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CPR Exam 2 > Pulmonary Clinical Medicine III: Pulmonary HTN, PE, Sleep Apnea, and Interstitial Lung Disease > Flashcards

Pulmonary Clinical Medicine III: Pulmonary HTN, PE, Sleep Apnea, and Interstitial Lung Disease Flashcards

1
Q

What is pulmonary HTN defined as?

A

Mean pulmonary artery pressure (PAP) > 20 mmHg

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2
Q

When diagnosing pulmonary HTN with ECG what is found?

A

Right ventricular hypertrophy

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3
Q

What is the most common tool in diagnosing pulmonary HTN?

What does it estimate?

A

1) Transthoracic Echocardiogram

2) Pulmonary artery systolic pressure

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4
Q

What is the gold standard tool and the most definitive in diagnosing pulmonary HTN?

A

Swan-Ganz Catheter

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5
Q

What is the normal RA pressure?

Normal RV pressure?

Normal pulmonary capillary wedge pressure?

Normal pulmonary artery pressure?

A

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

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6
Q

What is pulmonary embolism defined as?

What does it usually arise from?

A

1) Venous thromboembolism (VTE) located in pulmonary vasculature
2) DVT

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7
Q

What are the factors that contribute to venous thrombus formation?

A

Virchow’s Triad:

1) Hypercoagulability
2) Venous stasis
3) Endothelial injury

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8
Q

What role do protein C and S have in the Anti-Coagulation Pathway?

What role does antithrombin III have?

A

1) Blocks sites at VIII and V to inhibit clotting cascade

2) Blocks site at II and X

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9
Q

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?

A

1) Protein C and S
2) Antithrombin III
3) Factor V Leiden mutation

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10
Q

What point based scoring is used to determine the probability of PE

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?

A

1) Well Criteria
2) D-dimer
3) Rule out PE
4) Further investigation because it is a sensitive test

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11
Q

What is found on EKG in PE?

A

S1,Q3,T3:

1) Deep S wave in lead 1
2) Q wave in lead 3
3) Inverted T wave in lead 3

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12
Q

What is the primary test for diagnosis of PE?

What is used if they are contraindicated to that test?

A

1) CT chest with Contrast

2) V/Q scan (used in those with contrast allergy)

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13
Q

What is unstable PE characterized by?

A

Hypotension

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14
Q

In the Tx of unstable PE what should be done first?

What therapy can be done next after ensuring no contraindication?

A

1) Resuscitation (Oxygen and IVF)

2) Thrombolytic therapy

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15
Q

What are the Tx options for stable PE?

A

1) Heparin
2) Low Molecular Weight Heparin (enoxaparin, Lovenox)
3) Vitamin K antagonist (warfarin, Coumadin)
4) Direct Oral Anticoagulants: (rivaroxaban, apixaban, edoxaban, dabigatran)

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16
Q

What is the duration of treatment of PE?

This extended treatment is not typically recommended for those patients who had?

A

1) Minimum of 3 months for all patients

2) Provoked DVT such as travel, surgery, hormone therapy

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17
Q

What is intended for those with underlying disease with high risk of VTE recurrence such as malignancy or genetic mutations?

A

Indefinite anticoagulation

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18
Q

Obstructive Sleep Apnea is defined as?

A

Disruption in breathing pattern while sleeping resulting in excessive daytime somnolence (drowsiness) despite adequate sleep periods and not explained by other causes

*Sx: Snoring, Gasping for air, breathing pause

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19
Q

What are examples of the disruptive breathing patterns seen in Obstructive Sleep Apnea?

A

1) Snoring
2) Gasping for air
3) Breathing pause

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20
Q

What is apnea defined as?

A

Reduction in breathing for at least 10 seconds with a noted drop in SpO2 by > 3%

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21
Q

In sleep related breathing disorders what are the 2 issues?

A

1) Obstruction (Soft tissue or anatomical abnormalities)

2) Ventilatory drive (Body’s sensitivity to CO2)

22
Q

What is the number one cause/predictor of Obstructive Sleep Apnea?

A

Obesity

23
Q

What is the gold standard for diagnosis of Obstructive Sleep Apnea?

A

Polysomnogram

24
Q

What does polysomnogram monitor?

A

1) EEG
2) ECG
3) Ocular movement
4) Airflow
5) O2 saturation

25
Q

What is the standard of care treatment for Obstructive Sleep Apnea?

How does it work?

