Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Transport > Pulmonary Circulation/haemoptysis > Flashcards

Pulmonary Circulation/haemoptysis Flashcards

1
Q

where do most emboli originate from in PE

A

the deep veins of the leg

more rarely they can originate fro the upper limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Paradoxical emboli can present in the arterial system such as in a cerebrovascular event. What three conditions can produce paradoxical emboli?

A

conditions producing a right to left shunt:

1) atrial/ventricular septal defects (patent foramen ovale, post MI, pulmonary hypertension)
2) Patent Ductus Arteriosus
3) AV malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which pulmonary artery passes through the pericardium for the longest

A

the right pulmonary artery passes horizontally through the pericardium anterior to the left main bronchus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

From which arteries do the bronchial arteries arise?

A

RIGHT: the third right intercostal artery (a branch off the aorta)
LEFT: arise at the level of T5
superior–> antero-medial surface of the aortic arch (lateral to carina)
inferior –> directly from the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the differences between the bronchial and pulmonary circulations? what links them?

A

the bronchial arteries:
- smaller proportion of cardiac output (pulmonary arteries receive entire cardiac output)
- higher pressure as systemic
-supplies blood to air ways
- can cause massive haemoptysis
They are linked by the ligamentum arteriosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what clinical sign is present in a patent ductus arteriosus

A

continuous machine like murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is transposition of the great vessels and how is it treated?

A

the aorta and the pulmonary trunk are switched and therefore the baby is reliant upon the ductus arteriosus. The child becomes symptomatic upon the closure of the ductus arteriosus 2-3 weeks after birth.
treatment is with prostaglandins to maintain patency followed by surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is Virchow’s triad and what does it describe

A

The predisposition to thrombosis following an alteration in:

1) blood flow
2) blood constituents
3) injury to the endothelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what might alter blood flow

A 
SLUGGISH BF:
- immobility (incompetent venous valves, compression of VC, cardiac failure)
- AF
- cardiomyopathy and dilated ventricle
- ventricular and aortic aneurysms
TURBULENCE:
- prosthetic/infected valves
- bifurcation of vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What might alter the constituents of blood

A
  • increased cells (polycythaemia, thrombocythaemia, leukaemia)
  • dehydration
  • nephrotic syndrome
  • disturbed clotting factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what might endothelial inury

A
  • surgery (pressure on limbs)
  • trauma
  • inflammation/vasculitis
  • hypertension
  • bacterial toxins
  • chemo/radiotherapy
  • turbulent flow
  • smoking
  • hyperlidiaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

list 6 causes of venous emboli

A

1) DVT
2) fat embolism
3) gas embolism
4) amniotic fluid embolism
5) tumour embolism
6) schistosomiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

list 8 causes of arterial emboli

A

1) AF
2) mitral stenosis
3) atrial myxomas
4) thrombi overlying MIs
5) ventricular or aortic aneurysm
6) infected or prosthetic valve
7) atherosclerotic plaque
8) vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

list the 4 major causes of atheromatous plaques

A

1) hypertension
2) hyperlipidaemia
3) cigarette smoking
4) diabetes mellitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the definition of pulmonary hypertension

A

MEAN pulmonary arterial pressure of >25mmHg measured at rest from right heart catheterisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pulmonary hypertension can be split into 5 groups, breifly describe each one

A

1) pulmonary arterial hypertension - right sided heart disease
2) pulmonary venous hypertension - left sided heart disease
3) pulmonary hypertension associated with hypoxaemia - respiratory disease (esp interstitial lung)
4) pulmonary hypertension due to chronic thromboembolic disease
5) miscellaneous (sarcoidosis, histiocytosis X, lymphangiomatosis, compression of pulmonary vessels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

list some connective tissue disorders associated with pulmonary arterial hypertension

A 
Scleroderma
SLE
mixed connective tissue disease
antiphospholipid disease
rheumatoid arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the symptoms of pulmonary hypertension

A

often silent until right heart failure prevails, often misdiagnosed as athma, COPD or hysteria

  • progressive dyspnoea
  • fatigue
  • palpitations
  • chest pain
  • cough/haemoptysis
  • syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what ECG changes might you expect in pulmonary hypertension

A

Right ventricular hypertrophy:
- right axis deviation (isoelectric lead V5,6 instead of 3,4; negative QRS in lead I and tall QRS in lead II)

Right atrial enlargement:

  • Tall peaked T-waves
  • P-wave >2mm in lead II
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what might you see on an echo in pulmonary hypertension

A

tricuspid regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what might you see on a CXR in pulmonary hypertension

A

hilar enlargement
enlargement of the pulmonary arteries
pruning of the peripheral arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why should pregnancy be avoided in pulmonary arterial hypertension

A

high mortality rate (30-50%) therefore patients should be counselled about using contraception:

  • barrier methods
  • POP
  • mirena coil
23
Q

what causes septic emboli

A

IV DRUG USERS!!!
pelvic thrombophlebitis
infected venous catheter/pacemaker wire
skin infections

usually staphylococci

24
Q

describe the presentation of an acute minor PE

A

often with infarction:

  • SOB
  • pleuritic pain
  • haemoptysis
  • fever
25
Q

clinical signs which may be present in PE

A

pleural friction rub
pleuritic pain
signs of effusion (stony dull percussion, reduced expansion, reduced breath sounds and vocal resonance)
signs of DVT (unilateral, oedema, warmth, tenderness)
elevation of the JVP

