Pulmonary circulation

Question 1

ARDS signs

Answer 1

Bilateral alveolar infiltrates

No LA hypertension PCWP

Question 2

Classification of Pulmonary HTN (WHO groups)

Answer 2

1. PAH *
2. PH due to Left heart disease
3. PH due to Lung diseases and/or hypoxia
4. Thromboembolic Pulmonary HTN
5. PH w/ unclear mechs.

Question 3

Causes of pulmonary arterial hypertension (PAH)

7

Answer 3

1. idiopathic *primary
2. heritable
3. diet
4. cirrhosis
5. HIV
6. Collagen vascular disease
7. Congenital heart disease

Question 4

Criteria for Pulmonary HTN

Pulmonary arterial HTN?

Answer 4

MPAP >/= 25 mmhg

PAH:
MPAP >/= 25 mmhg PLUS
PCWP/LVEDP = 15 mmhg PLUS
PVR > 3 woods units

Question 5

What does the chest x ray show with DVT?

Answer 5

almost always clear

Question 6

Where does the main adaptive immune response occur in lung diseases? Describe process.

Answer 6

In the lymph nodes.
Lungs are where sampling occurs.

Dendritic cell takes up antigen → processes it → puts on MHC 2 → presents to CD4s → goes to lymph nodes/presents → activates adaptive response

Question 7

Mesotheliomas are associated with what?

Answer 7

its a malignant lung diseases associated with asbestos

Question 8

There are two types of respiratory failure:

Answer 8

1. hypercapneic
   (elevated CO2 or impaired ventilation)
2. Hypoxemic
   (inadequate oxygenation)

Question 9

Hypoxemic respiratory failure

Answer 9

any process that impairs oxygen transport across the alveolar/capillary barrier

(note that oxygenation/ventilation is fine)

• Alveolar filling processes, LHF w/ pulm edema, pneumonia, alveolar hemorrhage, ARDS, pulm vascular disease, shunt

Question 10

Hypercapneic respiratory failure

Answer 10

due to inadequaet ventilation (CO2 removal)

• obstructive/restrictive lung disease, central causes of hypoventilation

Question 11

If PaO2: FIO2 ratio is between 300-200, what types of lung disease is it?

Answer 11

acute lung injury

(ARDS is

Question 12

Histophathological findings in ARDS

Answer 12

1. alveolar flooding
2. hyaline membranes
3. neutrophil influx
4. inflammation

Question 13

Conditions that predispose to ARDS (8)

Answer 13

1. sepsis
2. pancreatitis
3. trauma
4. transfusion
5. aspiration/inhalation
6. acute CNS processes
7. Amniotic fluid embolism
8. fat embolism

Question 14

What is the only treatment for ARDS?

Answer 14

low tidal volume ventilation (6cc/kg)

Question 15

Know the differences between atopic asthma, nonatopic asthma

Answer 15

atopic asthma: allergy induced asthma

non-atopic asthma: inflammation/constriction of airways not caused by exposure to allergen

Question 16

What has higher radiation, X ray or CT? PET?

Answer 16

PET + CT!!

- more radiation AND more expensive

Question 17

Is MRI good imaging tool for lung?

Answer 17

No, but great for cardiac and vascular imaging

• even more expensive than CT! which is more expensive than x ray!

Question 18

Opacity vs lucency

Answer 18

Opacity: too dense

Lucency: not dense enough