CMD - Pulmonary Edema Flashcards
favors cardiogenic pulmonary edema
a. increased pulmonary pressure
b. altered alveolar capillary membrane permeability
c. decreased plasma oncotic pressure
d. increased negativity of interstitial pressure
A
Cardiogenic pulmonary edema with engorgement of pulmonary vasculature:
a. mild
b. moderate
c. severe
A
cardiogenic pulmonary edema with alveolar filling
a. mild
b. moderate
c. severe
C
cardiogenic pulmonary edema with extravasation into intestitial space due to changes in oncotic pressure
a. mild
b. moderate
c. severe
B
The following statements favor non cardiogenic pulmonary edema EXCEPT
a. altered alveolar capillary membrane permeability
b. decreased plasma oncotic pressure
c. increased negativity of interstitial pressure
d. lymphatic insufficiency or obstruction
e. AOTA
E
True about pulmonary edema
a. mechanism depends on balance of hydrostatic and oncotic forces in the capillaries surrounding tissue.
b. hydrostatic pressure favors fluid movement into the vessel
c. oncotic pressure favors fluid movement from capillary to interstitium
d. hypoalbuminemia can cause interstitial edema by itself
A.
oncotic: fluid movement into the vessel; hydrostatic: into interstitium
Give 2 conditions under acute Myocardial infarction or ischemia that causes pulmonary edema
LV failure, vLV failure due to ventricular septal rupture
papillary muscle/chordal rupture causiing severe MR
Increase airway edema is associated with what auscultatory findings?
rhonchi and wheezes
as pulmonary edema worsens, alveo fill with fluid showing patchy alveolar filling in the perihilar distribution progressing to
diffuse alveolar infiltrates
altered alveolar-capillary membrane permeability causing noncardiogenic pulmonary edema
ARDS
True about noncardiogenic pulmonary edema
a. ARDS
b. increase plasma oncotic pressure
c. decreased negativity of interstitial pressure
d. AOTA
A
The following can cause pulmonary edema EXCEPT
a. bacterial infection
b. chlorine
c. snake venom
d. NOTA
D
The following can cause pulmonary edema EXCEPT
a. bacterial toxin
b. smoke
c. teflon
d. NOTA
D
The following can cause pulmonary edema
a. aspiration of gastric contents
b. acute radiation pneumonitis
c. both
d. neither
C
Endogenous vasoactive substances causing pulmonary edema (2)
histamine
kinins
Immunologic causes of pulmonary edema (3)
hypersensitivity penumonitis
drugs (nitrofurantoin
leukoagglutinins
T/F acute hemorrhagic pancreatitis can cause pulmonary edema
T
Causes of lymphatic insufficiency causing pulmonary edema
lungtransplantation
lymphangitic carcinomatosis
fibrosing lymphangitis
fibrosing lymphangitis is a.k.a
silicosis
a patient with pulmonary edema with central nervous system disorders, without apparent pre existing LV dysfunction
Neurogenic pulmonary edema
most frequent cause of narcotic overdose is
parenteral heroin
t/f eclampsia can cause pulmonary edema
T
The following statements are true
a. rapid onset or aggravation of dyspnea at rest
b. tachypnea
c. tachycardia
d. frothy and blood tinged sputum are rare in cardiogenic
D; more common in cardiogenic cause
Hypertension in pulmonary edema is due to
endogenous release catecholamines
wheezing is due to
airway compression from peribronchial cuffing
Evidence of heart failure
s3 gallop
jugular venous distension
causes of lymphatic blockade (3)
fibrotic disease
inflammatory disease
lymphangitic carcinomatosis
steps proposed to differentiate between cardiogenic and non cardiogenic pulmonary edema
history and PE
lab exam: cardiac enzyme, bnp
cxr
if dx uncertain, echocardiography
pulmonary artery catheterizaiton is necessary when
cause remains uncertain
disease is refractory to therapy
disease is accompanied by hypotension
T/F ABG is needed in lab investigation of pulmonary edema
T
BNP level, heart failure unlikely
<100pg/mL
Most patients with symptomatic heart failure have BNP
> 400 pg/ml
indiscriminate zone of bnp levels
100-400
proposed cutoff of bnp level for diagnosis of heart failure in px with renal disease
> 200pg/mL
BNP may be falsely low in px with
flash pulmonary edema
acute papillary muscle rupture and obesity
kerly b lines favors
a. cardiogenic
b. noncardiogenic
A
the following favor cardiogenic cause EXCEPT
a. cardiomegaly
b. cephalization
d. butterfly appearance
e. alveolar edema
E
Non cardiogenic cause of pulmonary edema is favored when
cardiomegaly is absent
alveolar edema
lack of cephalization
pleural effusion is less common
reticular opacities at the lung base representing Kerley’s B lines en face
Kerley’s C
short horizontal lines situated perpendicularly to the pleural surface at the lung base
Kerley’s B lines
Linear opacities extending from the periphery to the hila caused by distention of anastomotic channels between peripheral and central lymphatics
Kerley’s A
PCWP <19 mmHg
a. cardiogenic
b. non cardiogenic
B
PCWP >20 mmHg
a. cardiogenic
b. non cardiogenic
A
Cardiogenic pulmonary edema can be
a. high pressure
b. normal pressure
c. low pressure
A
the following favor cardiogenic cause EXCEPT
a. cardiomegaly
b. cephalization
d. butterfly appearance
e. alveolar edema
E
Non cardiogenic cause of pulmonary edema is favored when
cardiomegaly is absent
alveolar edema
lack of cephalization
pleural effusion is less common
reticular opacities at the lung base representing Kerley’s B lines en face
Kerley’s C
short horizontal lines situated perpendicularly to the pleural surface at the lung base
Kerley’s B lines
Linear opacities extending from the periphery to the hila caused by distention of anastomotic channels between peripheral and central lymphatics
Kerley’s A
PCWP <19 mmHg
a. cardiogenic
b. non cardiogenic
B
PCWP >20 mmHg
a. cardiogenic
b. non cardiogenic
A
V/Q mismatch as a cause of hypoxemia
a. noncardiogenic pulmonary edema
b. cardiogenic Pulmonary edema
c. both
d. neither
B
intrapulmonary shunting and persistence despite high concentration of inhaled oxygen as a cause of hypoxiema
a. cardiac
b. noncardiac
A
