Pulmonology Flashcards
1
Q
What classifies as a Pulmonary nodule?
A
<3 cm
2
Q
What classifies as a Pulmonary mass?
A
> 3 cm
3
Q
What is the most common cause of cancer deaths in men and women?
A
Bronchogenic carcinoma
-Commonly presents in 50-60s
4
Q
What is the most common cause of Bronchogenic carcinoma?
A
Cigarette smoking
-includes 2nd hand
5
Q
What is the second most common cause of Bronchogenic carcinoma?
A
Asbestos
6
Q
Where does Bronchogenic carcinoma typically metastasize?
A
Brain Bone Liver Lymph nodes Adrenals
7
Q
What is the most common type of Bronchogenic carcinoma?
A
Non-small cell carcinoma (85%)
8
Q
What is the most common type of Non-small cell carcinoma that is seen in smokers, women, and non-smokers?
A
Adenocarcinoma
9
Q
Which type of Bronchogenic cancer is a rare low-grade sub-type that has the best prognosis? This type of cancer presents with voluminous sputum and an interstitial lung pattern on CXR.
A
Bronchoalveolar
10
Q
Which of the following is true regarding Adenocarcinoma?
A. Centrally located
B. Peripherally located
C. Cavitary lesions are present
D. Hypercalcemia is typically present
A
B. Peripherally located 35%
11
Q
What is the origin of Squamous cell carcinoma?
A
It is Bronchial in origin.
12
Q
What of the following is not true regarding Squamous cell carcinoma?
A. Centrally located
B. Peripherally located
C. Cavitary lesions are present
D. Hypercalcemia is typically present
A
B. Peripherally located
13
Q
A patient is suspected of Squamous cell carcinoma. What are some classic hallmarks of this type of lung cancer?
A
- Centrally located
- May cause hemoptysis
- Associated with Cavitary lesions (central necrosis)
- Hypercalcemia
- Pancoast tumor
Think: CCCP 20%
14
Q
Which type of Non-small cell carcinoma is considered very aggressive?
A
Large cell (Anaplastic) 10%
15
Q
Which type of Bronchogenic carcinoma typically metastasizes early and causes METS usually found on presentation?
A
Small cell (Oat cell carcinoma (13%)
16
Q
What is the tx/management of Small cell (Oat cell) carcinoma?
A
SURGERY IS NOT THE TX OF CHOICE!
CHEMOTHERAPY IS TOC***
17
Q
What is the management for Non-small cell carcinoma?
A
Surgical resection TOC* especially if localized in the chest
18
Q
When is a sputum cytology and Bronchoscopy useful in bronchogenic carcinoma?
A
Central lesions
19
Q
What diagnostic test is used for peripheral lesions in bronchogenic carcinoma?
A
Trans-thoracic needle biopsy
20
Q
What is SVC syndrome and which type of cancer is it associated with?
A
Dilated neck veins, facial plethora, prominent chest veins
-MC with Small cell carcinoma
21
Q
What clinical manifestations are more commonly seen with Small cell carcinoma?
A
- SVC syndrome
- SIADH/Hyponatremia
- Cushing syndrome
- Lambert-Eaton syndrome
22
Q
What is Lambert-Eaton syndrome and what type of cancer is it associated with?
A
MC with Small cell
-Antibodies against calcium-gated channel at the neuromuscular junction that progresses to weakness similar to myasthenia gravis but in Lambert-Eaton syndrome, the weakness improves with continues use
23
Q
What is the difference between myasthenia gravis and Lambert-Eaton syndrome?
A
Lambert-Eaton syndrome: gets BETTER with continued use
Myasthenia gravis: gets WORSE with continued use
24
Q
A patient is diagnosed with a Pancoast tumor. Explain to the patient what this is?
A
Tumors at the superior sulcus of the lung
- Shoulder pain
- Horners syndrome: miosis, ptosis, and anhidrosis (due to cervical cranial sympathetic compression)
- Atrophy of the hand/arm muscles
25
What causes Horner's syndrome in a patient with a Pancoast tumor?
Due to cervical cranial sympathetic compression
26
What is a common cause for a granulomatous pulmonary nodule?
1. Tuberculosis*
2. Histoplasmosis
3. Coccidiomycosis
27
What is the most common mediastinal tumor?
