608 - Pulmonary HTN, Sleep apnea, Lung physical findings in dz Flashcards
What is a normal pulmonary artery pressure?
10-14 mmHg
What is the arterial pressure in pulmonary hypertension?
≥ 25 mmHg at rest
What are the consequences of pulmonary HTN on pulmonary arteries?
- arteriosclerosis
- medial hypertrophy (tunica media)
- intimal fibrosis
What causes primary pulmonary HTN?
inactivating mutation in the BMPR2 gene (normally functions to inhibit vascular smooth muscle proliferation)
Does primary pulmonary HTN have a good or bad prognosis?
poor
What are 7 causes of secondary pulmonary HTN?
- COPD
- mitral stenosis
- recurrent thromboemboli
- Autoimmune disease
- L → R shunt
- Sleep apnea
- Living at high altitudes
How does COPD → pulmonary HTN?
destruction of lung parenchyma
How does mitral stenosis lead to pulmonary HTN?
↑ resistance → ↑ pressure
how do recurrent thromboemboli → pulmonary HTN?
↓ cross-sectional area of pulmonary vascular bed
How does autoimmune disease → pulmonary HTN?
inflammation → intimal fibrosis → medial hypertrophy
How does sleep apnea → pulmonary HTN?
hypoxic vasoconstriction
How does living at high altitude → pulmonary HTN?
hypoxic vasoconstriction
What is the course of pulmonary HTN?
severe respiratory distress → cyanosis and RVH → death from decompensated cor pulmonale
What is sleep apnea?
Repeated cessation of breathing > 10 seconds during sleep → disrupted sleep → daytime somnuolence
During the day, do sufferers of sleep apnea have ↑, ↓, or normal PaO2?
normal
What are some complications of sleep apnea?
nocturnal hypoxia →
- systemic/pulmonary HTN
- arrhythmias (atrial fib/flutter)
- sudden death
What are the 2 types of sleep apnea?
Central and obstructive
Differentiate central and obstructive sleep apnea
Central = no respiratory effort Obstructive = respiratory effort against airway obstruction
Which type of sleep apnea is associated with obesity and loud snoring?
obstructive sleep apnea
What is the treatment for sleep apnea?
weight loss, CPAP, surgery
What is a hematologic abnormality that accompanies sleep apnea?
Hypoxia → EPO release → ↑ erythropoiesis
What is obesity hypoventilation syndrome?
obesity (BMI ≥ 30) → hypoventilation → ↓ PaO2 and ↑ PaCO2 during waking hours
Describe the following findings in a patient with a pleural effusion:
- breath sounds
- percussion
- fremitus
- tracheal deviation
- breath sounds: ↓
- percussion: dull
- fremitus: ↓
- tracheal deviation: none
Describe the following findings in a patient with atelectasis (bronchial obstruction):
- breath sounds
- percussion
- fremitus
- tracheal deviation
- breath sounds: ↓
- percussion: dull
- fremitus: ↓
- tracheal deviation: toward side of lesion
Describe the following findings in a patient with spontaneous pneumothorax:
- breath sounds
- percussion
- fremitus
- tracheal deviation
- breath sounds: ↓
- percussion: hyperresonant
- fremitus: ↓
- tracheal deviation: none
Describe the following findings in a patient with tension pneumothorax:
- breath sounds
- percussion
- fremitus
- tracheal deviation
- breath sounds: ↓
- percussion: hyperresonant
- fremitus: ↓
- tracheal deviation: away from lesion
Describe the following findings in a patient with a consolidation (lobar pneumonia, pulmonary edema):
- breath sounds
- percussion
- fremitus
- tracheal deviation
- breath sounds: bronchial breath sounds; late inspiratory crackles
- percussion: dull
- fremitus: ↑
- tracheal deviation: none
