Scalia Circulatory disorders
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Questions and Answers

Which of the following is a common symptom of disorders that affect cardiovascular, renal, or hepatic function?

  • Edema (correct)
  • Muscle pain
  • Fever
  • Headache

    • 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 (correct)
  • It drains fluid via lymphatics back to circulation
  • It pulls water and salts back into vessels
  • It balances the tendency of plasma colloid osmotic pressure

    • What disrupts the balance between hydrostatic pressure and colloid osmotic pressure in vessels?

  • Elevated hydrostatic pressure
  • Diminished colloid osmotic movement
  • All of the above (correct)
  • None 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.

    <p>Inflammatory edema or effusions</p> Signup and view all the answers

    What are protein-poor transudates and are common in many diseases, including heart failure, liver failure, renal disease and severe nutritional disorders?

    <p>Non-inflammatory edema or effusion</p> Signup and view all the answers

    In which type of edema do inflammatory edema and effusions occur?

    <p>Localized edema</p> Signup and view all the answers

    What can disrupt lymphatic vessels and impair the clearance of interstitial fluid?

    <p>All of the above</p> Signup and view all the answers

    What is the term for the accumulation of fluid within the adjacent body cavity?

    <p>Effusion</p> Signup and view all the answers

    Which of the following is a common cause of non-inflammatory edema and effusions?

    <p>Heart failure</p> Signup and view all the answers

    What term is used to describe the accumulation of interstitial fluid due to lymphatic obstruction?

    <p>Lymphedema</p> Signup and view all the answers

    Which of the following induces obstructive fibrosis of lymphatic channels and lymph nodes, particularly of lower extremities resulting elephantiasis?

    <p>Parasitic infection filariasis</p> Signup and view all the answers

    What is the characteristic finding in severe renal disease?

    <p>Periorbital edema</p> Signup and view all the answers

    Which organ or tissue is most commonly affected by edema?

    <p>Subcutaneous tissues</p> Signup and view all the answers

    What is the term used to describe edema that is influenced by gravity?

    <p>Dependent edema</p> Signup and view all the answers

    What is the morphological feature of edema when examined grossly?

    <p>Diffuse subcutaneous edema</p> Signup and view all the answers

    What is the term used to describe the sign when finger pressure over edematous subcutaneous tissue leaves a depression?

    <p>Pitting edema</p> Signup and view all the answers

    Which condition may complicate surgical removal and/or irradiation of the breast and associated axillary lymph nodes in patients with breast cancer?

    <p>Severe edema of upper extremity</p> Signup and view all the answers

    In which parts of the body does edema caused by renal dysfunction often appear initially?

    <p>Eyelids</p> Signup and view all the answers

    What is the morphological feature of the brain in cases of brain edema?

    <p>Narrowed sulci and distended gyri</p> Signup and view all the answers

    Which of the following is the process by which blood clots form at sites of vascular injury?

    <p>Hemostasis</p> Signup and view all the answers

    In which group of disorders are hemostatic mechanisms blunted/insufficient to prevent abnormal blood loss?

    <p>Hemorrhagic disorders</p> Signup and view all the answers

    In thrombotic disorders, where do blood clots form?

    <p>Within intact blood vessels or within the chambers of the heart</p> Signup and view all the answers

    What is the morphological feature of the liver in chronic passive congestion?

    <p>Visibly red-brown and slightly depressed centrilobular regions</p> Signup and view all the answers

    What is the characteristic finding in congestive heart failure in the lungs?

    <p>Hemosiderin-laden macrophages in alveolar spaces</p> Signup and view all the answers

    What is the term used to describe the accumulation of fluid within the adjacent body cavity?

    <p>Effusion</p> Signup and view all the answers

    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?

    <p>Hyperemia</p> Signup and view all the answers

    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?

    <p>Congestion</p> Signup and view all the answers

    Which body cavity is commonly affected by hydrothorax?

    <p>Pleural cavity</p> Signup and view all the answers

    What is the term used to describe the accumulation of fluid in the pericardial cavity?

    <p>Hydropericardium</p> Signup and view all the answers

    What causes the milky color in peritoneal effusions?

    <p>Presence of lipids absorbed from the gut</p> Signup and view all the answers

    What is the characteristic appearance of exudative effusions?

    <p>Cloudy</p> Signup and view all the answers

    What is the term used to describe the accumulation of fluid in the peritoneal cavity?

    <p>Hydroperitoneum</p> Signup and view all the answers

    What is the characteristic color of congested tissues?

