Resp - Path (Rhinosinusitis, DVT, & Pulmonary emboli)

Question 1

What causes Rhinosinusitis, and what effects does it have? In which sinuses does it typically occur in adults?

Answer 1

Obstruction of sinus drainage into nasal cavity –> inflammation and pain over affected area (typically maxillary sinuses in adults)

Question 2

What is the most common acute cause of Rhinosinusitis? What is a complication of this?

Answer 2

Most common acute cause is viral URI; May cause superimposed bacterial infection, most commonly S. pneumoniae, H. influenzae, and M. catarrhalis

Question 3

What are 3 bacterial infections most commonly superimposed in Rhinosinusitis?

Answer 3

May cause superimposed bacterial infection, most commonly S. pneumoniae, H. influenzae, and M. catarrhalis

Question 4

What predisposes Deep venous thrombosis? Detail the factors in this predisposition.

Answer 4

Predisposed by Virchow triad: (1) Stasis (2) Hypercoagulability (e.g., defect in coagulation cascade proteins, most commonly factor V Leiden) (3) Endothelial damage (exposed collagen triggers clotting cascade)

Question 5

What percentage of pulmonary emboli arise from deep leg veins?

Answer 5

Approximately 95% of pulmonary emboli arise from deep leg veins.

Question 6

Name and define the sign associated with Deep venous thrombosis.

Answer 6

Homan sign - dorsiflexion of foot –> calf pain

Question 7

What is used for acute management versus long-term prevention of DVT?

Answer 7

Use heparin for prevention and acute management; use warfarin for long-term prevention of DVT recurrence

Question 8

What pathophysiological effects are caused by Pulmonary emboli?

Answer 8

V/Q mismatch –> hypoxemia –> respiratory alkalosis

Question 9

What are the symptoms of Pulmonary emboli? What is its most severe presentation?

Answer 9

Sudden-onset dyspnea, chest pain, tachypnea; May present as sudden death

Question 10

What are 6 types of pulmonary emboli?

Answer 10

Types: (1) Fat (2) Air (3) Thrombus (4) Bacteria (5) Amniotic fluid (6) Tumor; Think: “An embolus moves like a FAT BAT”

Question 11

With what 2 conditions are Fat emboli associated?

Answer 11

Fat emboli - associated with long bone fractures and liposuction

Question 12

What is the classic triad associated with Fat emboli?

Answer 12

Classic triad of hypoxemia, neurologic abnormalities, and petechial rash

Question 13

What can result from amniotic fluid emboli? In especially what setting does this complication occur?

Answer 13

Amniotic fluid emboli - can lead to DIC, especially postpartum

Question 14

What causes gas emboli?

Answer 14

Nitrogen bubbles precipitate in ascending divers

Question 15

What is used to treat gas emboli?

Answer 15

Treat with hyperbaric oxygen

Question 16

What is the imaging test of choice for a PE, and what do you look for?

Answer 16

CT pulmonary angiography is the imaging test of choice for a PE (look for filling defects)

Question 17

What is the significance of Lines of Zahn?

Answer 17

Lines of Zahn are interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi before death. Help distinguish pre- and postmortem thrombi