Pulm - Vascular Disease

Question 1

How is wedge pressure measured?

Answer 1

Via a pulmonary catheter

Question 2

How do Swan-Ganz catheters reach the pulmonary arteries?

Answer 2

Insertion into the jugular vein –> through the right heart –> pulmonary arteries

Question 3

Wedge pressure is a measure of what?

Answer 3

Left ventricular filling pressure

Question 4

Name three general causes of increased pulmonary vascular resistance.

Answer 4

Vasoconstriction;

vascular obstructions;

decreased vascular bed

Question 5

Vasoconstriction in the lungs is normally mediated by a balance between __________ and __________ (also, __________ is involved).

Answer 5

Vasoconstriction in the lungs is normally mediated by a balance between nitric oxide and endothelin (also, prostacyclin is involved).

Question 6

List the first of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. _____________
2. _____________
3. _____________
4. *_____________
5. *_____________

Answer 6

List the first of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. _____________
3. _____________
4. *_____________
5. *_____________

Question 7

List the second of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. _____________
3. _____________
4. *_____________
5. *_____________

Answer 7

List the second of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. Intimal fibroplasia
3. _____________
4. *_____________
5. *_____________

Question 8

List the third of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. Intimal fibroplasia
3. _____________
4. *_____________
5. *_____________

Answer 8

List the third of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. Intimal fibroplasia
3. Dilatation of small arteries
4. *_____________
5. *_____________

Question 9

List the second of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. Intimal fibroplasia
3. Dilatation of the small arteries
4. *_____________
5. *_____________

Answer 9

List the second of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. Intimal fibroplasia
3. Dilatation of the small arteries
4. *Plexiform (glomeruloid) and angiomatoid lesions
5. *_____________

Question 10

List the fifth of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. Intimal fibroplasia
3. Dilatation of the small arteries
4. *Plexiform (glomeruloid) and angiomatoid lesions
5. *_____________

Answer 10

List the fifth of the sequence of pulmonary hypertensive changes (irreversible stages marked by asterisk):

1. Medial thickening
2. Intimal fibroplasia
3. Dilatation of the small arteries
4. *Plexiform (glomeruloid) and angiomatoid lesions
5. *Necrotizing arteritis

Question 11

Pulmonary hypertension is defined as mean pulmonary pressures > ____ mmHg.

Answer 11

Pulmonary hypertension is defined as mean pulmonary pressures > 20 mmHg.

Question 12

Pulmonary arterial hypertension is typically __________ (cause) and found in __________ (demographic).

Answer 12

Pulmonary arterial hypertension is typically idiopathic and found in young adult women.

Question 13

Name some causal mechanisms associated with pulmonary arterial hypertension.

Answer 13

Excess endothelin;

deficiency of NO;

deficiency of prostacyclin synthetase

Question 14

How does pulmonary arterial hypertension present on CXR?

Answer 14

Enlargement of central pulmonary arteries

Question 15

What are the first-line and second-line treatments for idiopathic pulmonary arterial hypertension?

Answer 15

First-line: O₂ + anticoagulation

Second-line: vasodilators + lung transplant

Question 16

Familial pulmonary arterial hypertension is associated with mutations in what gene(s)?

Answer 16

BMPR2

Question 17

The mutation in BMPR2 associated with familial pulmonary arterial hypertension causes what direct effect?

Answer 17

Smooth muscle proliferation

Question 18

Familial pulmonary arterial hypertension follows what inheritance pattern?

Answer 18

Autosomal dominant

Question 19

What is the most common cause of pulmonary vascular disease?

Answer 19

Left heart disease

(pulmonary venous hypertension)

Question 20

Which category of left-to-right cardiac shunts increases both pulmonary vascular volume and pressure?

Answer 20

Post-tricuspid shunts

Question 21

Which category of left-to-right cardiac shunts increases pulmonary vascular volume but not pressure?

Answer 21

Pre-tricuspid shunts

Question 22

What category of cardiac shunts result in hyperkinetic hypertension (blood enters pulmonary arteries in greater volume and/or at higher pressure)?

Answer 22

Left-to-right shunts

(patent ductus, septal defects)

Question 23

True/False.

There are many categories of pulmonary vascular disease, including arterial (e.g. PAH), venous (e.g. left heart failure), COPD and hypoxia, obstruction (e.g. chronic thromboembolism), and multifactorial (e.g. cirrhosis, HIV, sarcoidosis, sickle cell, drugs and diet, etc,).

Answer 23

True.