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Diseases of Vascular Origin Flashcards

1
Q

Where is the usual location where PE’s arise from?

A

Deep leg vv.

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2
Q

What is the main etiology for DVT formations?

A

Immobilization (like in hip Fx)

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3
Q

This is a large emboli inside the bifurcation of the pulmonary a. and its major branches.

A

Saddle embolus

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4
Q

What is the acute problem with a large PE?

A

Sudden death

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5
Q

What is the more chronic problem with a large PE?

A

R sided heart failure (cor pulmonale)

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6
Q

What is the problem with small PE’s?

A

hemorrhage or infarction

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7
Q

Where do 3/4 of infarctions occur in the lungs?

A

Lower lobes

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8
Q

What is the gross morphology of an infarction of the lower lobes of the lung?

A

Wedge infarction with the apex pointing towards the hilus

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9
Q

True or False: there will not be lines of Zahn in the thrombus of the PE.

A

False. There will be.

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10
Q

In infarction, what will be in the pleural surface?

A

Fibrious exudate

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11
Q

Which test can u use to Dx a pulmonary embolus?

A

Spiral CT

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12
Q

At what % of systemic pressure must the pulmonary pressure meet to be termed “primary pulmonary HTN (PH)”?

A

1/4 the systemic levels.

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13
Q

If a pt has familial PH, what the protein that is mutated?

A

BMPR2

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14
Q

What is the fxn of the BMPR2 receptor in the cell?

A

Surface protein important for embryogenesis, apoptosis, and cell proliferation/differentiation

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15
Q

What are some secondary forms of PH?

A

endothelial dysfxn by mechnaical or biochemical injury

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16
Q

What is PH usually associated with?

A

Structural cardiopulmonary conditions that increas pulmonary blood flow or pressure (or both)

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17
Q

Which forms of PH have medial hypertrophy, atheromas of the pulmonary a. and RVH?

A

All forms of PH

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18
Q

What is the tuft of capillary fomrations that look like a web that spans the lumens of dilated thin-walled small arteries called?

A

Plexiform lesion

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19
Q

This is the condition where there’s an autoimmune hemorrhage syndrome of the lungs and kidneys.

A

Goodpastures syndrome

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20
Q

There are autoimmune Ab’s against which structural component of the kidney and lung?

A

Collagen IV

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21
Q

What is the triad of problems in goodpastures?

A
  1. destruction of the basement membrane (anti-GBM)
  2. proliferative and rapid glomerulonephritis
  3. necrotizing hemorrhagic intertitial pneumonitis
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22
Q

What type of hypersensitivity reaction is goodpastures?

A

type II

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23
Q

What is gross morpholgy of the lungs in goodpastures?

A

Heavy with red-brown consolidation

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24
Q

What types of cells are present in the lungs with goodpastures?