    <p>Dusky reddish blue</p> Signup and view all the answers

    What are the characteristic findings in chronic pulmonary congestion?

    <p>Thickened and fibrotic septa, presence of hemosiderin-laden macrophages</p> Signup and view all the answers

    Which protein is responsible for mediating platelet adhesion to collagen?

    <p>Gplb binding to vWF</p> Signup and view all the answers

    What is the consequence of genetic deficiency of vWF or GpIb?

    <p>Bleeding disorders</p> Signup and view all the answers

    Which molecule is released by platelets to promote further recruitment and activation?

    <p>ADP</p> Signup and view all the answers

    What is the role of translocating negatively charged phospholipids (PS) during platelet shape change?

    <p>Serve as nucleation sites for coagulation factor complexes</p> Signup and view all the answers

    Which molecule is principally responsible for platelet aggregation?

    <p>TXA2</p> Signup and view all the answers

    What is the consequence of genetic deficiency of platelet receptors GpIIb/GpIIIa?

    <p>Glanzmann thrombasthenia</p> Signup and view all the answers

    Which molecule stimulates irreversible platelet contraction to form a fused mass of platelets?

    <p>Thrombin</p> Signup and view all the answers

    What is the role of thrombin in platelet aggregation?

    <p>Increases aggregation</p> Signup and view all the answers

    What does thrombin create that further stabilizes the secondary plug?

    <p>Fibrin</p> Signup and view all the answers

    What are the two types of granules released during platelet activation?

    <p>ADP and TXA2 and CA++</p> Signup and view all the answers

    Which pathway is most physiologically relevant in driving coagulation after vascular damage and exposure of tissue?

    <p>Extrinsic pathway</p> Signup and view all the answers

    What is the additional cofactor for factors II, VII, IX, and X?

    <p>Vitamin K</p> Signup and view all the answers

    What is the enzyme responsible for converting fibrinogen into crosslinked fibrin?

    <p>Thrombin</p> Signup and view all the answers

    Which assay measures the efficacy of the extrinsic pathway?

    <p>Prothrombin Time (PT) assay</p> Signup and view all the answers

    Which assay measures the efficacy of the intrinsic pathway?

    <p>Partial Thromboplastin Time (PTT) assay</p> Signup and view all the answers

    What is the purpose of the International Normalized Ratio (INR) assay?

    <p>To measure the efficacy of the extrinsic pathway</p> Signup and view all the answers

    What is the purpose of the Partial Thromboplastin Time (PTT) assay?

    <p>To measure the efficacy of the intrinsic pathway</p> Signup and view all the answers

    Which factor is responsible for covalently crosslinking fibrin?

    <p>Factor XIII</p> Signup and view all the answers

    Which of the following factors limits coagulation by washing out activated coagulation factors?

    <p>Blood flow past the site of injury</p> Signup and view all the answers

    What is the most important plasminogen activator involved in fibrinolysis?

    <p>t-PA</p> Signup and view all the answers

    Which factors released by the endothelium inhibit platelet activation and aggregation?

    <p>PGI2, NO, and ADPase</p> Signup and view all the answers

    What is the consequence of endothelial cells losing their anticoagulant properties?

    <p>Formation of blood clots at sites of vascular injury</p> Signup and view all the answers

    Which molecule stimulates the release of endothelial t-PA and other mediators?

    <p>Thrombin</p> Signup and view all the answers

    What is the main function of plasmin in fibrinolysis?

    <p>To dissolve blood clots</p> Signup and view all the answers

    Which molecule is responsible for preventing platelets from binding to vWF?

    <p>All of them</p> Signup and view all the answers

    What determines whether clot formation, propagation, or dissolution occurs?

    <p>The balance between anti-coagulant and pro-coagulant activities of the endothelium</p> Signup and view all the answers

    Which molecule is responsible for inhibiting thrombin, IXa, Xa, XIa, and XIIa in the coagulation cascade?

    <p>Antithrombin III</p> Signup and view all the answers

    What is the clinical utility of heparin?

    <p>To stimulate antithrombin III</p> Signup and view all the answers

    Which molecule forms a complex with thrombin on the endothelial surface and inhibits Va and VIIIa?

    <p>Protein E</p> Signup and view all the answers

    What is the role of tissue factor pathway inhibitor (TFPI)?

    <p>To inactivate VIIa</p> Signup and view all the answers

    What is the function of thrombomodulin and endothelial protein C receptor on the endothelial surface?

