Vascular Lung Diseases

Question 1

What is an embolus?

Answer 1

A detached intravascular mas carried by the blood to a site in the body distal from its point of origin

Question 2

What are the types of emboli?

Answer 2

Thrombi
fat
gas
tumour
foreign bodies

Question 3

What is the most common type of emboli in pulmonary circulation?

Answer 3

Thromboemboli

Question 4

Where is the most common source of a PE

Answer 4

DVT in pelvic and lower limb region
Iliofemoral- most likely
Popliteal- least likely

Question 5

What is virchows triad?

Answer 5

Vessel wall problems
Hypercoagulation
Abnormal blood flow eg stasis

Question 6

Who is at risk of a PE?

Answer 6

Thrombophilia
contraceptive pill
pregnancy
pelvic obsturction
trauma
surgery
cancer patients
post MI
Po hypertension/vasculitis

Question 7

What are the symptoms of a DVT?

Answer 7

May be asymptomatic

Swolen, hot, red, tender

Question 8

What are the possible differentials for a DVT?

Answer 8

Popliteal synovial rupture (bakers cyst)
Superficial thrombophlebitis
Calf cellulitis

Question 9

How do you investigate a DVT?

Answer 9

Dopplers leg scan

CT of ileofemoral arteries, IVC and pelvis

Question 10

What are the clinical features of a small PE?

Answer 10

Asymptomatic
recurrent Po hypertension
cor pulmonale
progressive dyspnoea

Question 11

What are the clinical features of a medium PE?

Answer 11

pleuritic pain
Haemoptysis
Breathless

Question 12

What are the clinical features of a large PE?

Answer 12

Cardiovascular shock
low BP
central cyanosis
death

Question 13

What are the signs of a PE?

Answer 13

fever
cyanosis
tachypnoea
tachycardia
hypotension
raised jvp
pleural rub
pleural effusion
crackles

Question 14

What investigations are used to diagnose a PE?

Answer 14

ABG- decreased PaO2 and SaO2
CXR normal- basal aelectesis, consolidation, effusion post infarct
ECG- t wave invertion V1-V4
D dimer raised
VQ scan
CT pulmonary angiogram
Ultra sound leg and pelvis
Echocardiogram- pulmonary arterial pressure and RV size
TLCO

Question 15

How can you try find the underlying cause of the PE?

Answer 15

autoantibodies

coagulation factor scan

Question 16

How can you prevent DVTs?

Answer 16

Early post op movement
Compression stockings
Calf muscle exercises
Heparin
Dabigatran- thrombin inhibitor
Rivaroxoban/Apixaban- factor x inhibitor

Question 17

What are the complications of PE?

Answer 17

Pulmonary infarct- probably have bronchial artery damage too
Pulmonary hypertension
Death

Question 18

What is the treatment for a PE?

Answer 18

Anticoagulate
Begin heparin and warfarin for 3-5 days
Stop heparin when INR is greater than two
Continue warfarin for 3-6 months

Question 19

What treatment may be considered in serious cases?

Answer 19

Thrombolysis- streptokinase A inhibitor
IVC filter
Thrombo embolectomy- RARE
Asiprin no role as antiplatelet

Question 20

What should be done in the event of overanticoagulation?

Answer 20

Address underlying cause eg drugs
Stop anticoagulation
Prothrombin complex or fresh frozen plasma given
Reverse warfarin with vitamen K1- esp if liver disease
Reverse heparin with protamine

Question 21

What drugs can interact with and increase anticoagulation of warfarin?

Answer 21

Alcohol
Antibiotics
Asprin
NSAIDS
amioderone
Cimetidine
Omeprazole

Question 22

What is pulmonary oedema?

Answer 22

Fluid in the lung- interstitium and alveolar spaces included

Question 23

What pattern of disease does pulmonary oedema cause?

Answer 23

Restrictive

Question 24

What are the causes of pulmonary oedema?

Answer 24

1.Haemodynamic circulation (increasd hydrostatic pressure)
2.Due to alveolar lining or endothelium cell injury
Pneumonia- localised
ARDS- generalised