131 Questions
Which of the following is a common symptom of disorders that affect cardiovascular, renal, or hepatic function?
Edema
What is the role of vascular hydrostatic pressure in the movement of fluid in capillaries?
It pushes water and salts out of capillaries into interstitium
What disrupts the balance between hydrostatic pressure and colloid osmotic pressure in vessels?
All of the above
What are protein-rich exudates that are caused by increased vascular permeability caused by mediators? Usually localized to a site of injury or infection.
Inflammatory edema or effusions
What are protein-poor transudates and are common in many diseases, including heart failure, liver failure, renal disease and severe nutritional disorders?
Non-inflammatory edema or effusion
In which type of edema do inflammatory edema and effusions occur?
Localized edema
What can disrupt lymphatic vessels and impair the clearance of interstitial fluid?
All of the above
What is the term for the accumulation of fluid within the adjacent body cavity?
Effusion
Which of the following is a common cause of non-inflammatory edema and effusions?
Heart failure
What term is used to describe the accumulation of interstitial fluid due to lymphatic obstruction?
Lymphedema
Which of the following induces obstructive fibrosis of lymphatic channels and lymph nodes, particularly of lower extremities resulting elephantiasis?
Parasitic infection filariasis
What is the characteristic finding in severe renal disease?
Periorbital edema
Which organ or tissue is most commonly affected by edema?
Subcutaneous tissues
What is the term used to describe edema that is influenced by gravity?
Dependent edema
What is the morphological feature of edema when examined grossly?
Diffuse subcutaneous edema
What is the term used to describe the sign when finger pressure over edematous subcutaneous tissue leaves a depression?
Pitting edema
Which condition may complicate surgical removal and/or irradiation of the breast and associated axillary lymph nodes in patients with breast cancer?
Severe edema of upper extremity
In which parts of the body does edema caused by renal dysfunction often appear initially?
Eyelids
What is the morphological feature of the brain in cases of brain edema?
Narrowed sulci and distended gyri
Which of the following is the process by which blood clots form at sites of vascular injury?
Hemostasis
In which group of disorders are hemostatic mechanisms blunted/insufficient to prevent abnormal blood loss?
Hemorrhagic disorders
In thrombotic disorders, where do blood clots form?
Within intact blood vessels or within the chambers of the heart
What is the morphological feature of the liver in chronic passive congestion?
Visibly red-brown and slightly depressed centrilobular regions
What is the characteristic finding in congestive heart failure in the lungs?
Hemosiderin-laden macrophages in alveolar spaces
What is the term used to describe the accumulation of fluid within the adjacent body cavity?
Effusion
Which of the following terms describes an active process due to arteriolar dilation at sites of inflammation or skeletal muscle during exercise, leading to increased blood flow?
Hyperemia
What is the term used to describe a passive process due to reduced outflow of venous blood from a tissue, which may be systemic due to cardiac failure or local due to isolated venous obstruction?
Congestion
Which body cavity is commonly affected by hydrothorax?
Pleural cavity
What is the term used to describe the accumulation of fluid in the pericardial cavity?
Hydropericardium
What causes the milky color in peritoneal effusions?
Presence of lipids absorbed from the gut
What is the characteristic appearance of exudative effusions?
Cloudy
What is the term used to describe the accumulation of fluid in the peritoneal cavity?
Hydroperitoneum
What is the characteristic color of congested tissues?
Dusky reddish blue
What are the characteristic findings in chronic pulmonary congestion?
Thickened and fibrotic septa, presence of hemosiderin-laden macrophages
Which protein is responsible for mediating platelet adhesion to collagen?
Gplb binding to vWF
What is the consequence of genetic deficiency of vWF or GpIb?
Bleeding disorders
Which molecule is released by platelets to promote further recruitment and activation?
ADP
What is the role of translocating negatively charged phospholipids (PS) during platelet shape change?
Serve as nucleation sites for coagulation factor complexes
Which molecule is principally responsible for platelet aggregation?
TXA2
What is the consequence of genetic deficiency of platelet receptors GpIIb/GpIIIa?
Glanzmann thrombasthenia
Which molecule stimulates irreversible platelet contraction to form a fused mass of platelets?
Thrombin
What is the role of thrombin in platelet aggregation?
Increases aggregation
What does thrombin create that further stabilizes the secondary plug?
