Term
| Approximately ____ of lean body weight is water |
|
Definition
|
|
Term
| increased interstitial fluid can result from either _____. |
|
Definition
| increased capillary hydroostatic pressure or diminished colloid osmotic pressure |
|
|
Term
|
Definition
| severe and generalized edema with widespread subcutaneous tissue swelling |
|
|
Term
| congestive heart failure, constrictive pericarditis, ascites, and venous obstruction result in _____ pressure. |
|
Definition
| increased hydrostatic pressure |
|
|
Term
| heat and neurohumoral dysregulation result in ____. |
|
Definition
|
|
Term
| nephrotic syndrome, ascites, malnutrition, and protein-losing gastroenteropahty result in _____. |
|
Definition
| reduced plasma osmotic pressure (hyperprotenemia) |
|
|
Term
| Renal hypoperfusion and increased renin-angiotensin-aldosterone secretion would result in ____. |
|
Definition
|
|
Term
| inflammatory edema is _____. |
|
Definition
| a protein-rich exudate that is a result of increased vascular permeability |
|
|
Term
| Causes of lymphadema include: |
|
Definition
| chronic inflammation with fibrosis, invasive malignant tumors, physical disruption, radiation damage, and certain infectious agents |
|
|
Term
|
Definition
| an active process in which arteriolar dilation leads to increased blood flow |
|
|
Term
|
Definition
| chronic passive hepatic congestion areas grossly red-brown and slightly depressed accentuated against the surrounding zones of uncongested tan liver |
|
|
Term
| A hemorrage accumulaton is called a _____. |
|
Definition
|
|
Term
| Minute 1- to 2-mm hemorrhages into skin, mucous membranes, or serosal surfaces are called ____ |
|
Definition
|
|
Term
| Slightly larger (≥3 mm) hemorrhages are called |
|
Definition
|
|
Term
| Larger (>1 to 2 cm) subcutaneous hematomas (i.e., bruises) are called |
|
Definition
|
|
Term
|
Definition
| potent endothelium-derived vasoconstrictor |
|
|
Term
| primary hemostasis results in a |
|
Definition
|
|
Term
| secondary hemostasis results in a |
|
Definition
|
|
Term
| after a permanent plug is formed at the site of injury ___ limits the plug to the site of the injury. |
|
Definition
| tissue plasminogen activator (t-PA) |
|
|
Term
| prostacyclin (PGI2) and nitric oxide produced by the endothelial cells impede |
|
Definition
|
|
Term
| heparin-like molecules are cofactors that greatly enhance the inactivation of |
|
Definition
|
|
Term
| Thrombomodulin binds to thrombin and converts it from a procoagulant into an anticoagulant via its ability to activate _______ which ______. |
|
Definition
| protein C, which inhibits clotting by inactivating factors Va and VIIIa |
|
|
Term
| Tissue factor is the _____, and it is synthesized by _____. |
|
Definition
| major activator of the extrinsic clotting cascade / endothelial cells |
|
|
Term
| α-Granules have the adhesion molecule _____ on their membranes |
|
Definition
|
|
Term
|
Definition
| fibrinogen, fibronectin, factors V and VIII, platelet factor 4 (a heparin-binding chemokine), platelet-derived growth factor (PDGF), and transforming growth factor-β (TGF-β) |
|
|
Term
| On contact with collagen and the adhesive glycoprotein vWF, platelets undergo: |
|
Definition
| (1) adhesion and shape change, (2) secretion (release reaction), and (3) aggregation |
|
|
Term
| vWF acts as a bridge between ____. |
|
Definition
| platelet surface receptors (e.g., glycoprotein Ib [GpIb]) and exposed collagen |
|
|
Term
| In response to ______, endothelial cells synthesize tissue factor, the major activator of the extrinsic clotting cascade |
|
Definition
| cytokines (e.g., tumor necrosis factor [TNF] or interleukin-1 [IL-1]) or bacterial endotoxin |
|
|
Term
| platelet activation leads to the appearance of _______on their surfaces. |
|
Definition
| calcium-binding negatively charged phospholipids (particularly phosphatidylserine) |
|
|
Term
| thromboxane A2 (TxA2) is a |
|
Definition
| vasoconstrictor and platlet aggregator |
|
|
Term
| deficiency of GpIIb-IIIa results in _______. |
|
Definition
| a bleeding disorder (Glanzmann thrombasthenia) |
|
|
Term
| What does prostaglandin PGI2 (prostacyclin) do? |
|
Definition
