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pathology 2


What 2 things are responsible for Normal circulatory hemodynamics? PGI 2 (vasodilates, desirable, produced by endothelial cell) and TXA2 (vasoconstrict, undesirable, platelet aggregation, produced by platelets (good for stopping hemorrhage)
endothelial funciton is important in _________ and endothelial dysfunction is important in __________/ vascular health... vascular disease
True or False: vascularization is a large but dispersed organ? True
Endothelial dysfunciton initiates________ involving what types of arteries? atherosclerosis; arteries big-small... aorta, small, smallest arteries, precappillary arterioles
endothelium controls the caliber of arterioles which regulates_______ blood pressure (cardiac output also regulates blood pressure)
formation of a blood clot within a blood vessel thrombosis
what is a stationary blood clot composed of? fibrin and platelets (trapped RBS and WBC in response to exposed subendothelial damage)
What 3 factors predispose to thrombus formation? endothelial injury, alteration in blood flow (turbulence or stasis), alteration in blood itself
what are some predispositions to thrombosis? atheroma, aneurysms, slow flow, change in coagulability of blood
hardening of arteries is known as______. What are the 3 types? arteriosclerosis; 1-atherosclerosis(large, medium, small arteries), 2-Monckeberg medial calcific sclerosis (muscular arteries-but does Not narrow lumen by itself, 3-arteriolosclerosis (small arteries and arterioles)
What are the 2 variants of arteriolsclerosis? hyaline and hyperplastic
The American Heart Association(AHA) classifies atherosclerotic lesions into 6 types of increasing severity... 1- initial lesion is fatty dot(1st decade of life), 2-fatty streak, 3-6- increasing severity, 6- advanced complicated lesion w/ surface defect (fatty atheroma)
What initiates the process of atherosclerosis? when endothelial cells become dysfunctional
What are the participating cells of atherosclerosis? endothelial cells, macrophages, vascular smooth muscle(VSM), Platelets, T-lymphocytes
How do macrophages participate in atherosclerosis? blood monocytes transform to macrophages, ingest oxidized LDL and become foam cells
How does Vascular smooth muscle participate in atherosclerosis? it undrgoes hyperplasia to thicken vessel wall and may also transform into fibroblasts and produce collagen after migrating into intima
How do platelets affect atherosclerosis? produce growth factor which stimulates the process and also participates in thrombosis
How do T-lyphocytes participate in atherosclerosis? both CD4 and CD8 are present in atherosclerotic plaques and participate in inflammatory process in plaque
Major risk factors for atherosclerosis hypertension, cigarettes, diabetes mellitus, dyslipidemia (hyperlipidmia (high LDL cholesterol/and/or tryglycerides, low HDL also risk factor), obesity, sedentary life, stressful life, age males- equal after menopause, genetic factors
An advance atherosclerotic plaque can also be called pulmonary embolism
a clot that moves is known as____ and is caused by ___ or ____ embolus.... fat or air
a systemic arterial disease that affects the arterial system in a widespread manner... list 5 areas of involvement atherosclerosis predilection...1-lower ABD aorta and iliac arteries, 2-proximal coronary arteries 3-femoral and polpliteal arteries, thoracic aorta, 4-internal carotid arteries, 5- circle of willis, middle cerebral, vertebral, basilar
loss of surface endothelium over an atherosclerotic plaque is called... most of these (85%) produce <75% fixed narrowing so cause NO anginal symptoms coronary thrombosis (plaque fissuring or rupture)
heart disease resulting from reduced or absent blood flow to left ventricular myocardium ischemic heart disease
the most important cause of passive congestion of the lungs ischemic heart disease
what results if left ventricle is suddenly cut off by coronary artery thrombosis acute myocardial infarciton
infarcted cardiac myocytes are removed by a ___________ and they __________regenerate but are _______ by noncontractile collagenous fibrous tissue.... resulting in.... inflammatory reaction... do NOT... replaced....reduced pump efficiency of left ventricle =>left ventricular heart failure