Thymoma
28
Answer the following in reference to a malignant pulmonary nodule:
A. Shape
B. Growth
C. Calcium Deposition
D. Cavitary
A. Irregular, speculated*
B. Rapid (may double in 4 months)
C. No calcium deposition
D. Cavitary with thickened walls
29
When is a bronchoscopy indicated for a pulmonary nodule?
Central lesions
-Intermediate probability of being malignant
30
When is a needle aspiration indicated for a pulmonary nodule?
Peripheral lesions
-Intermediate probability of being malignant
31
What are the inflammatory etiologies of a pulmonary nodule?
1. Rheumatoid Arthritis
2. Sarcoidosis
3. Wegener's granulomatosis
32
What is a Bronchial carcinoid tumor?
A rare neuroendocrine (enterochromaffin cell) tumor characterized by slow growth
33
What is the most common site for carcinoid tumors?
GI tract
34
What is the 2nd most common site for carcinoid tumors?
Lung
35
A patient is diagnosed with a Bronchial carcinoid tumor. Describe to this patient which hormones may be released from this type of tumor?
1. ACTH
2. ADH
3. Melanocyte stimulating hormone
4. Serotonin
36
A patient is diagnosed with a Bronchial carcinoid tumor. What would their bronchoscopy reveal?
Pink to purple well-vascularized central tumor
37
How do you manage Bronchial carcinoid tumors?
Surgical excision is definitive management
BECAUSE it is often resistant to chemo & radiation
38
A patient is diagnosed with a Bronchial carcinoid tumor. You are trying to localize the tumor. How would you go about doing this?
CT scan & Octreotide scintography
39
A patient in complaining of diarrhea, and you see them wheezing. On PE, you also notice they looked flushed, he is tachycardic, & hypotensive. Based on this, what is the most likely diagnosis?
Carcinoid syndrome
- Diarrhea is due to increase serotonin
- Increase bradykinin & histamine lead to:
1. Flushing,
2. Tachycardia,
3. Bronchocontriction (wheezing)
4. Hemodynamic instability (hypotension)
5. Acidosis
40
What is bronchiectasis?
Irreversible bronchial dilation 2ndary to transmural inflammation of medium-sized bronchi leading to the destruction of muscular and elastic tissues of the bronchial wall.
The inflamed airways collapse easily leading to obstruction of airflow & impaired clearance of mucus secretions leading to lung infections
41
A patient is diagnosed with bronchiectasis and wants to know what causes this. How do you respond to this patient?
1. Recurrent/ chronic lung infections:
- H. flu MCC if not due to Cystic Fibrosis*
- Pseudomonas if it is due to Cystic fibrosis*
2. Hereditary: CF MCC of bronchiectasis is US*** alpha-antitrypsin deficiency
3. Obstruction: FBA, tumor, severe mucous impaction
42
You overhear a patent is diagnosed with bronchiectasis. How would you expect them to present?
- Daily chronic, cough with thick, mucopurulent, foul-smelling sputum
- Pleuritic chest pain
- Pts often develop recurrent pneumonia
- Hemoptysis* (50-70%)
- Persistent crackles at the bases is common
- Dyspnea, wheezing, rhonchi, clubbing
43
What is the MCC of massive hemoptysis?
bronchiectasis
44
A patient is thought to have bronchiectasis. The patient is having thick, foul-smelling sputum and large volumes of hemoptysis. What is the best diagnostic study useful in evaluating this patient?
High-resolution CT*
- airway dilation
- lack of tapering of the bronchi
- bronchial wall thickening "tram track thickening"
45
What is a "signet ring sign" indicative of?
pulmonary artery coupled with a dilated bronchus
-seen in bronchiectasis high-resolution CT scan
46
A patient is complaining of a severe productive cough. The patient is having thick, foul-smelling sputum and large volumes of hemoptysis. His pulmonary function tests reveal an obstructive pattern: decreased FEV1, decreased FVC, decreased FEV1/FVC <70%. What is the most likely diagnosis for this patient?
bronchiectasis
47
A patient is thought to have bronchiectasis. The patient is having thick, foul-smelling sputum and large volumes of hemoptysis. His pulmonary function tests reveal an obstructive pattern: decreased FEV1, decreased FVC, decreased FEV1/FVC <70%. Sputum culture reveals Mycobacterium Avium Complex (MAC). How do you manage this patient?
