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Respiratory > Pulm Vasc Dz > Flashcards

Pulm Vasc Dz Flashcards

1
Q

pulmonary circulation is ___ pressure and ____ volume

A

low; low

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2
Q

how does pulm circulation accommodate increased cardiac output?

A

recruitment of additional blood vessels (rather than distension)

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3
Q

what is an avg pulm blood pressure (syst/diast)

A

25/8

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4
Q

blood flow is greatest in this region of the lung

A

zone 3 (lower region)

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5
Q

alveolar pressure is greatest in this region of the lung

A

zone 1 (upper)

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6
Q

an intrinsic pulm vacular disease implies that the etiology of the dz is?

A

related to injury of the blood vessels themselves

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7
Q

the ultimate cause/precurser of pulm HTN is

A

decreased cross-sectional area

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8
Q

what vascular changes (4 steps) lead to thromboembolism and/or a decrease in cross-sectional area of pulm blood vessels?

A

medial hypertrophy –> intimal proliferation –> angiomatoid transformation –> fibrinoid necrosis (flexiform lesions)

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9
Q

definition of pulm HTN

A

mean pulm artery pressure (PAP) > 25mmHg at rest (average is 15)

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10
Q

definition of pulm arterial HTN (PAH)

A

mean PAP >/= 25, pulm wedge pressure =/< 15, PVR >/= 3 wood units

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11
Q

what is the equation of pulm vascular resistance?

A

mPAP - PCWP/CO

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12
Q

the ultimate negative consequence of pulm vascular disease is?

A

cor pulmonale

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13
Q

passive PH is due to?

A

left heart dysfunction leading to increase LA pressure

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14
Q

hyperkinetic PH is due to?

A

intracardiac shunt (high flow), hemolytic anemia, dialysis

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15
Q

occlusive PH is due to?

A

chronic PE, tumor emboli

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16
Q

obliterative PH is due to?

A

emphysema, ILD, vasculitis, sarcoidosis

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17
Q

vasoconstrictive PH is due to?

A

hypoxia, scleroderma

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18
Q

group 1 PH is defined as?

A

pulm arterial hypertension (intrinsic PH) = idiopathic, heritable, drug/toxin-induced, etc.

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19
Q

intrinsic PH is assoc with what diseases?

A

connective tissue disease, HIV infection, portal HTN, congenital heart dz, schistosomiasis, sickle cell anemia

20
Q

group 2 PH is due to?

A

heart disease

21
Q

group 3 PH is due to?

A

lung disease and/or hypoxia (leading to vasoconstriction)

22
Q

group 4 PH is due to?

A

chronic thromboembolic pulm HTN (CTEPH)

23
Q

name 4 risk factors for group 4 PH

A

younger age, female, chronic inflamm conditions, large central PE

24
Q

name 3 causes of group 5 PH

A

myeloproliferative disorders, sarcoidosis, chronic renal failure on dialysis, metabolic disorders

25
Q

when pulm HTN progresses, there is loss of response to what drug?

A

calcium-channel blockers (short-acting vasodilators)

26
Q

what is the go to screening tool for PH?

A

echocardiogram - assess RH size, estimate PAP, evaluate LV function

27
Q

labs are collected in a patient with PH in order to?

A

rule out secondary causes

28
Q

name several labs that would be collected to evaluate PH

A

HIV, liver fnc, ANA, tox screen, polysomnogram (apnea), PFTs

29
Q

is a CXR diagnostic for PH?

A

NO, but can rule out other disease

30
Q

what is the gold standard eval of PH

A

right heart catheterization to measure PAP, PCWP, CO

31
Q

the WHO defines how many functional classifications of PH

A

IV, with Class IV being complete inability to perform any physical activity without sx

32
Q

where do plexiform lesions form?

A

around obliterated arteries

33
Q

in addition to the three major pathways for PAH tx, what adjunct tx can be added?

A

conservative anticoag, oxygen, atrial septostomy, lung transplant (digoxin questionable)

34
Q

death beyond the first few hours post-emboism is generally due to?

A

recurrence (and thus it is preventable)

35
Q

pulmonary consequences of PE

A

deadspace, hypoxemia (shunt, mismatch), hyperventilation, depletion of surfactant(?), pulm infarct

36
Q

hemodynamic consequences of PE

A

decreased cross-sectional area (leading to PH, RHF), humoral reflex mechanisms (hypoxic vasoconstriction, mediator release)

37
Q

dx of PE

A

elevate D-Dimers, doppler US, V/P scan, pulm angiogram

38
Q

sx of acute PE

A

dyspnea, pleuritic pain, sense of doom, cough, hemoptysis, syncope

39
Q

signs of acute PE

A

tachy, increased P2, thrombophlebitis, S3/S4, sweating, edema, murmer, cyanosis

40
Q

tx options for PE

A
  1. anticoag, 2. thrombolytics (massive or RVD), IVC filter (if possibility of fatal), acute embolectomy
41
Q

how to screen for chronic thromboembolic PH

A

V/Q scan, followed by pulm angio to confirm

42
Q

clinical signs of pulmonary vasculitis

A

diffuse alveolar hemorrhage, cavitation, nodular dz, or nothing

43
Q

name three diseases that cause secondary pulm vasculitis

A

wegener’s granulomatosis, goodpasture’s syndrome, SLE

44
Q

this autoimmune dz results in antibodies against basement membrane and affects the lungs and kidneys

A

goodpasture’s syndrome

45
Q

this autoimmune dz causes pulm vasculitis and is assoc with upper airway/oral lesions

A

wegener’s granulomatosis

Respiratory (15 decks)

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