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Clin Med - Pulmonary > Disorders of Pulmonary Circulation > Flashcards

Disorders of Pulmonary Circulation Flashcards

1
Q

what is a thrombus

A

clot of blood formed within a blood vessel and remaining attached to its place of origin

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2
Q

what is an embolus

A

abnormal particle circulating in the blood (air bubble)

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3
Q

what is the branch of physiology that deals with blood circulation

A

hemodynamics

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4
Q

where do thrombi usually form?

A

deep veins- usually distally in the femoral or popliteal veins

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5
Q

when a diagnosis of PE is made, what imaging study is typically performed next

A

doppler/ultrasound of the legs to check for a clot

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6
Q

true or false: a PE comes from a clot in the veins of the legs

A

false

will not necessarily find a clot, but often do

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7
Q

hemodynamic effects of a PE

A

reduced total area of pulmonary vascular bed
chemical mediators induce vasoconstriction
increased resistance

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8
Q

what is the major factor that will dictate prognosis

A

size of the thrombus or embolism

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9
Q

what kind of non-thrombotic PEs are there

A

Air
Fat/Bone
Amniotic Fluid
Foreign body

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10
Q

3 highest risk factors for PE

A

venous stasis
immobilization
surgery/trauma

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11
Q

how many deaths per year are caused by PE

A

300,000

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12
Q

how many PEs are clinically silent

A

60-80%

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13
Q

is PE mortality greater in men or women

A

men

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14
Q

highest risk group among surgical specialties

A

orthopedic surgery

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15
Q

which race is PE more common in

A

black > white

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16
Q

highest risk for women

A

OCPs

smoking

17
Q

4 classic symptoms of PE

A

SOB
cough
abrupt onset of chest pain
hx of risk factors

18
Q

which symptoms do the majority of patients present with

A

none

most are silent

19
Q

most common physical exam findings (5)

A 
tachypnea
rales
tachycardia
prominent S2
fever
20
Q

what tool is used to assess risk of PE

A

wells prediction rule

high risk >7

21
Q

what criteria is used to determine whether testing for DVT is necessary

A

PERC

22
Q

what testing is done to check for DVT

A 
ECG
d dimer
V/Q scan
helical CT
CT pulmonary angiogram
ultrasound of lower extremity (for DVT)
23
Q

What is a D- dimer

A

tests for fibrin degradation product- elevated in the presence of thrombosis
sensitive but not specific
great to rule out a DVT, not great for Dx

24
Q

what signs are found on x-ray for PE

A

westmark’s

hamton’s

25
Q

which diagnostic test is the gold standard for PE testing

A

pulmonary angiogram
used rarely now
able to remove clot at the time of testing but lots of contrast and radiation

26
Q

treatment of PE

A

anticoagulation
3 to 12 months
O2 if they’re hypoxic
surgery if hemodynamically compromised

27
Q

which anticoagulation therapy should be used

A

heparin or lovanox (for inpatients)
warfarin- takes time to kick in
Xa inhibitors
thrombin inhibitor

28
Q

what makes heparin a great choice for inpatients with a new Dx of PE

A

reversible treatment- can be stopped if it turns out to be a saddle embolus or something else that needs surgery

29
Q

pulmonary hypertension definition

A

MAP = 25 mmHg at rest

PCWP or LVEDP < 15 mmHg

30
Q

what is the primary cause of pulmonary hypertension

A

idiopathic

possibly familiar

31
Q

symptoms of pulmonary hypertension

A

DOE

fatigue syncope

32
Q

signs of pulmonary hypertension

A

loud P2
early systolic click
JVD

33
Q

ECG signs of pulmonary hypertension

A

p pulmonale
right atrial and right ventricular enlargement
right axis deviation

34
Q

treatment of pulmonary hypertension

A

calcium channel blockers
endothelin receptor agonist
phosphdiesterase inhibitors
prostanoids

35
Q

what is a common outcome (diagnosis) after prolonged right sided heart failure

A

cor pulmonale

36
Q

symptoms of cor pulmonale

A 
fatigue
tachypnea
doe
peripheral edema
angina
37
Q

signs of cor pulmonale

A 
s2 split
early ejection click
systolic ejection murmur
left parasternal heave
hepatojugular reflux
pitting edema
38
Q

what diagnostic study is used for cor pulmonale

A

ecg
echo
right heart cath

39
Q

treatment for cor pulmonale

A 
fluids
treat underlying disease
chronic:
o2
diuretics
vasodilators
digoxin

Clin Med - Pulmonary (13 decks)

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