A

1) Continuous Positive Airway Pressure (CPAP) device

2) Provides positive pressure ventilation to overcome obstruction

26
Q

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?

A

1) Restrictive Pattern on Pulmonary Function Tests (PFTs)
2) Decreased DLCO
3) Dyspnea on exertion
4) Absence of primary infection or malignancy

27
Q

Pulmonary interstitial tissue refers to the CT that supports?

A

Alveoli and capillaries to allow gas exchanges

28
Q

Idiopathic pulmonary fibrosis most commonly occurs at what age?

What is found on PE?

What is found on CT?

A

1) Greater than 60 y/o
2) Prominent inspiratory crackles (Velcro lung)
3) Honeycomb pattern with traction bronchiectasis

29
Q

Why is diagnosis and early treatment crucial for idiopathic pulmonary fibrosis?

A

The survival rate is only 50% at 3-5 years after diagnosis

30
Q

Sarcoidosis is characterized by the presence of?

What race is it most common in?

What sex is it more common in?

A

1) Non-caseating granulomas
2) African Americans
3) Women

31
Q

What syndromes can sarcoidosis present with?

A

1) Lofgren’s Syndrome

2) Heerfordt’s Syndrome

32
Q

What is Lofgren’s Syndrome characterized by?

A

1) Erythema nodosum
2) Hilar lymphadenopathy
3) Fever
4) Arthritis

33
Q

What is Heerfordt’s Syndrome characterized by?

A

1) Anterior uveitis
2) Parotitis
3) Cranial VII nerve palsy
4) Fever

34
Q

What is the most common finding on radiology for sarcoidosis?

What are the Radiographic Stages?

A

Hilar Lymphadenopathy

Stage 0: No Pulmonary Involvement
Stage 1: Hilar LAD
Stage 2: Hilar LAD + Infiltrates
Stage 3: Infiltrates only
Stage 4: Fibrosis

*Not a progression of disease

35
Q

What causes systemic small-vessel vasculitis most often affecting the sinuses, kidneys and lungs?

What are the symptoms?

A

Granulomatosis with Polyangiitis

1) Dyspnea
2) Cough/Hemoptysis
3) Saddle Nose
4) Chronic sinusitis

36
Q

What lab finding points to Granulomatosis with Polyangiitis?

What is the treatment?

A

1) C-ANCA

2) Steroid and cyclophosphamide

37
Q

What is an autoimmune condition with antibodies against the basement membrane of alveolar and glomerular parenchyma?

A

Goodpasture’s syndrome

38
Q

What lab finding points to Goodpasture’s syndrome?

What is the treatment given along with steroids and cyclophosphamide?

A

1) Anti-GBM

2) Plasmapheresis

39
Q

Interstitial lung disease can be associated with what connective tissue diseases?

A

1) Systemic Sclerosis
2) Rheumatoid Arthritis
3) Dermatomyositis

40
Q

What is an Hypersensitivity Pneumonitis

When do symptoms improve?

A

An inflammatory process that affects alveoli, bronchioles and interstitium due to repeated exposure to specific antigens

Sx improvement when patient goes on vacation

41
Q

Along with non-caseating granulomas, what is specifically found on histology for hypersensitivity pneumonitis?

A

Plasma cells

42
Q

What is an interstitial lung disease caused by the inhalation of inorganic dust that results in tissue inflammatory response that results in fibrosis?

What is the PFT

A

Pneumoconiosis

Restrictive PFT

43
Q

What type of pneumoconiosis is prominent in miners, stone cutters, sandblasting, and quarry workers?

A

Silicosis

44
Q

What is found on radiographs for simple silicosis (long exposure to silicosis)?

A

1) Nodular lung disease

2) Calcified hilar LNs

45
Q

What is found on radiographs for complicated silicosis (progressive disease)?

A

Large nodules with extensive fibrosis

46
Q

What infection are patients at an increased for with silicosis?

A

TB

47
Q

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?

A

Asbestosis

48
Q

What are Asbestosis patients at an increased risk of?

A

1) Malignant mesothelioma

2) Lung cancer

49
Q

Those that work in the manufacturing of alloys and electronic devices have an increased risk for?

A

Berylliosis

50
Q

What are the Symptoms of Pulmonary Hypertension

A 
DOE
Fatigue
Chest pain
Pre-Syncope
Signs of R sided Heart Failure (Cor Pulmonae)

CPR Exam 2 (13 decks)

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