PHTN, PE, Acidosis

Question 1

PHTN if mean pulmonary arterial pressure at rest is –

Answer 1

greater than 25 mmHg

Question 2

PHTN if mean pulmonary arterial pressure is – at exercise

Answer 2

greater 35 mmHg

Question 3

types of PHTN

Answer 3

primary and due to specific disease

Question 4

PHTN leads to –

Answer 4

RV overload and failure

Question 5

PHTN also involves increased risk of –

Answer 5

coagulation

Question 6

cardiac cause of PHTN

Answer 6

congenital heart disease, (L –> R shunt), LV diastolic dysfunction

Question 7

pulmonary cause of PHTN

Answer 7

COPD, restrictive lung disease, etc

Question 8

hepatic cause of PHTN

Answer 8

portal hypertension/liver failure

Question 9

determine cardiac origin of PHTN with –

Answer 9

CXR and echo

Question 10

In primary pulmonary vessels become constricted due to –

Answer 10

hypertrophy and fibrosis

Question 11

endothelin 1, thromboxane

Answer 11

vasoconstrictors

Question 12

prostacyclin, NO

Answer 12

vasodilators

Question 13

hypertrophied and fibrotic vessels are caused by –

Answer 13

endothelial dysfunction

Question 14

endothelial dysfunction includes

Answer 14

enhanced remodeling, increased vasoconstrictors, decreased vasodilators

Question 15

T/F: primary PHTN can be sporadic or familial

Answer 15

true

Question 16

both types of primary PHTN involves a genetic defect that leads to – and stimulation of endothelial smooth muscle proliferation

Answer 16

serotonin overproduction

Question 17

what receptors are involved in primary PHTN

Answer 17

TGF-beta

Question 18

symptoms of PHTN: – progressive exertional dyspnea, chest discomfort and syncope

Answer 18

fatigue

Question 19

when all diagnosis tests (CXR, echo, pul fxn) are negative, how do you test for PHTN?

Answer 19

measure pulmonary artery pressure with pulmonary artery cathererization

Question 20

primary PHTN treatment

Answer 20

vasodilators and lung transplant for severe

Question 21

secondary PHTN treatment

Answer 21

treat underlying disorder

Question 22

Prognosis of PHTN

Answer 22

poor without a treatable etiology

Question 23

prevalence of PHTN

Answer 23

women 30-35 y/o

Question 24

it’s important to need to rule out – as primary cause of PHTN

Answer 24

embolism

Question 25

-- can help determine if PHTN has a ventilation or vascular issue

Answer 25

V/P scan

Question 26

pulmonary embolism is occlusion of one or more pulmonary arteries by --

Answer 26

distant thrombi

Question 27

risk factors for pulmonary embolism

Answer 27

impaired venous return, endothelial injury/dysfunction (DVT, hypercoaguable states)

Question 28

origin of embolism

Answer 28

pelvic vein, lower deep veins, non-thrombotic emboli (fat)

Question 29

cause of acidosis

Answer 29

increased acid production, decreased acid excretion or reduced body's buffering capacity

Question 30

response to metabolic acidosis

Answer 30

pulmonary - hyperventilation (fast)

Question 31

response to pulmonary acidosis

Answer 31

renal buffering (slow)

Question 32

cause of respiratory acidosis

Answer 32

hypoventilation and elevated PCO2 (hypercapnia)

Question 33

what usually causes hypercapnia?

Answer 33

reduced alveolar ventilation

Question 34

T/F: obstruction, pulmonary disease, neuromuscular disease, drug overdose can cause hypoventilation

Answer 34

true

Question 35

respiratory acidosis can be --

Answer 35

acute or chronic

Question 36

cause of metabolic acidosis

Answer 36

reduced serum bicarbonate or build up of non-volatile acids

Question 37

causes of reduced bicarbonate

Answer 37

renal failure and severe diarrhea

Question 38

causes of excess acids

Answer 38

diabetic ketoacidosis, alcoholic ketoacidosis

Question 39

anion gap refers to a -- relative to available bicarbonate

Answer 39

disproportionate increase in non-volatile acids

Question 40

symptoms and signs of respiratory acidosis depends on --

Answer 40

degree and duration

Question 41

-- if breathing stops or becomes severely impaired, within moments see confusion, anxiety, psychosis, seizures, and drowsiness that may progress to stupor and coma

Answer 41

Acute respiratory acidosis

Question 42

– may start with headache and drowsiness but will advance to fatigue, lethargy, confusion

Answer 42

Chronic respiratory acidosis

Question 43

tx of respiratory acidosis

Answer 43

intubation (titrate oxygen carefully)

Question 44

if you don't titrate oxygen carefully when treating acute respiratory acidosis then

Answer 44

reduce ventilatory drive

Question 45

tx of chronic respiratory acidosis

Answer 45

treat underlying diseases (or administer sodium bicarbonate if first tx not effective)

Question 46

mild metabolic acidosis may be -- or experience nausea, vomiting and fatigue

Answer 46

asymptomatic

Question 47

T/F: severe acidosis may result in hypotension, shock, coma and death

Answer 47

true

Question 48

Acidosis may lead to --, gastrointestinal and cardiac manifestations

Answer 48

CNS