Clarithrocycin + Ethambutol
48
A patient is complaining of a severe productive cough. The patient is having thick, brown, foul-smelling sputum and large volumes of hemoptysis. His pulmonary function tests reveal an obstructive pattern: decreased FEV1, decreased FVC, decreased FEV1/FVC <70%. What is the most likely diagnosis for this patient?
Aspergillus bronchiectasis
49
A patient is complaining of a severe productive cough. The patient is having thick, brown, foul-smelling sputum and large volumes of hemoptysis. His pulmonary function tests reveal an obstructive pattern: decreased FEV1, decreased FVC, decreased FEV1/FVC <70%. What is the best management for this patient?
Corticosteroids + Itraconazole
Surgical if sxs aspergilloma
50
A patient is complaining of a severe productive cough. The patient is having thick, foul-smelling sputum and large volumes of hemoptysis. His pulmonary function tests reveal an obstructive pattern: decreased FEV1, decreased FVC, decreased FEV1/FVC <70%. What is the best management for this patient?
Abx is Cornerstone of tx: Empric
- Ampicillin
- Amoxicillin
- Bactrim
Pseudomonal coverage:
- Fluoroquinolone
- Piperacillin/tazobactam
- Aminoglycoside
- Cephalosporin
- Azithromycin has anti-inflammatory properties
Mucus management/chest physiotherapy:
- Bronchodilators
- Anti-inflammatory agents
- surgery, embolization for bleeding
Surgery: resection in complicated cases
51
What is Sarcoidosis?
It is a chronic multi-systemic, inflammatory, granulomatous disorder of unknown etiology
52
What populations are at higher risk for Sarcoidosis?
Afro-Americans
North Europeans
Females*
Onset is usually 20-40 y/o
53
What is the pathology of Sarcoidosis?
Exaggerated T cell response to a variety of antigens or self-antigens leading to central immune ACTIVATION & peripheral immune DEPRESSION
T cell accumulation leads to granuloma formation*
54
What is a granuloma found in Sarcoidosis?
Mass of immune cells formed by macrophages, epithelial cells (activated macrophages) & multinucleate giant cells surrounded by a rim of lymphocytes (especially T4), mast cells & fibroblasts +/- fibrosis
- T cells in the periphery
- Epithelioid macrophages
- Langerhans giant cells
55
What is the effect of granulomas in Sarcoidosis?
Take up space, distributing the normal structure &/or function
56
What manifestations can you expect to see in a patient with Sarcoidosis?
50% patients are asymptomatic
1. Pulmonary (90%) Dry (non-productive) cough, dyspnea, & chest pain
2. Lymphadenopathy: painless, intra-thoracic (hilar nodes +/-paratracheal)
3. Skin (25%): 2nd MC organ involved in Sarcoidosis
- Erythema Nodosum*
- Lupus Pernio*
- Maculopapular rash
- Subcutaneous nodules & waxy
- Parotid gland enlargement
4. Visual:
- Anterior uveitis
- Conjunctivitis
5. Myocardial: arrhythmias
6. Rheumatologic: arthralgias, fever, malaise, weight loss, hepatosplenomegaly
7. Neurologic: cranial nerve palsies, esp CN 7
57
A patient is suspected of having Sarcoidosis. The patinet is experiencing a non-productive cough, with painless intra-thoracic lymphadenopathy. The patient also has anterior uveitis, and erythema nodosum. How would this patient be diagnosed officially?
1. Clinical/Radiological findings
2. NCGs
3. Exclusion of other diseases
4. Tissue biopsy: non-caseating granulomas
58
What does "non-caseating" signify in a patient with Sarcoidosis?
No central necrosis
59
A patient is suspected of having Sarcoidosis. The patinet is experiencing a non-productive cough, with painless intra-thoracic lymphadenopathy. The patient also has anterior uveitis, and erythema nodosum. What is the Classic finding you would expect this patient's CXR reveal?
Bilateral hilar lymphadenopathy
60
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. You decide to order a CXR to rule out possible pneumonia. CXR reveals bilateral hilar lymphadenopathy. What is your leading diagnosis based on this finding?