| it inhibits platelet aggregation and is a potent vasodilator |
|
|
Term
| What effect does aspirin have on TxA2 and PGI2 synthesis? |
|
Definition
| Permanently blocks TXA2 but not PGI2, which can overcome its inhibition |
|
|
Term
| What event activates the extrinsic pathway? |
|
Definition
|
|
Term
| What acivates Factor VII? |
|
Definition
|
|
Term
| Is Factor VII intrinsic or extrinsic? |
|
Definition
|
|
Term
| What activates Hageman factor? |
|
Definition
| Hageman Factor (Factor XII) is activated by HMWK. |
|
|
Term
| What factors are excluive to the Intrinsic Pathway? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What 3 factors does thrombin activate? |
|
Definition
|
|
Term
| What factors are found in the common coagulation cascade? |
|
Definition
|
|
Term
| For what 4 steps in the coaguation cascade is Ca+ a cofactor? |
|
Definition
| Activation of Factors II, X, XIII and Fibrin |
|
|
Term
| What 2 factors are required to activate Thrombin (Factor IIa)? |
|
Definition
|
|
Term
| Factor I / Ia are also known as _____. |
|
Definition
|
|
Term
| What does Tissue Factor Pathway Inhibitor do? |
|
Definition
| Inhibits activation of Factors IX and X |
|
|
Term
| Clots are held together by ____ and inhibited by ____ chelators. |
|
Definition
|
|
Term
| The binding of coagulation factors II, XII, IX, and X to calcium depends on the addition of______to certain glutamic acid residues on these proteins. This reaction uses ____ as a cofactor. |
|
Definition
| γ-carboxyl groups / vitamin K |
|
|
Term
| Coumadin is an anticoagulant which acts as a ___ agonist. |
|
Definition
|
|
Term
| tissue factor is also known as _____. |
|
Definition
| thromboplastin or factor III |
|
|
Term
|
Definition
| the function of the proteins in the extrinsic pathway (factors VII, X, II, V, and fibrinogen) |
|
|
Term
| he partial thromboplastin time (PTT) screens for the function of ______. |
|
Definition
| the proteins in the intrinsic pathway (factors XII, XI, IX, VIII, X, V, II, and fibrinogen) |
|
|
Term
| ______ assays are accomplished by adding tissue factor and phospholipids to citrated plasma |
|
Definition
|
|
Term
| ____ assays initiate clotting factor through the addition of negative charged particles (e.g., ground glass) |
|
Definition
| partial thromboplastin time (PTT) |
|
|
Term
| protease activated receptors (PARs) belong to the _____ receptor family and activate ______. |
|
Definition
| seven-transmembrane G protein-coupled / the clotting cascade. |
|
|
Term
| What three categories of endogenous anticoagulants also control clotting? |
|
Definition
| Antithrombins, Proteins C and S, and TFPI |
|
|
Term
| Elevated levels of FSPs (most notably fibrin-derived D-dimers) can be used in diagnosing abnormal thrombotic states including ______. |
|
Definition
| disseminated intravascular coagulation (DIC), deep venous thrombosis, or pulmonary embolism |
|
|
Term
| What are the three primary abnormalities that lead to thrombus formation (called Virchow's triad)? |
|
Definition
| (1) endothelial injury, (2) stasis or turbulent blood flow, and (3) hypercoagulability of the blood |
|
|
Term
| ____ is a major contributor in the development of venous thrombi |
|
Definition
|
|
Term
|
Definition
| platelets (and other blood cellular elements) flow centrally in the vessel lumen, separated from endothelium by a slower moving layer of plasma |
|
|
Term
| Name 4 common types of genetic hypercoaguable states. |
|
Definition
# Factor V mutation (G1691A mutation; factor V Leiden)
# Prothrombin mutation (G20210A variant)
# 5,10-Methylenetetrahydrofolate reductase (homozygous C677T mutation)
# Increased levels of factors VIII, IX, XI, or fibrinogen |
|
|
Term
| What aquired conditions signal a high risk for thrombosis? |
|
Definition
# Prolonged bedrest or immobilization
# Myocardial infarction
# Atrial fibrillation
# Tissue injury (surgery, fracture, burn)
# Cancer
# Prosthetic cardiac valves
# Disseminated intravascular coagulation
# Heparin-induced thrombocytopenia
# Antiphospholipid antibody syndrome |
|
|
Term
| Factor V (called the Leiden mutation) results in a ______. |
|
Definition
| glutamine to arginine substitution at position 506 that renders factor V resistant to cleavage by protein C |
