Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

JL Respiratory > Pulmonary Vascular Disease Overview > Flashcards

Pulmonary Vascular Disease Overview Flashcards

1
Q

Give 6 causes of pulmonary arterial hypertension

A
  1. Hypoxia - COPD
  2. Multiple PE
  3. Pulmonary vasculitis e.g. SLE, systemic sclerosis
  4. Drugs (appetitie suppressants)
  5. Cardiac left to right shunt - ASD, VSD
  6. Primary pulmonary hypertension (only once excluded above)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are central cyanosis if hypoxic, dependent oedema, raised JVP with V waves, right ventricular heave at left parasternal edge, murmur of tricuspid regurgitation, loud P2 and enlarged liver (pulsatile) all signs of?

A

Pulmonary hypertension and right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a raised JVP with V waves due to?

A

Secondary tricuspid regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name some investigations used to investigate pulmonary hypertension?

A

ECG, CXR, SaO2 and arterial blood gases, pulmonary function including DLCO, Echocardiogram/cardiac catheterisation

CT pulmonary angiogram, cardiac MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What investigations would you choose if PE was a suspected cause of pulmonary hypertension?

A

D dimers and VQ scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What investigation would you choose if vasculitis was a suspected cause of pulmonary hypertension?

A

Auto-antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is primary pulmonary hypertension diagnosed?

A

By exclusion of other secondary causese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What clinical features might be found in primary pulmonary hypertension?

A

SOB on exertion and signs of right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What three pharmacological treatments are used for primary pulmonary hypertension?

A

Prophylactic anticoagulation [warfarin]
O2 if hypoxic
Pulmonary vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give 5 types of pulmonary vasodilators

A
  1. Calcium channel blockers (oral nifedipine, diltiazem)
  2. Endothelin antagonist (oral Bosentan, Macitentan)
  3. PDE5-inhibitor (oral Sildenafil)
  4. Prostanoids (IV Epoprostenol or inh Iloprost)
  5. Guanylate Cyclase stimulator (oral Riociguat)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes thromboembolic lung disease?

A

Pulmonary infarction - in situ, venous emboli

Virchow’s triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Virchow’s triad?

A
  1. Stasis
  2. Vessel wall damage
  3. Hypercoagulability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors for DVT and PE?

A 
Thrombophilia - FH, freq, site, age
Contraceptive pill, HRT
Pregnancy
Pelvic obstruction (e.g. uterus, ovary, lymph nodes)
Trauma e.g. RTA
Surgery e.g. pelvic, hip, knee
Immobility e.g. bed rest, long haul flights
Malignancy
Myocardial infarction
Pulmonary hypertension/vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two areas you can get DVTs?

A

Proximal (ileofemoral)

Distal (popliteal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which location of DVT is most likely to embolise and lead to chronic venous insufficiency and venous leg ulcers?

A

Proximal (ileofemoral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give three differential diagnoses of DVT?

A
  1. Popliteal synovial rupture [bakers cyst]
  2. Superficial thrombophlebitis
  3. Calf cellulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe a leg with a DVT?

A

Swollen, hot, red and tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are two methods of investigating a DVT?

A

Ultrasound leg scan (1st line)

CT scan of ileofemoral veins, IVC and pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How will a patient with a large PE present?

A

Cardiovascular shock, low BP, central cyanosis and sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How will a patient with a medium PE present?

A

Pleuritic pain, haemoptysis, breathless

21
Q

How will a patient with a small recurrent PE present?

A

Progressive dyspnoea, pulmonary hypertension and right heart failrue

22
Q

What is the heart rate, breathing, skin colour, temperature, blood pressure and lugns like in PE?

A 
Tachycardia
Tachypnoea
Cyanosis
Fever
Low BP
Crackles, rub, pleural effusion
23
Q

What are arterial blood gases like in a PE patient?

A

Decreased PaO2

Decreased SaO2

24
Q

In a patinet with a PE, what will be seen on teh CXR after infarction?

A

Basal atelectesis, consolidation and pleural effusion

25
Q

What would you see on an ECG in a patient with a PE?

A

Acute right heart strain pattern (S1, Q3, T3, T inversion in V1-3)

26
Q

What are the D dimer levels like in a patinet with a PE?

A

Raised

27
Q

What is another name for an isotope lung scan?

A

Ventialtion/perfusion: VQ scan

28
Q

What investigation only picks up larger clots in proximal vessels?

A

CT pulmonary angiogram - to image pulmonary artery filling defect

29
Q

How can silent DVT be detected?

A

Leg and pelvic ultrasound

30
Q

What does an Echocardiogram measure in PE?

A

pulmonary artery pressure and right ventricle size

31
Q

How can a perfusion defect be measured in a patient with PE?

A

Gas transfer factor (DLCO)

32
Q

How can an underlying cause of PE be detected?

A

Coagulation factor screen

Autoantibodies (SLE)

33
Q

What 2 autoantibodies are detected in underlying PE cause?

A

Antinuclear

Anticardiolipin Ab

34
Q

When investigating underlying causes of PE, what 3 substances will a coagulation factor screen be looking for?

A

Antithrombin-3
Protein C/S
Factor 5/8

35
Q

Name a direct thrombin inhibitor?

A

Dabigatran

36
Q

Name two direct inhibitors of activated factor Xa?

A

Rivaroxaban/apixaban

37
Q

In the treatment of DVT/PE - what does anticoagulation prevent?

A

Clot propagation - tips balance to thrombolysis - body dissovles clot

38
Q

What treatment is initiated first with DVT/PE treatment?

A

Parenteral heparin - fast acting via antithrombin 3

39
Q

What other drug can be started at the same time as low molecular weight heparin in treatment of DVT/PE?

A

Warfarin

40
Q

How long does oral warfarin take to work and how does it work?

A

Oral warfirin - takes 3 days - antagonises vitamin K1 dependent prothrombin

41
Q

What drug treatment in DVT/PE would you stop after 3-5 days?

A

Heparin when INR>2

42
Q

In the treatment of DVT/PE - what drug will you continue for 3-6 months?

A

warfarin

43
Q

What is used to monitor wardarin?

A

INR target range 2.5 - 3.5

44
Q

What do alcohol, antibiotics, aspirin, NSAIDS, amiodarone, cimetidine, omeprazole all do?

A

Increase anticoagulation

45
Q

What treatment for DVT/PE would you use for life threatening PE?

A

Thrombolysis-Streptokinase or TPA

46
Q

For recurrent PEs, what can you use to prevent embolisation from large ileofemoral/IVC clot?

A

IVC filter

47
Q

How do you reverse warfarin?

A

With vitamin K1

48
Q

How do you reverse heparin?

A

With protamine

49
Q

Name three conditions that cause pulmonary venous hypertension

A
  1. LVF - ischaemic
  2. Mitral regurgitation/stenosis
  3. Cardiomyopathy e.g. alcohol, viral

JL Respiratory (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions