pHTN, PE, OSA, ILD Flashcards Preview

CPR II Exam 2 > pHTN, PE, OSA, ILD > Flashcards

Flashcards in pHTN, PE, OSA, ILD Deck (40)
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1

What is pulmonary HTN?

mean pulmonary artery pressure >20mmHg

associated with mortality if untreated 

2

What are the symptoms of pHTN?

DOE, fatigue, pleuritic chest pain, pre-syncope, edema, JVP

3

How is pHTN diagnosed? 

EKG changs: RAD, iBBB, RAE in lead II

Labs: increased BNP

TTE: estimates pulm. artery systolic pressure, looks at RV size

Cardiac catheterization (Swan Ganz catheterization) 

4

What is the best way to diagnose pHTN? 

Swan Ganz catheterization 

5

How is pHTN treated? 

treat underlying cause

prostacyclin agonist

PDE inhibtor: Tadalafil

Endothelium antagonist: Ambrisentan

CCB

6

What is a PE?

VTE located in pulmonary vasculature usually arising from a DVT

7

What is virchow's triad?

hypercoagulability

venous stasis

endothelial injury 

8

What are the sx of PE?

chest pain

palpitations

dyspnea

syncope

+/- LE edema 

9

How is PE diagnosed?

 

What is the Gold Standard?

Well's criteria 

D-Dimer (sensitive, rules out PE if normal)  

EKG changes: sinus tach, S1Q3T3

CT Chest with Contrast is gold standard 

VQ scan is second line image

10

If a D shaped LV champer is seen on Echo, what does this indicate?

PE

11

What is the treatment for an unstable PE? 

(presents with hypotension) 

1. resuscitation 

2. thrombolytic therapy 

if thrombolytic therapy fails, repeat thrombolysis, consider catheter-directed thrombolysis, or proceed to surgery 

12

How to treat a stable PE?

Heparin

LMWH

Warfarin 

DOACs

 

13

What is the mechanism of direct oral anticoagulants? (DOACs) 

Do they require bridge therapy? 

What are the cons? 

Xa inhibitors-rovaroxaban, apixaban 

approved to be used without LMWH bridge

expensive, may be hard to reverse

14

How long is treatment for PE? 

at least three months

Pt's with provoked DVT from travel, surgery or HRT do not require extended therapy 

15

Who requires indefinite anticoagulation after PE?

those with underlying disease with high risk of VTE recurrence

-malignancy

-genetic mutations

16

What is the definition of OSA?

disruption in breathing pattern while sleeping that results inexcessive daytime somnolence despite adequate sleep periods and not explained by other causes 

(snoring, gasping for air, breathing pause) 

17

What is the definition of apnea?

reduction in breathing for at least 10 seconds with a noted drop in SpO2 by >3% 

 

18

How is the Apnea-Hypopnea index calculated?

number of apnea episodes/hour 

determines OSA severity 

 

19

If OSA is untreated, what can occur?

death

Sleep related breathing disorders are associated with increased morbidity and mortality if left untreated

20

What is the number 1 cause/predictor of OSA?

 

What facial malformation can cause OSa?

obesity

 

 

micrognathia (small mandible) 

21

What is the diagnostic criteria for OSA?

STOP-BANG

22

What is the Gold standard for diagnosing OSA?

PSG

occurs in sleep lab or at home, records sleep activity for 6-7 hrs 

Monitors EEG, ECG, ocular movement, airflow, and O2sat

allows clinician to generate AHI and diagnose the severity of sleep apnea 

23

What are the treatment options for OSA?

CPAP

oral appliances 

24

What is interstitial lung disease?

group of pulmonary disorders with a variety of different causes that present with the same characteristics

25

what are the general characteristics of ILD?

restrictive pattern on PFTs

Decreased DLCO

DOE

absence of infection or malignancy 

26

What part of the lung is affected with ILD?

the CT that supports the alveoli and capillaries to allow gas exchange

27

What are the main findings associated with idiopathic pulmonary fibrosis?

Velcro Lung

Honeycombing 

treat with supportive care, steroids, imunimodulators, anti-fibrotics

50% survival at 3-5 years; early diagnosis=better prognosis 

28

What are the main findings of Sarcoidosis?

non-caseating granulomas, lungs commonly affected 

More common in African Americans, females, family members

Associated with Lofgren's syndrome and Heerfordt's syndrome

29

What is Lofgren's syndrome

 

What is Heerfordt's syndrome?

Erythema nodosum, hilar lymphadenopathy, fever, arthritis

Anterior uveitis, parotitis, CN VII palsy, fever

 

30

What is the treatment for sarcoidosis?

supportive care

steroids: 1st line therapy

immunosupression, biologics