608 - Pulmonary HTN, Sleep apnea, Lung physical findings in dz

Question 1

What is a normal pulmonary artery pressure?

Answer 1

10-14 mmHg

Question 2

What is the arterial pressure in pulmonary hypertension?

Answer 2

≥ 25 mmHg at rest

Question 3

What are the consequences of pulmonary HTN on pulmonary arteries?

Answer 3

1. arteriosclerosis
2. medial hypertrophy (tunica media)
3. intimal fibrosis

Question 4

What causes primary pulmonary HTN?

Answer 4

inactivating mutation in the BMPR2 gene (normally functions to inhibit vascular smooth muscle proliferation)

Question 5

Does primary pulmonary HTN have a good or bad prognosis?

Answer 5

poor

Question 6

What are 7 causes of secondary pulmonary HTN?

Answer 6

1. COPD
2. mitral stenosis
3. recurrent thromboemboli
4. Autoimmune disease
5. L → R shunt
6. Sleep apnea
7. Living at high altitudes

Question 7

How does COPD → pulmonary HTN?

Answer 7

destruction of lung parenchyma

Question 8

How does mitral stenosis lead to pulmonary HTN?

Answer 8

↑ resistance → ↑ pressure

Question 9

how do recurrent thromboemboli → pulmonary HTN?

Answer 9

↓ cross-sectional area of pulmonary vascular bed

Question 10

How does autoimmune disease → pulmonary HTN?

Answer 10

inflammation → intimal fibrosis → medial hypertrophy

Question 11

How does sleep apnea → pulmonary HTN?

Answer 11

hypoxic vasoconstriction

Question 12

How does living at high altitude → pulmonary HTN?

Answer 12

hypoxic vasoconstriction

Question 13

What is the course of pulmonary HTN?

Answer 13

severe respiratory distress → cyanosis and RVH → death from decompensated cor pulmonale

Question 14

What is sleep apnea?

Answer 14

Repeated cessation of breathing > 10 seconds during sleep → disrupted sleep → daytime somnuolence

Question 15

During the day, do sufferers of sleep apnea have ↑, ↓, or normal PaO2?

Answer 15

normal

Question 16

What are some complications of sleep apnea?

Answer 16

nocturnal hypoxia →

1. systemic/pulmonary HTN
2. arrhythmias (atrial fib/flutter)
3. sudden death

Question 17

What are the 2 types of sleep apnea?

Answer 17

Central and obstructive

Question 18

Differentiate central and obstructive sleep apnea

Answer 18

Central = no respiratory effort
Obstructive = respiratory effort against airway obstruction

Question 19

Which type of sleep apnea is associated with obesity and loud snoring?

Answer 19

obstructive sleep apnea

Question 20

What is the treatment for sleep apnea?

Answer 20

weight loss, CPAP, surgery

Question 21

What is a hematologic abnormality that accompanies sleep apnea?

Answer 21

Hypoxia → EPO release → ↑ erythropoiesis

Question 22

What is obesity hypoventilation syndrome?

Answer 22

obesity (BMI ≥ 30) → hypoventilation → ↓ PaO2 and ↑ PaCO2 during waking hours

Question 23

Describe the following findings in a patient with a pleural effusion:

• breath sounds
• percussion
• fremitus
• tracheal deviation

Answer 23

• breath sounds: ↓
• percussion: dull
• fremitus: ↓
• tracheal deviation: none

Question 24

Describe the following findings in a patient with atelectasis (bronchial obstruction):

• breath sounds
• percussion
• fremitus
• tracheal deviation

Answer 24

• breath sounds: ↓
• percussion: dull
• fremitus: ↓
• tracheal deviation: toward side of lesion

Question 25

Describe the following findings in a patient with spontaneous pneumothorax:

• breath sounds
• percussion
• fremitus
• tracheal deviation

Answer 25

• breath sounds: ↓
• percussion: hyperresonant
• fremitus: ↓
• tracheal deviation: none

Question 26

Describe the following findings in a patient with tension pneumothorax:

• breath sounds
• percussion
• fremitus
• tracheal deviation

Answer 26

• breath sounds: ↓
• percussion: hyperresonant
• fremitus: ↓
• tracheal deviation: away from lesion

Question 27

Describe the following findings in a patient with a consolidation (lobar pneumonia, pulmonary edema):

• breath sounds
• percussion
• fremitus
• tracheal deviation

Answer 27

• breath sounds: bronchial breath sounds; late inspiratory crackles
• percussion: dull
• fremitus: ↑
• tracheal deviation: none