pin-point hemorrhage.

Remember the scale:
Petechia<Purpura<Echymoses<Hematoma (Dr. Knollman)
Where would you likely see "Phlebothromboses"?
In Large Veins

(LV stasis --> phlebothrombosis; swelling w/ pain and tenderness of LE)
Pulmonary Edema
Ccommon clinical problem. Typically from Left-ventricular failure.

Also: Renal failure, acute resp. distess syndrome, P. infections, hypersensitivity rxns.
1-3 days following Long bone fracture, pt presents w/ dyspnea & tachycardia.

Name the respiratory complication.
Fat embolism.

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

(Cause both mechanical & chem damage)
May present w/ thrombocytopenia
61 y/o pt presents w/ incr. serum AST, ALT; lower leg swelling; prominent JVD; nut-meg liver. What's underlying condition?
Congestive Heart failure = Rt side.

(with liver necrosis & chronic passive congestion
Cholestasis can commonly arises from what?
Biliary tract obstruction.

(seen w/ icterus)
Define Icterus
Name the most common cause of DVT.
Vascular stasis (from immobility)
What is the role of Nitric Oxide (NO) in clotting?
Platelet aggregation INHIBITOR

(also a vasodilator... & microbicidal)
What is role of Aspirin in clotting?
Aspirin INHIBITS platelet functioning.
What is role of Calcium in clotting?
Calcium is a cofactor in coagulation pathway.

But hypercalcemia --| minimal effect on clotting.
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?
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.
Define Von Willebrand disease.
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)--
vWF produced by normal endothelium (NOT post injury)
Define: Factor V (Leiden)Mutation
Coagulation problem.
(PT, PTT normal) Not cleaved; by Protein C.
Name mechanism of Tissue plasminogen activator.
Thrombolytic agent: generates Plasmin -> cleaves fibrin to dissolve clots.
Name Heparin's mechanism of action on clotting
Heparin prevents thrombosis by activating anti-thrombin III...
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?
See congestion of alveolar capillaries w/ transudate in alveoli.

(acute Left heart failure-->backed up pulmonary vein --> incr. hydrostatic pressure in capillaries)
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
What happens (expected) in "Decompression Sickness"
dissolution of Nitrogen (ascending from deep scuba dive) in blood--> forms gas bubbles--> occludes arterioles.
the bends
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?
Lymphatic obstruction. w/ "peau d'orange" appearance
venous thrombosis?
lymphatic obstruction?
Chronic passive congestion?
Chronic inflammation?
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?
Platelet adhesion.

Decr vWF affects adhesion step only.
where's that picture from lecture?
Define Factor V (leiden) mutation; list incidence.
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)
(Disorder of 50% of DVT pts)
How does cigarette smoking affect clotting?
Forms atherosclerotic plaques on Arterial walls.
Describe DIC

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

(consumption coagulopathy; present w/ thrombocytopenia)
What is simple causes of gangrene?
ARTERIAL Obstruction

(not venous)
Describe interplay between Thromboxane (TxA2) and prostacyclin (PGI2) in platelet aggregation.
TxA2 (synthesized -COX- from platelets) vasoconstricts and favors platelet aggregation. PGI2 vasodilates and inhibits platelet aggregation.
What are the 4 stages of normal hemostasis?
1) Reflex Vasoconstriction
2) Primary Hemostasis (platelet recruitment, adhering)
3) Secondary hemostasis =coagulation cascade. (Thrombin activation)
4) Thrombus/Antithrombotic events (tPA, thrombomodulin release)
Describe Shock (cardiovascular collapse)

List the 3 categories
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
Most common cause of Arterial Thrombosis?

Of Venous thrombosis?
Arterial Thrombosis = Atherosclerotic damage to v endothelium.

Venous = Stasis of blood
Dense alpha granules in Platelets contain/release what?
Primarily ADP. Also: fibrinogen, factor V, extra vWF (besides that on healthy endothelial cells), and factor IV (recruit more platelets)
Describe Glanzmann's thromboasthenia.
Deficieny of GPIIb-IIIa: the platelet receptor that binds/cross-links fibrinogen forming platelet aggregates.

"Fibrinogen Glanzes off platelets" lol.
What is the function of Thrombomodulin?
Present on intact endothelium, it binds thrombin & activates Protein C (to inhibit coagulation by cleaving Va & VIIIa)
What is the role (if any) between diabetes and atherosclerosis?
Diabetes mellitus accelerates and worsens atherosclerosis.
Define "Organization & Recanalization" as it pertains to hemostasis.
The boring of new channels/lumens through a non-dissolved thrombus to allow some blood flow.
Describe the clinical terms for sizes of hemorrage.
Petechia (pinpoint)
Purpura (3 mm)
Echymosis (1-3 cm)
Hematoma (space/cavity-filling)
Congestion - occurs w/ vascular dilation/pooling within an organ.
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)
Liver: it has a dual blood supply (hepatic artery + portal vein)
In which organs could a "hemorrhagic infarct" be seen?
Those with dual blood-supply: Lungs, Liver, GI tract...
What is Aspirin's mechanism of action on clotting?
Aspirin --| COX --> TxA2 --> platelet aggregation

Aspirin blocks cyclooxygenase pathway of AA metabolism & eicosanoid production --including Thromboxane A2, which causes vasoconstriction, promotes platelet aggregation.
Define: anasarca
generalized edema into subQ connective tissue
An otherwise healthy woman delivering her full-term infant suddenly turns dyspnic, cyanotic, hypotensive. Seizure & coma follow. What happened? Expected findings?
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.
Describe what PTT tests.
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.