Pulmonary vascular disease

Question 1

How does pulmonary embolism arise?

Answer 1

Thrombus is usually formed in deep veins in legs and then embolises to pulmonary artery

Question 2

What are the risk factors for pulmonary embolism?

Answer 2

Recent surgery, major trauma, pregnancy, cancer, cardiopulmonary disease, inherited thrombophilia

Question 3

What are the symptoms of pulmonary embolism?

Answer 3

pleuritic chest pain, cough, haemoptisis due to necrotising tissue, isolated acute dyspnoea, syncope or cardiac arrest

Question 4

What are the signs of pulmonary embolism?

Answer 4

pyrexia, pleural run, stony dullness to percussion on pleural effusion, tachycardia, tachypnoea, hypotension, hypoxia, shock, also signs of vein thrombosis such as oedema of legs

Question 5

What are the investigations that should be carried out?

Answer 5

full blood count, blood gas, biochemistry, chest X ray, ECG, D dimer for clotting cascade, CT pulmonary angiogram, V/Q scan, echocardiogram, thrombophilia testing

Question 6

What tests are used to asses the risk factor for pulmonary embolism?

Answer 6

Wells score, Geneva score

Question 7

What test is used to asses severity of pulmonary embolism?

Answer 7

PESI score

Question 8

What is the treatment for pulmonary embolism?

Answer 8

O2, low moleculer heparin, warfarin, direct oral anticoagulants, thrombolysis, or pulmonary embolectomy

Question 9

What is pulmonary hypertension?

Answer 9

Elevated pressure in pulmonary arteriolar tree, mean P > 25 mmHg

Question 10

What are the causes of pulmonary hypertension?

Answer 10

Primary cause, rare, idiopathic

Secondary causes due to chronic respiratory disease, or chronic cardiac disease, chronic thromboembolism, miscellaneous

Question 11

What are the symptoms of pulmonary hypertension?

Answer 11

Exertion dyspnoea, chest tightness, exertional presyncope, or syncope

Question 12

What are the signs of pulmonary hypertension?

Answer 12

elevated JVP, ankle oedema, hepatomegaly, loud pulmonary second heart sound, right ventricular heave

Question 13

What are the investigations for plenary hypertension?

Answer 13

lung function, ECG, chest X ray, echocardiogram, V/Q scan, right heart catheterisation to measure pulmonary pressure, CT pulmonary angiogram

Question 14

What is the treatment for pulmonary hypertension?

Answer 14

treat underlying condition, O2, anticoagulants, diuretics, thromboendarterectomy