in ischemic heart disease there's >90% cases due to atherosclerotic coronary artery obstruction. What are the 4 syndromes of IHD: 1-angina pectoralis, 2-myocardial infarction, 3-chronic IHD w/ heart failure (CIHD), 4-sudden cardiac death
occurs when there is decreased myocardial perfusion w/ insufficient oxygen supplied to myocardium... and what is a common setting angina pectoris... exercise with increased HR, and at rest which reflects a greater decrease in myocardial perfusion
_______angina occurs when there's fixed atherosclerotic narrowing of 75% or greater stable, typical or exertional angina
_______angina is due to coronary artery spasm, and may be associated with coronary atherosclerosis or No narrowing variant (prinzmetal) angina
_______angina is due to slow buildup of a partially occluding thrombus on an atherosclerotic plaque unstable, crescendo or preinfarction angina
the 2 anatomic types of Myocardial infarction 1-subendocardial infarction -outer part of myocardium is spared -partially occluded thrombus in coronary artery [non ST segment elevation], 2-transmural infarction (entire thickness of myocar- occluding thrombus in a coronary artery [ST segment elevation]
3 complications of MI 1-myocardial perforation (7-10 days after acute MI through softened infarcted muscle may cause pericardial tamponade), 2-mural endocardial thrombi may cause embolism eg. brain, 3-left ventricular aneurysm formation
inflammation of a blood vessel, artery, or vein... 2 general causes? vasculitis... 1. immune mediated (autoimmune) 2. infections- due to invasion of the blood vessel wall by an infectious pathogenic micro-organism
4 criteria used to claassify systemic vasculitides 1-clinical manifestations, 2-size of vessel, 3-anatomic location of involved vessel, 4-histologic type of inflammation
vessels involved in vasculitis 1 large vessel eg-_________2 medium sized vessel eg-________ 3- small vessel eg-_______ 4- capillary-_______ 1 large vessel eg-giant cell arteritis, takayasu arteritis 2 medium sized vessel eg-polyarteritis nodosa, kawasaki disease 3- small vessel eg-microscopic polyangitis, wegener granulomatosis 4- capillary-goodpasture syndrome
What type of vasculitis results from bacteria, viruses, SLE, and has intense neutrophilic infiltration, has fibrinoid necrosis, and has C3 deposits microscopic polyangiitis, hypersensitivity or leukocytoclastic vasculitis
What affects medium sized arteries, has organ failur, skeletal mm. weakness, kidney fx, affected most in this order kidney> heart>liver polyarteritis nodosa
what usually presents with extensive granulomas in lung, necrotizing vasculitis, necrotizing glomerulonephritis, (also skin rash, muscle px, joint disease, mono, polyneuritis) WEGENER GRANULOMATOSIS (immunosuppressive therapy is used)
what is more common in females, affects temporal artery with other arteries of head and can affect muscle arteries, usually above 50yrs temporal (giant cell) arteritis
aorta, pulmonary artery and major branches affected, there's a genetic predisposition, and ocular disturbances (blindness, retinal atrophy, retinal hemorrhages, no pulse in upper limbs, <40 and females takayasu arteritis
80% pts <4 years, acute febrile illness w/erythema of oral mucosa, skin of palms and soles, cervical lymph node enlargement, large/medium arteries w/intimal thickening=>coronary artery obstruction (most frequent cause of MI in kids Kawasaki disease (mucocutaneous lymph node syndrome)... w/ appropriate therapy rate of symptomatic coronary artery disease is reduced to 4%
this disease is found in smokers, males, relapsing and remitting, tibia and radial arteries, vascular insufficiency and gangrene of limbs buerger disease (thromboangitis obliterans)
left ventricular cardiac hypertrophy resulting from systemic hypertension which increases the work load of the left ventricle.... WHAT ARE THE 2 TYPES? hypertensive heart disease...1-CONCENTRIC HYPERTROPHY-left ventricular wall thickens, 2-ECCENTRIC HYPERTROPHY-left ventricular wall thickens and heart dilates, right sides also dilate =>CHF
when cardiac valve fails to open properly=>narrowing of aperature (orifice) stenosis
when cardiac valve fails to close properly with resulting regurgitation of blood back through incompletely closed valve in next phase of cardiac cycle insufficiency
the most common valvular disease which tends to occur in older persons (1-2% have congenital bicuspid aortic valves and develop it a younger age... if NL tricuspid aortic valve develop after age 60) calcific aortic valve stenosis... when valve orifice is reduced by >50% the work load of Left ventricle significant increased
