Pulmonary vascular disease Flashcards
Mr. Morgan is a 42 year old male with a history of HIV infection who presents for evaluation of dyspnea. He has 1+ pitting edema of the lower extremities. You suspect the patient may have pulmonary hypertension. You order a transthoracic echocardiogram that is read as normal; of note, the patient has no significant tricuspid regurgitation. What would be the best test to order to confirm your suspicion?
Right heart catheterization
Which of the following lab tests should be monitored in patient’s taking endothelin receptor antagonists?
Liver function tests
Mrs. LaGuerta is a 25 year old patient with a history of severe pulmonary arterial hypertension. She is on triple therapy. Which medication class in this therapy would be routinely delivered via the IV route?
Prostacyclin analog
Ms. Pierce is a 30 year old female who presents to the emergency room for evaluation of dyspnea and tachycardia. She recently arrived in town after a 3 day drive from California. Using Wells’ criteria, you determine she is at intermediate risk for pulmonary embolism. What is the most appropriate next test to order?
D-dimer
Mr. Mitchell is a 62 year old male who presents to the emergency room for pleuritic chest pain and dyspnea. He has a previous history of DVT 3 years ago and is on apixaban. He endorses taking his meds regularly with no missed doses. You order pulmonary angiography which shows a new pulmonary embolus. He is hemodynamically stable with no signs of right heart failure. What would be the most appropriate next step to prevent another PE?
Placement of IVC filter
Mr. Doakes is a 75 year old male who has been admitted to the ICU for acute respiratory distress syndrome. Which of the following conditions is the most common cause of his ARDS?
Sepsis
Mr. Masuka is a 43 year old male who has been admitted to the ICU in acute hypoxemic respiratory failure. His chest xray demonstrates bilateral diffuse interstitial opacities. Six days prior he was discharged from the emergency room after a near-drowning episode. He is on a mechanical ventilator with an FiO2 of 80% and an ABG with a PaO2 of 80 mm Hg. In order to diagnose him with acute respiratory distress syndrome, what other finding must be present?
Normal PCWP
You are taking care of Mr. Prado in the ICU. He was just admitted with acute respiratory distress syndrome and is currently on BiPAP. He has continued to worsen, and you are planning to intubate him and place him on a mechanical ventilator. When discussing the patient with the ICU team, which of the following strategies do you mention as appropriate for this patient?
Placing the patient in a prone position periodically
Which of the following would not cause group 1 pulmonary hypertension?
A. Chronic obstructive pulmonary disease
B. HIV infection
C. Amphetamine use disorder
E Systemic sclerosis
F. Cirrhosis w/ portal hypertension
A. COPD (group 3 cause of PH)
B. Pulmonary embolism
C. Systemic sclerosis
D. HFpEF
Pulmonary embolism (Group 4)
Pulmonary embolism (Group 4)
HFpEF (Group 2)
Why does oxygen improve mortality when appropriately used in COPD patients?
It prevents PH by causing pulmonary vasodilation
C. Prominent P2 component of second heart sound
D. Peripoheral edema
E. Ascites
Answers D/E are indicative of right heart failure
Pulmonary artery pressure >20 mmHg for PH
Exam findings are usually normal until late in the disease process, and include JVD, peripheral edema, and ascites. The P2 component of the second heart sound may be more prominent
B. Inverted T wave in III
Right heart strain pattern
S1, Q3, T3 - S waves in lead 1, Q waves in lead 3, and inverted T waves in lead 3
