Pulmonary Clinical Medicine III: Pulmonary HTN, PE, Sleep Apnea, and Interstitial Lung Disease Flashcards
What is pulmonary HTN defined as?
Mean pulmonary artery pressure (PAP) > 20 mmHg
When diagnosing pulmonary HTN with ECG what is found?
Right ventricular hypertrophy
What is the most common tool in diagnosing pulmonary HTN?
What does it estimate?
1) Transthoracic Echocardiogram
2) Pulmonary artery systolic pressure
What is the gold standard tool and the most definitive in diagnosing pulmonary HTN?
Swan-Ganz Catheter
What is the normal RA pressure?
Normal RV pressure?
Normal pulmonary capillary wedge pressure?
Normal pulmonary artery pressure?
1) 0-8 mmHg
2) Systolic: 20-25 mmHg, Diastolic: 6-12 mmHg
3) 6-12 mm Hg
4) Systolic: 20-25 mmHg, Diastolic: 4-8 mmHg
What is pulmonary embolism defined as?
What does it usually arise from?
1) Venous thromboembolism (VTE) located in pulmonary vasculature
2) DVT
What are the factors that contribute to venous thrombus formation?
Virchow’s Triad:
1) Hypercoagulability
2) Venous stasis
3) Endothelial injury
What role do protein C and S have in the Anti-Coagulation Pathway?
What role does antithrombin III have?
1) Blocks sites at VIII and V to inhibit clotting cascade
2) Blocks site at II and X
If there is ineffective regulation of factor VIIIa and Va then what is deficient in the anti-coagulation pathway?
If there is ineffective regulation of Xa and IIa what is deficient?
What prevent binding of protein C?
1) Protein C and S
2) Antithrombin III
3) Factor V Leiden mutation
What lab test contributes to the diagnosis of PE by measuring the breakdown of fibrin by plasmin?
What can be done if it is normal?
What can be done if it is elevated?
1) D-dimer
2) Rule out PE
3) Further investigation because it is a sensitive test
What is found on EKG in PE?
S1,Q3,T3:
1) Deep S wave in lead 1
2) Q wave in lead 3
3) Inverted T wave in lead 3
What is the primary test for diagnosis of PE?
What is used if they are contraindicated to that test?
1) CT chest with Contrast
2) V/Q scan (used in those with contrast allergy)
What is unstable PE characterized by?
Hypotension
In the Tx of unstable PE what should be done first?
What therapy can be done next after ensuring no contraindication?
1) Resuscitation (Oxygen and IVF)
2) Thrombolytic therapy
What are the Tx options for stable PE?
1) Heparin
2) Low Molecular Weight Heparin (enoxaparin, Lovenox)
3) Vitamin K antagonist (warfarin, Coumadin)
4) Direct Oral Anticoagulants: (rivaroxaban, apixaban, edoxaban, dabigatran)
What is the duration of treatment of PE?
This extended treatment is not typically recommended for those patients who had?
1) Minimum of 3 months for all patients
2) Provoked DVT such as travel, surgery, hormone therapy
What is intended for those with underlying disease with high risk of VTE recurrence such as malignancy or genetic mutations?
Indefinite anticoagulation
Obstructive Sleep Apnea is defined as?
Disruption in breathing pattern while sleeping that
results in excessive daytime somnolence despite adequate sleep periods and not explained by other causes
What are examples of the disruptive breathing patterns see in in Obstructive Sleep Apnea?
1) Snoring
2) Gasping for air
3) Breathing pause
What is apnea defined as?
Reduction in breathing for at least 10 seconds with a noted drop in SpO2 by > 3%
In sleep related breathing disorders what are the 2 issues?
1) Obstruction (Soft tissue or anatomical abnormalities)
2) Ventilatory drive (Body’s sensitivity to CO2)
What is the number one cause/predictor of Obstructive Sleep Apnea?
Obesity
What is the gold standard for diagnosis of Obstructive Sleep Apnea?
Polysomnogram
What does polysomnogram monitor?
1) EEG
2) ECG
3) Ocular movement
4) Airflow
5) O2 saturation
What is the standard of care treatment for Obstructive Sleep Apnea?
How does it work?
1) Continuous Positive Airway Pressure (CPAP) device
2) Provides positive pressure ventilation to overcome obstruction
Interstitial lung disease is a heterogeneous group of pulmonary disorders with a variety of different causes (acquired, genetic, both) that present with what same
characteristics?
1) Restrictive Pattern on Pulmonary Function Tests (PFTs)
2) Decreased DLCO
3) Dyspnea on exertion
Pulmonary interstitial tissue refers to the CT that supports?
Alveoli and capillaries to allow gas exchanges
Idiopathic pulmonary fibrosis most commonly occurs at what age?
What is found on PE?
What is found on CT?
1) Greater than 60 y/o
2) Prominent inspiratory crackles (Velcro lung)
3) Honeycomb pattern with traction bronchiectasis
Why is diagnosis and early treatment crucial for idiopathic pulmonary fibrosis?
The survival rate is only 50% at 3-5 years after diagnosis
Sarcoidosis is characterized by the presence of?
What race is it most common in?
What sex is it more common in?
1) Non-caseating granulomas
2) African Americans
3) Women
What syndromes can sarcoidosis present with?
1) Lofgren’s Syndrome
2) Heerfordt’s Syndrome
What is Lofgren’s Syndrome characterized by?
1) Erythema nodosum
2) Hilar lymphadenopathy
3) Fever
4) Arthritis
What is Heerfordt’s Syndrome characterized by?
1) Anterior uveitis
2) Parotitis
3) Cranial VII nerve palsy
4) Fever
What is the most common finding on radiology for sarcoidosis?
Hilar Lymphadenopathy
What causes systemic small-vessel vasculitis most often affecting the sinuses, kidneys and lungs?
Granulomatosis with Polyangiitis
What lab finding points to Granulomatosis with Polyangiitis?
What is the treatment?
1) C-ANCA
2) Steroid and cyclophosphamide
What is an autoimmune condition with antibodies against the basement membrane of alveolar and glomerular parenchyma?
Goodpasture’s syndrome
What lab finding points to Goodpasture’s syndrome?
What is the treatment given along with steroids and cyclophosphamide?
1) Anti-GBM
2) Plasmapheresis
Interstitial lung disease can be associated with what connective tissue diseases?
1) Systemic Sclerosis
2) Rheumatoid Arthritis
3) Dermatomyositis
What is an inflammatory process that affects alveoli, bronchioles and interstitium due to repeated exposure to specific antigens?
Hypersensitivity Pneumonitis
Along with non-caseating granulomas, what is specifically found on histology for hypersensitivity pneumonitis?
Plasma cells
What is an interstitial lung disease caused by the inhalation of inorganic dust that results in tissue inflammatory response that results in fibrosis?
Pneumoconiosis
What type of pneumoconiosis is prominent in miners, stone cutters, sandblasting, and quarry workers?
Silicosis
What is found on radiographs for simple silicosis (long exposure to silicosis)?
1) Nodular lung disease
2) Calcified hilar LNs
What is found on radiographs for complicated silicosis (progressive disease)?
Large nodules with extensive fibrosis
What infection are patients at an increased for with silicosis?
TB
Due to the risk of inhaling fibrous material made of a composite of inorganic minerals, those that work in construction, insulation, demolition, and automobiles are at an increased risk for?
Asbestosis
What are Asbestosis patients at an increased risk of?
1) Malignant mesothelioma
2) Lung cancer
Those that work in the manufacturing of alloys and electronic devices have an increased risk for?
Berylliosis