Fibrin
What are the two types of granules released during platelet activation?
ADP and TXA2 and CA++
Which pathway is most physiologically relevant in driving coagulation after vascular damage and exposure of tissue?
Extrinsic pathway
What is the additional cofactor for factors II, VII, IX, and X?
Vitamin K
What is the enzyme responsible for converting fibrinogen into crosslinked fibrin?
Thrombin
Which assay measures the efficacy of the extrinsic pathway?
Prothrombin Time (PT) assay
Which assay measures the efficacy of the intrinsic pathway?
Partial Thromboplastin Time (PTT) assay
What is the purpose of the International Normalized Ratio (INR) assay?
To measure the efficacy of the extrinsic pathway
What is the purpose of the Partial Thromboplastin Time (PTT) assay?
To measure the efficacy of the intrinsic pathway
Which factor is responsible for covalently crosslinking fibrin?
Factor XIII
Which of the following factors limits coagulation by washing out activated coagulation factors?
Blood flow past the site of injury
What is the most important plasminogen activator involved in fibrinolysis?
t-PA
Which factors released by the endothelium inhibit platelet activation and aggregation?
PGI2, NO, and ADPase
What is the consequence of endothelial cells losing their anticoagulant properties?
Formation of blood clots at sites of vascular injury
Which molecule stimulates the release of endothelial t-PA and other mediators?
Thrombin
What is the main function of plasmin in fibrinolysis?
To dissolve blood clots
Which molecule is responsible for preventing platelets from binding to vWF?
All of them
What determines whether clot formation, propagation, or dissolution occurs?
The balance between anti-coagulant and pro-coagulant activities of the endothelium
Which molecule is responsible for inhibiting thrombin, IXa, Xa, XIa, and XIIa in the coagulation cascade?
Antithrombin III
What is the clinical utility of heparin?
To stimulate antithrombin III
Which molecule forms a complex with thrombin on the endothelial surface and inhibits Va and VIIIa?
Protein E
What is the role of tissue factor pathway inhibitor (TFPI)?
To inactivate VIIa
What is the function of thrombomodulin and endothelial protein C receptor on the endothelial surface?
To activate protein C
Which molecule loses its ability to activate coagulation factors and platelets when bound in a complex with protein C and protein S on the endothelial surface?
Thrombin
What is the function of protein C in the coagulation cascade?
To cleave and activate coagulation factors
Which molecule binds and activates antithrombin III, leading to the inhibition of thrombin, IXa, Xa, XIa, and XIIa?
Heparin-like molecules
What is the function of the activated complex formed by thrombin, protein C, and protein S on the endothelial surface?
To inhibit Va and VIIIa
Which of the following events describes the process of a thrombus becoming larger by the accumulation of fibrin and platelets?
Propagation
What is the main concern with venous thrombi in the deep leg veins?
Embolization to the lungs
Which of the following events describes the process of a thrombus being dislodged from the vessel and transported elsewhere in circulation?
Embolization
Which of the following events describes the process of recent thrombi being removed by fibrinolysis?
Dissolution
What is the main clinical problem associated with arterial thrombi?
Occlusion of a critical vessel
What is the process by which older thrombi become organized by ingrowth of endothelial cells, smooth muscle cells, and fibroblasts into the fibrin matrix?
Organization and recanalization
What is the term used to describe the formation of a blood clot within a blood vessel?
Thrombosis
What is THE MAIN clinical feature/CONCERN of venous thrombi?
Embolization to the lungs
Which of the following is NOT one of the primary abnormalities that lead to thrombosis according to Virchow's triad?
Platelet activation
Which type of thrombi characteristically occur at sites of stasis?
Venous thrombi
What is believed to have an important role in triggering arterial thrombotic events?
Endothelial dysfunction
Which type of thrombi tend to grow in a retrograde direction?
Arterial thrombi
What is the term used to describe the process of thrombus formation in the heart and arterial circulation?
Clot formation
What is the primary reason for the use of aspirin and other platelet inhibitors in coronary artery disease and myocardial infarction?
To inhibit platelet activation
Which of the following can induce endothelial dysfunction and trigger thrombosis?
All of the above
Which direction do both arterial and venous thrombi tend to propagate?
Toward the heart
What is believed to be a necessary prerequisite for thrombus formation under high shear stress?
