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Clinical Pulm > PHTN, PE, OSA, Interstitial lung disease > Flashcards

PHTN, PE, OSA, Interstitial lung disease Flashcards

1
Q

what is considered pulmonary hypertension and what is normal

A

> 25 mmHg

normal 10-14mmHg

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2
Q

what are the groups of pHTN?

A

Pulmonary arterial hypertension

Left heart disease

pulmonary disease
-COPD, ILD, OSA

Chronic VTE

Miscellaneous (sarcoidosis, tumor suppression

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3
Q

Diagnosis of pHTN

A

ECG

  • show right ventricular hypertrophy
  • right atrial enlargement
  • incomplete bundle branch

Labs:
-elevated BNP

Transthoracic echocardiogram (TTE)
-can estimate pulmonary artery systolic pressure by using the tricuspid regurgitation gradient, RV chamber size

Cardiac catherization

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4
Q

what is the swan-Ganz Catheter

A

puts a balloon in the pulmonary artery to determine the pulmonary artery pressure

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5
Q

what is the treatment of pHTN

A

treat underlying cause

Medications:

  • prostacyclin agonist
  • phosphodiesterase inhibitor (tadalafil)
  • endothelium antagonists (ambrisentan)
  • calcium channel blockers
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6
Q

what is Virchows triad that leads to DVT

A

Hypercoagulability
Venous stasis
endothelial injury

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7
Q

what are some symptoms of PE

A 
Chest pain
Palpitations
dyspnea
syncope
lower extremity edema
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8
Q

what is the wells criteria used for

A

Clinical assessment for pulmonary embolism

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9
Q

what is a lab that can be used for ruling out PE?

A

D dimer which is elevated levels in clot burden or inflammatory states

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10
Q

how does EKG appear on PE

A

sinus tachycardia

S1Q3T3: deep S wave in lead 1 Q wave in lead 3 inverted T wave in lead 3

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11
Q

how to image PE

A

CT chest with contrast
(gold standard)

V/Q scan is second line nuclear study

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12
Q

Treatment of Unstable PE

A

Unstable = Hypotension, RV strain, elevated cardiac enzymes

Resuscitation

  • thrombolytic therapy
  • proceed to surgery
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13
Q

Treatment of a stable PE

A

Heparin

LMWH (enoxaparin, lovenox)

Vitamin K antagonists (warfarin, coumadin

Direct oral anticoagulants (DOAC) (rivaroxban, apixaban, endoxaban, dabigatran)

  • expensive, reversible
  • does not need a LMWH therapy bridge
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14
Q

what is the duration of treatment for PE?

A

Minimum of 3 months for all patients
-not longer for DVT provoked by surgery, hormone therapy, or travel

Indefinite anticoagulation:
-undelying disease with high risk

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15
Q

Definition of OSA

A

disruption in breathing pattern while sleeping
-snoring, gasping for air, breathing pause

reduction in breathing for at least 10 seconds with a noted drop in SpO2>3%

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16
Q

how is OSA/CSA severity measured

A

apnea hypopnea index

-calculated by taking the number of apnea episodes/hours

17
Q

what are the issues in sleep related breathing disorders

A

Obstruction: soft tissue or anatomical abnormalities that predispose patient to having more difficult time keeping airway patent during sleep

Ventilatory drive:
-bodys sensitivity to CO2 (too little or too much regulation is directly linked to apnea/hypoapnea episodes

18
Q

what is OSA associated with?

A 
HTN
Afib/flutter
CAD
insulin resistence T2DM
Occupational hazard
19
Q

what is the number one risk factor for OSA

A

Obesity

20
Q

what is the clinical questionnaire to ask to determine OSA

A

STOPBANG

21
Q

How to diagnosis OSA or CSA

A

gold standard Polysomnogram

  • records sleep activity for 6-7 hrs
  • monitors EEG, ECG, ocular mvmt, airflow, and O2 saturation
22
Q

Treatment of OSA

A

Continuous Positive airway pressure (CPAP)

Oral appliances that thrusts the mandible forward and result in opening airway that is good for mild OSA
-mandibular advancement splint

23
Q

what are interstital lung diseases?

A
  • Restrictive pattern on Pulmonary function tests
  • decreased DLCO
  • dyspnea on exertion
  • absence of primary infection or malignancy
24
Q

what are the 5 categories of interstitial lung disease

A

Idiopathic Interstital pneumonia

Granulamatous interstitial lung disease

Interstitial lung disease associated with connective tissue disorders

Hypersensitivity pneumonitis

Pneumoconius

25
Q

what is symptoms, heard on PE and seen on CT imaging with Idiopathic Pulmonary fibrosis

A

Symptoms:
Progressive dyspnea, dry cough, fatigue, inabillity to perform activities of daily living

PE: velcro lung

CT imaging: honeycombing with traction bronchiectasis

26
Q

Treatment of pulmonary fibrosis?

A 
Supportive care
steroids
immunomodulators
antifibrotic therapy
-pirfenidone: decrease fibroblast proliferation
-nintedanib: tyrosine kinase inhibitor
27
Q

Clinical Presentation of Sacroidosis

A

Cough, dyspnea
Cutaneous involvement: lupus pernip, erythema nodosum, maculopapular rash
ocular symptoms: anterior uveitis

Lofgrens syndrome: erythema nodosum, hilar lymphadenopathy, fever, arthritis

Heerfordts syndrome: anterior uveitis, parotitis, cranial VII nerve palsy, fever

28
Q

What histology is iconic for sarcoidosis

A

Non caseating granulomas

29
Q

what are the 4 stages of radiographic images of sarcoidosis

A

stage 0 = No pulmonary involvement

Stage 1 = Hilar LAD

Stage 2 = Hilar LAD and infiltrates

stage 3 = infiltrates only

stage 4 = fibrosis

these are not progression of the disease can be at any point of the disease

30
Q

Characteristics of Granulomatosis with Polyangiitis

A

affects small vessels of the sinuses, kidneys, and lungs

Clinical presentation: dyspnea, cough, hemoptysis, fevers, saddle nose, chronic sinusitis/rhinitis, recurrent otitis media

Labs: C ANCA

Radiology: Lung nodules, patchy ground glass opacities, hilar LAD

Treatment: steroids + cyclophosphamide

31
Q

Characteristics of Good pastures syndrome

A

autoimmune condition of antibodies anti GBM against the basement membrane of alveolar amd glomerular parenchyma
-lead to diffuse alveolar hemorrhage and glomerulonephritis

CP: weight loss, fevers, proteinuria, hematuria, dyspnea, cough, hemoptysis, hypoxemia

labs: anti- GBM
treatment: Plasmapheresis, steroids, cyclophosphamide

32
Q

what are the 3 Connective tissue diseases that are associated with Interstitial lung disease

A

systemic sclerosis

rheumatoid arthritis

Dermatomyositis/polymyositis

33
Q

what is seen with hypersensitivity pneumonitis on histology and what are some common names? and when do they get better

A

Farmers lung
bird fanciers lung
woodworkers lung
bakers lung

symptoms improve when they go on vacation

Histology: non caseating granulomas with plasma cells

34
Q

what do radiographs show in silicosis and what are they increased risk for?

A

show nodular lung disease and calcified hilar lymph nodes

show large nodules with extensive fibrosis

increased risk for TB

35
Q

what is the treatment of berylliosis and how do the radiographs show?

A

steroids

hilar LAD, diffuse infiltrates

Clinical Pulm (5 decks)

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