Chapter 4-test 3

Question Answer
Define disseminated Intra-vascular Coagulation (DIC) multiple thrombi inside vessels, all over the body
What are the four main things that can cause DIC Thrombin activating substances enter the circulation Massive tissue necrosis Immune complexes Endothelial damage
What are some examples causing thrombin activating substances entering the circulation amniotic fluid embolism snake venom cell necrosis
What are some examples causing Massive Tissue necrosis shock obstetric problems acute hepatic necrosis burns cancer
What are some causes of immune complexes cancer, infections, vasculitides
What are some causes of endothelial damage endotoxic shock, viral infections, Rickettsial infections, other infections
Define embolus an abnormal mass of material, that can be solid, a liquid of a gas, present in the circulation that usually ends up lodging in a vessel and producing tissue ischemia or infarction
What are the six types of embolisms Thromboembolism Air Embolism Amniotic fluid embolism fat embolism bone marrow embolism miscellaneous
What is the most common form of embolism? thromboembolism
What type of embolus is a thromboembolism a venous thrombus
What is the site of origin for a thromboembolism deep veins of the legs or anywhere where there is inflammation of a vein
What usually results from a thromboembolism a pulmonary embolus
What are the major effects of a thromboembolism circulatory obstruction if large embolus Flow obstruction to one lung–> exchange problems, death smaller embolus blocks small arteries, breathlessness, chest pain many small lead to pulmonary hypertension
T/F the pulmonary embolism always leads to pulmonary infarction F, because the bronchial arteries are still operating
What is a paradoxical embolus a venous thrombus that ends up in the systemic arterial circulation; production of a venous thrombus
How are pulmonary emboli named? By where they lodge, not where they start
What are the ways that a paradoxical embolus is formed Must be due to a genetic defect allowing it to move from R to L side of the heart; atrial/ventricular septal defect,R to L shunt even though the blood flow should be L to R-blood flow switched due to P change
What is a TIA Transient ischemic attack, 3-5 minute ischemic attack due to a small embolus, neural function stopped but not killed, temporary.
What are some associated symptoms of TIA transient blindness, transient weakness
Define air embolism A large bolus above 100mls that can obstruct blood flow through the heart-sudden death
Define acute decompression sickness due to nitrogen buubles coming out of solutino when a diver ascends to low pressures
What are the emboli associated with acute decompression sickness the bends-emboli in muscles and bones the chokes-in lungs nitrogen emboli-cardiac ischemia,cerebral ischemia
What is Caisson's disease chronic problem of air embolism. especially construction workers exposed daily. Ischemic necrosis of the lungs organs and bones
Amniotic fluid embolism rare complication of child birth that occurs after placenta detached. amniotic fluid can produce DIC because of fetal skin cells, hair. Can occlude vessels in brain and lungs; abrupt ceo placenti
Fat embolism occurs following fracture of long bones in adult. Fat from marrow gets into venous or systemic circulation.
What happens if a fat embolism obstructs venous circulation dyspnea and exchange problems
What happens if a fat embolism obstructs systemic circulation petechial skin rashes and cerebral dysfunction
T/F Bone marrow embolisms are harmless T
Miscellaneous embolism usually seen in IV drug abusers who inject various particulate matter with pharmacological agents.
Define infarction death of a tissue due to decreased blood supply
What causes tissue ischemia arterial and venous obstruction
Is arterial obstruction local or generalized, or both usually local due to atherosclerosis or the thrombus that develops on the top of atherosclerosis
Is venous obstruction local, generalized, or both both. Local due to venous obstruction, generalized due to cardiac failure
How are arterial obstruction effects determined presence of collateral circulation Integrity of collateral circulation Rate of devlp't of obstruction; faster = fatal duration of obstruction tissue susceptibility to ischemia tissue metab rate Pre-existinf state of pt
Which is more likely to survive, tissue with a low or high metabolic rate low, because requires less nutrients therefore can handle slower blood flow
Which organ is most susceptible to ischemia after loss of blood supply the brain; 5-10 minutes
What are some of the causes of venous obstruction (generalized) LVF, RVF
In LVF in what form is pulmonary edema? acute
In LVF in what form is pulmonary congestion chronic
In RVF in what form is acute hepatic enlargement acute
In RVF in what form is hepatic venous congestion chronic
What are the most common causes of chronic RVF LVF, corporal monoly
If there is good collateral drainage, what happens in localized obstruction in a venous thrombosis no effect
define proptosis outward bulging of the eyes due to edema
What are the three different classifications of infarction pale vs red solid vs liquefied sterile vs septic
What type of infarctions are pale or anemic arterial infarctions that occur in solid organs that lack significant collateral circulation
What type of infarctions are red or hemorrhagic occur due to venous obstruction or due to arterial obstruction in organs that have a double blood supply or good collaterals
Where does liquefaction occur in the CNS in the center of an abscess
What type of necrosis is in the majority of necrosis cases coagulative
T/F most infarctions are not sterile F, most are sterile unless caused by a septic emboli, tissue contains bacteria, or there's a colonization from the blood
What is the gross appearance and light microscopy look like of an infarction on day one minimal changes
What is the appearance 2-4 days after an infarction (gross, microscope) coagulative necrosis with rim of acute inflammation, hyperemia neutrophil infiltration and coagulative necrosis
What is the appearance 4-7 days after an infarction (gross and microscopy) Granulation tissue appearing around the edges of the infarction and central softening; thrombus in the artery is undergoing organization macrophages and neutrophils are showing active lysis of fibers
What is the appearance of an infarction after 7-14 days (gross and microscopy) granulation tissue strongly established; artery starting to recannalize and granulation tissue obvious
What does an infarction area look like after 2-10 weeks (gross and microscopy) formation of a fibrous scar; recannalized artery and formation of a fibrous scar
T/F permanent tissues always get repair T
What is the leading cause of mortality and morbidity in the US the results of abnormal blood flow
Define shock inability of the circulation to adequately perfuse the tissues so as to meet their metabolic demands
T/F you always have a decrease in bp during shock F, compensation may be able to maintain the bp
What are the causes of shock hypovolemic, vascular, cardiogenic, obstructive
Define bleeding diathesis abnormal coagulation, can't stop blood flow
What do you loose a lot of after a burn plasma, exudates
What do you loose during neurogenic shock sympathetic tone to muscles
What type of shock is type 1 hypersensitivity anaphylactic
What is atrial myxoma a benign tumor of the endothelium
What two organs are irreversibly affected by shock heart and brain
What complications are associated with shock in the lungs ischemia, hypoxemia, shock lung
What complications are associated with shock in the kidney acute tubular necrosis, anuria
What complications are associated with shock in the heart myocardial ischemia
What complications are associated with shock in the brain ischemia, confusion, coma
What complications are associated with shock in the liver centrizonal necrosis, abnormal function
What complications are associated with shock in the intestines ischemic necrosis, bacteremia, endotoxemia
What percentage of young patients with hypovolemic shock survive 80%
What is the mortality rate of cardiogenic shock? 75%
What other factors determine the prognosis of shock rapidity of appropriate care, presence/absence of other disease, pre-existing state of the patient

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