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

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Flashcards in 608 - Pulmonary HTN, Sleep apnea, Lung physical findings in dz Deck (27)
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1

What is a normal pulmonary artery pressure?

10-14 mmHg

2

What is the arterial pressure in pulmonary hypertension?

≥ 25 mmHg at rest

3

What are the consequences of pulmonary HTN on pulmonary arteries?

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

4

What causes primary pulmonary HTN?

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

5

Does primary pulmonary HTN have a good or bad prognosis?

poor

6

What are 7 causes of secondary pulmonary HTN?

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

7

How does COPD → pulmonary HTN?

destruction of lung parenchyma

8

How does mitral stenosis lead to pulmonary HTN?

↑ resistance → ↑ pressure

9

how do recurrent thromboemboli → pulmonary HTN?

↓ cross-sectional area of pulmonary vascular bed

10

How does autoimmune disease → pulmonary HTN?

inflammation → intimal fibrosis → medial hypertrophy

11

How does sleep apnea → pulmonary HTN?

hypoxic vasoconstriction

12

How does living at high altitude → pulmonary HTN?

hypoxic vasoconstriction

13

What is the course of pulmonary HTN?

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

14

What is sleep apnea?

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

15

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

normal

16

What are some complications of sleep apnea?

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

17

What are the 2 types of sleep apnea?

Central and obstructive

18

Differentiate central and obstructive sleep apnea

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

19

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

obstructive sleep apnea

20

What is the treatment for sleep apnea?

weight loss, CPAP, surgery

21

What is a hematologic abnormality that accompanies sleep apnea?

Hypoxia → EPO release → ↑ erythropoiesis

22

What is obesity hypoventilation syndrome?

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

23

Describe the following findings in a patient with a pleural effusion:
- breath sounds
- percussion
- fremitus
- tracheal deviation

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

24

Describe the following findings in a patient with atelectasis (bronchial obstruction):
- breath sounds
- percussion
- fremitus
- tracheal deviation

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

25

Describe the following findings in a patient with spontaneous pneumothorax:
- breath sounds
- percussion
- fremitus
- tracheal deviation

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

26

Describe the following findings in a patient with tension pneumothorax:
- breath sounds
- percussion
- fremitus
- tracheal deviation

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

27

Describe the following findings in a patient with a consolidation (lobar pneumonia, pulmonary edema):
- breath sounds
- percussion
- fremitus
- tracheal deviation

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