Pulmonary Vascular Disease Flashcards
Which of these is a Endothelin receptor antagonist?
A) Ambrisentan
B) Tadalafil
C) Riociguat
D) Treprostinil
E) Selexipag
Ambrisentan
Other Endothelin receptor antagonist include: Bosentan, and Macitentan
What is the most common side effect of Abrisentan?
A) Abnormal LFT’s
B) Mood changes
C) Low Hb
D) Peripheral Odema
E) None of the above
Peripheral Oedema
“An increased incidence of peripheral oedema was reported with ambrisentan use, while there was no increased incidence of abnormal liver function.” - 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
Selexipag is what type of medication?
A) Oral Prostacyclin analogue
B) Nebulised Prostacyclin analogue
C) IV Prostacyclin analogue
D) SC Prostacyclin analogues
E) Oral Prostacyclin receptor agonist
Oral Prostacyclin receptor agonist
Selexipag is an orally available, selective, prostacyclin receptor agonist that is chemically distinct from prostacyclin, with different pharmacology.
Side effects: headache, diarrhoea, nausea, and jaw pain.
2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
Which gene is most commonly found in cases of heritable pulmonary arterial hypertension?
A) BMPR2
B) EIF2AK4
C) GDF2
D) Sox17
E) KCNK3
BMPR2
“In the evolving list of genes known to be associated with PAH, experience is largely restricted to BMPR2 mutation carriers who carry a lifetime risk of developing PAH of ∼20%, with penetrance higher in female carriers (42%) compared with male carriers (14%).” - 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
What is the mode of inheritance of hereditary haemorrhagic telangiectasia (HHT)?
A) Autosomal Dominant
B) Autosomal Recessive
C) X-Linked Dominant
D) X- Linked Recessive
E) Mitochondrial
Autosomal Dominant
HHT is inherited as an autosomal dominant trait and most
commonly results from a pathogenic sequence variant in ENG encoding endoglin (HHT type 1/ HHT1), ACVRL1 encoding ALK-1 (HHT type 2/ HHT2) or SMAD4.
Which of these symptoms is classically described in hepatopulmonary syndrome (HPS)?
A) Orthopnea
B) Platypnoea
C) Bendopnoea
D) Palpitations
E) Angina
Platypnoea
Platypnoea and orthodeoxia, the increase in dyspnoea or deoxygenation while in the standing position, are classically described in HPS.
Which of these tests is commonly used to diagnose intravascular vasodilatation in HPS?
A) ECG
B) TTE
C) Contrast enhanced TTE
D) Myocardial perfusion scan
E) CPET
Contrast enhanced TTE (Bubble echo)
This opacifies the left atrium four or more beats after the initial appearance of contrast in the right atrium in patients with HPS, whereas those with a cardiac right-to-left shunt (i.e. atrial septal defect) will show opacification of the left atrium within the first three beats
Which of these Pulmonary Hypertension medications is teratogenic?
A) Calcium channel blockers
B) Endothelin receptor antagonists
C) Phosphodiesterase 5 inhibitors
D) Prostacyclin analogues
Endothelin receptor antagonists
Endothelial receptor antagonists have teratogenic effects and should not be used during pregnancy
Which of these is not used as vasoreactivity testing in PAH?
A) Inhaled Nitric Oxide
B) Inhaled Iloprost
C) IV Adenosine
D) IV Epoprostenol
IV Adenosine
Inhaled NO or inhaled iloprost, are the recommended test compounds. There is similar evidence for intravenous (i.v.) epoprostenol, but due to incremental dose increases and repetitive measurements, testing takes much longer and is therefore less feasible. Adenosine i.v. is no longer recommended due to frequent side effects.
Which of these is not an absolute contraindication for systemic thrombolysis in acute PE?
