Which finding on CXR is suggestive of pulmonary HTN?
Pulmonary artery enlargement
What is needed to confirm the diagnosis of pulmonary HTN and to assess its cause if therapy is to be considered?
- Right heart catheterization*** and direct measurement of mean pulmonary artery pressure
- Echocardiography w/ estimated mean systolic pulmonary artery pressure of 40 mmHg or greater is highly suggestive
What are the best predictors of prognosis for pulmonary HTN?
- Right-sided heart function
- Functional status (as determined by 6-minute walk test)
What are the etiologies for group 1-group 5 pulmonary HTN?
- Group 1 = idiopathic and CT diseases
- Group 2 = heart (i.e., systolic, diastolic, valvular)
- Group 3 = lungs
- Group 4 = pulmonary emboli
- Group 5 = all others (i.e., hematologic, systemic, metabolic..)
What are the classic findings of PFT's in pt with pulmonary HTN?
Normal PFT EXCEPT isolated reduction in DLCO
Common EKG findings that may be seen in pt w/ pulmonary HTN?
- Right-axis deviation
- Right atrial enlargement = peaked 'p' waves
- RV strain = repolarization abnormality
What are 3 echocardiogram findings which may be seen w/ pulmonary HTN?
- Increased estimated PA pressures
- RA enlargement
- RV enlargement
What is a PE finding which may help distinguish pulmonary HTN from IHD?
↑ P2 in pulmonary HTN; parasternal heave and persistent splitting of S2
Which questionnaire has been shown to have a high sensitivity and negative predictive value for moderate to severe sleep apnea?
Which validated questionnaire can be used to assess the level of somnolence during daytime activity to help determine need for diagnostic testing for sleep disorders?
Epworth Sleepiness Scale
What is the most important risk factor obstructive sleep apnea?
Excess body weight
What is the test of choice/needed for the diagnosis of obstructive sleep apnea?
Which value of the apnea-hypopnea index (AHI) taken during a polysomnography confirms obstructive sleep apnea?
AHI >5 per hour
What will a polysomnography show in a person with central sleep apnea which distinguishes it from obstructive sleep apnea?
Absence of respiratory effort during apnea
The neurologic disorder termed "periodic limb movements of sleep" is most common in which patients?
Pt's on dialysis
If a daytime awake pulse oximetry demonstrates hypoxemia in a pt with suspected OSA, what test should be drawn and what is a likely cause?
- Arterial blood gasses (ABG's)
- Obesity hypoventilation syndrome (awake PCO2 >45 mmHg)
Obese patients with depression must be screened for what?
Obstructive sleep apnea
What are the major goals of tx for obstructive sleep apnea?
- Improve daytime sleepiness and cognitive performance
- Prevent long-term sequelae
What are 4 lifestyle modifications which should be used in the tx of obstructive sleep apnea (i.e., obese, alcohol, sleep position, and OTC's?
- Obese? Lose 10% or more (may ↑ size of airway)
- Avoid alcohol and sedatives 3-4 hrs prior to bed
- Lateral decubitus sleeping position (keeps airways from collapsing)
- Intranasal steroid/decongestants
If moderate to severe OSA persists despite interventions, or if the changes cannot be instituted, what tx should be started?
Nocturnal CPAP has what effect on intraluminal airway pressure and FRC?
↑ intraluminal airway pressure and ↑ FRC
What are 4 measures shown to improve adherence when using CPAP?
- Early pt education
- Heated humidification
- Establishing a comfortable interface for the CPAP device
What is a solution for pt's that aren't able to adjust to a nocturnal CPAP prior to surgery?
- bi-level PAP (BiPAP)
- Mandibular assist device
Which tx device may eliminate the need for CPAP in mild/moderate cases of OSA?
Mandibular assist device
What is the most common surgical intervention for OSA to remove obstruction to airflow?
Obesity-hypoventilation syndrome can mimic COPD, but what is a major difference seen during PFT's?
PFT's demonstrate a restrictive defect rather than obstructive
Erythema nodosum + fever + arthralgia + hilar adenopathy (on CXR) is characteristic of what?
What is the tx of choice for Sarcoidosis?
Pleural plaques in the lungs which are often calcified is a characteristic finding in what cause of restrictive lung disease?