Pulmonary

Question 0

Obese patient HTN

Answer 0

Look for sleep apnea

Question 1

Trousseau syndrome

Answer 1

Malignancy with recurrent PEs

Question 2

Malignant HTN

Answer 2

Papilleda

Question 3

Pulmonary hypertension

Answer 3

> 25 mm at rest

Question 4

Pulmonary hypertension

Answer 4

Primary

Secondary

Question 5

Eisenmenger PFO closure

Answer 5

Helps in some cases

Question 6

Pulm HTN idiopathic

Answer 6

Autosomal dominant

Abnormal Bone marrow protein receptor

Question 7

Drug induced pulm HTN

Answer 7

Aminorex
Fenfen
Amphetamine
Increases serotonin

Question 8

Pm HTN associated with

Answer 8

Lupus
Scleroderma
HIV
Portal HTN
Eisenmenger 
Schistosomiasis

Question 9

Venoocclusive

Answer 9

Male female 1:1
Genetic
Imminogenic
Bleomycin 
Diffuse occlusion of pulm veins
Severe pulm HTN pulm edema elevated LVEDP
Death in 2 years prostacyclins worsen
No Bosentan

Question 10

Pulm HTN due to left heart disease

Answer 10

No prostacyclins

Question 11

Pulm HTN due to hypoxia

Answer 11

Copd
ILD
Sleep apnea

Question 12

Pulm veno occlusive

Answer 12

Make female 1:1
Severe pulm HTN pulm edema and elevated EDP

Death in 2 yrs
Prostacyclin may worsen the condition
No Bosentan

Question 13

Chronic thromboembolic pulmonary hypertension

Answer 13

Progressive dyspnea
Chest pain
Exertional intolerance
Syncope
Pedal edema
Best test is VQ scan
Ct angiography 
Pulm angio

Question 14

chronic thromboembolic pulm HTN

Answer 14

Peri op mortality 4%

Question 15

Pulm HTN other causes

Answer 15

Splenectomy
Sarcoidosis
Dialysis

Question 16

Pulm HTN

Answer 16

Angina due to sub endo RV is bad sign
P2 wise split

VCR enlarged PA
Oligemic lung fields

RSVP =4x TRV2+RA pressure

Question 17

Pulm HTN tests

Answer 17

HIV 
Liver
ANA, ANCA.
,bnp
Sleep study
Exercise test 6min walk

Question 18

Pulm HTN

Right heart cath

Answer 18

Mean PAP >25 mm

Group 2 has high LVEDP over 15

Question 19

Pul HTN treatment

Answer 19

Group 1 IPAH no treatment 
Group 2 left heart treat CHF 
Group 3 hypoxemia
Group 4 thromboembolic anticoag and surgery
Group 5 underlying cause

Question 20

Pulm HTN respond to nitric oxide

Answer 20

Treat with ca blockers

Question 21

Pulm HTN no response to nitro up

Answer 21

Iloprost inhalation 6-9x a day
Flolan iv 1-4 weeks diarrhea flushing
Bosentan endothelial antagonist improved exercise hepato toxic
62.5 bid
Sildenafil improves exercise and oxygenation can be additive

Question 22

Pulm HTN

Answer 22

Atrial septatomy 15-20% mortality

Transplant

Question 23

PE

Answer 23

Mortality 30%
RV dysfunction 
High bnp
Pulm embolism severity index -pesi
Age>80,cancer, copd, high hr,low BP , low sat
0 point 1% mortality
One or more 10%

Question 24

PE risk

Answer 24

DVT Surgery Immobilization obesity Smoking

Question 25

Symptoms

Answer 25

33% a symptomatic

Question 26

Wells criteria

Answer 26

``` DVT 3 points No explanation 3 points Tachycardia 1.5 Immobility surgery 1.5 H/o DVT 1.5 Hemoptysis 1 Cancer 1 Score 6 high prob 2 low prob ```

Question 27

PE

Answer 27

Tropinin high 30-50% | Normal D dimer in low to moderate probability excludes PE

Question 28

PE echo

Answer 28

30-40% abnormal | Decrease RV function and increase RV size

Question 29

Warfarin induced skin necrosis

Answer 29

In protein C deficiency

Question 30

First PE | 3-6 mos provoked

Answer 30

Unprovoked and recurrent indefinite Coumadin therapy

Question 31

Thrombolysis PE

Answer 31

``` Severe hypoxemia Large PE RV dysfunction Free floating thrombus PFO ```

Question 32

Cpap

Answer 32

``` 26% at risk Ahi total number of apnea and hypoapnea per hour Mild 5-15 Moderate 15-30 Severe >30 ```