what 3 major symptoms occur in advanced aortic stenosis 1-angina, 2-syncope, 3-congestive heart failure
enlarged mitral valve leaflets prolapse /balloon into left atrium during left ventricular systole mitral valve prolapse
the valve lesions are termed vegetations and are composed of fibrin, platelets, and bacteria... mitral valve prolapse is the most common predisposing condition infective (bacterial) endocarditis
is usually a complication of rheumatic fever with rheumatic carditis.... there's thickening of valve cusps and fusion of commisures resulting in stenosis mitral valve stenosis
the most prominent symptom of CHF is_______. _______ is another symptom dyspnea on exertion... leg edema
up-regulation of _____ occurs in almost all CHF patients and is an important cause of increase in plasma blood volume RAAS renin angiotensin aldosterone system
In CHF the heart dilates undergoing ______hypertrophy with both _____and _____ of the cardiac myocytes. The ejection fraction goes down due to decreased myocardial___________ eccentric... elongation... thickening.... contractility
an increased amount of blood in an organ or tissue congestion... (acive congestion due to increased arterial inflow of blood in an organ or tissue inflammation or exercising muscle)
due to decreased venous outflow of blood from an organ or tissue, CHF or venous obstruction passive congestion
CHF refers to passive congestion of inflow or upstream organs to the L or R sides of the heart when the L or R ventricle fails in its pump function. L ventricular failure causes_____. R ventricular failure causes______. L=> pulmonary passive congestion and brown deposits macrophages in lungs(acute or chronic), R=>chronic passive congestion of liver> spleen> kidney and bowel (ascites and edema also present)
causes of L ventricular pump failure (4) 1-ischemic heart disease, 2-hypertensive heart disease, 3-aortic valve disease, calcific aortic stenosis, 4- primary myocardial disease, viral myocarditis, hemochromatosis
what's the most common cause of R sided heart failure? preexistent L heart failure
R sided heart failure with a NL L heart (unusual cause of R heart failure)... results from primary disease in lungs (emphysema), pulmonary vessels or chest cavity deformity raising pressure in pulmonary artery and increasing work load of R ventricle Cor Pulmonale
list 4 congenital left to right shunts 1-atrial septal defect(ASD)l=>r atrium, 2-ventricular septal defect (VSD) L=>R ventricle(most common), 3-atrioventricular septal defect(AVSD) all 4 chambers communicate eg)downs synd, 4-patent ductus arteriosus (PDA) outside heart shunt aorta=> pulm arter
list the congenital right to left shunts 1-tetralogy of fallot, 2-transposition of great arteries(TGA),3-truncus arteriosus, 4-tricuspid atresia
in rheumatic carditis or carditis ______ are the inflammatory focus in the myocardium and contain lymphocytes and may contain enlarged macrophages called__________ aschoff nodule... anitschkow cells.......... the mitral valve is involved in 65% of cases and aortic valve involved in 25% casaes and R sided cardiac valves rarely involved
_____shock due to primary decrease in blood volume (ABD aneurysim rupture, GI bleed, 3rd degree burn, dehydration) hypovolemic shock
____shock due to pahological condition in heart (MI, cardiac tamponade, myocarditis, pulmonary embolism, arrhythmias) cardiogenic shock
_____shock due to bacterial invasion into bloodstream (more gram + then gram -, fungi) septic shock
______shock has neurological causes or popularly known as nervous breakdown neurogenic shock
3 clinical phases of shock 1-initial (nonprogressive shock), 2- progressive phase, 3- irreversible phase leading to death
an x-linked recessive genetic disorder with mutaion/deletion of dystrophin gene in skeletal and cardiac muscle... results in lack of scaffold protein duchenne muscular dystrophy... die in early twenty/teen due to respiratory failure but cardiac arrhythmias and cardiac failure may also occur
3/100,000 and <40 more frequent in females, ptosis and diplopia in extraocular muscles, generalized muscle weakness, thymic hyperplasi present in 65% pts and thyoma in 15%... removal of ABN thymus could improve muscle weakness Myasthenia gravis... No cardiac involvement
Created by: abva