Test 7.3

Question 1

Elevated pulmonary arterial pressure and secondary right ventricular failure

Answer 1

Pulmonary hypertension

Question 2

What is primary pulmonary htn caused by?

Answer 2

idiopathic

Question 3

What is secondary pulmonary htn caused by?

Answer 3

PE
COPD
CT d/o
Sleep apnea
Congenital heart defects
Sickle cell anemia
Cirrhosis
AIDS
living at high altitudes
Cocaine
Pulmonary fibrosis
Left sided heart failure

Question 4

What part of the heart fails secondary to pulmonary htn?

Answer 4

Right sided heart failure

Question 5

Average time from sx onset to dx of pulmonary htn

Answer 5

2 years

Question 6

Early symptoms of pulmonary htn

Answer 6

Dyspnea
Weakness
Recurrent syncope

Question 7

When is an echo useful in pulmonary htn?

Answer 7

If the underlying problem is right and left ventricular dysfunction

Question 8

When is high res CT and VQ scan helpful in pulmonary htn?

Answer 8

If underlying problem is interstitial or thromboembolic dz

Question 9

When is pulm. angiography useful in pulm htn?

Answer 9

Thromboembolic dz, high risk procedure

Question 10

Pulm htn treatment

Answer 10

Refer to a specialist
CCBs, vasodilators, PDE-5 inhibitors (smooth muscle relaxation), endothelial receptor antagonists, diuretics, anticoagulants, soluble guanylate cyclase (sGC)

Question 11

Which of the following is NOT PH treatment?

PDE-5 inhibitors, sGC, epithelial receptor agonists, vasodilators

Answer 11

Epithelial receptor agonists

Correct would be ENDOTHELIAL receptor antagonists.

Question 12

An alteration in the structure and function of the right ventricle secondary to dz of the lung, thorax, or pulmonary circulation

Answer 12

Cor pulmonale

Question 13

Adaptive response to long term increase in pressure resulting in right ventricular hypertrophy

Answer 13

chronic cor pulmonale

Question 14

Dilation in response to increased pressure from PE or ARDS

Answer 14

Acute cor pulmonale

Question 15

Cor pulmonale effects on Pulmonary Vascular Resistance,

RV afterload, CO, RV failure

Answer 15

Pulm. Vascular Resistance: Inc.
RV afterload: Increased
CO: Decreased
RV function: decreased

Question 16

Most common cause of PE death

Answer 16

RV failure

Question 17

Most common cause of cor pulmonale

Answer 17

COPD

Question 18

What murmur goes along with cor pulmonale?

Answer 18

Systolic ejection murmur with click, S3/S4 with systolic tricuspid regurg

Question 19

What’s the most accurate test to diagnose cor pulmonale?

Answer 19

Right heart catheterization

Question 20

Cor Pulmonale Tx

Answer 20

Treat the cause: Anticoagulation for PE, bronchodilation for COPD, Oxygen therapy if PaO2 is <88%

Question 21

COPD pts who develop cor pulmonale have a ____% chance of surviving 5 years

Answer 21

30

Question 22

An abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption

Answer 22

Pleural effusion

Question 23

Most common manifestation of pleural disease

Answer 23

Pleural effusion

Question 24

Most common cause of pleural effusion (then two next most common)

Answer 24

1. CHF
2. Cancer
3. Pneumonia

Question 25

Why does CHF cause pleural effusion?

Answer 25

Increased capillary hydrostatic pressure

Question 26

Why does cirrhosis cause pleural effusion?

Answer 26

Reduced intravascular pressure

Question 27

Why does malignancy or PE cause pleural effusion?

Answer 27

altered permeability of pleural membranes. Malignancy also decreases lymph drainage due to blockage

Question 28

Why does mesothelioma cause pleural effusion?

Answer 28

Reduced pleural space pressure

Question 29

Extravascular fluid with low protein from atelectasis or heart failure

Answer 29

Transudates

Question 30

Extravascular fluid with high protein from vessel alteration during inflammation. Caused by malignancy, pneumonia, PE, TB, pancreatitis

Answer 30

Exudates

Question 31

Pleural effusion presentation

Answer 31

Dyspnea, cough, CP, LE edema, orthopnea, paroxysmal nocturnal dyspnea, TB or pneumonia

Question 32

Night sweats, fever, hemoptysis, weight loss

Answer 32

TB

Question 33

Fever, purulent sputum

Answer 33

Pneumonia

Question 34

How much effusion do you need to get physical findings on exam?

Answer 34

at least 300 mL

Question 35

Percussion note and tactile fremitus of pleural effusion

Answer 35

Dull | Decreased tactile fremitus

Question 36

Other PE findings of pleural effusion

Answer 36

``` Diminished respiratory expansion Tracheal displacement toward effusion Diminished breath sounds Egophony Pleural friction rub ```

Question 37

How well do physical findings and CXR work for diagnosing pleural effusion?

Answer 37

not very helpful. Use thoracocentesis

Question 38

Pleural effusion tx

Answer 38

``` Drain if 500-1000 mL Manage infx Pleurodesis Thoracostomy Vasodilators Diuretics Anticoag for PE ```

Question 39

Most common exudative cause of pleural effusion

Answer 39

Parapneumonic

Question 40

Collapsed lung. Occurs when air leaks into the pleural space causing lung to collapse

Answer 40

Pneumothorax

Question 41

PTX symptoms

Answer 41

``` Chest pain (sharp on affected side) Dyspnea ```