    <p>To activate protein C</p> Signup and view all the answers

    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?

    <p>Thrombin</p> Signup and view all the answers

    What is the function of protein C in the coagulation cascade?

    <p>To cleave and activate coagulation factors</p> Signup and view all the answers

    Which molecule binds and activates antithrombin III, leading to the inhibition of thrombin, IXa, Xa, XIa, and XIIa?

    <p>Heparin-like molecules</p> Signup and view all the answers

    What is the function of the activated complex formed by thrombin, protein C, and protein S on the endothelial surface?

    <p>To inhibit Va and VIIIa</p> Signup and view all the answers

    Which of the following events describes the process of a thrombus becoming larger by the accumulation of fibrin and platelets?

    <p>Propagation</p> Signup and view all the answers

    What is the main concern with venous thrombi in the deep leg veins?

    <p>Embolization to the lungs</p> Signup and view all the answers

    Which of the following events describes the process of a thrombus being dislodged from the vessel and transported elsewhere in circulation?

    <p>Embolization</p> Signup and view all the answers

    Which of the following events describes the process of recent thrombi being removed by fibrinolysis?

    <p>Dissolution</p> Signup and view all the answers

    What is the main clinical problem associated with arterial thrombi?

    <p>Occlusion of a critical vessel</p> Signup and view all the answers

    What is the process by which older thrombi become organized by ingrowth of endothelial cells, smooth muscle cells, and fibroblasts into the fibrin matrix?

    <p>Organization and recanalization</p> Signup and view all the answers

    What is the term used to describe the formation of a blood clot within a blood vessel?

    <p>Thrombosis</p> Signup and view all the answers

    What is THE MAIN clinical feature/CONCERN of venous thrombi?

    <p>Embolization to the lungs</p> Signup and view all the answers

    Which of the following is NOT one of the primary abnormalities that lead to thrombosis according to Virchow's triad?

    <p>Platelet activation</p> Signup and view all the answers

    Which type of thrombi characteristically occur at sites of stasis?

    <p>Venous thrombi</p> Signup and view all the answers

    What is believed to have an important role in triggering arterial thrombotic events?

    <p>Endothelial dysfunction</p> Signup and view all the answers

    Which type of thrombi tend to grow in a retrograde direction?

    <p>Arterial thrombi</p> Signup and view all the answers

    What is the term used to describe the process of thrombus formation in the heart and arterial circulation?

    <p>Clot formation</p> Signup and view all the answers

    What is the primary reason for the use of aspirin and other platelet inhibitors in coronary artery disease and myocardial infarction?

    <p>To inhibit platelet activation</p> Signup and view all the answers

    Which of the following can induce endothelial dysfunction and trigger thrombosis?

    <p>All of the above</p> Signup and view all the answers

    Which direction do both arterial and venous thrombi tend to propagate?

    <p>Toward the heart</p> Signup and view all the answers

    What is believed to be a necessary prerequisite for thrombus formation under high shear stress?

    <p>Platelet adherence and activation</p> Signup and view all the answers

    Which vessels supply the lung with blood?

    <p>Pulmonary arteries and bronchial arteries</p> Signup and view all the answers

    What is the usual outcome when medium-sized arteries in the lung are obstructed with subsequent vascular rupture?

    <p>Pulmonary hemorrhage</p> Signup and view all the answers

    Which of the following is the most common cause of pulmonary embolism?

    <p>Thrombi</p> Signup and view all the answers

    What can multiple emboli over time lead to in the lung?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    What is the term used to describe an embolus that passes from the venous to the arterial circulation?

    <p>Paradoxical embolism</p> Signup and view all the answers

    What is the consequence of >60% obstruction of the pulmonary circulation by emboli?

    <p>All of the above</p> Signup and view all the answers

    What can myocardial infarction predispose to?

    <p>Embolism</p> Signup and view all the answers

    Where can mural thrombi embolize to cause infarctions?

    <p>Brain, kidneys, and spleen</p> Signup and view all the answers

    What is the term used to describe the process by which emboli become incorporated into the vascular wall?

    <p>Organized</p> Signup and view all the answers

    What is the main concern with venous thrombi in superficial veins in the skin?

    <p>Pulmonary infarction</p> Signup and view all the answers

    What is the term used to describe an embolus that occludes the main pulmonary artery?

    <p>Saddle embolus</p> Signup and view all the answers

    What is the process by which older thrombi become organized by ingrowth of cells into the fibrin matrix?

