Pulmonary thromboembolism

Question 1

Pulmonary thromboembolism

Answer 1

Movement of a blood clot form a systemic vein throug hthe right side of the heart to the pulmonary ciruclation. Can present with zero symptoms or can cause sudden death

Question 2

Genesis of thrombus

Answer 2

Endothelial injury, hypercoagulability, stasis

Question 3

Things that cause hypercoagulablity

Answer 3

Genetics: antithrombin deficiency/proein c deficiency/protein s deficiency, favort v leiden, prothromboin gene mtuation.

Advanged age, preveious embolism, cancer, cobsetist. Also immboliklation preganancy estrogens ans rugery.

Question 4

Factor V Leiden

Answer 4

Most common cause of heredity thrombophilia in caucasians. Causes factor Va to be resistant to inactivation by protein C, causes prothrombin to be converted to thrombin with greater ease.

Question 5

Sequelae of pulmonary embolism

Answer 5

Hemodynamic perturbations and impaired gas exchange. Due to mechaniscal obstuction and from mediators released from the thrombus.

Question 6

What types of things do thrombi release

Answer 6

Serotonin ADP TXA2. potent vasoconstrictors.

Question 7

20% obstruction of PA causes…

Answer 7

Normal PAP and pulmonary resistance due to recruitment of additional vessels. CO maintained

Question 8

30-40% obstruction

Answer 8

Increases in PAP and some increase in RAP

Question 9

50-60 % obstruciton

Answer 9

Compensatory mechanisms are fucked. CO begins to fall and rap increases dramatiocally.

Question 10

What happens to breathing with PE

Answer 10

Tachypnea because deadspace ventilation increased, so need to increase minute ventilation to stabilize alveolar ventilation.

Question 11

Does dead space ventilation cause hypoxemia?

Answer 11

No. Hypoxemia with PE because increased PVR, intracardiac shunt, more O2 taken out of blood. Loss of surfactant resulting in atalectasis and edema. And bronchoconstfiction due to the lmediators of plastemetsn .

Question 12

Infarction common with PE?

Answer 12

No because of dual blood supply, but if it occurs, it is wedge shaped.

Question 13

Symptoms of PE

Answer 13

Acute onset dyspnea, pleuritic chest pain, hemoptysis, syncope, leg tenderness

Question 14

Chest radiograph in PE

Answer 14

Normal. But increased AA gradient. Hamptons hump with wedge shaped opacity in periphery (infarction). Westmark’s sign (decreased lung vascular markings)

Question 15

How to diagnose PE if xray is so bad

Answer 15

CT angiography or V/Q scan. Ultrasound can show DVT. D dimer increased.

Question 16

D dimer good for?

Answer 16

If negative, no PE. If postive, can be many things.

Question 17

Worst complication of PE?

Answer 17

Chronic thromboembolic pul;monary hypertesnion (whoIV)

Question 18

How does PE cause death

Answer 18

lodging in major branches of pulmonary arteries causing electrochemical dissociation.

Acute cor pulmonale

Question 19

Describe the infarcts of the lung

Answer 19

Hemorragic infarcts in a wedge pattern

Question 20

Key pathological feature of thrombi vs clots

Answer 20

Lines of Zahn

Question 21

Old pulmonary infarct

Answer 21

Triangular shaped retracted scar

Question 22

What pathological feature in pulmonary arteries imp[lies there in pulmonary hypertension?

Answer 22

Atherosclerosis

Question 23

What is the key pathological finding in primary pulmonary hypertension?

Answer 23

Plexiform lesions. They have elastin around the new lumena.

Question 24

What type of patient has pulmonary arterial hypertension?

Answer 24

Young woman with progressive shortness of breath, angina, snycope, and possibly sudden death.

Question 25

Grading pulmonary arterial hypertension

Answer 25

Grade I and II have intimal hyperplasia

Grade III Onion ring appearance

Grade IV and V - plexiform lesions

Question 26

How to distinguish plexiform lesions from chronic thromboembolic disease

Answer 26

Chronic thromboembolus in artery has one layer of elastin, not multiple rings in the walls.

Question 27

Granulomatosis with polyangiitis

Answer 27

C anca- sinusitis, hemoptysis and glomerulonephritis. Multiple lung nodules common. Areas of necrosis

Question 28

Granulomas in wegeners?

Answer 28

NOT like sarcoid. Definitely looser.

Question 29

Churg-Strauss symptoms

Answer 29

Eosinophilic granulomatosis w/polyangiitis Asthma, eosinophilia. Neuropathy, cardiac, lung, but not reneal involveent. Granulomas with eosinophils in the middle.

Question 30

Microscopic polyangiitis

Answer 30

Pauci-immune vasculitis. Only with glomerulonephritis, no nasopharynx. P-anca. Diffuse alveolar hemorrhage with neutrophilic capillaritis. This is super unique with neutrophils. Hemosiderin too.