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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
Q

What are some signs that a patient is unstable with their pulmonary embolism?

A

Hypotension

Cardiac issues

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26
Q

What is the treatment for an unstable pulmonary embolism patient?

A
  • Resuscitation = O2 and hemodynamic support
  • Thrombolytic therapy
  • Surgery for a thrombectomy
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27
Q

What are the treatment options for a stable pulmonary embolism patient?

A
  • Heparin
  • LMWH
  • Vitamin K antagonists like warfain/coumadin
  • DOAC like rivaroxaban
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28
Q

How long is treatment for a pulmonary embolism?

A

At least 3 months, but may be indefinite for certain conditions

29
Q

Is extended treatment recommended for patient’s who had a provoked DVT?

A

NO

30
Q

What is Obstructive Sleep Apnea?

A

Disruption in breathing pattern while sleeping that results in excessive daytime sleepiness despite adequate sleep periods

31
Q

What disruptions in breathing pattern may be present with OSA?

A

Snoring, gasping, breathing pause

32
Q

What is Apnea?

A

Decreased breathing for more than 10 seconds with a drop in O2 sat by more than 3%

33
Q

What measures the severity of OSA?

A

Apnea-Hypoapnea Index (AHI)

= apnea episdoes/hour

34
Q

Disruption in breathing pattern while sleeping that results in excessive daytime somnolence despite adequate sleep periods

A

Obstructive Sleep Apnea (OSA)

35
Q

What are the risk factors for OSA?

A
  • Obesity!
  • Male
  • Large tongue, tonsils, lymph nodes, cranial abnormalities
36
Q

What is OSA associated with?

A
  • HTN, CAD, Afib
  • Type 2 Diabetes
  • Occupational hazard
37
Q

What is the primary risk factor for OSA?

A

Obesity

38
Q

A STOPBANG questionnaire is used for?

A

OSA

39
Q

What is the gold standard to diagnose OSA?

A

Polysomnogram

40
Q

What does a Polysomnogram measure for OSA?

A

EEG
ECG
Ocular movement
Airflow and O2 saturation

41
Q

What are the treatment options for OSA and what do they do?

A

CPAP: (+) ventilation pressure to overcome obstruction

Oral appliance: thrust mandible forward to open airway

42
Q

What are the cons to the treatment options for OSA?

A

CPAP - high non-compliance rate

Oral appliances - require adjustments, jaw/teeth pain

43
Q

What are the characteristics that Interstitial Lung Diseases share?

A

Restrictive pattern on PFTs
Decreased DLCO
Absence of infection/malignancy
Dyspnea on exertion

44
Q

What are the characteristics that Interstitial Lung Diseases share?

A
  • Restrictive pattern on PFTs
  • Decreased DLCO
  • Absence of infection/malignancy
  • Dyspnea on exertion
45
Q

What is heard on auscultation with Idiopathic Pulmonary Fibrosis?

A

Velcro like crackles

46
Q

What is seen on CXR with Idiopathic Pulmonary Fibrosis?

A

Honeycombing fibrosis with traction bronchiectasis bilaterally

47
Q

What are the extra symptoms with Sarcoidosis

(non-caseating granulomata)?

A 
Cutaneous involvement - erythema nodosum, maculopapular rash, lupus pernio
Ocular symptoms (uveitis)
48
Q

Lofgren’s Syndrome

A

Sarcoidosis

= Erythema nodosum, hilar LAD, arthritis

49
Q

Heerfordt’s Syndrome

A

Sarcoidosis

= Ocular issues, parotitis, CN VII palsy

50
Q

What are the extra symptoms with Granulomatosis with Polyangiitis?

A

Hemoptysis
Saddle nose
Chronic rhinitis/sinusitis and recurrent otitis media

51
Q

What marker will be (+) with Granulomatosis with Polyangiitis?

A

(+) C-ANCA

52
Q

What is the treatment for Granulomatosis with Polyangiitis?

A

Steroids + Cyclophosphamide

53
Q

What are the extra symptoms with Goodpasture Syndrome?

A

Proteinuria
Hematuria
Hemoptysis
Weight loss

54
Q

What antibodies are (+) with Goodpasture Syndrome?

A

(+) anti-GBM

– against basement membrane

55
Q

What is the treatment for Goodpasture Syndrome?

A

Plasmapheresis + steroids + cyclophosphamide

56
Q

What 3 connective tissue diseases are associated with ILDs?

A

Systemic Sclerosis
Rheumatoid Arthritis
Dermatomyositis/Polymyositis

57
Q

In what 2 ILDs is HISTORY very important in the diagnosis?

A

Hypersensitivity Pneumonitis

Pneumoconiosis

58
Q

Hypersensitivity Pneumonitis involves an allergic alveolitis due to an inhaled allergen. What will be present on histology?

A

Plasma cells

59
Q

With Hypersensitivity Pneumonitis, chronic forms may have a honeycomb pattern that spares?

A

Bases of lungs

60
Q

When will symptoms improve for Hypersensitivity Pneumonitis?

A

When patient is away from the allergen

61
Q

4 Pneumoconiosis?

A

Silicosis
Asbestosis
Coal Worker’s Pneumoconiosis
Berylliosis

62
Q

What workers are at an increased risk for Silicosis?

A

Miners, stone and sand workers, quarry workers

63
Q

Simple Silicosis

A

Nodular lung disease + calcified hilar lymph nodes

64
Q

Complicated Silicosis

A

Large nodular lung disease + fibrosis

65
Q

With Silicosis, patients are at an increased risk for?

A

Infection, especially TB

66
Q

With Asbestosis, what will be seen on CXR?

A

Pleural effusions/fibrosis

Blurring of the cardiac silhouette

67
Q

Berylliosis occurs due to Beryllium exposure. Where can that occur?

A

Alloy and electronic manufacturing

68
Q

Treatment for Berylliosis?

A

Steroids and removal from environment

2 - CPR (pulmonary) (26 decks)

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