Stage 1 Sarcoidosis
61
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. On PE, you notice bilateral tender red nodules on her anterior legs. You also notice violaceous, raised discoloration of the nose, ear, cheek, & chin. You decide to order a CXR to rule out possible pneumonia. CXR reveals bilateral hilar lymphadenopathy with reticular opacities with fine ground glass appearance. Radiologist also mentions eggshell nodal calcifications. What is your leading diagnosis based on this finding?
Stage 2 Sarcoidosis: Interstitial lung disease
62
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. On PE, you notice bilateral tender red nodules on her anterior legs. You also notice violaceous, raised discoloration of the nose, ear, cheek, & chin. You decide to order a CXR to rule out possible pneumonia. CXR reveals reticular opacities with fine ground glass appearance. Radiologist also mentions eggshell nodal calcifications. What is your leading diagnosis based on this finding?
Stage 3 Sarcoidosis: Interstitial lung disease only on CXR*
63
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. On PE, you notice bilateral tender red nodules on her anterior legs. You also notice violaceous, raised discoloration of the nose, ear, cheek, & chin. You decide to order a CXR to rule out possible pneumonia. CXR reveals marked pulmonary fibrosis with volume loss indicative of restrictive disease. What is your leading diagnosis based on this finding?
Stage 4: Sarcoidosis
64
What is the MC finding that is associated with Sarcoidosis on Pulmonary function testing?
Isolated decreased DLco
65
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. On PE, you notice bilateral tender red nodules on her anterior legs. You also notice violaceous, raised discoloration of the nose, ear, cheek, & chin. You decide to order a CXR to rule out possible pneumonia. CXR reveals marked pulmonary fibrosis with volume loss indicative of restrictive disease. PFTs reveal slightly increased FEV1/FVC and slightly decreased FVC with decreased lung volumes (VC,RV,FRC,TLC). Based on this finding, what is the most likely diagnosis?
Sarcoidosis: advanced disease
66
What does a "panda sign" signify?
Gallium scan: increased uptake in affected areas
| *Parotid/salivary glands tracer localization = Panda sign*
67
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. On PE, you notice bilateral tender red nodules on her anterior legs. You also notice violaceous, raised discoloration of the nose, ear, cheek, & chin. You decide to order a CXR to rule out possible pneumonia. CXR reveals marked pulmonary fibrosis with volume loss indicative of restrictive disease. PFTs reveal slightly increased FEV1/FVC and slightly decreased FVC with decreased lung volumes (VC,RV,FRC,TLC). Based on this finding, what would you expect to find on a bronchoalveolar lavage?
- study is used to rule out infectious causes
| * Sarcoid finding: Increased CD4; Decreased CD8
68
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. On PE, you notice bilateral tender red nodules on her anterior legs. You also notice violaceous, raised discoloration of the nose, ear, cheek, & chin. You decide to order a CXR to rule out possible pneumonia. CXR reveals marked pulmonary fibrosis with volume loss indicative of restrictive disease. PFTs reveal slightly increased FEV1/FVC and slightly decreased FVC with decreased lung volumes (VC,RV,FRC,TLC). Based on this finding, what laboratory studies would be consisted with the suspected diagnosis?
1. Increased ACE
2. Hypercalciuria/Hypercalcemia
3. Eosinophilia; leukopenia
4. Cutaneous anergy*: 70% pts have diminished skin test reactivity to common skin allergens
5. Increased IgG (hypergammaglobulin); Increased ESR
69
A patient has been complaining about a dry, non-productive cough for a month. This patient is not on an ACE I, does not have allergies, and does not smoke. She says she has had an intermittent fever. However, she says the temperature has not been high. On PE, you notice bilateral tender red nodules on her anterior legs. You also notice violaceous, raised discoloration of the nose, ear, cheek, & chin. You decide to order a CXR to rule out possible pneumonia. CXR reveals marked pulmonary fibrosis with volume loss indicative of restrictive disease. PFTs reveal slightly increased FEV1/FVC and slightly decreased FVC with decreased lung volumes (VC,RV,FRC,TLC). Based on this finding, what management would be best for this patient?
