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2 - CPR (pulmonary) > Approach to Dyspnea, Fatigue, Palpitations > Flashcards

Approach to Dyspnea, Fatigue, Palpitations Flashcards

1
Q

What defines Pulmonary Hypertension?

A

Mean Pulmonary Arterial Pressure > 20 mmHg

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2
Q

What are the symptoms with Pulmonary Hypertension that have an insidious onset?

A

Dyspnea on exertion
Fatigue
Pleuritic chest pain

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3
Q

What are the symptoms with Pulmonary Hypertension that have an insidious onset?

A

Dyspnea on exertion
Fatigue
Pleuritic chest pain

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4
Q

Besides dyspnea on exertion, fatigue and pleuritic chest pain, what other symptoms can be seen with Pulmonary Hypertension?

A

Pre-syncope

Signs of Right sided heart failure

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5
Q

What are some options for diagnosing Pulmonary Hypertension?

A

ECG
TTE
Cardiac Catheterization

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6
Q

What may an ECG show with Pulmonary Hypertension?

A
  • Right axis deviation/RBBB — (RSR’)

- Signs of Right Atrial Enlargement

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7
Q

What diagnostic test for Pulmonary Hypertension can estimate the pulmonary artery systolic pressure and heart chamber sizes?

A

TTE (transthoracic echocardiography)

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8
Q

What may the labs show with Pulmonary Hypertension?

A

Elevated BNP

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9
Q

How do you treat Pulmonary Hypertension?

A

Focus on underlying disease and symptoms based treatment

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10
Q

What demonstrates the risk factors for a Pulmonary Embolism?

A

Virchow’s Triad

  • Hypercoagulability
  • Endothelial injury
  • Venous stasis
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11
Q

Normal action of Protein C and S?

A

(-) sites at factors VIII and V to (-) clotting

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12
Q

Normal action of Antithrombin III?

A

(-) sites at factors X and II to (-) clotting

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13
Q

Factor V Leiden Mutation

A

Mutation that does NOT allow Protein C to bind to factor V to (-) it and the clotting cascade

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14
Q

Deficiencies in what things along with the factor V leiden mutation lead to what aspect of Virchow’s Triad and an increased risk for a Pulmonary Embolism?

A

Deficiencies in Protein C and S, and Antithrombin III

= Hypercoagulability!

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15
Q

What are the symptoms for a pulmonary embolism?

A 
Dyspnea
Chest pain
Palpitations
Syncope
-- possibly LE edema from a DVT
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16
Q

What are the symptoms for a pulmonary embolism?

A 
Dyspnea
Chest pain
Palpitations
Syncope
-- possible LE edema from a DVT
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17
Q

What criteria can help with an index of suspicion for a pulmonary embolism?

A

Well’s criteria

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18
Q

What lab has a high negative predictive value for a pulmonary embolism?

A

D-Dimer

= If it is normal/(-) then there is NO thromboembolic event occurring

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19
Q

What do abnormal or increased levels of D-Dimer indicate and what is it?

A

Increased degradation product of fibrin

= increased clot burden and/or inflammation

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20
Q

If D-Dimer is (-) or normal, what does that mean?

A

NO pulmonary embolism is occurring

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21
Q

What may be seen on an ECG that could indicate a pulmonary embolism?

A

S1Q3T3

= deep s wave in lead 1, q wave in lead 3, inverted t wave in 3

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22
Q

What is the gold standard diagnostic test for a pulmonary embolism?

A

CT of the chest with contrast

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23
Q

What diagnostic test can be used for patients that may have a pulmonary embolism, but are allergic to contrast or have renal disease?
(i.e. cannot have a CT with contrast)

A

V/Q scan

- nuclear study

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24
Q

Treatment of a pulmonary embolism depends on?