A

hemosiderin-laden macrophages

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25
What are the beginning respiratory Sx of goodpastures?
hemoptysis
26
What is teh most common cause of death in goodpastures?
uremia
27
What improves prognosis in goodpastures?
Plasmapheresis
28
This is a rare disorder of intermittent, diffuse alveolar hemorrhage, typically in young children.
Pulmonary hemosiderosis
29
What are the Sx to pulmonary hemosiderosis?
productive couhg, hemoptysis, anemia, and weight loss.
30
True or False: there is diffuse pulmonary infiltration in pulmonary hemosiderosis similiar to goodpastures.
True.
31
What drugs can u give for the Tx of pulmonary hemosiderosis?
Prednisone or azathioprine
32
This is an autoimmune disease with granulomatous inflammation of the upper respiratory tract and necrotizing vasculitis affecting the small vessels.
Wegener granulomatosis
33
What type of ANCA do u see with wegener granulomatosis?
c-ANCA (PR3)
34
What are the 3 components of the triad to wegener's granulomatosis?
1. acute necrotizing granulomas of the upper resp tract 2. necrotizing or granulomatous vasculitis of small-med sized vessels 3. crescentric glomerulonephritis
35
What is the major Sx of Wegeners?
Hemoptysis
36
What do u see in the lungs and kidneys in wegeners?
lungs- capillaritis and scattered, poorly formed granulomas | kidneys- necrotizing glomerulonephritis
37
What % of pts die within a year with Wegeners?
80%
38
What is the Tx for Wegeners?
steroids, cyclophosphamide, and TNF-antagonists
39
At what mean pulmonary arterial pressure (MPAP) is indicative of pulmonary HTN?
> 25mmHg
40
What must be NORMAL alongside the ↑ MPAP to be a pulmonary HTN Dx?
Pulmonary capillary wedge pressure
41
True or False: there is lower extremity edema in pulmonary HTN.
True
42
What is the non-invasive way of diagnosing a DVT?
Duplex ultrasonography
43
What are the Sx to a PE?
tachypnea, tachycardia, dyspnea, pleuritic pain, hemoptysis, pleural friction rub, wheezing
44
What are the 2 big red flags that point to acute PE?
syncope or acute hypoTN
45
Gib me all the tests for a PE Dx.
``` Clinical exam EKG (S1, Q3, T3) CXR Blood gases BNP Troponins + ↑ d-dimer ```
46
What is the gold standard test for a PE?
Pulmonary angiography
47
What are the 2 drugs u can give for a PE?
Heparin Warfarin
48
If a pt has a massive PE, what is the class of drugs u should give within 24 hrs?
Thrombolytics (streptokinase, urokinase)
49
This type of heparin is used in outpatient therapy or prophylaxis, for proximal DVT or PE, normal v/s, low risk of bleeding, lower incidence of HIT, and rapid onset.
LMWH
50
What route must u give unfractionated heparin?
IV drip
51
Nasal septal perforation and ulceration of the vomer is a sign of what disease?
Wegener's
52
This is a disease where there is systemic and pulmonary vasculitis, there are extravascular granulomas, and ↑ IgE + eosinophilia.
Churg_Strauss syndrome (CSS)
53
CSS occur exclusively in patients with a Hx of what?
Asthma or allergies
54
What are the Sx to CSS?
resp distress, nasal polyps, allergic rhinitis, nasal mucosa crusting and septal perforations.
55
What do u see on CXR in CSS?
patchy + occasiaonally diffuse alveolar infiltrates in perihilar area
56
This is a relapsing chronic multisystemic inflammatory disorder where there is apthous ulcers/stomatitis along with others Sx.
Behcet disease
57
How many of these Sx (alongside the apthous ulcers/stomatitis) must the pt have to be diagnosed with Behcet disease? ``` Apthous ulcerations Uveitis Cutaneous nodules/pustules Synovitis Meningoencephalitis ```
2
58
What can u see in the upper and lower extremities in Behcet disease?
DVT's
59
True or False: in behcet disease, there is mile hemoptysis.
FALSE. ITS SUPER GNARLY.
60
What shows up on CXR in behcet disease?
Lung infiltrates, pleural effusions, prominent pulmonary artereis and pulmonary artery aneurysms
61
This is the condition where there is chronic inflammatory disease that affects the primary aorta and major branches. Ella Chan Baek.
Takayasu artertitis
62
This is the condition where there is recurrent episodes of purpura, arthralgias, weakness + multiorgan involvement.
Mixed cryoglobulinemia
63
What is the mose serious complication to mixed cyroglobulinemia?
Glomerulonephritis
64
What Ab do u screen for in goodpastures?
Anti-GMB Ab
65
What Ab lines the basement membrane with complement in goodpastures?
IgG
66
Which patients with goodpatures get glomerulonephritis and lung hemorrhage?
Young men in 20's
67
Which patients with goodpastures get glomerulonephritis alone?
Elderly women
68
What are the classic Sx to goodpastures?
Recurrent hemoptysis, pulmonary insufficiency, hematuria, renal failure, anemia
69
This is the condition characterized by vasoconstriction, pulmonary vascular remodeling + thrombosis in situ.
Pulmonary Arterial Hypertension (PAH)
70
What are the clinical manifestations of PAH?
leads to progressive increase in pulmonary vascular resistnace, RHF, and death.
71
True or False: PAH has non-specific Sx of progressive dyspnea, lower extremity edema, and fatigue.
True
72
What is the most common causes of PAH?
Idiopathic

Respiratory (9 decks)

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