Clin Med: Pulm highlights

Question 13

Pneumothorax: Patho, S/S, PE

Answer 13

Pathophys: DVT–>1. Endothelial injury–> 2. Hypercoagulability–> 3. Circulatory stasis
S/S: non-specific symptom; less common: hemoptysis, leg pain, syncope, AMS, seizures)
PE: tachycardia (happens long before hypoxia & leg swelling/tenderness)

Question 14

Pneumothorax DX

Answer 14

• CT angiography
• V/Q scan (young or preg pts, pts w/ hx of contrast allergy, pts w/ severe RF)
• EKG shows S1Q3T3 (Rare to use)
• D-Dimer–>can help predict likelihood of VTE (high = PE) (highly used)
• Baseline CBC, PT/PTT/INR, ABG

Question 15

Pulmonary Embolism: Tx

Answer 15

Stable:
- oral anticoagulants or IVC filter

Unstable:
- Thrombolytic therapy (break the clot)
- Embolectomy (physically remove blood clot surgically)

Question 16

Factors that say no to anticoagulants:

Answer 16

> 75yo, previous bleeding, pts w/ metastatic cancer, RF, liver failure, thrombocytopenia, on antiplatelet therapy, recent surg, hemorrhage stroke, alcohol abuse

Question 17

Guidelines for the duration of full anticoagulation

Answer 17

• 3-mo: after a first episode provoked by a surgery or a transient nonsurgical risk factor
• Extended therapy (no scheduled stop date) for unprovoked or recurrent
• For patients with cancer, extended therapy w/ LMWH (low molecular weight heparin)

Question 18

The most common arrhythmia seen on EKG to indicated PE?

Answer 18

Sinus tachycardia

Question 19

What is pulmonary HTN?

Answer 19

elevation in pulm arterial pressure

Question 20

Pulm HTN: patho, S/S, Course of dz, PE

Answer 20

-Pathophys: ^ pulm arterial pressure–> v blood flow through vasculature–> blood “backs up” into RV–> Right-sided HF (Cor pulmonale)

-S/S: non-specific symptoms

• Course of dz: progressive breathlessness, chest pain, syncope/dizziness w/exertion, peripheral edema, ascites (fluid in peritoneal cavity of abdomen)
• PE: Cardiac: jugular venous distension Lungs: crackles Abdomen: ascites Extremities: edema, cool

Question 21

Pulmonary HTN: Dx & Tx

Answer 21

• Dx: Echo, determine underlying dz, CXR, EKG, right-sided heart catheterization
• Tx: improve baseline via exercise capacity, treat underlying dz

Question 22

What things should you ask about w/ a pulm HTN patient?

Answer 22

cocaine, methamphetamines, alcohol, HIV

Question 23

What is Cor Pulmonale?

Answer 23

Right-sided HF resulting from lung dz

Question 24

Acute cause of Cor Pulmonale

Answer 24

PHTN & RV overload from massive pulmonary thromboembolic event

Question 25

Chronic causes of Cor Pulmonale

Answer 25

result of chronic disease-causing PHTN or idiopathic PHTN

Question 26

ARDS: pathophys, S/S, PE

Answer 26

Pathophys: inflammation–> ^ permeability in of lung–>inhibit surfactant–>alveoli can’t complete gas exchange (can get pulm edema)

S/S: sudden onset of hypoxia, fever, tachypnea/cardia, AMS

PE: hypoxia not responsive to O2

Question 27

Common causes of ARDs

Answer 27

pneumonia & sepsis

Question 28

ARDS: Dx

Answer 28

blood tests (ABG, B-natriuretic peptide, CBC w/diff), imaging (CXR [bilateral infiltrates], Echo, CT)

Question 29

ARDS: Tx

Answer 29

treat underlying conditions & supportive (mechanical ventilation)