1. Observation: majority of patients have spontaneous remission w/in 2 years with no tx
2. Oral corticosteroids: TOC when tx is needed!*
- reduces granuloma formation & fibrosis
- ACE levels usually fall
3. Methotrexate: may be used as a steroids alternative or if refractory to steroids
4. Hydroxychloroquine: may be good for chronic disfiguring skin lesions
5. NSAIDS for musculoskeletal symptoms & erythema nodosum
* single lung transplant in severe cases
70
What is the prognosis for Sarcoidosis?
Good overall:
1. Stage 1, erythema nodosum good prognosis
2. 40% patients resolve spontaneously
3. 40% resolve with treatment
4. 20% progress to irreversible lung injury
5. Interstitial lung disease & lupus pernio associated with poorer prognosis
71
What population of Sarcoid patients is most at risk for developing Erythema Nodosum?
Increased incidence in Northern Europeans
72
When a patient is displaying signs of erythema nodosum, which should be included in your differentials?
1. Infections:
- Sarcoidosis
- Coccidiomycosis
- Strep,
- TB
2. Inflammatory bowel disease
3. Leukemia
4. Meds (OCPs)
73
Which skin finding is pathognomonic for Sarcoidosis?
Lupus pernio: violaceo, raised discoloration of the nose, ear, cheek and chin (resembles frost bite)
74
What is the most common dermatologic manifestation in Sarcoid patients?
Maculopapular rash
75
20% of Sarcoid patients will experience visual changes. How will these visual changes manifest?
1. Anterior uveitis: inflammation of the iris/ciliary body leading to blurred vision,* ocular discomfort, photophobia, ciliary flush, floaters *Ophthalmic exams indicated in ALL pts!
2. Conjunctivitis: tearing, erythema, may develop glaucoma, cataracts, & blindness
76
When a patient is sent for a biopsy sample for suspected Sarcoidosis, what are common biopsy sites?
Skin and lymph nodes
| -Transbronchial is also high yield
77
A young patient presents with respiratory and constitutional symptoms, blurred vision and erythema nodosum. What does this classically present?
Sarcoidosis
78
A Northern European patient is presenting with Erythema nodosum, polyarthralgias, and fever. CXR findings reveal bilateral hilar lymphadenopathy. What is this condition called?
Lofgren's syndrome:
1. Erythema nodosum
2. Bilateral hilar lymphadenopathy
3. Polyarthralgias + fever
-spontaneous remission
79
What is another name for Idiopathic Fibrosing Interstitial Pneumonia?
Pulmonary fibrosis
80
What is Pulmonary Fibrosis?
Chronic PROGRESSIVE interstitial scarring (fibrosis) from persistent inflammation that leads to loss of pulmonary function with a restrictive component
81
What population is most at risk for developing Pulmonary fibrosis?
1. MC in men 40-50 y/o
| 2. MC in smokers
82
A 45 y/o male patient presents with dyspnea and non-productive cough. On PE, you notice fine bibasilar inspiratory crackles, clubbing of his fingers but no cyanosis. CXR reveals diffuse reticular opacities "honeycombing" and ground glass opacities. Biopsy also reveals honeycombing. What would you expect this patients PFTs to reveal?
```
RESTRICTIVE DISEASE PATTERN
Decreased lung volumes:
-decreased TLC, RV
-decreased DLCO
-normal to elevated FEV1/FVC
```
83
A 45 y/o male patient presents with dyspnea and non-productive cough. On PE, you notice fine bibasilar inspiratory crackles, clubbing of his fingers but no cyanosis. CXR reveals diffuse reticular opacities "honeycombing" and ground glass opacities. Biopsy also reveals honeycombing. How would you manage this patient?
No effective tx!
- Strategies include:
- smoking cessation
- oxygen
- corticosteroids in acute exacerbations
* Lung transplant is the only cure* = poor prognosis w/o transplant
84
A patient is recently diagnosed with Pneumoconiosis. How do you explain what this is to the patient?
Chronic fibrotic lung disease secondary to inhalation of mineral dust*
-Mineral dust in ingested by the macrophages, triggering inflammation & release of chemical mediators leading to parenchymal fibrosis leading to restrictive lung disease & decreased lung compliance
85
A patient is seen with a non-productive cough and dyspnea on exertion. When you ask what this patient does for a living, (because you should ask people what they do for a living!) he says he is a mine worker and also works part time at a quartz quarry. CXR reveals multiple small, < 10 mm round nodular opacities primarily in the upper lobes, with egg shell calcifications of the hilar & mediastinal nodes. Based on this information, what is the most likely diagnosis?
