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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

20
Q

what is the clinical questionnaire to ask to determine OSA

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
what is symptoms, heard on PE and seen on CT imaging with Idiopathic Pulmonary fibrosis
Symptoms: Progressive dyspnea, dry cough, fatigue, inabillity to perform activities of daily living PE: velcro lung CT imaging: honeycombing with traction bronchiectasis
26
Treatment of pulmonary fibrosis?
``` Supportive care steroids immunomodulators antifibrotic therapy -pirfenidone: decrease fibroblast proliferation -nintedanib: tyrosine kinase inhibitor ```
27
Clinical Presentation of Sacroidosis
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
What histology is iconic for sarcoidosis
Non caseating granulomas
29
what are the 4 stages of radiographic images of sarcoidosis
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
Characteristics of Granulomatosis with Polyangiitis
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
Characteristics of Good pastures syndrome
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
what are the 3 Connective tissue diseases that are associated with Interstitial lung disease
systemic sclerosis rheumatoid arthritis Dermatomyositis/polymyositis
33
what is seen with hypersensitivity pneumonitis on histology and what are some common names? and when do they get better
Farmers lung bird fanciers lung woodworkers lung bakers lung symptoms improve when they go on vacation Histology: non caseating granulomas with plasma cells
34
what do radiographs show in silicosis and what are they increased risk for?
show nodular lung disease and calcified hilar lymph nodes show large nodules with extensive fibrosis increased risk for TB
35
what is the treatment of berylliosis and how do the radiographs show?
steroids hilar LAD, diffuse infiltrates

Clinical Pulm (5 decks)

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