pulmonary Vascular Disease

Question 1

Where do Pulmonary Embolisms originate from

Answer 1

DVT in the legs which travel ot the lungs

Question 2

Where do Pulmonary Embolisms originate from

Answer 2

DVT in the legs which travel ot the lungs

Question 3

What do PEs do

Answer 3

Obstruct the pulmonary vasculature

Question 4

Who are vulnerable to DVTs

Answer 4

Patients who are immobilised in the community or in hospital

Question 5

What is Virchow’s triad?

Answer 5

Venous stasis
Damage to the wall of the vein
hypercoagulable state

Question 6

How does venous stasis occur

Answer 6

As a result of immobility, local pressure, venous obstruction, congestive cardiac failure and dehydration

Question 7

How does damage to a vein occur

Answer 7

Local trauma to the vein, previous thrombosis and inflammation

Question 8

How do hypercoagulable states arise?

Answer 8

As part of the body’s response to surgery, trauma and childbirth.
In association with malignancy and use of oral oestrogen contraceptives.

Question 9

What are the classic signs of DVT

Answer 9

Oedema of the leg with tenderness

erythema and pain on flexing the ankle (Homan’s sign)

Question 10

What is the usual investgation used to confirm or exclude DVT

Answer 10

Compression ultrasound of the leg veins

Question 11

What happens when there is an occlusion of a large part of the pulmonary circulation

Answer 11

A catastrophic drop in cardiac output and the patient collapses with hypotension, cyanosism tachypnoea and engorged neck veins

Question 12

What happens when there is an occlusion of a large part of the pulmonary circulation

Answer 12

A catastrophic drop in cardiac output and the patient collapses with hypotension, cyanosism tachypnoea and engorged neck veins

Question 13

What are the 3 main clinical symptoms of a pulmonary embolism

Answer 13

Dyspnoea
Tachyphnoea (>20)
Pleuritic chest pain

Question 14

What is the purpose of the CXR during investigations

Answer 14

To rule out any other causes

Question 15

Is a CXR is usually normal in a PE. True or false

Answer 15

True

Question 16

An ECG is often normal in a PE. True or false

Answer 16

True

Question 17

What does an ECG do for investigating PE

Answer 17

Rules out an MI and cardiac arrhythmias

Question 18

ABGs are normal in a PE. True or False

Answer 18

False.

Question 19

What are the main changes in the ABGs for a PE

Answer 19

Low PCO2 and low PO2 due to underperfused areas of lung resultin in hypoxaemia and hyperventilation

Question 20

D dimers are reduced in thromboembolism. True or false

Answer 20

False. They are elevated

Question 21

What are D dimers

Answer 21

A breakdown product of cross-linked fibrin

Question 22

Can D Dimers exclude PE

Answer 22

No - other causes

Question 23

What is the definitive test for diagnosing PE

Answer 23

Pulmonary angiography

Question 24

What is the problem with pulmonary angiography

Answer 24

They are invasive and require specialist expertise and equipment that are not widely available

Question 25

What is the definitive initial non-invasive investigation for PE

Answer 25

CTPA - computed tomography pulmonary angiography

Question 26

What is injected IV before a VQ scan

Answer 26

Famma emitting radio isotope

Question 27

What do the cold areas on the VQ scan suggest

Answer 27

There is defective blood flow

Question 28

What is the treatment for PEs

Answer 28

Anti-coagulatant therapy - Low molecular weight heparin

Question 29

How is the dose for low molecular weight heparin determined

Answer 29

Based on the patients weight

Question 30

What are some of the adverse effects of heparin

Answer 30

Haemorrhage, bruising and thrombocytopenia

Question 31

Once there is supportive subsequent investigations, what should be given

Answer 31

Oral anti-coagulation as warfarin

Question 32

Once there is supportive subsequent investigations, what should be given

Answer 32

Oral anti-coagulation as warfarin

Question 33

Can warfarin and heparin be used together

Answer 33

Yes - when warfarin is just newly introduced to the body - 48-72 hours

Question 34

What is the aim of thrombolytic therapy

Answer 34

To actively dissolbe clots

Question 35

When is thrombolytic therapy used

Answer 35

In patients with acute massive pulmonary embolism who remain in severe haemodynamic collapse

Question 36

What are 3 contraindications of thrombolytic therapy

Answer 36

Active haemorrhage Recent major surgery Trauma

Question 37

What is used to correct hypoxaemia

Answer 37

High flow oxygen

Question 38

In patients who are contraindicative of thrombolytic therapy, what could be used

Answer 38

A venous filter into the inferior vena cava

Question 39

What is cor pulmonale

Answer 39

The development of pulmonary hypertension and right ventricular hypertrophy secondary to disease of the lungs.

Question 40

What is cor pulmonale

Answer 40

The development of pulmonary hypertension and right ventricular hypertrophy secondary to disease of the lungs.

Question 41

What is Wegener's granulomatosis characterised by

Answer 41

Necrotising granulomatous inflammation and vasculitis affecting in particular the upper airways, the lungs and kidneys

Question 42

What is usually present in the serum of Wegener's granulomatosis

Answer 42

Anti-neutrophil cytoplasmic antibodies

Question 43

How is Wegener's granulomatosis treated

Answer 43

Combination of corticosteroids and also cyclophosphamide

Question 44

How is Wegener's granulomatosis treated

Answer 44

Combination of corticosteroids and also cyclophosphamide

Question 45

What is Goodpasture's syndrome

Answer 45

It consists of a combination of glomerulonephritis and alveolar haemorrhage in association with circulating anti-basement membrane antibody that binds to the lung and renal tissue

Question 46

What is the treatment of Goodpasture's syndrome?

Answer 46

Corticosteroids and cyclophosphamide with plasmapheresis to remove circulating antibodies

Question 47

What are the values of pulmonary hypertension

Answer 47

Mean pressure of more than 25mmHg