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Pulmonology > Pulmonary Circulation Disorders > Flashcards

Pulmonary Circulation Disorders Flashcards

1
Q

Refers to the movement of a clot (most commonly blood) from a systemic vein through the right side of the heart and into the pulmonary

A

Pulmonary Embolism

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2
Q

What is the most common preventable cause of hospital death?

A

Pulmonary Embolism

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3
Q

3rd most common vessel death after MI and stroke

A

Pulmonary Embolism

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4
Q

Most pulmonary embolisms arise from where?

A

thrombi in venous circulation of lower extremities 🡪 thromboembolism (typically around a valve)

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5
Q

What are other sources of pulmonary embolisms besides a LE thrombi?

A

Amniotic fluid
Air
Fat
Bone Marrow
Intravenous material
Septic emboli

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6
Q

What percentage of PE’s originate as clots in the deep veins of lower extremities, mostly in calves

A

70%

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7
Q

List some risk factors for a PE

A

Hypercoagulable States
Limb stasis (immobilization)
Prior DVT/PE
Malignancy
Age >45 years
Obesity
CHF
Trauma within the past 4 weeks
Surgery within the past 4 weeks
Major surgery
Serious infection

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8
Q

Virchow’s Triad

A

Local trauma to vessel wall (endothelial injury)

Hypercoagulability

Stasis or stagnation of the blood

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9
Q

Why can a diagnosis of PE be so difficult?

A

No single sign or symptom or combination of clinical findings are
indicative of a PE

there is not one single diagnostic test we can do to make the diagnosis

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10
Q

What is a rule that can help with a PE diagnosis?

A

The PERC Rule – Pulmonary Embolism Rule Out Criteria
(aids - not absolute)

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11
Q

When measuring and comparing the contralateral leg in suspicion for PE, what difference should you be concerned about?

A

≥2cm difference highly suspicious

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12
Q

List some low pretest probability for PE:

A

Age less than 50
Pulse rate less than 100 beats/min
Oxygen saturation greater than 94%
No hormone use
No hemoptysis
No unilateral leg swelling (measure with tape, NOT eyes)
No recent major surgery or trauma
No prior PE or DVT

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13
Q

What is a good predictor of the outcomes from PEs?

A

The degree of hypoxemia

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14
Q

One of the first workups we’re going to do in a suspected PE?

A

Pulse Ox

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15
Q

PE Workup – what Chest Xray finding is described below?

Increased opacity from intraparenchymal hemorrhage

Wedge-shaped density/area of infiltrate pointing towards hilum

A

Hampton’s Hump

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16
Q

PE Workup – what Chest Xray finding is described below?

Prominent central pulmonary artery with local oligemia

Unilateral lung oligemia (absence of vasculature)

Rare sign of a very large pulmonary embolism

A

Westermark’s Sign

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17
Q

What is the classic EKG finding in a PE?

A

T wave inversion in V1-V4

S1Q3T3: classic

18
Q

This non-specific test can help confirm, but not diagnostic of a PE

A

D Dimer

19
Q

What D-dimer level is strong evidence against thromboembolism?

A

less than 500

20
Q

What screening test for a PE is 90% sensitive?

A

Venous ultrasound

21
Q

What imaging is gold standard for diagnosing PE?

A

Pulmonary Angiography

22
Q

Why is Pulmonary Angiography not commonly used for PE even though it is the gold standard?

A

Minimal use secondary to toxicity issues

Also invasive - must insert a catheter int the pulmonary artery and inject dye in the cath lab

23
Q

What imaging has largely replaced Pulmonary Angiography for diagnosing PEs?

A

Helical (spiral) CT angiography

24
Q

Which imaging used to be the gold standard – was the most useful screening tool to rule out PE?

A

Ventilation-Perfusion Scan

25
Q

Which imaging is preferred for pregnant patients for evaluation of a PE?

A

Ventilation-Perfusion Scan

26
Q

The prognosis of patients with pulmonary embolism depends on what 2 factors?

A

underlying disease state

appropriate diagnosis and treatment

27
Q

Approximately what percentage of patients who develop PE die within the first hour?

A

10%

28
Q

The mortality in patients with undiagnosed PE is what percentage?

A

30%

29
Q

As a cause of sudden death, massive pulmonary embolism is second
only to what?

A

sudden cardiac death

30
Q

Pathological state in which the systolic pressure in the PA is consistently elevated above normal

A

Pulmonary Hypertension

31
Q

Most common cause of pulmonary hypertension is what?

A

left heart failure

32
Q

Pulmonary circulation is unique because of what factors?

A

it’s high blood flow and low pressure and low resistance

33
Q

What type of pulmonary HTN is most common?

A

secondary

34
Q

Which type of pulmonary HTN is described below?

most common

Hypoxic vasoconstriction

Obliteration of pulmonary vasculature

Volume/pressure overload

A

Secondary Pulmonary Hypertension

35
Q

Which type of pulmonary HTN is described below?

Rare (often genetic) - however cause unknown

Occurs mostly in young and middle aged women

Progressive dyspnea, rapid downhill course (self-perpetuates)

Invariably fatal if not treated – can be crippled within 6 months

Characteristic histopathologic plexiform lesions found in muscular
pulmonary arteries

A

Primary Pulmonary Hypertension

36
Q

What signs may you hear on auscultation in pulmonary HTN?

A

Narrow splitting of second heart sound with accentuation of pulmonary component - P2 may be fixed or paradoxical splitting

Paradoxical splitting: splitting of S2 heard on expiration only (disappears during inspiration)

37
Q

What are two of the biggest signs you may find on physical exam for pulmonary HTN?

A

RFV and Cor pulmonale

38
Q

What is the is gold standard to confirm diagnosis of Pulmonary HTN?

A

Right heart catheterization

39
Q

Right sided heart failure – enlargement of the right ventricle due
to high blood pressure in the arteries of the lungs usually caused by chronic lung disease

A

Cor Pulmonale

40
Q

Cor Pulmonale is most commonly caused by what lung disease in the US?

A

COPD

41
Q

What imaging is done to confirm the diagnosis of cor pulmonale?

A

Right heart catheterization

42
Q

What heart rhythm is common to see in cor pulmonale and why?

A

Atrial fib/flutter

From RA dilation – the flimsiest chamber of the heart we have

Pulmonology (8 decks)

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