A

Stability of the patient

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25
What are some signs that a patient is unstable with their pulmonary embolism?
Hypotension | Cardiac issues
26
What is the treatment for an unstable pulmonary embolism patient?
- Resuscitation = O2 and hemodynamic support - Thrombolytic therapy - Surgery for a thrombectomy
27
What are the treatment options for a stable pulmonary embolism patient?
- Heparin - LMWH - Vitamin K antagonists like warfain/coumadin - DOAC like rivaroxaban
28
How long is treatment for a pulmonary embolism?
At least 3 months, but may be indefinite for certain conditions
29
Is extended treatment recommended for patient's who had a provoked DVT?
NO
30
What is Obstructive Sleep Apnea?
Disruption in breathing pattern while sleeping that results in excessive daytime sleepiness despite adequate sleep periods
31
What disruptions in breathing pattern may be present with OSA?
Snoring, gasping, breathing pause
32
What is Apnea?
Decreased breathing for more than 10 seconds with a drop in O2 sat by more than 3%
33
What measures the severity of OSA?
Apnea-Hypoapnea Index (AHI) | = apnea episdoes/hour
34
Disruption in breathing pattern while sleeping that results in excessive daytime somnolence despite adequate sleep periods
Obstructive Sleep Apnea (OSA)
35
What are the risk factors for OSA?
- Obesity! - Male - Large tongue, tonsils, lymph nodes, cranial abnormalities
36
What is OSA associated with?
- HTN, CAD, Afib - Type 2 Diabetes - Occupational hazard
37
What is the primary risk factor for OSA?
Obesity
38
A STOPBANG questionnaire is used for?
OSA
39
What is the gold standard to diagnose OSA?
Polysomnogram
40
What does a Polysomnogram measure for OSA?
EEG ECG Ocular movement Airflow and O2 saturation
41
What are the treatment options for OSA and what do they do?
CPAP: (+) ventilation pressure to overcome obstruction | Oral appliance: thrust mandible forward to open airway
42
What are the cons to the treatment options for OSA?
CPAP - high non-compliance rate | Oral appliances - require adjustments, jaw/teeth pain
43
What are the characteristics that Interstitial Lung Diseases share?
Restrictive pattern on PFTs Decreased DLCO Absence of infection/malignancy Dyspnea on exertion
44
What are the characteristics that Interstitial Lung Diseases share?
- Restrictive pattern on PFTs - Decreased DLCO - Absence of infection/malignancy - Dyspnea on exertion
45
What is heard on auscultation with Idiopathic Pulmonary Fibrosis?
Velcro like crackles
46
What is seen on CXR with Idiopathic Pulmonary Fibrosis?
Honeycombing fibrosis with traction bronchiectasis bilaterally
47
What are the extra symptoms with Sarcoidosis | (non-caseating granulomata)?
``` Cutaneous involvement - erythema nodosum, maculopapular rash, lupus pernio Ocular symptoms (uveitis) ```
48
Lofgren's Syndrome
Sarcoidosis | = Erythema nodosum, hilar LAD, arthritis
49
Heerfordt's Syndrome
Sarcoidosis | = Ocular issues, parotitis, CN VII palsy
50
What are the extra symptoms with Granulomatosis with Polyangiitis?
Hemoptysis Saddle nose Chronic rhinitis/sinusitis and recurrent otitis media
51
What marker will be (+) with Granulomatosis with Polyangiitis?
(+) C-ANCA
52
What is the treatment for Granulomatosis with Polyangiitis?
Steroids + Cyclophosphamide
53
What are the extra symptoms with Goodpasture Syndrome?
Proteinuria Hematuria Hemoptysis Weight loss
54
What antibodies are (+) with Goodpasture Syndrome?
(+) anti-GBM | -- against basement membrane
55
What is the treatment for Goodpasture Syndrome?
Plasmapheresis + steroids + cyclophosphamide
56
What 3 connective tissue diseases are associated with ILDs?
Systemic Sclerosis Rheumatoid Arthritis Dermatomyositis/Polymyositis
57
In what 2 ILDs is HISTORY very important in the diagnosis?
Hypersensitivity Pneumonitis | Pneumoconiosis
58
Hypersensitivity Pneumonitis involves an allergic alveolitis due to an inhaled allergen. What will be present on histology?
Plasma cells
59
With Hypersensitivity Pneumonitis, chronic forms may have a honeycomb pattern that spares?
Bases of lungs
60
When will symptoms improve for Hypersensitivity Pneumonitis?
When patient is away from the allergen
61
4 Pneumoconiosis?
Silicosis Asbestosis Coal Worker's Pneumoconiosis Berylliosis
62
What workers are at an increased risk for Silicosis?
Miners, stone and sand workers, quarry workers
63
Simple Silicosis
Nodular lung disease + calcified hilar lymph nodes
64
Complicated Silicosis
Large nodular lung disease + fibrosis
65
With Silicosis, patients are at an increased risk for?
Infection, especially TB
66
With Asbestosis, what will be seen on CXR?
Pleural effusions/fibrosis | Blurring of the cardiac silhouette
67
Berylliosis occurs due to Beryllium exposure. Where can that occur?
Alloy and electronic manufacturing
68
Treatment for Berylliosis?
Steroids and removal from environment

2 - CPR (pulmonary) (26 decks)

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