patho pharm II- exam 2- Alterations in Blood Flow - 9 points

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patho pharm II- exam 2- Alterations in Blood Flow - 9 points
2012-10-03 11:51:22
patho pharm II exam Alterations Blood flow points reynaud buerger aneurysm atherosclerosis

patho pharm II- exam 2- Alterations in Blood Flow - 9 points
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  1. Define a thrombus.
    • Develops in a blood vessel 
    • obstructs blood flow distally
    • leads to tissue ischemia and necrosis

    • ischemia : deficient supply of blood to a body part
    • necrosis: death of living tissue
  2. Define an Embolus.
    • A thrombus that MOVES. 
    • Travels to areas of body such as the lungs or brain
    • can lead to DEATH.
  3. Interruption of blood flow interferes with delivery of _____ and _____ to the tissues.
    oxygen and nutrients
  4. Alterations in _____ flow produce ischemia.
  5. Alterations in ____ flow cause congestion and edema.
  6. What would you see in a patient's lower extremeties with arterial obstruction?
    Decreased pulses, cool to touch, pallor, numbness, tingling, weakness, pain with exercise, changes in skin.
  7. What would you see in a patient's lower extremeties with venous obstruction? 
    Engorged with fluid, edematous, painful, red,hyperpigmentation, statis 
  8. Name the 5 mechanisms of vessel obstruction.
    • 1. Thrombus: blood clot
    • 2. Emboli: abnormal or foreign mass (air bubble)
    • 3. Compression
    • 4. Vasospasm
    • 5. Structural defect
  9. What is arteriosclerosis?
    Chronic disease characterized by thickening and hardening of vessel walls, narrowing of vessel lumen.
  10. Define atherosclerosis.
    Form of arteriosclerosis where the thickening of the vessel walls is caused by soft deposits of intraarterial fat and fibrin that harden overtime.
  11. What is the leading contributor to CAD and CVD?
  12. When do clinical manifestations become evident for atherosclerosis?
    • Starts as benign. May not show for 20-40 years.
    • "Silent disease"
  13. Atherosclerotic lesions are characterized by which three things?
    • 1. Accumulation of intracellular and extracellular lipids
    • 2. Proliferation of vascular smooth muscle cells
    • 3. Formation of large amounts of scar tissue and connective tissue proteins.
  14. Atherosclerotic lesions generally do not cause symptoms until ___ % of the vessel is _____.
    60% of the vessel is occluded.
  15. If plaque formation develops slowly in a vessel ___ ____ may develop to supply the area with blood.
    Collateral circulation
  16. _____ _______ is the earliest atherosclertoic lesion- causes no obstruction and reversible.
    Fatty streak
  17. The ____ ____ consists of the lipid core covered by a fibrous cap- develops from a ____ _____ and protrudes into the lumen. 
    The fibrous plaque  consists of the lipid core covered by a  cap- develops from a fatty  streak and protrudes into the lumen. 
  18. _____ contain hemorrhage, ulceration, and scar tissue deposits. 
  19. List 4 contributing factors for atherosclerosis
    • 1. Diabetes Mellitus
    • 2. Obesity
    • 3. Stress
    • 4. Lack of physical activity
  20. List 3 modifiable and 3 nonmodifiable major risk factors for atherosclerosis.
    • Modifiable: Smoking, HTN, High cholesterol
    • Non-modifiable: Heriditary, Male, Age
  21. Which of the following are true?
    1.Atherosclerosis produces early signs and symptoms.
    2.The development of collateral circulation is a complication of atherosclerosis.
    3.Atherosclerosis is an acute condition that is easily reversed.
    4.Atherosclerosis begins with an inflammatory process.
    4.Atherosclerosis begins with an inflammatory process.
  22. Atherosclerosis- early in the disease process partial vessel obstruction leads to .....
    ischemic events associated with exercise or stress
  23. Atherosclorsis- as the disease progresses, increased obstruction and ____ _____ ____ occurs. 
    thrombus formation infarction (necrosis)
  24. Define aneurysm = 
    localized vessel dilation caused by the weakness of the arterial wall 
  25. How are aneurysms classified? 
    • Etiology (cause)
    • Location
    • Anatomical features 
  26. Where do most aneurysms occur? 
    In the aorta- the main artery that carries blood from the heart to the rest of the body.
  27. What are the two types of aortic aneurysms? 
    AAA = Abdominal aortic aneurysms- occur in the part of the aorta running through the abdomen. 4 x more likely. 

    TAA= Thoracic aortic aneurysms occur in the part of the aorta running through the chest.
  28. Who is most at risk for aneurysm formation? 
    • White males
    • 50-60 years old
    • with HTN and Atherosclerosis as a risk factor 
  29. Syphilis and other infections can also lead to ______. 
    aneurysm formation
  30. The weakness that leads to an aneurysm formation can be due to several factors such as:
    • Congenital defects
    • Trauma
    • Infections 
    • Atherosclorsis- most common
  31. Aneurysms are at risk of rupturing leading to ...
    blood loss, shock and death

    *Even unruptured aneurysm can cause pressure and damage to adjacent structures and interruption of blood flow. 
  32. What is one classic clinical manifestation of aortic aneurysm? 
  33. What are the clinical manifestations associated with AAAs? 
    • 1. Pain-  abdomen and back 
    • 2. Palpable mass- in stomach
    • 3. Pain more intense with rupture
  34. What are the clinical manifestations of TAA? 
    • 1. Chest pain- substernal, radiating
    • 2. Dysphagia - trouble swallowing
    • 3. Dyspnea - trouble breathing
  35. The diagnosis of an aneurysm can be made by which diagnostic tests? 
    Arteriography, ultrasound, CT and MRI
  36. The treatment of an aneurysm...
    almost always surgical. 

