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PANRE PULM > Misc Pulm > Flashcards

Misc Pulm Flashcards

1
Q

Occlusion of deep veins (thrombosis); usually lower extremity =
Occlusion of pulm arterial circ (embolus); usually from thrombus in deep calf veins =

A

= DVT

= PE

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2
Q

Virchow’s triad

A

Hypercoagubility
Venous stasis
Endothelial injury

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3
Q

MC preventable death in hospital

A

PE

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4
Q

Common etiologies of VTE

A

1) Hereditary - Factor V Leiden (stops Prot.C)

2) Acquired - surgery, trauma, malignancy, age, OCP/HRT, pregnancy, infx, travel

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5
Q

Common presentation
DVT:
PE:

A
  • extremity edema & pain & warmth; palpable cord, Homan’s sign (???)
  • sudden dyspnea, pleuritic CP, Tachypnea, Tachycardia, cough
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6
Q

Dx (DVT)

A

H&P
Calf/thigh circumf
Well’s Criteria
Thrombophilia w/u for fam hx, personal hx
D-Dimer (only if - , strong evidence against)
Venous doppler US - best screening (90%)
Venography - gold stnd, but…pain, contrast rxn, $$$

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7
Q

Dx (PE)

A

H&P, Well’s Criteria, Thrombophilia w/u, D-dimer
ABGs - show resp alk 2/2 hyperventilation
EKG - S1Q3T3 “Classic”; sinus tach MC
CXR - Westermark’s Sign; Hamptom’s Hump
Helical (spiral) CT = CT angiography (c contrast) - filling defects; Screening test
V/Q scan - for renal dz, pregnancy (not COPD); Screening test; eval matched/ mismatched defects; low/med/high prob.
Pulm angiography - gold stnd; injected contrast reveals filling defect; toxicity issue

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8
Q

Prevention (VTE)

A

Mechanical (early ambulation, SCDs)

+/- Pharm (UFH, LMWH)

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9
Q

Tx (VTE)

A

Anticoagulation (UFH, LMWH, warfarin, Xarelto) 3-12 months
IVC filter
Thrombolytic therapy
Surgery (saddle embolus)

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10
Q

Normal Pulm circ pressure

A

Low-pressure (< 20/10 mmHg), low-resistance, high-capacitance to accomodate large inc in blood flow during exercise s signif inc in press

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11
Q

Pulm artery pressure > 25 or > 30 c exercise

Measured by right heart catheterization

A

Pulm HTN

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12
Q

Classification (Pulm HTN)

A

Primary (rare)

Secondary (MC)

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13
Q

Etiology (Pulm HTN)

A

Primary - genetic
Secondary -
*dec area arterial bed, hypoxia, loss/obstruct vascular bed (lung resection, emphysema, PE), collagen-vascular dz.
*inc venous pressure, constrictive pericarditis, LV failure, MS

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14
Q

Signs/Sxs (Pulm HTN)

A 
(insidious)
Dyspnea
Fatigue
Angina-like CP
Edema
Syncope
Palpitations
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15
Q

Dx (Pulm HTN)

A 
(multi-factorial - find underlying etiology)
CXR, CT
PFTs
Echo
Right heart catheterization
Other labs/bx...based on suspected cause
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16
Q

Tx (Pulm HTN)

A

Manage cor pulmonale - diuretics, Na/fluid restriction

Vasodilation - CCB, sildenafil

17
Q

RV enlargement 2/2 Pulm HTN (inc resistance or high BP in the lungs)
EKG: low volt, R axis dev, poor R wave prog, RVH, RAE
Assoc c COPD & Pulm HTN

A

Cor pulmonale

18
Q

Etiology (Cor pulm)

A

Pulm vascular dz (PE, vasculitis, ARDS)
Pulm parenchymal dx
Obstructive (Asthma, COPD)
Restrictive (IPF, pneumoconiosis)

19
Q

Signs/Sxs (Cor pulm)

A

Accentuated S2
Peripheral edema
JVD
Hepatomegaly

20
Q

Airway obstruction during sleep

A

Obstructive Sleep Apnea (OSA)

21
Q

Signs/Sxs (OSA)

A 
Loud snoring
Episodes of silence
Microarousals
Fatigue, HA, cognitive impairment
Daytime somnolence
22
Q

Acute hypoxemic resp failure
Without heart failure
Systemic or Pulm insult only

A

Acute Resp Distress Synd (ARDS)

23
Q

MC etiology of ARDS…

and others…

A

…Sepsis

…Aspiration, toxic inhalation, near-drowning

24
Q

Signs/Sxs (ARDS)

A

Pink, frothy sputum
Bilat diffuse pulm infiltrates
Nml pulm capillary wedge press (PCWP < 18)
PaO2/FIO2 < 200

25
Q

Tx (ARDS)

A

Underlying cause
Supportive
High mortality (esp. c sepsis)

26
Q

Phases (ARDS)

A

1) Exudative - Dyspnea, Tachypnea, resp fatigue/failure, inc work breathing
2) Proliferative - worsening sxs, fibrotic changes start
3) Fibrotic - inc mortality

27
Q

Peds resp distress syndrome
Premies
Surfactant deficiency
Poor lung compliance

A

Hyaline membrane dz.

28
Q

Signs/Sxs (Hyaline mem dz)

A

Tachypnea, Tachycardia, grunting, intercostal retractions, nasal flaring, cyanosis
Appears in first hours of life; worsens over 1-3 days
Require mech vent

29
Q

Dx (Hyaline mem dz)

A

CXR - dec aeration, AIR BRONCHOGRAM

GROUND GLASS, white out like PNA

30
Q

Prevention & Tx (Hyaline mem dz)

A

Monitor lecithin/sphingomyelin ratio (amnio)
Mom gets steroids
Baby gets surfactant if < 28 wks
Supportive, mech vent, IVF, endotrach surfact

PANRE PULM (6 decks)

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