|
|
Term
| Elevated levels of homocysteine have what effect on thrombosis? |
|
Definition
| contributes to arterial and venous thrombosis, as well as the development of atherosclerosis |
|
|
Term
| Heparin-induced thrombocytopenia (HIT) syndrome occurs______. |
|
Definition
| following the administration of unfractionated heparin |
|
|
Term
| Antiphospholipid antibody syndrome43 (previously called the lupus anticoagulant syndrome) results in what clinical manifestations? |
|
Definition
| recurrent thromboses, repeated miscarriages, cardiac valve vegetations, and thrombocytopenia |
|
|
Term
| arterial thrombi tend to grow _____, while venous thrombi extend ______. |
|
Definition
| retrograde from the point of attachment / in the direction of blood flow (thus both propagate toward the heart) |
|
|
Term
| Thrombi often have grossly and microscopically apparent laminations called _____ which signify that a thrombus has formed in flowing blood |
|
Definition
|
|
Term
| Thrombi occurring in heart chambers or in the aortic lumen are called _____. |
|
Definition
|
|
Term
| The most common sites ofocclusive arterial thrombi in decreasing order of frequency are _____. |
|
Definition
| the coronary, cerebral, and femoral arteries |
|
|
Term
| Venous thrombosis (phlebothrombosis) tend to contain more _____. |
|
Definition
| enmeshed red cells (and relatively few platelets) and are therefore known as red, or stasis, thrombi |
|
|
Term
| Thrombi on heart valves are called _____ and are caused by |
|
Definition
| vegetation / blood-borne bacteria or fungi that adhere to previously damaged valves |
|
|
Term
| High risk factors for thrombosis include _____. |
|
Definition
* High Risk for ThrombosisProlonged bedrest or immobilization
* Myocardial infarction
* Atrial fibrillation
* Tissue injury (surgery, fracture, burn)
* Cancer
* Prosthetic cardiac valves
* Disseminated intravascular coagulation
* Heparin-induced thrombocytopenia
* Antiphospholipid antibody syndrome |
|
|
Term
| Antiphospholipid antibody syndrome can cause ______. |
|
Definition
| recurrent thromboses, repeated miscarriages, cardiac valve vegetations, and thrombocytopenia |
|
|
Term
| Thrombi often have grossly and microscopically apparent laminations called ______ to signify that a thrombus has formed in flowing blood |
|
Definition
|
|
Term
| Thrombi occurring in heart chambers or in the aortic lumen are called ______. |
|
Definition
|
|
Term
| What is infective endocarditis? |
|
Definition
| When blood-borne bacteria or fungi adhere to previously damaged valves inducing formation of large thrombotic masses |
|
|
Term
| What 4 events occur in the days to weeks after thrombosis? |
|
Definition
Propagation
Embolization Dissolution Organization and recanalization |
|
|
Term
| Most venous thrombi occur in _______. |
|
Definition
| the superficial or deep veins of the leg |
|
|
Term
| Superficial venous thrombi typically occur in _______. |
|
Definition
| the saphenous veins in the setting of varicosities |
|
|
Term
| What is the most serious site for Deep venous thrombosis (DVT)? |
|
Definition
| in the larger leg veins-at or above the knee (e.g., popliteal, femoral, and iliac veins) |
|
|
Term
|
Definition
| The sudden or insidious onset of widespread fibrin thrombi in the microcirculation. DIC is not a primary disease but rather a potential complication. |
|
|
Term
|
Definition
| detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin |
|
|
Term
|
Definition
| right-sided heart failure |
|
|
Term
| Fat emboli result from _____. |
|
Definition
| fractures of long bones (which have fatty marrow) or, rarely, in the setting of soft tissue trauma and burns |
|
|
Term
| Fat embolism syndrome is characterized by ______. |
|
Definition
| pulmonary insufficiency, neurologic symptoms, anemia, and thrombocytopenia, sudden onset of tachypnea, dyspnea, and tachycardia; irritability and restlessness that can progress to delirium or coma |
|
|
Term
| Air embolism can result from _____. |
|
Definition
| Surgury, scuba, unpressurized aircraft. |
|
|
Term
| Amniotic fluid embolism is a complication of ______. |
|
Definition
