Disorders of Pulmonary Circulation

Question 1

what is a thrombus

Answer 1

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

Question 2

what is an embolus

Answer 2

abnormal particle circulating in the blood (air bubble)

Question 3

what is the branch of physiology that deals with blood circulation

Answer 3

hemodynamics

Question 4

where do thrombi usually form?

Answer 4

deep veins- usually distally in the femoral or popliteal veins

Question 5

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

Answer 5

doppler/ultrasound of the legs to check for a clot

Question 6

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

Answer 6

false

will not necessarily find a clot, but often do

Question 7

hemodynamic effects of a PE

Answer 7

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

Question 8

what is the major factor that will dictate prognosis

Answer 8

size of the thrombus or embolism

Question 9

what kind of non-thrombotic PEs are there

Answer 9

Air
Fat/Bone
Amniotic Fluid
Foreign body

Question 10

3 highest risk factors for PE

Answer 10

venous stasis
immobilization
surgery/trauma

Question 11

how many deaths per year are caused by PE

Answer 11

300,000

Question 12

how many PEs are clinically silent

Answer 12

60-80%

Question 13

is PE mortality greater in men or women

Answer 13

men

Question 14

highest risk group among surgical specialties

Answer 14

orthopedic surgery

Question 15

which race is PE more common in

Answer 15

black > white

Question 16

highest risk for women

Answer 16

OCPs

smoking

Question 17

4 classic symptoms of PE

Answer 17

SOB
cough
abrupt onset of chest pain
hx of risk factors

Question 18

which symptoms do the majority of patients present with

Answer 18

none

most are silent

Question 19

most common physical exam findings (5)

Answer 19

tachypnea
rales
tachycardia
prominent S2
fever

Question 20

what tool is used to assess risk of PE

Answer 20

wells prediction rule

high risk >7

Question 21

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

Answer 21

PERC

Question 22

what testing is done to check for DVT

Answer 22

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

Question 23

What is a D- dimer

Answer 23

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

Question 24

what signs are found on x-ray for PE

Answer 24

westmark’s

hamton’s

Question 25

which diagnostic test is the gold standard for PE testing

Answer 25

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

Question 26

treatment of PE

Answer 26

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

Question 27

which anticoagulation therapy should be used

Answer 27

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

Question 28

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

Answer 28

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

Question 29

pulmonary hypertension definition

Answer 29

MAP = 25 mmHg at rest | PCWP or LVEDP < 15 mmHg

Question 30

what is the primary cause of pulmonary hypertension

Answer 30

idiopathic | possibly familiar

Question 31

symptoms of pulmonary hypertension

Answer 31

DOE | fatigue syncope

Question 32

signs of pulmonary hypertension

Answer 32

loud P2 early systolic click JVD

Question 33

ECG signs of pulmonary hypertension

Answer 33

p pulmonale right atrial and right ventricular enlargement right axis deviation

Question 34

treatment of pulmonary hypertension

Answer 34

calcium channel blockers endothelin receptor agonist phosphdiesterase inhibitors prostanoids

Question 35

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

Answer 35

cor pulmonale

Question 36

symptoms of cor pulmonale

Answer 36

``` fatigue tachypnea doe peripheral edema angina ```

Question 37

signs of cor pulmonale

Answer 37

``` s2 split early ejection click systolic ejection murmur left parasternal heave hepatojugular reflux pitting edema ```

Question 38

what diagnostic study is used for cor pulmonale

Answer 38

ecg echo right heart cath

Question 39

treatment for cor pulmonale

Answer 39

``` fluids treat underlying disease chronic: o2 diuretics vasodilators digoxin ```