clinical knowledge

Question 1

cor pulmonale

Answer 1

肺心病 or pulmonale is right ventricular enlargement secondary to a lung disorder that causes pulmonary artery hypertension. Right ventricular failure follows. Findings include peripheral edema, neck vein distention, hepatomegaly, and a parasternal lift. Diagnosis is clinical and by echocardiography. Treatment is directed at the cause.

Cor pulmonale results from a disorder of the lung or its vasculature; it does not refer to right ventricular (RV) enlargement secondary to left ventricular (LV) failure, a congenital heart disorder (eg, ventricular septal defect), or an acquired valvular disorder.

Question 2

Causes of acute and chronic Cor Pulmonale

Answer 2

PE (massive - acute); ARDS/mechanical ventilation injury

COPD, chornic PE, traua/scar, sysstemic sclerosis, ILD, kyphoscoliosis, obesity with aveolar hypoventilation, neuromuscular involving resp muscles, idiopathic,

Question 3

normopressure hydrocephalus

Answer 3

Classic triad

• Gait difficulty
• Cognitive disturbance (executive function, distraction, multitasking, working under time stress)
• Urinary incontinence

Other features of NPH may include:

●Long tract signs with lower extremity spasticity, hyperreflexia, and extensor plantar responses

●Decreased coordination, hand tremor (usually postural rather than resting), and bradykinesia suggestive of parkinsonism

●Rigidity that is usually characterized by paratonia or Gegenhalten rather than the cogwheel rigidity of parkinsonism. (See “The detailed neurologic examination in adults”.)

●In late stages, frontal release signs, akinetic mutism, and quadriparesis may occur