| labor and the immediate postpartum period |
|
|
Term
|
Definition
| an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage |
|
|
Term
|
Definition
|
|
Term
| White infarcts are _____ and occur in ______. |
|
Definition
| anaemic / arterial occlusions in solid organs with end-arterial circulation (e.g., heart, spleen, and kidney) |
|
|
Term
| The dominant histologic characteristic of infarction is ______. |
|
Definition
| ischemic coagulative necrosis |
|
|
Term
| A central nervous system infarction results in _____ necrosis |
|
Definition
|
|
Term
| Septic infarctions occur when ______. In these cases the infarct is converted into an _____. |
|
Definition
| infected cardiac valve vegetations embolize or when microbes seed necrotic tissue / abscess |
|
|
Term
| The major determinants of the eventual outcome of vascular occlusion are: |
|
Definition
| (1) the nature of the vascular supply, (2) the rate at which an occlusion develops, (3) vulnerability to hypoxia, and (4) the oxygen content of the blood. |
|
|
Term
| Shock is characterized by______. |
|
Definition
| systemic hypotension due either to reduced cardiac output or to reduced effective circulating blood volume |
|
|
Term
| The consequences of shock are are _______. |
|
Definition
| impaired tissue perfusion and cellular hypoxia |
|
|
Term
| Cardiogenic shock results from ______. |
|
Definition
| low cardiac output due to myocardial pump failure |
|
|
Term
| Hypovolemic shock results from _____. |
|
Definition
| low cardiac output due to the loss of blood or plasma volume, such as can occur with massive hemorrhage or fluid loss from severe burns |
|
|
Term
| Septic shock results from _______. |
|
Definition
| vasodilation and peripheral pooling of blood as part of a systemic immune reaction to bacterial or fungal infection |
|
|
Term
| The mechanisms of cardiogenic shock are _____. |
|
Definition
| Failure of myocardial pump resulting from intrinsic myocardial damage, extrinsic pressure, or obstruction to outflow |
|
|
Term
| The mechanisms of septic shock are _____. |
|
Definition
| Peripheral vasodilation and pooling of blood; endothelial activation/injury; leukocyte-induced damage, disseminated intravascular coagulation; activation of cytokine cascades |
|
|
Term
| The 3 stages of shock are _____. |
|
Definition
| nonprpgressive, proressive, and irreversible |
|
|
Term
| progressive shock is characterized by ______. |
|
Definition
| tissue hypoperfusion and onset of worsening circulatory and metabolic imbalances, including acidosis |
|
|
Term
| In the early nonprogressive phase of shock, a variety of neurohumoral mechanisms help to maintain cardiac output and blood pressure including _____. The net effect is _____. |
|
Definition
| baroreceptor reflexes, catecholamine release, activation of the renin-angiotensin axis, ADH release, and generalized sympathetic stimulation / tachycardia, peripheral vasoconstriction, and renal conservation of fluid |
|
|
Term
| During progressive shock ____. |
|
Definition
| metabolic lactic acidosis lowers the tissue pH and blunts the vasomotor response; arterioles dilate, and blood begins to pool in the microcirculation |
|
|
Term
| Cardiogenic or hypovolemic shock are most evident in ____. |
|
Definition
| brain, heart, lungs, kidneys, adrenals, and gastrointestinal tract |
|
|
Term
| During shock, the adrenals exhibit ______. |
|
Definition
| cortical cell lipid depletion |
|
|
Term
| During shock, the kidneys exhibit ____. |
|
Definition
|
|
Term
| When shock is caused by bacterial sepsis or trauma, changes of ____ may develop in the lungs. |
|
Definition
|
|
Term
| In septic shock the skin may initially be ______. |
|
Definition
| warm and flushed because of peripheral vasodilation |
|
|
Term
| Individuals who survive the initial complications of shock may enter a second phase dominated by _____. |
|
Definition
| renal insufficiency and marked by a progressive fall in urine output as well as severe fluid and electrolyte imbalances |
|
|
Term
| Greater than ____ of young, otherwise healthy patients with hypovolemic shock survive with appropriate management |
|
Definition
|
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