Brainscape's Knowledge GenomeTM

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


See full index

Respiratory > Pulmonary Embolism and Hypertension > Flashcards

Pulmonary Embolism and Hypertension Flashcards

1
Q

what two conditions compose thromboembolic disease

A

deep vein thrombosis, pulmonary embolism

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

what is a pulmonary embolism

A

blockage of a pulmonary artery by a blood clot, fat, tumour or air

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

what is a pulmonary infarction

A

when blood flow and oxygen to the tissue is compromised (tissue may die)

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

what are the two locations of DVT

A

proximal (ileo-femoral), Distal (polpiteal)

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

a proximal DVT is a higher risk than a distal DVT as it is more likely to… (2)

A

most likely to;

  • embolise
  • lead to chronic venous insufficiency and venous leg ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the clinical presentation of a DVT

A

whole leg or half calf involved depending on site; swollen, hot, red, tender

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

what are the differential diagnosis of a DVT

A

popliteal synovial rupture, superficial thrombophlebitis, calf cellulitis

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

how is a DVT investigated

A

ultrasound doppler leg scan, CT scan

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

how can a DVT turn into a pulmonary embolism

A

predisposing DVT may be silent, sub clinical, and can embolise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does the clinical presentation of a pulmonary embolism depend on

A

the size of the clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how does a large pulmonary embolism present

A

cardiovascular shock, low BP, central cyanosis, sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how does a medium pulmonary embolism present

A

pleuritic pain, haemoptysis, breathless (goes out to periphery (lungs))

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

how does a small recurrent pulmonary embolism present

A

progressive dyspnoea (difficult breathing), pulmonary hypertension and right heart failure

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

what are the risk factors for DVT and PE

A

thrombophilia (abnormality of blood clotting), contraceptive pills (particularly in smokers), hormone replacement therapy, pregnancy, pelvic obstruction, trauma, surgery, immobility (Venastasis), malignancy, pulmonary hypertension, obesity

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

what is the history of a presenting complaint in PE

A

breathlessness, chest pain, haemoptysis, leg pain/swelling, collapse/ sudden death

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

what are the clinical features of a PE

A

tachycardia, tachyponea, cyanosis, fever, low BP, crackles, pleural effusion

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

describe the arterial blood gases of of a patient with a PE

A

decreased PaO2 and SaO2 (type one resp failure: PaCO2 normal or low)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

describe the chest x ray of someone with a PE

A

basal atelectasis (lung collapse), consolidation, pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how is a DVT prevented

A

early post-op mobilisation, compression stockings, calf muscle exercises, subcutaneous heparin pre-op, direct oral anticoagulant medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what does an ECG show that helps to diagnose a PE

A

acute right heart strain pattern

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

what happens to D-dimers in PE

A

usuallt raised

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

what does an isotope lung scan show that helps to diagnose a PE

A

ventilation/ perfusion; sensitive for small peripheral emboli. Perfusion defect before infarction, p + v matched defect after infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what does a PESI score mean

A

pulmonary embolism severity index- calculates risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how can troponin and BNP show that the heart is under strain

A

troponin rises, BNP/ pro-BNP present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how is a low risk PE managed

A

ambulatory pathway to home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

describe the clinical factors of a low risk PE

A

-ve troponin, low PESI, no oxygen, no co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the clinical factors of a high risk PE

A

cardiovascular compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how is a high risk PE managed

A

may require thrombolysis (breakdown of clots), BP monitoring, medical high dependency unit

29
Q

how is a intermediate/intermediate-high risk PE treated

A

ward or MHDU

30
Q

how does anticoagulant prevent DVT/PE

A

prevents clot propagation, tips balance to thrombolysis, body dissolves clot

31
Q

describe how heparin is administered

A

subcutaneous low mol weight (rarely IV) once daily

32
Q

what drug is started at the same time as heparin to treat a DVT/PE

A

warfarin

33
Q

how does warfarin prevent a DVT/PE

A

blocks the formation of vitamin K clotting factors. antagonises vit k dependant prothrombin