    • - —Utilization of graft to repair; stents
    • - —HTN must be controlled
    • -—Dissecting and leaking aneurysms require emergency repair
    • -Cerebral aneurysm treated in IR with coils commonly or surgically clipped if coiling is not possible. Increased ICP is treated. 
  37. List and define the 5 categories of aneurysms. 
    • 1. Saccular: localized outpouching of the vessel wall
    • 2. Fusiform: diffuse circumferential dilation
    • 3. Berry: small sphere (1-1.5 cm) dilation of vessel 
    • 4. False or Pseudoaneurysm: Complete tear in all tissues filling layers with blood producing a pulsable hematoma
    • 5. Dissecting: blood accumulates within the layers of the vessel causing it to dilate
  38. Who is affected by dissecting aneurysms? 
    • —40-60 years of age
    • Men > women
    • —History of HTN
    • —Connective Tissue Disorders - Marfan’s
    • Pregnancy
    • Traumatic Dissection - MVC
  39. Which of the following statements are true about dissecting aneurysms? 
    1. Chronic, non life-threatening disorder
    2. It involves hemorrhage and lengthwise tearing (dissection) of the wall to form a blood filled channel.
    3. Often occurs with previous vessel dilation.
    4. Causes – conditions that strengthen the elastic and smooth muscle fibers of the medial layer of the aorta.
    • 1. No -- Acute life-threatening condition
    • 2. Yes
    • 3. No-- Often occurs without previous vessel dilation.
    • 4. No-- Causes – conditions that weaken or cause degeneration of the elastic and smooth musclefibers of the medial layer of the aorta.
  40. What are the 3 types of peripheral arterial conditions? 
    • 1. Raynauds
    • 2. Buerger's Disease
    • 3. Atherosclerotic Occlusive Disease
  41. Raynauds definition:
    intense vasospasm of the arteries causes constriction of the fingers and less often the toes
  42. What is the difference between Raynaud's disease and Raynaud's phenomenon?
    • —Raynaud’s Disease: occurs without demonstrable cause,
    • healthy young women precipitated by cold or strong emotions. Blood vessels appear normal.
    • —Raynaud’s Phenomenon: occurs secondary to another condition
    • - Previous vessel injury-- frostbite, occupational trauma, neurologic disorders, chronic arterial occlusive disease.  
    • - Often first symptoms of collagen diseases.
    • - Blood vessels are abnormal.
  43. What are the clinical manifestations of Raynaud's disease?
    • —-Skin color changes from pallor to cyanosis
    • -—Sensation of cold 
    • -Numbness and tingling 
    • -Slight swelling
    • —-Repeated episodes lead to brittle nails, and the skin is  thickened over the tops of the fingers
  44. What are the clinical manifestation following an ischemic episode in Raynaud's syndrome?
    – hyperemia (excess blood) with intense rubor (reddness), throbbing, and paresthesias (numbness/tingle)
  45. What are the treatments for Raynaud's disease?
    • Tx: No smoking, vasodilators, surgery (poor results), —if ischemia leads to ulceration and gangrene – amputation may be necessary.
    • -Prevent: —Protect the digits from trauma, —Protection from the cold, Avoid vasoconstrictor medication and stress
  46. What is the another name for Buerger's disease and what is the definition?
    • Thromboangitis Obliterans
    • - Inflammatory disorder of the arteries that leads to thrombus formation usually in the lower leg or foot
  47. What is the common location of the vessels that are affected by Buerger's disease?
    • The medium sized arteries, usually the plantar and digital vessels  of the foot and lower leg.
    • Arteries in the hand and arm may also be affected.
  48. Who is at greatest risk of developing Buerger's disease? 
    Men between the ages of 25 and 40 who are heavy cigarette smokers. 
  49. What are the clinical manifestations associated with Beurger's disease?
    • FEET--- **—Pain
    • —-Early stages - intermittent claudication (lameness) of the calf muscles and arch of the foot
    • -—Severe cases – pain is present at rest
    • —-Increased sensitivity to the cold
    • -—Diminished or absent peripheral pulses
    • -—Changes in the color of the extremity
    • —-Shiny skin -with little hair growth and poor nutrition 
    • Thick nails
    • -With disease progression tissue ulceration and gangrene may necessitate amputation.
  50. What is the treatment for Beurger's disease?
    • Tx: No smoking, vasodilators, surgery (poor results), —if ischemia leads to ulceration and gangrene – amputation may be necessary.
    • —!Prevent tissue injury!
  51. Which of the following are true?

    1.Raynaud’s disease is most common in young men that smoke.
    2.The cause of Raynaud’s disease is vasospasm.
    3.Buerger’s disease is an inflammatory disorder.
    4.Buerger’s disease is a venous disorder.
    • 2.The cause of Raynaud’s disease is vasospasm.
    • 3.Buerger’s disease is an inflammatory disorder.