26
Q

what is the gold standard investigations for PE

A

CTPA

27
Q

what might you see on an ECG in PE

A 
sinus tachy
massive PE: 
-ST/T changes in V123
-right axis deviation
- S1Q3T3 pattern --> right heart strain
- right bundle branch block
28
Q

what basic tests should be carried out on all PE presentation

A

ABGs on air
CXR
ECG
D-dimer

29
Q

which score is used to determine a patients risk of developing a PE

A

modified Wells

30
Q

which score is used in the risk stratification for the management of PE

A

Pesi score

31
Q

what might prompt you to investigate for inherited thrombophillia

A 
young age
recurrent VTE
FHx
unusual site
recurrent foetal loss/still birth
complications late in pregnancy
warfarin-induced skin necrosis
32
Q

list some inherited thrombophillias

A 
factor V leiden
anti-thrombin activity
protein C deficiency
protein S deficiency
prothrombin G20210A mutation
33
Q

list some acquired thrombophillias

A 
anti-phospholipid syndrome
anti-cardiolipin antibody
anti beta 2 glycoprotein 1
lupus anticoagulant
elevated factor VIII
JAK2 mutations
HIT
34
Q

What is HIT

A

heparin induced thrombocytopenia
heparin dependant IgG antibodies bind to heparin/platelet factor 4 complexes, this activated platelets and produces a hypercoagulable state.
This causes thombus or thrombocytopenia 5-10 days after starting heparin

35
Q

which presentations should make you think of HIT

A
  • adrenal haemorrhagic necrosis (recent onset of Addison’s)
  • necrotising skin lesions at injection site
  • acute systemic reaction
36
Q

define haemoptysis

A

coughing up blood/bloody sputum from below the larynx

37
Q

common causes of streaks/small clots

A 
SMOKERS (bronchitis)
pneumonia/TB
Bronchiectasis
Lung Ca
Heart failure
PE
Anti-coagulants/aspirin
38
Q

common causes of massive haemoptysis (>100ml)

A 
bronchiectasis
lung Ca
TB (active or healed)
aspergilloma
vascular abnormalities
vasculitis
39
Q

which therapeutic agents may be given to stop massive haemoptysis

A 
tranexamic acid
nebulised adrenaline (3ml or 1:1000)
40
Q

what are the vascular disorders which may cause haemoptysis?

A 
pulmonary infarction
AV malformation
Elevated pulmonary venous pressure (HF/MS)
pulmonary veno-occlusive disease
bronchial arteries
pulmonary arteries
capillaries
41
Q

which airways diseases can cause haemoptysis

A 
acute/chronic bronchitis
bronchogenic carcinoma
metastatic cancer
bronchiectasis
bronchial adenoma/carcinoids
sarcoidosis
Kaposi's sarcoma
foreign bodies
airway trauma
Dieulafoy's/bronchovascular fistulae
42
Q

which infective parenchymal diseases may cause haemoptysis

A 
TB
pneumonia
lung abscess
aspergilloma
mycetoma
43
Q

which inflammatory/immune parenchymal diseases may cause haemoptysis

A

Wegener’s granulomatosis (vasculitis with granulomatosis)
Goodpasture’s syndrome (associated with renal symptoms)
lupus pneumonitis
rheumatoid
scleroderma
idiopathic pulmonary haemosiderosis

44
Q

what other causes of haemoptysis are there other than vascular, airway or parenchymal disease

A 
coagulopathy
cocaine use
catamenial
trauma
idiopathic
45
Q

what are the DDx of consolidation on a CXR

A
  1. infection
  2. water
  3. tumour
  4. proteinacious fluid
  5. blood
46
Q

what are the DDx for a cavitating mass on CXR

A
  1. squamous cell carcinoma
  2. lung abscess
  3. rheumatoid nodule
  4. embolus
  5. vasculitis with granulomatosis
  6. bronchogenic cyst
  7. hydatid cyst
47
Q

what are the signs of bronchiectasis

A

finger clubbing
coarse inspiratory crackles
wheeze
(often copious purulent sputum but can be dry)

48
Q

define bronchiectasis

A

permenant dilation of bronchi and bronchioles resulting from chronic bronchial sepsis

49
Q

what is the difference between bronchiectasis and traction bronchiectasis

A

bronchiectasis -> signet ring sign on CT –> airways wider than vessels
traction bronchiectasis –> honey comb changes on CT–> pulmonary fibrosis pulls open airways

50
Q

what are the causes of bronchiectasis

A 
CONGENITAL
CF
young's syndrome
primary ciliary dyskinesia
Kartagener's syndrome
INFECTIVE
measles
childhood pneumonia
childhood pertussis
bronchiolitis
TB/HIV
CHRONIC BRONCHIAL OBSTRUCTION
CHRONIC APIRATION
ABPA
HYPOGAMMAGLOBULINAEMIA
RHEUMATOID ARTHRITIS
ULCERATIVE COLITIS
IDIOPATHIC
51
Q

What is the triad associated with Kartagener’s syndrome

A

situs inversus
abnormal frontal sinuses
primary ciliary dyskinesia

52
Q

what are the complications of bronchiectasis

A 
infective exacerbation
pleural effusion
haemoptysis (can be massive)
cerebral abscess
amyloidosis
respiratory failure
cor pulmonale
53
Q

Differentials of bronchiectasis

A

COPD
asthma
chronic sinusitis
pneumonia

Transport (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions