Pulmonary hypertension & Pulmonary embolism Flashcards
Recommend a treatment goal for a patient with a diagnosis of pulmonary embolism.
A) The treatment in the acute or initial phase should make the patient comfortable until the condition’s unavoidable outcome.
B) The treatment in the acute or initial phase should help the patient recover from the sequelae.
C) The treatment in the acute or initial phase should prevent new episodes.
D) The treatment in the acute or initial phase should eliminate the cause of the embolism.
C) The treatment in the acute or initial phase should prevent new episodes.
The diagnosis of pulmonary hypertension is a staggered process. From the following components, identify which is part of the diagnostic process of pulmonary hypertension.
A) Clinical findings are sufficient to start treatment.
B) Confirmatory exams include blood tests (e.g., D-dimer).
C) The process starts with a clinical suspicion.
D Cardiac function tests are not specific.
C) The process starts with a clinical suspicion.
A provider is evaluating a patient as part of a new patient assessment. The patient affirms a medical history of pulmonary hypertension. Recommend a question that the provider should ask to confirm that the pathology is primary and not secondary.
A) Have you been diagnosed with bronchiectasis?
B) Do any of your grandparents have or has had pulmonary hypertension?
C) What is your BMI?
D) Have you been diagnosed with scleroderma?
B) Do any of your grandparents have or has had pulmonary hypertension?
Determine the statement that explains the pathophysiology of pulmonary hypertension and its prognosis.
A) The main prognostic factor of this disease is the expression of the right ventricular function (hemodynamic, clinical, and biochemical).
B) The pathophysiological basis that underlies the decrease in pulmonary vascular resistance is hypotensive vascular disease in the small arteries and pulmonary arterioles.
C) The main prognostic factor of this disease is the expression of the left ventricular function (hemodynamic, clinical, and biochemical).
D) The increase in preload continues to be the main determinant of heart failure in patients with PAH and left ventricular dysfunction.
A) The main prognostic factor of this disease is the expression of the right ventricular function (hemodynamic, clinical, and biochemical).
A diagnosis of pulmonary embolism is based on a patient’s symptoms and risk factors, such as recent surgery, prolonged convalescence, or inherent tendency to form blood clots. However, some additional testing is recommended to confirm this diagnosis. Propose a diagnostic test that you will require for a patient with the clinical characteristics of this condition.
A) Electrolytes: Check if the blood level is elevated.
B) Genetic testing: This helps check whether the patient is genetically predisposed to this condition.
C) Angiogram: This shows transient abnormalities that may suggest the presence of thromboembolism.
D) X-ray: After pulmonary infarction, there are subtle changes in the patterns of the venous capillaries of the lung, but they do not help establish an accurate diagnosis.
D) X-ray: After pulmonary infarction, there are subtle changes in the patterns of the venous capillaries of the lung, but they do not help establish an accurate diagnosis.
Consider how a diagnosis of deep vein thrombosis is made, and determine what the clinical symptoms and signs depend on.
A) Medical history of blood thinners
B) Chronic consumption of aspirin
C) Severity of the associated vascular occlusions and inflammation
D) Evidence of hypercholesterolemia
C) Severity of the associated vascular occlusions and inflammation
All types of pulmonary hypertension show identical obstructive pathological changes in pulmonary microcirculation that are defined as hypertensive pulmonary vascular disease. This similarity suggests a pathobiological process shared by various HP diseases. Analyze the following statements about the histopathology of pulmonary hypertension, and identify the most accurate one.
A) The hallmark is the caseating granuloma, which consists of giant cells with central caseating necrosis.
B) Vascular proliferative remodeling affects all layers of the vessel wall. The main pathological finding is an abnormal and disorganized cell proliferation, which causes a marked parietal thickening.
C) It is characterized by irregular, nonlaminar, and often obliterative intimal fibrosis.
D) The lung scarring that occurs in pulmonary hypertension cannot be reversed, and treatment will not always be effective in stopping the ultimate progression of the disease.
B) Vascular proliferative remodeling affects all layers of the vessel wall. The main pathological finding is an abnormal and disorganized cell proliferation, which causes a marked parietal thickening.
A diagnosis of pulmonary embolism is based on a patient’s symptoms and risk factors, such as recent surgery, prolonged convalescence, or inherent tendency to form blood clots. However, some additional testing is recommended to confirm this diagnosis. Propose a diagnostic test that you will require for a patient with the clinical characteristics of this condition.
A) Electrolytes: Check if the blood level is elevated.
B) Angiogram: This shows transient abnormalities that may suggest the presence of thromboembolism.
C) Electrocardiogram: This shows transient abnormalities that may suggest the presence of thromboembolism.