    <p>Organization</p> Signup and view all the answers

    What is the term used to describe an embolus that straddles the bifurcation of the pulmonary arteries?

    <p>Saddle embolus</p> Signup and view all the answers

    What is the term used to describe an embolus composed of nitrogen bubbles?

    <p>Nitrogen embolus</p> Signup and view all the answers

    Which type of infarction is frequently fatal?

    <p>Bowel infarction</p> Signup and view all the answers

    What is the most common cause of infarctions?

    <p>Arterial thrombosis</p> Signup and view all the answers

    Which type of thrombosis results in congestion rather than infarction?

    <p>Venous thrombosis</p> Signup and view all the answers

    Which organs are largely affected by venous thrombosis?

    <p>Testis and ovary</p> Signup and view all the answers

    What is the serious problem in diabetics caused by infarction?

    <p>Gangrene</p> Signup and view all the answers

    Which of the following best describes an infarct?

    <p>An area of cell death caused by lack of blood supply</p> Signup and view all the answers

    What is the main cause of an infarct?

    <p>Lack of blood supply to the affected tissue</p> Signup and view all the answers

    What is the term used to describe the process of occlusion of vascular supply to a tissue?

    <p>Ischemia</p> Signup and view all the answers

    What is the common pathogenesis of shock associated with systemic inflammation?

    <p>Arterial vasodilation and vascular leakage</p> Signup and view all the answers

    Which form of shock involves acute vasodilation leading to hypotension and tissue hypoperfusion?

    <p>Neurogenic shock</p> Signup and view all the answers

    What is the consequence of prolonged shock?

    <p>Irreversible tissue injury</p> Signup and view all the answers

    Which of the following is a symptom of shock?

    <p>Tissue hypoperfusion</p> Signup and view all the answers

    What is the term used to describe shock caused by low cardiac output due to myocardial pump failure?

    <p>Cardiogenic shock</p> Signup and view all the answers

    What is the term used to describe shock caused by low cardiac output due to low blood volume?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What is the term used to describe shock caused by acute vasodilation leading to hypotension and tissue hypoperfusion?

    <p>Anaphylactic shock</p> Signup and view all the answers

    Which type of shock presents with warm, flushed skin due to vasodilation?

    <p>Septic shock</p> Signup and view all the answers

    What is the initial threat to life that precipitates shock?

    <p>All of the above</p> Signup and view all the answers

    Which phase of shock is dominated by renal insufficiency and lack of urine output?

    <p>Second phase</p> Signup and view all the answers

    Which type of shock carries a high mortality rate even with state-of-the-art care?

    <p>Cardiogenic shock</p> Signup and view all the answers

    What complicates shock, particularly if it is due to sepsis or trauma?

    <p>Coagulopathy</p> Signup and view all the answers

    What is the survival rate of a young healthy patient with hypovolemic shock and appropriate treatment?

    <p>80-90%</p> Signup and view all the answers

    What is the consequence of shock being prolonged?

    <p>All of the above</p> Signup and view all the answers

    Which type of bacteria is the most common cause of septic shock?

    <p>Gram(+) followed by gram negative</p> Signup and view all the answers

    Which cells recognize and are activated by substances derived from microorganisms in septic shock?

    <p>Macrophages</p> Signup and view all the answers

    What are the main inflammatory responses initiated by activated cells and secreted factors in septic shock?

    <p>Vasodilation and increased vascular permeability</p> Signup and view all the answers

    What is the standard of care for septic shock?

    <p>Treatment of underlying infection with appropriate antibiotics and i.v. fluids</p> Signup and view all the answers

    What additional group of bacterial proteins can cause a similar syndrome to septic shock?

    <p>Superantigens</p> Signup and view all the answers

    What factors contribute to the severity and outcome of septic shock?

    <p>Extent and virulence of infection, immune status of the host, presence of other co-morbid conditions, and pattern and level of mediator production</p> Signup and view all the answers

    What is the main goal of pressors and supplemental oxygen in the treatment of septic shock?

    <p>To maintain systemic pressures and limit hypoxia</p> Signup and view all the answers

    Why have attempts to intervene therapeutically with inhibitors for specific mediators in septic shock been limited?

    <p>Limited success due to the complexity of factors and interactions underlying sepsis</p> Signup and view all the answers

    What do the clinical manifestations of shock depend on?

    <p>The precipitating insult</p> Signup and view all the answers

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