Resp - Path (Pulmonary hypertension, Sleep apnea, & Lung physical findings)

Question 1

What is normal pulmonary artery pressure?

Answer 1

Normal pulmonary artery pressure = 10-15 mmHg

Question 2

What defines pulmonary hypertension?

Answer 2

Pulmonary hypertension >= 25 mmHg at rest

Question 3

What are 3 effects of pulmonary hypertension?

Answer 3

Results in arteriosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary arteries

Question 4

What causes primary pulmonary hypertension?

Answer 4

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

Question 5

Which type of pulmonary hypertension is associated with a poor prognosis?

Answer 5

Primary

Question 6

Give 6 causes of secondary hypertension, briefly noting the pathogphysiology of each.

Answer 6

Secondary - (1) due to COPD (destruction of lung parenchyma) (2) mitral stenosis (increased resistance –> increased pressure) (3) recurrent thromboemboli (decreased cross-sectional area of pulmonary vascular bed) (4) autoimmune disease (e.g., systemic sclerosis, inflammation –> intimal fibrosis –> medial hypertrophy) (5) left-to-right shunt (increased shear stress –> endothelial injury) (6) sleep apnea or living at hight altitude (hypoxic vasoconstriction)

Question 7

What is the course of complications stemming from pulmonary hypertension?

Answer 7

Course: severe respiratory distress –> cyanosis and RVH –> death from decompensated cor pulmonale

Question 8

What is the definition of sleep apnea? What major effect does it have?

Answer 8

Repeated cessation of breathing > 10 seconds during sleep –> disrupted sleep –> daytime somnolence

Question 9

What are the PaO2 changes in sleep apnea patients?

Answer 9

Normal PaO2 during the day; Nocturnal hypoxia

Question 10

What are 3 effects of nocturnal hypoxia?

Answer 10

Nocturnal hypoxia–> systemic/pulmonary hypertension, arrhythmias (atrial fibrillation/flutter) , and sudden death

Question 11

What is central versus obstructive sleep apnea?

Answer 11

Central sleep apnea - no respiratory effort; Obstructive sleep apnea - respiratory effort against airway obstruction

Question 12

What are 2 conditions associated with obstructive sleep apnea?

Answer 12

Associated with obesity, loud snoring

Question 13

What are 3 treatment options for sleep apnea?

Answer 13

Treatment: (1) weight loss (2) CPAP (3) surgery

Question 14

How does sleep apnea relate to erythropoiesis?

Answer 14

Hypoxia –> increased EPO release –> increased erythropoiesis

Question 15

What defines obesity hypoventilation syndrome, and what causes it?

Answer 15

obesity (BMI > 30 kg/m^2) –> hypoventilation –> low PaO2 and high PaCO2 during waking hours

Question 16

Which of the following physical lung finds are associated with Pleural effusion, and how: (1) breath sounds (2) percussion (3) fremitus (4) tracheal deviation?

Answer 16

(1) decreased (2) dull (3) decreased (4) no change

Question 17

Which of the following physical lung finds are associated with Atelectasis (bronchial obstruction), and how: (1) breath sounds (2) percussion (3) fremitus (4) tracheal deviation?

Answer 17

(1) decreased (2) dull (3) decreased (4) toward side of lesion

Question 18

Which of the following physical lung finds are associated with Spontaneous pneumothorax, and how: (1) breath sounds (2) percussion (3) fremitus (4) tracheal deviation?

Answer 18

(1) decreased (2) hyperresonant (3) decreased (4) no change

Question 19

Which of the following physical lung finds are associated with Tension pnemothorax, and how: (1) breath sounds (2) percussion (3) fremitus (4) tracheal deviation?

Answer 19

(1) decreased (2) hyperresonant (3) decreased (4) away from side of lesion

Question 20

Which of the following physical lung finds are associated with Consolidation (lobar pneumonia, pulmonary edema), and how: (1) breath sounds (2) percussion (3) fremitus (4) tracheal deviation?

Answer 20

(1) Bronchial breath sounds; late inspiratory crackles (2) Dull (3) Increased (4) no change

Question 21

What is a structural lung condition to associate with Atelectasis?

Answer 21

Atelectasis (bronchial obstruction)

Question 22

What are 2 examples of conditions causing consolidation?

Answer 22

Consolidation (lobar pneumonia, pulmonary edema)