pulmonary vascular disease

Question 1

pulmonary circulation

Answer 1

deoxygenated blood comes from right ventricle and goes to pulmonary trunk and goes to right and left pulmonary arteries
goes to lobar and segmental branches, pulmonary capillaries which wrap around alveoli and feed to pulmonary veins
go to left atrium

Question 2

the alveoli are entirely supplied by

Answer 2

pulmonary arteries

Question 3

systemic circulation

Answer 3

bronchial arteries supply the lung stroma

Question 4

left lung bronchial arteries

Answer 4

2 (superior and inferior)

Question 5

right lung bronchial arteries

Answer 5

has 1

Question 6

bronchial arteries

Answer 6

run as far as the small bronchioles where they form capillary networks
drain to bronchial veins and pulmonary veins (small component)

Question 7

what is the main blood supply of the lungs

Answer 7

pulmonary circulation

smaller % bronchial circulation

Question 8

loss of pulmonary circulation

Answer 8

results in infarction of terminal airways, but blood still partly flows around infarct and venous blood pools
infarct is red rather than pale

Question 9

loss of bronchial arterial circulation

Answer 9

blood flow not compromised

Question 10

pulmonary infarct

Answer 10

an infarct is an area of ischemic necrosis caused by occlusion of the vascular supply to the affected tissue

Question 11

causes of pulmonary infarct

Answer 11

thrombus, embolus, vasospasm, expansion of atherosclerotic plaque, torsion or compression of vessels, trauma, vasculitis

Question 12

commonest cause of of pulmonary infarct in the lung

Answer 12

small/medium sized PE

Question 13

lung infarcts tend to be

Answer 13

peripheral
wedge shaped
hemorrhagic

Question 14

Pulmonary emboli

Answer 14

a detached intravascular solid, liquid or gaseous mass that is carried by the blood from its point of origin to a distant site, where it often causes tissue dysfunction or infarction

Question 15

classification of emboli

Answer 15

solid vs liquid vs gas
arterial vs venous
type of embolic material

Question 16

types of embolic material

Answer 16

1. thromboembolism
2. air/gas
3. fat
4. amniotic fluid emboli
5. septic emboli
6. foreign. body

Question 17

pathogenesis of venous thromboemboli

Answer 17

increased blood platelets
the formation of a blood clot
formation of thromboembolic masses
embolism

Question 18

acute provoking factors of formation of emboli

Answer 18

surgery, burns, trauma, period of immobilisation, commencement of oestrogen therapy, pregnancy

Question 19

chronic predisposing factors of formation of emboli

Answer 19

clotting abnormality, obesity, smoking, hypertension n, malignancy

Question 20

mechanical problem of PE

Answer 20

ventilation perfusion mismatch

Question 21

large embolus can lead to

Answer 21

can lead to right heart failure and sudden death

Question 22

smaller emboli symptoms

Answer 22

shortness of breath, sudden onset, chest pain

Question 23

multiple small emboli symptoms

Answer 23

may be asymptomatic or have lower grade symptoms

Question 24

3 possible sequelae of of embolus

Answer 24

1. lysis
2. superimposed thrombus/inflammation/extension of infarct
3. organisation and recanalization

Question 25

air emboli

Answer 25

trauma, surgical

Question 26

gas emboli

Answer 26

often nitrogen divers at high pressure more nitrogen dissolves into blood rapid return to low pressure results in bubbles forming in the microvasculature - brain,, lungs joints, heart

Question 27

fat and marrow emboli

Answer 27

usually happen because of trauma | fragments of fat or marrow enter the circulation

Question 28

adipocytes with or without associated haematopoietic marrow elements

Answer 28

release of free fatty acids from fat globules causes toxic injury to the endothelium, platelet activation and recruitment go white blood cells

Question 29

fat embolism syndrome

Answer 29

1-3 days after injury pulmonary insufficiency tachypnoea, dyspnoea neurological symptoms

Question 30

amniotic fluid emboli

Answer 30

rare critical complication for labour amniotic fluid getting into blood stream dyspnoea, cyanosis and shock headaches, seizures and coma

Question 31

septic emboli

Answer 31

colonies of bacteria and fungi can detach and lodge/proliferate elsewhere

Question 32

pulmonary hypertension

Answer 32

defined as a mean pulmonary artery pressure greater than or equal to 25mm Hg at rest or mean pressure > 30mm Hg during exercise

Question 33

causes of pulmonary hypertension

Answer 33

- increase in pulmonary blood flow - increase in pulmonary vascular resistance - increase in left heart resistance to blood flow - idiopathic

Question 34

5 groups of pulmonary hypertension

Answer 34

1. pulmonary arterial hypertension 2. pulmonary hypertension owing to left heart disease 3. pulmonary hypertension owing to lung disease and/or hypoxia 4. chronic thromboembolic pulmonary hypertension 5. pulmonary hypertension with unclear multifactorial mechanisms

Question 35

pulmonary arterial hypertension

Answer 35

idiopathic, hereditary or drug and toxin induced | associated with autoimmunity

Question 36

group 3 - lung disease and/or hypoxia

Answer 36

COPD sleep disordered breathing alveolar hypoventilation disorders chronic exposure to high altitudes

Question 37

group 5 - unclear multifactorial mechanisms

Answer 37

haematological disorders eg.g myeloproliferative diseases sarcoidosis. vasculitis, langerhans call histiocytosis metabolic disorders

Question 38

pathological findings in pulmonary hypertension

Answer 38

muscular vessels more elastic and scarred atherosclerosis right ventricular hypertrophy

Question 39

pathogenesis of vascular changes - mutations in BMPR2

Answer 39

dysfunction of endothelial cells and vascular smooth muscle cells

Question 40

patient presentation of pulmonary hypertension

Answer 40

right heart failure failure to oxygenate arrhythmias in idiopathic group death from right heart failure usually ensues with 2 to 5 years

Question 41

treatment of pulmonary hypertension

Answer 41

treat the trigger vasodilators have been used with varying success in those with group 1 or refractory disease lung transplantation provides definitive treatment for selected patients

Question 42

diffuse pulmonary haemorrhage

Answer 42

usually immunologicaly mediated or inflammatory diseases

Question 43

good pasture syndrome

Answer 43

uncommon autoimmune disease in which kidney and lung injury are caused by circulating autoantibodies against the non collagenous domain of the a3 chain of collagen IV the antibodies initiate inflammatory destruction of the basement membrane in renal glomeruli and pulmonary alveoli, giving rise to rapidly progressive glomerulonephritis and necrotising hemorrhagic interstitial pneumonitis

Question 44

Granulomatosis with pulmonary angiitis

Answer 44

systemic inflammatory disorder aetiology and pathogenesis are not clear autoimmune vasculitis