Pathophysiology Tutorial 3 Hemodynamic Disorders
ILOs Recall different causes of thrombosis. Explain different types of embolism and their predisposing factors. Differentiate between hemorrhage types. Differentiate between types of shock in terms of the clinical examples and the principle pathogenic mechanism.
Case 1 A 29 year old woman has a history of frequent epistaxis (nosebleed) and increased menstrual flow. On physical examination, petechiae and purpura are present on the skin of her extremities. Laboratory studies show normal partial thromboplastin time, prothrombin time, and platelet count, and decreased Von Willebrand factor activity. This patient most likely has a derangement in which of the following steps in homeostasis? A. Platelet adhesion B. Platelet aggregation C. Prothrombin generation D. Prothrombin inhibition E. Fibrin polymerization
Case 2 A 23-year-old woman complains of a recent onset of yellowing of her skin and increasing abdominal girth. Physical examination reveals jaundice and ascites. Ultrasound examination of her abdomen demonstrates thrombosis of the hepatic veins. A Liver biopsy shows severe sinusoidal dilation within the centrilobular regions. This pathologic finding is caused by which of the following hemodynamic disorders? A. Active hyperemia B. Hematoma C. Passive congestion D. Arterial thrombosis
Case 3 A 70 year old man who was hospitalized 3 weeks ago for a cerebral infarction is ambulating for the first time. Within minutes of returning to his hospital room, he has sudden onset of dyspnea with diaphoresis. He cannot be resuscitated. The gross appearance of the hilium of the left lung at autopsy showed large pulmonary thromboembolus. Which of the following risk factors most likely contributed to this finding? A. Venous stasis B. Pulmonary arterial atherosclerosis C. Lupus anticoagulant D. Bronchopneumonia E. Factor V mutation
Embolism http://emedicine.medscape.com/article/300901-overview#aw2aab6b2b2 Pulmonary thromboembolism following DVT Stroke caused by atrial fibrillation 6
Case 4 A 25 years old man who had multiple episodes of deep venous thrombosis during the past 10 years and one episode of pulmonary thromboembolism during the past year. Prothrombin time, partial thromboplastin time, platelet count, and platelet function studies are all normal. Which of the following risk factors has most likely contributed to the patient s condition? A. Factor V mutation B. Antithrombin III deficiency C. Mutation in protein C D. Hyperhomocysteinemia E. Smoking cigarettes
Antithrombotic Properties of Normal Endothelium Deficiencies of antithrombin protein C and protein S Factor V Leiden 8
Case 5 A 21-year-old woman sustains multiple injuries, including fractures of the right femur and tibia and the left humerus in a motor vehicle collision. She is admitted to the hospital and the fractures are stabilized surgically. Soon after admission to the hospital, she is in stable condition. However, 2 days later, she suddenly becomes very dyspneic. Which of the following complications is the most likely cause of this sudden respiratory difficulty? a) Pulmonary edema b) Bacterial infection c) Fat embolism d) Cardiac tamponade
Case 6 A 49-year-old man is in stable condition after an infarction of the anterior left ventricular wall. He receives therapy with antiarrythmic and pressor agents. Three days later, he develops severe breathlessness, and an echocardiogram shows a markedly decreased ejection fraction. He dies 2 hours later. At autopsy, which of the following microscopic changes is most likely to be present in the lungs? a) Congestion of alveolar capillaries with fibrin and neutrophils in alveoli b) Congestion of alveolar capillaries with transudate in alveoli c) Fibrosis of alveolar walls with hemosiderin-laden macrophages in alveoli d) Purulent exudates in the main stem bronchi e) Purulent exudates in pleural space
Case 7 A-50 year old fire fighter emerges from a burning house with third degree burn over 70% of his body. The patient expires 24 hours later. Which of the following was the most likely cause of death? A. Congestive heart failure B. Disseminated intravascular coagulation C. Hypovolemic shock D. Septic shock E. Pulmonary embolism
SHOCK Three Major Types of Shock 12
Case 8 A 67-year old man presents with sudden left leg pain, absence of pulses, and a cold limb. His past medical history is significant for coronary artery disease and a small aortic aneurysm. Which of the following is the most likely responsible for development of a cold limb in this patient? A. Acute myocardial infarction B. Arterial thromboembolism C. Cardiogenic shock D. Deep venous thrombosis E. Ruptured aortic aneurysm