Platelet adherence and activation
Which vessels supply the lung with blood?
Pulmonary arteries and bronchial arteries
What is the usual outcome when medium-sized arteries in the lung are obstructed with subsequent vascular rupture?
Pulmonary hemorrhage
Which of the following is the most common cause of pulmonary embolism?
Thrombi
What can multiple emboli over time lead to in the lung?
Pulmonary hypertension
What is the term used to describe an embolus that passes from the venous to the arterial circulation?
Paradoxical embolism
What is the consequence of >60% obstruction of the pulmonary circulation by emboli?
All of the above
What can myocardial infarction predispose to?
Embolism
Where can mural thrombi embolize to cause infarctions?
Brain, kidneys, and spleen
What is the term used to describe the process by which emboli become incorporated into the vascular wall?
Organized
What is the main concern with venous thrombi in superficial veins in the skin?
Pulmonary infarction
What is the term used to describe an embolus that occludes the main pulmonary artery?
Saddle embolus
What is the process by which older thrombi become organized by ingrowth of cells into the fibrin matrix?
Organization
What is the term used to describe an embolus that straddles the bifurcation of the pulmonary arteries?
Saddle embolus
What is the term used to describe an embolus composed of nitrogen bubbles?
Nitrogen embolus
Which type of infarction is frequently fatal?
Bowel infarction
What is the most common cause of infarctions?
Arterial thrombosis
Which type of thrombosis results in congestion rather than infarction?
Venous thrombosis
Which organs are largely affected by venous thrombosis?
Testis and ovary
What is the serious problem in diabetics caused by infarction?
Gangrene
Which of the following best describes an infarct?
An area of cell death caused by lack of blood supply
What is the main cause of an infarct?
Lack of blood supply to the affected tissue
What is the term used to describe the process of occlusion of vascular supply to a tissue?
Ischemia
What is the common pathogenesis of shock associated with systemic inflammation?
Arterial vasodilation and vascular leakage
Which form of shock involves acute vasodilation leading to hypotension and tissue hypoperfusion?
Neurogenic shock
What is the consequence of prolonged shock?
Irreversible tissue injury
Which of the following is a symptom of shock?
Tissue hypoperfusion
What is the term used to describe shock caused by low cardiac output due to myocardial pump failure?
Cardiogenic shock
What is the term used to describe shock caused by low cardiac output due to low blood volume?
Hypovolemic shock
What is the term used to describe shock caused by acute vasodilation leading to hypotension and tissue hypoperfusion?
Anaphylactic shock
Which type of shock presents with warm, flushed skin due to vasodilation?
Septic shock
What is the initial threat to life that precipitates shock?
All of the above
Which phase of shock is dominated by renal insufficiency and lack of urine output?
Second phase
Which type of shock carries a high mortality rate even with state-of-the-art care?
Cardiogenic shock
What complicates shock, particularly if it is due to sepsis or trauma?
Coagulopathy
What is the survival rate of a young healthy patient with hypovolemic shock and appropriate treatment?
80-90%
What is the consequence of shock being prolonged?
All of the above
Which type of bacteria is the most common cause of septic shock?
Gram(+) followed by gram negative
Which cells recognize and are activated by substances derived from microorganisms in septic shock?
Macrophages
What are the main inflammatory responses initiated by activated cells and secreted factors in septic shock?
Vasodilation and increased vascular permeability
What is the standard of care for septic shock?
Treatment of underlying infection with appropriate antibiotics and i.v. fluids
What additional group of bacterial proteins can cause a similar syndrome to septic shock?
Superantigens
What factors contribute to the severity and outcome of septic shock?
Extent and virulence of infection, immune status of the host, presence of other co-morbid conditions, and pattern and level of mediator production
What is the main goal of pressors and supplemental oxygen in the treatment of septic shock?
To maintain systemic pressures and limit hypoxia
Why have attempts to intervene therapeutically with inhibitors for specific mediators in septic shock been limited?
Limited success due to the complexity of factors and interactions underlying sepsis
What do the clinical manifestations of shock depend on?
The precipitating insult
Test your knowledge of disorders affecting cardiovascular, renal, and hepatic function and their association with fluid accumulation in tissues and body cavities. Explore the balance between vascular hydrostatic pressure and plasma colloid osmotic pressure in maintaining fluid homeostasis.
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