Pulmonary Vascular Disease

Question 1

What 2 topics does pulmonary vascular disease cover?

Answer 1

Thromboembolic disease

Pulmonary hypertension

Question 2

What are the 2 main examples of thromboembolic disease?

Answer 2

Deep venous thrombosis (DVT)
Pulmonary embolism (PE)

Question 3

Where do the majority of thrombi originate

Answer 3

Veins in the legs

Question 4

Are thrombi in bigger veins more or less likely to embolise?

Answer 4

More likely

Question 5

What concept are the risk factors for thromboembolic disease related to?

Answer 5

Virchows Triad

Question 6

Name at least 3 signs and symptoms of DVT?

Answer 6

Leg swelling
Redness
Tenderness
Oedema

Question 7

What 3 investigations should you perform (in order) to confirm a DVT diagnosis?

Answer 7

D Dimer
Ultrasound
Venography

Question 8

What does a negative D Dimer test tell us about DVT and PE diagnosis?

Answer 8

Negative test effectively excludes PE/DVT

Question 9

What is a pulmonary embolism?

Answer 9

When a blood clot embolises in the pulmonary circulation

Question 10

What are some of the symptoms of a large pulmonary embolism? (4)

Answer 10

Hypoxia
Hypotension
Pain
Collapse

Question 11

What are the 3 main symptoms of a pulmonary embolism?

Answer 11

Dyspnoea
Pleuritic chest pain
Tachypnoea

Question 12

What 3 scans can be performed to help identify PE?

Answer 12

V/Q scan
Doppler ultrasound
CT pulmonary angiography

Question 13

What immediate supportive management should be given to a patient with PE?

Answer 13

Oxygen (either with or without ventilation)

Question 14

What type of drug (and an example of this drug) could be used to prevent the recurrence of a clot?

Answer 14

Anticoagulant (i.e. Warfarin)

Question 15

What 3 clinical measures should be taken in the case of a Massive Pulmonary Embolism?

Answer 15

Resuscitate (oxygen, careful fluids, analgesia)
IV Heparin
Thrombolysis

Question 16

What is the pressure in:
Mild pulmonary hypertension
Moderate PH
Severe PH

Answer 16

25-45 mmHg
45-65mmHg
>65mmHg

Question 17

Name at least 2 causes of pulmonary arterial hypertension?

Answer 17

Idiopathic
HIV infection
Connective tissue disease
Portal hypertension
Coronary heart disease
Schistosomiasis
Chronic haemolytic anaemia

Question 18

What are the 5 groups of pulmonary hypertension?

Answer 18

1: Pulmonary arterial hypertension
2: Pulmonary hypertension due to L heart disease
3 Pulmonary hypertension due to lung diseases and/or hypoxia
4: Chromic thromboembolic pulmonary hypertension
5: Pulmonary hypertension with unclear multifactoral mechanisms

Question 19

What are the 3 mechanisms of PE?

Answer 19

Hypoxia vasoconstriction
Reduced surface area of pulmonary vascular bed
Cardiac disease

Question 20

What are they 5 early signs of PE?

Answer 20

Unexplained dyspnoea
Fatigue
Syncope
Chest tightness
Haemoptysis

Question 21

What is a late sign of PE?

Answer 21

Ankle swelling

Question 22

What 6 investigations should be performed if a patient has unexplained dyspnoea?

Answer 22

CXR
ECG
PFTs
V/Q scan
Echo
High-res CT if chest

Question 23

What is the first line treatment for primary pulmonary HT?

Answer 23

Warfarin
Diuretics
Oxygen

Question 24

What us the second line treatment for PHT if the patient has an acute vasodilator response?

Answer 24

CCBs (amlodipine)

Question 25

What 3 surgical treatments could be performed for PHT?

Answer 25

Atrial septostomy
Pulmonary endarterectomy
Lung transplant