A)History of haemorrhagic stroke or stroke of unknown origin
B) Ischaemic stroke in previous 6 months
C) Central nervous system neoplasm
D) Major trauma, surgery, or head injury in previous 3 weeks
E) Non-compressible puncture sites
Non-compressible puncture sites
Absolute:
History of haemorrhagic stroke or stroke of unknown origin
Ischaemic stroke in previous 6 months
Central nervous system neoplasm
Major trauma, surgery, or head injury in previous 3 weeks
Bleeding diathesis
Active bleeding
Relative:
Transient ischaemic attack in previous 6 months
Oral anticoagulation
Pregnancy or first post-partum week
Non-compressible puncture sites
Traumatic resuscitation
Refractory hypertension (systolic BP >180 mmHg)
Advanced liver disease
Infective endocarditis
Active peptic ulcer
- 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism
You review a 33 year old pregnant female in SDEC with a high suspicion of PE. Her CXR shows a patch of opacification on the right lower. She has no calf swelling or tenderness.
What is the most appropriate next investigation?
A) B/L leg dopplers
B) V/Q scan
C) CTPA
D) Treat as PE for 6 months only. No Investigations needed.
E) Echocardiogram
CTPA
When the chest X-ray is abnormal and there is a clinical suspicion of PE, CTPA should be performed in preference to a V/Q scan.
- Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management Green-top Guideline No. 37b April 2015
You diagnose a patient with PE. Her blood pressure is 120/80. Her saturations are 94% on 35% FiO2. Troponin is raised. CTPA shows bilateral PE with features of right heart strain?
What is her severity classification of PE?
A) High risk PE
B) Intermediate High risk PE
C) Intermediate Low risk PE
D) Low Risk PE
E) Submassive PE
Intermediate High risk PE
Intermediate-risk group who display evidence of both RV dysfunction (on echocardiography or CTPA) and elevated cardiac biomarker levels in the circulation (particularly a positive cardiac troponin test) are classified into the intermediate−high-risk category
You have seen a patient in PE follow up clinic. He was diagnosed as a unprovoked PE 3 months ago. He has no identifiable risk factors.
What is his risk of VTE recurrence?
A) <3%
B) 3-8%
C) 8-10%
D) 10-15%
E) >15%
3-8%
Low risk <3% - Major transient or reversible factors with >10 fold risk of VTE
Intermediate risk 3-8% - transient or reversible factors with <10 fold risk of VTE (first VTE only), Non malignant persistent risk factors, No identifiable risk factor.
High risk >8% - Active cancer, Antiphospholipid syndrome, and previous VTE
- 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism
Which of these is a positive vasoreactivity test in PAH?
A) Reduction in mPAP by ≤10 mmHg to reach an absolute value ≤40 mmHg, with increased or unchanged CO
B) Reduction in mPAP by ≥10 mmHg to reach an absolute value ≤40 mmHg, with increased or unchanged CO
C) Reduction in mPAP by ≥10 mmHg to reach an absolute value ≥40 mmHg, with increased or unchanged CO
D) Reduction in mPAP by ≥10 mmHg to reach an absolute value ≥40 mmHg, with decreased CO
E) Reduction in mPAP by ≤10 mmHg to reach an absolute value ≤40 mmHg, with decreased CO
Reduction in mPAP by ≥10 mmHg to reach an absolute value ≤40 mmHg, with increased or unchanged CO
- 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
You see patient in SDEC with a confirmed PE. You would like to start him on apixaban
At what CrCl/min does BNF say apixaban should be avoided?
A) <30ml/min
B) <25ml/min
C) <20ml/min
D) <15ml/min
E) <10ml/min
<15ml/min
Manufacturer advises avoid if creatinine clearance less than 15 mL/minute—no information available. [online BNF accessed 03/02/25]
Which of these 2 drugs is a definite association with developing Pulmonary HTN as per 2022 ESC/ERS guideline?
A) Amiodarone
B) Bosentan
C) Fenfluramine
D) Nitrofurantoin
E) Toxic Rapeseed Oil
Fenfluramine & Toxic Rapeseed Oil
Definite Association:
Aminorex
Benfluorex
Dasatinib
Dexfenfluramine
Fenfluramine
Methamphetamines
Toxic rapeseed oil
