Pulm 6 Flashcards
A 35 yo woman comes in complaining of SOB on exertion, angina chest pain, fatigue, lethargy, and weakness. On exam you hear syncope, a narrow split and accentuated S2, and a systolic ejection click. What would you expect to find when you measure her pulmonary artery pressure and capillary wedge pressure? What disease does she have? What group is it? What test will you perform to confirm your diagnosis?
Group 1 (idiopathic) pulmonary hypertension
Increased pulmonary artery pressure
Normal capillary wedge pressure
Right heart catheter!
A pt presents with orthopnea, paryoxysmal nocturnal dyspnea, and SOB at night. Tests show increased pulmonary artery pressure and increased capillary wedge pressure. What is the underlying cause of this pt’s disease? What disease did the pt come in because of? What group is it? How do you confirm the diagnosis? How will you treat it?
The pt has an underlying left sided heart disease
Group 2 PAH
Right heart catheter
Treat the underlying disease. Consider diuretics, supplemental O2, and exercise/cardiac rehab
A pt comes in complaining of SOB, fatigue, lethargy, and weakness. You notice a blue tinge around his lips and on the tip of his nose. He tells you that he has a history of sleep apnea but that these symptoms are new. Tests show a mild increase in pulmonary artery pressure. What condition do you think the pt might have? What underlying disease should you be worried about? How will you definitively diagnose the pt? What treatment do you recommend for this pt?
Group 3 PAH
Underlying pulmonary disease
Right heart catheter
Treat with O2 (cornerstone!!) and treat the underlying cause of hypoxemia
A pt comes in because he has been experiencing SOB on exertion, fatigue, lethargy, and weakness. On exam you find a right sided murmur & S4, distended neck veins, and a palpable RV pulse. The pt tells you that he has had a pulmonary artery obstruction for the past 3 1/2 months. What disease do you suspect he has? What is the underlying cause of his disease? What test will you perform to confirm your diagnosis? How should you treat this pt?
Group 4 PAH
Underlying pulmonary artery obstruction
Right heart catheter
Treat with anticoagulants or a surgical embolectomy
A pt comes in to your office. You recently diagnosed him with Grave’s disease, but today on exam you find syncope, a narrow split and accentuated S2, systolic ejection click, distended neck veins, and a palpable RV impulse. What type of disease does he have (other than Grave’s)? What diagnostic test will you use to prove your diagnosis? How should he be treated?
Group 5 PAH
Most likely caused by his underlying thyroid disease
Right heart catheter
Treat by treating his thyroid disease
What do you HAVE to do before you can treat a pt for their PAH?
A right sided heart catheter!
What tests might you perform if you suspect PAH?
Labs (CBC), CXR (look for an enlarged pulmonary artery), EKG (RVH, RV strain), and an Echo (measures pulmonary artery pressure)
A pt came in with DOE, a chronic, productive cough, wheezing, weakness, fatigue, orthopnea, and SOB. Physical exam shows increased JVP, V was in JVP, hepatomegaly, and a palpable RV heave. What is the first test you are going to perform on the pt? What other test will you do to confirm the diagnosis? What does this pt have?
Cor pulmonale
An echo will be your initial test
A right heart catheter will confirm CP
A pt presents with DOE, wheezing, effort-related syncope, and SOB. Exam shows increased JVP, decreased ejection, and hepatomegaly. What is the most likely cause of this pt’s disease? How should you treat him?
Cor pulmonale
Most likely caused by PAH
After performing a right heart catheter, you should treat his underlying PAH and stabilize his BP. You should then improve O2 & RV function, increase RV contractility, and decreased his pulmonary vasoconstriction
A 48 yo man presents with hemoptysis, dyspnea, and chest pain. On exam you find tachypnea, sinus tachycardia, rales, decreased breath sounds, and jugular venous distension. What findings would you look for on a CXR? What is the gold standard diagnostic test for this disease?
Pulmonary embolism
Look for Westermark’s sign or Hampton’s hump on CXR
Pulmonary angiography is the gold standard for diagnosing a PE
A pt presented with hemoptysis, dyspnea, and chest pain. His pulmonary angiogram showed a blood clot lodged in the right side of the bifurcation of his main pulmonary artery. What disease does this pt most likely have? What treatment should you recommend for this pt?
Saddle PE
Recommend anticoagulants to prevent new clots or an embolectomy
What are the 4 types of PE?
Acute massive PE
Acute submassive PE
Saddle PE
Chronic PE
A pt presents with hemoptysis, dyspnea at rest, a cough, and wheezing. On exam you find hypotension, elevated central venous pressure, neck vein distension, and acute right ventricular failure. What are you most worried about in this pt? What is your diagnosis?
Acute massive PE
Most worried about risk of sudden death in the next 72 hours
A pt comes in because he has been experiencing SOB, chest pain, and coughing. He has a history of CHF. On exam you notice decreased chest movement on his right side, decreased breath sounds over his RUL and RML, and dull percussion over his RUL. What disease do you think this pt has? What is the underlying pathological cause?
Transudative pleural effusion
Caused by altered pleural fluid production/absorption
A pt presents with SOB, chest pain, and coughing. On exam you find decreased breath sounds over his left side and dull percussion over his LLL. A sample of the fluid shows protein/serum protein levels are 0.6 and LDH/serum levels are 0.8. What is most likely causing his symptoms? What 2 etiologic causes are you worried about?
Exudative pleural effusion
Most commonly caused by PNA (MC) or a malignancy (2nd MC)