Silicosis
86
A patient is seen with a non-productive cough and dyspnea on exertion. When you ask what this patient does for a living, (because you should ask people what they do for a living!) he says he is a mine worker and also works part time at a quartz quarry. CXR reveals multiple small, < 10 mm round nodular opacities primarily in the upper lobes, with egg shell calcifications of the hilar & mediastinal nodes. Based on this information, what is the best management for this patient?
```
Silicosis:
-no proven tx
-Supportive =
bronchodilators
O2
vaccinations (influenza, pneumococcal)
+/- corticosteroids (for silicosis alveolitis)
rehabilitation
```
87
What is the "black lung"?
Coal worker's pneumoconiosis
88
What is the etiology behind the "black lung"?
Caused by inhalation of dust from coal or carbon mines
89
How do you manage the "black lung"?
Supportive like Silicosis
90
What can you expect to see on a "black lung" patient's CXR?
Small upper lobe nodules & hyperinflation resembling centrilobar emphysema (similar to smoking emphysema)
91
When ordering PFTs for a "black lung" patient, what should you keep in mind?
May have an OBSTRUCTIVE pattern
92
What is Caplan syndrome?
Coal worker's pneumoconiosis + RA
93
A patient is diagnosed with Berylliosis. What causes this?
- Electronics
- Aerospace
- Ceramics
- tool & dye manufacturing
- fluoroescent light bulbs
94
What is the treatment for Berylliosis?
-Corticosteroids
-O2
+/- Methotrexate if corticosteroids are unsuccessful
95
How is the diagnosis of Berylliosis made?
+ exposure
| + beryllium lymphocyte proliferation test & non-caveating granulomas on BIOPSY
96
A patient with a history of Berylliosis, is at risk for which cancers?
- lung
- stomach
- colon cancers
97
What findings are indicative of Berylliosis?
NORMAL 50% of the time!
- hilar lymphadenopathy
- increased interstitial lung markings
98
What is "Monday fever" or "Brown lung disease"?
Byssinosis
99
How would a patient with Byssinosis present?
Dyspnea, wheezing, cough, chest tightness. The sxs tend to get worse at the beginning of the work week then improve later in the week or on the weekend.
100
What causes Byssinosis?
Cotton exposure in the textile industry
101
Patients with Asbestosis are at higher risk for which other conditions?
1. Bronchogenic carcinoma MC
| 2. Malignant mesothelioma of the pleura
102
What could you expect to see on an Asbestosis CXR?
-Pleural plaques (pleural thickening); interstitial fibrosis (honeycomb LUNG)
-Affects lower lobes primarily
+/- shaggy heart sign (blurring of the diaphragm & the heart border)
103
What would an Asbestosis biopsy reveal?
-may show linear asbestos bodies in lung tissues (brown rods due to iron/protein deposits)
104
What is the management for Asbestosis?
Supportive*
| No specific tx
105
What defines Pulmonary HTN?
Mean Pulmonary arterial pressure > or = 25mm Hg at rest
OR
>30 mmHg during exercise
106
What is the pathophysiology of pulmonary HTN?
Increased pulmonary vascular resistance leading to RVH leading to R sided heart failure
107
What causes Stage I pulmonary HTN?
IDIOPATHIC pulmonary arterial hypertension = PRIMARY
108
What causes Stage II pulmonary HTN?
Left heart disease
109
What causes Stage III pulmonary HTN?
Hypoxemic or chronic lung disease (COPD)
110
What is the etiology of Stage IV pulmonary HTN?
Chronic thromboembolic disease
111
What is the gene defect associated with primary pulmonary HTN?
BMPR2
112
What is the BMPR2 gene responsible for?
Normally inhibits pulmonary vessel smooth muscle growth & vasoconstriction
-Pulmonary vasculature is regulated by located mediators
113
What is the 2nd MCC of Pulmonary HTN?
COPD
114
The clinical manifestations of pulmonary HTN are vague. What are some of these manifestations?
1. Dyspnea*
2. Chest pain
3. Weakness
4. Fatigue
5. Cyanosis
6. Edema
7. Exertional syncope if severe*
