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2020 CPR II Pulm Exam 2 > Clinical Part 3 pHTN, PE, OSA, ILD (Pence) > Flashcards

Clinical Part 3 pHTN, PE, OSA, ILD (Pence) Flashcards

1
Q

What is pulmonary HTN?

A

mean pulmonary artery pressure > 25mmHg

associated with mortality if untreated

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2
Q

What are the symptoms of pHTN?

A

DOE, fatigue, pleuritic chest pain, pre-syncope, edema, JVP

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3
Q

What are the cardinal signs of Right HF?

A

syncope on exertion

excessive and rapid weight gain

JVP

lower extremiyt swelling

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4
Q

How is pHTN diagnosed?

A

EKG changs: RAD, iBBB, RAE in lead II

Labs: increased BNP

Transthoracis Echocardiogram (TTE): estimates pulm. artery systolic pressure, looks at RV size

Cardiac catheterization (Swan Ganz catheterization)

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5
Q

What is the best way to diagnose pHTN?

A

Swan Ganz catheterization

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6
Q

How is pHTN treated?

A

Treat underlying cause (HF, COPD, ILD, OSA, etc)

Prostacyclin agonist: epoprostenol, iloprost, selexipag

PDE inhibtor: tadalafil, sildenafi

Endothelium antagonist: bosentan, ambrisentan, macicentran

CCB: amolidipine, nifedipine, diltiazem

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7
Q

What is a PE?

A

VTE located in pulmonary vasculature

–> usually arising from a DVT

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8
Q

What is virchow’s triad?

A

hypercoagulability

venous stasis

endothelial injury

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9
Q

What are the sx of PE?

A

chest pain

palpitations

dyspnea

syncope

+/- LE edema

Consider HF and Arrythmia as DSS

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10
Q

How is PE diagnosed?

What is the Gold Standard?

A

Well’s criteria!!! or Geneva Score

LABS

D-Dimer (sensitive, rules out PE if normal)

EKG changes: sinus tach, S1Q3T3

CT Chest with Contrast is gold standard

VQ scan is second line image

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11
Q

If a D shaped LV champer is seen on Echo, what does this indicate?

A

PE

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12
Q

What is the treatment for an unstable PE?

(presents with hypotension)

A
  1. resuscitation
  2. thrombolytic therapy

if thrombolytic therapy fails, repeat thrombolysis, consider catheter-directed thrombolysis, or proceed to surgery

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13
Q

How to treat a stable PE?

A

Heparin

LMWH

Warfarin

DOACs

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14
Q

What is the mechanism of direct oral anticoagulants? (DOACs)

Do they require bridge therapy?

What are the cons?

A

Xa inhibitors-rovaroxaban, apixaban

approved to be used without LMWH bridge

expensive, may be hard to reverse

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15
Q

How long is treatment for PE?

A

at least three months

Pt’s with provoked DVT from travel, surgery or HRT do not require extended therapy

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16
Q

Who requires indefinite anticoagulation after PE?

A

those with underlying disease with high risk of VTE recurrence

  • malignancy
  • genetic mutations
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17
Q

What is the definition of OSA?

A

disruption in breathing pattern while sleeping that results inexcessive daytime somnolence despite adequate sleep periods and not explained by other causes

(snoring, gasping for air, breathing pause)

18
Q

What is the definition of apnea?

A

reduction in breathing for at least 10 seconds with a noted drop in SpO2 by >3%

19
Q

How is the Apnea-Hypopnea index calculated?

A

number of apnea episodes/hour

determines OSA severity

20
Q

If OSA is untreated, what can occur?

A

death

Sleep related breathing disorders are associated with increased morbidity and mortality if left untreated

21
Q

What is the number 1 cause/predictor of OSA?

What facial malformation can cause OSa?

A

obesity

micrognathia (small mandible)

22
Q

What is the diagnostic criteria for OSA?

A

STOP-BANG

23
Q

What is the Gold standard for diagnosing OSA?

A

PSG

occurs in sleep lab or at home, records sleep activity for 6-7 hrs

Monitors EEG, ECG, ocular movement, airflow, and O2sat

allows clinician to generate AHI and diagnose the severity of sleep apnea

24
Q

What are the treatment options for OSA?

A

CPAP

oral appliances

25
Q

What is interstitial lung disease?

A

group of pulmonary disorders with a variety of different causes that present with the same characteristics

26
Q

what are the general characteristics of ILD?

A

restrictive pattern on PFTs

Decreased DLCO

DOE

absence of infection or malignancy

27
Q

What part of the lung is affected with ILD?

A

the CT that supports the alveoli and capillaries to allow gas exchange

28
Q

What are the main findings associated with idiopathic pulmonary fibrosis?

A

Velcro Lung

Honeycombing

treat with supportive care, steroids, imunimodulators, anti-fibrotics

50% survival at 3-5 years; early diagnosis=better prognosis

29
Q

What are the main findings of Sarcoidosis?

A

non-caseating granulomas, lungs commonly affected

More common in African Americans, females, family members

Associated with Lofgren’s syndrome and Heerfordt’s syndrome

30
Q

What is Lofgren’s syndrome

What is Heerfordt’s syndrome?

A

Erythema nodosum, hilar lymphadenopathy, fever, arthritis

Anterior uveitis, parotitis, CN VII palsy, fever

31
Q

What is the treatment for sarcoidosis?

A

supportive care

steroids: 1st line therapy

immunosupression, biologics

32
Q

What are the main findings in granulomatosis with polyangitis

A

small vessel vasculitis affecting sinuses, lungs, kidneys

+C-ANCA

Treat with steroids and cyclophosphamide

33
Q

What are the main findings in Goodpasture’s syndrome?

A

autoimmune condition with Anti-GBM against the basement membrane in lungs and kidneys

+Anti-GBM

treat with plasmaphoresis

34
Q

What are some ILD assicated with CT disease?

A

Sclerosis

RA

Dermatomyosistis/Polymyositis

35
Q

What are some causes of hypersensitivity pneumonitis

A

repeated expsures to specific antigens that cause an extrinsic allergic alveolitis

  • farmer’s lung
  • Bird fancier’s lung
  • woodworker’s lung
  • baker’s lung
36
Q

What are some common symptoms of HSN pneumonitis?

What is seen on histology?

A

cough, dyspnea

sx improve on vacation

PLasma cells on histology

37
Q

What are some findings associated with Silicosis?

A

seen in miners, stone cutters, quarry workers

nodular lung disease and calcified hilar LN-simple silicosis

large nodules with fibrosis-complicated silicosis

increased risk for infection and TB

38
Q

What are some findings associated with asbestosis?

A

insulation workers, construction, demolition

nodular opacities, effusions, fibrosis, increased risk for mesothelioma esp if smoker

39
Q

What are some findings associated with coal-workers pneumoconiosis?

A

miners who inhale coal dust

may be asymptomatic or have small nodules

can have cough, dysnpea, restrictive pattern, and fibrosis with large nodules (Complicated CWP)

40
Q

What are some findings associated with Berylliosis?

A

manufacturers of electronics

similar to HSN pneumonitis in acute setting

chronically, can have hilar LAD, infiltrates, restrictive pattern, obstruction due to LAD enlargement

increased risk for lung cancer

treat with steroids

41
Q

What kind of biopsy is needed to diagnose asbestosis?

A

pleural biopsy

2020 CPR II Pulm Exam 2 (28 decks)

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