34
Q

what anti clotting treatment is as effective as heparin + warfarin

A

DOACs- direct oral thrombin inhibitor (dabigatran) or factor x inhibitor (rivaroxaban) (use both solely from start)

35
Q

how long does warfarin take to work

A

3 days

36
Q

what should happen after 3-5 days on a herparin + warfarin combo when the patient’s INR>2

A

stop heparin, or use NOAC (novel oral) without LMWH

37
Q

how long should the warfarin be administered for

A

3-6 months

38
Q

how is warfarin use monitored

A

with INR- target range

39
Q

what substances can interact with warfarin

A

alcohol, antibiotics, aspirin, NSAIDS, amiodarone, cimetidine, omeprazole, grapefruit.

40
Q

what is a thrombolysis

A

treatment to dissolve clots- tissue plasminogen activator (tPA- tenecteplase)

41
Q

what are the features of a life threatening PE

A

low bp, severe hypoxaemia due to main pulmonary artery occlusion

42
Q

when is a thrombolysis used

A

in life threatening PEs

43
Q

what is used to prevent embolisation from large ileofemoral/ IVC clot (in recurrent PEs)

A

IVC filter (inferior vena cava)

44
Q

what are the relative risks of a PE and how should they be treated be treated

A

pregnancy/ post partum

45
Q

what anticoagulant drugs have long half lives

A

low MW heparin, warfarin

46
Q

when does the use of anticoagulant need to stop and effect reversed

A

if bleeding

47
Q

how is warfarin reversed

A

with vitamin K

48
Q

how is heparin reserved

A

protamine

49
Q

how are NOACs reversed

A

no reversal agents

50
Q

what does the duration of treatment depend on?

A

balance of risk (rpt clot) vs bleeding

51
Q

how should intravenous drug users or people with active cancer be treated

A

fragmin only

52
Q

when is life long treatment necessary

A

recurrent DVT/PE

53
Q

describe the flow and pressure of a healthy pulmonary circulation system

A

high flow, low pressure

54
Q

what is normal mean pulmonary arterial blood pressure

A

12-20 mmHg

55
Q

when is mPAP pulmonary hypertension

A

> 25 mmHg

56
Q

how is mPAP measured

A

right heart catheter

57
Q

how can systolic pulmonary pressure be estimated

A

with an ECHO doppler

58
Q

what is left heart disease

A

pulmonary venous hypertension

59
Q

what can cause primary pulmonary hypertension

A

hypoxia, multiple PE, vasculitis, drugs, HIV, cardiac left to right shunt

60
Q

what is cor pulmonale

A

right heart disease secondary to lung disease

61
Q

what are the components of cor pulmonale

A

fluid retention due to hypoxia +/- right heart failure

62
Q

what can cor pulmonale complicate

A

COPD, fibrotic lung disease, chronic PE, chronic ventilatory failure

63
Q

what are the clinical signs of pulmonary hypertension and right heart failure

A

central cyanosis (if hypoxic), dependant oedema (influenced by gravity), raised JVP, enlarged liver

64
Q

how is pulmonary hypertension investigated

A

ECG, CXR, SaO2 and ABGs, pulmonary function with DLCO, echo, cardiac catherterisation, D-Dimers, VQ scan, CTPA, cardiac MRI, auto-antibodies (if vasculitis suspected)

65
Q

what is primary pulmonary arterial hypertension a disease of

A

pulmonary arteries/arterioles

66
Q

what is a symptom of primary pulmonary arterial hypertension

A

progressive exertional breathlessness

67
Q

what is the prognosis of primary PAH without treatment

A

3 years

68
Q

how is primary PAH treated

A

prophylactic anticoagulant (warfarin), O2 if hypoxic, pulmonary vasodilators- (primary disease only), lung transplant

69
Q

how is chronic thromboembolic pulmonary hypertension treated

A

ricoiguat (pulmonary arterial vasodilator), pulmonary endarterectomy (surgical procedure to unblock a carotid artery)

Respiratory (26 decks)

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