D) CT scan: After pulmonary infarction, there are subtle changes in the patterns of the venous capillaries of the lung, but they do not help establish an accurate diagnosis.
C) Electrocardiogram: This shows transient abnormalities that may suggest the presence of thromboembolism.
Recommend a treatment goal for a patient with a diagnosis of pulmonary embolism.
A) The treatment in the acute or initial phase should eliminate the cause of the embolism.
B) The treatment in the acute or initial phase should observe the patient’s evolution.
C) The treatment in the acute or initial phase should resolve vascular obstruction.
D) The treatment in the acute or initial phase should help the patient recover from the sequelae.
C) The treatment in the acute or initial phase should resolve vascular obstruction.
Determine the statement that explains the pathophysiology of pulmonary hypertension and its prognosis.
A) The increase in preload continues to be the main determinant of heart failure in patients with PAH and left ventricular dysfunction.
B) The pathophysiological basis that underlies the decrease in pulmonary vascular resistance is hypotensive vascular disease in the small arteries and pulmonary arterioles.
C) The prognosis is conditioned by the complex pathophysiological interactions between the amount of obstructive changes in pulmonary microcirculation and the left ventricular response.
D) The increase in afterload continues to be the main determinant of heart failure in patients with PAH and HPTC, because its elimination due to a lung transplant or thromboendarterectomy almost invariably implies a rapid recovery of RV function.
D) The increase in afterload continues to be the main determinant of heart failure in patients with PAH and HPTC, because its elimination due to a lung transplant or thromboendarterectomy almost invariably implies a rapid recovery of RV function.
The diagnosis of pulmonary hypertension is a staggered process. From the following components, identify which is part of the diagnostic process of pulmonary hypertension.
A) The electrocardiogram is the most important diagnostic test.
B) Clinical findings are sufficient to start treatment.
C) Confirmatory exams include blood tests (e.g., D-dimer).
D) Specific etiology must be identified (PH should be considered a diagnosis of exclusion).
D) Specific etiology must be identified (PH should be considered a diagnosis of exclusion).
Evaluate the following semiology, and identify the symptom that you will see in a patient with pulmonary thrombotic disease.
A) Symptoms of mental confusion or deterioration of mental function in older people
B) Loss of appetite and fever
C) A persistent chronic cough
D) Constant fatigue and significant weight loss
A) Symptoms of mental confusion or deterioration of mental function in older people
Evaluate the following semiology, and identify the symptom that you will see in a patient with pulmonary thrombotic disease.
A) A very large pulmonary embolus can cause a severe decrease in blood pressure (hypotension), which is dangerous and can cause shock.
B) Hemoptysis and night sweats may be encountered in patients with pulmonary thrombotic disease.
C) Patients with pulmonary thrombotic disease may present with constant fatigue and significant weight loss.
D) A persistent chronic cough may occur in patients with pulmonary thrombotic disease.
A) A very large pulmonary embolus can cause a severe decrease in blood pressure (hypotension), which is dangerous and can cause shock.
Determine the true statement about the diagnosis of thromboembolic disease.
A) The symptoms of this disease are caused by the heart being unable to send oxygen-rich blood to the brain or other organs of the body.
B) Abnormal arterial blood gas analysis results are directly related to the prognosis.
C) Pulmonary thrombi will show in a chest X-ray with bilateral infiltrates.
D) Fever that lasts for 24 hours or more is usually seen in the beginning of this disease’s pathophysiologic process.
A) The symptoms of this disease are caused by the heart being unable to send oxygen-rich blood to the brain or other organs of the body.
It has been shown that certain specific pharmacological treatments are effective depending on the group of pulmonary hypertension that a patient has. From the following treatment recommendations, identify the correct action mechanism of the pharmacological agent.
A) Sildenafil is a potent and selective oral phosphodiesterase inhibitor that exerts its pharmacological effect by increasing the intracellular concentration of cyclic guanosine monophosphate (cGMP). Sildenafil is totally contraindicated in patients with pulmonary hypertension.
B) Vasodilators reverse the effect of endothelin, a substance in the walls of blood vessels that makes them narrow.
C) A low dose of calcium channel blockers helps relax the muscles in the walls of blood vessels. Calcium channel blockers are very effective in people with pulmonary hypertension.
D) Sildenafil and tadalafil. Sildenafil and tadalafil are sometimes used to treat pulmonary hypertension. These medications open the blood vessels in the lungs to allow blood to flow more easily. Their side effects may include upset stomach, headaches, and vision problems.
D) Sildenafil and tadalafil. Sildenafil and tadalafil are sometimes used to treat pulmonary hypertension. These medications open the blood vessels in the lungs to allow blood to flow more easily. Their side effects may include upset stomach, headaches, and vision problems.
