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Clinical Medicine: Pulmonary Vascular Disease

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Pulmonary Vascular Disease ppt
campbellpa2017
Quiz by campbellpa2017, updated more than 1 year ago
campbellpa2017
Created by campbellpa2017 over 8 years ago
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Resource summary

Question 1

Question
Mortality rates in the first 3 months following a PE dx are:
Answer
  • 1.5%
  • 5%
  • 15%
  • 30%
  • 50%

Question 2

Question
Emboli begin as thrombi which may consist of:
Answer
  • fat
  • air
  • tumor
  • Only A & B
  • All of the above

Question 3

Question
Venous thromboembolism may originate from:
Answer
  • DVTs
  • catheters
  • infections
  • A & C only
  • All of the above

Question 4

Question
Which of the following are physiologic anticoagulants that oppose thrombosis?
Answer
  • AT-III
  • Fibrin
  • Protein C
  • A & C only
  • All of the above

Question 5

Question
Which of the following are the most common sources for clinically important pulmonary emboli? (select all that apply)
Answer
  • Subclavian veins
  • Right Atrium/Ventricle
  • Femoral vein
  • Iliac vein
  • Pelvic vein

Question 6

Question
Which of the following compose Virchow's Triad:
Answer
  • Factors in the vessel wall (e.g. tissue damage)
  • Abnormal blood flow (e.g. venous stasis)
  • Abnormal/Hypercoagulable states
  • Abnormal/Hypocoagulable states
  • Abnormal branching of vessels

Question 7

Question
Which of the following may cause venous stasis?
Answer
  • Surgery
  • Congestive Heart Failure
  • Pregnancy
  • Only A & B
  • All of the above

Question 8

Question
Which of the following may cause hypercoagubility? (select all that apply)
Answer
  • Oral contraceptives
  • Hormone Replacement Therapy
  • Pregnancy
  • Malignancy
  • Excesses of Proteins C or S

Question 9

Question
Over 95% of pulmonary emboli are thromboemboli.
Answer
  • True
  • False

Question 10

Question
Which of the following are NOT true regarding the natural history of a venous thomboembolism?
Answer
  • Non-extended distal DVTs rarely cause PE
  • 80% of symptomatic DVTs have extended into the distal veins
  • 60% of pts w/ symptomatic DVTs w/ will have a PE
  • 70% of pts with symptomatic PE will have asymptomatic DVTs
  • DVTs most often start in the calf (distal) veins

Question 11

Question
Of the following sxs, which are all associated w/ PE, which is the least common? (choose one)
Answer
  • Dyspnea
  • Cough
  • Leg Pain/Swelling
  • Pleuritic chest pain
  • Hemoptysis
  • Wheezing
  • Orthopnea

Question 12

Question
Which of the following is the most common sign associated with PE? (found in approximately 54% of PE presentations)
Answer
  • Tachypnea
  • Calf swelling/tenderness
  • Tachycardia
  • Decreased breath sounds
  • Crackles

Question 13

Question
Which of the following is NOT part of the PERC clinical decision tool (i.e. HADCLOTS) used for diagnosing PE?
Answer
  • Surgery/trauma w/in past 28 days
  • Coughing blood
  • Lower extremity swelling unilaterally
  • O2 Saturation <95%
  • All of the above are associated with PERC

Question 14

Question
Which of the following pairs would have the HIGHEST Wells score?
Answer
  • 1) PE most likely dx (on ddx), 2) Hemoptysis
  • 1) Clinical signs and sxs of DVT, 2) Immobilization for > 3 consecutive days or surgery in previous 4 weeks
  • 1) Previous Dx of PE or DVT, 2) Cancer (tx w/in past 6 mo)
  • 1) Tachycardia (>100bpm), 2) Immobilization for > 3 consecutive days or surgery in previous 4 weeks
  • 1) PE most likely dx (on ddx), 2) Cancer (tx w/in past 6 mo)

Question 15

Question
An EKG & Chest X-ray can be helpful tools in diagnosing a PE.
Answer
  • True
  • False

Question 16

Question
Which of the following may be found on a chest x-ray of a pt w/ PE? (note: these are neither sensitive nor specific findings)
Answer
  • Decreased vascular markings in an area of lung (i.e. Westermark’s sign)
  • Wedge-shaped infiltrate extending to the pleural surface (i.e. Hampton’s hump)
  • Normal (no abnormal findings)
  • Only A & B
  • All of the above

Question 17

Question
Which of the following may be found on an EKG of a pt w/ PE? (note: these are neither sensitive nor specific findings)
Answer
  • Ventricular arrhythmias
  • Left bundle branch block
  • S1 Q3 T3 pattern
  • Only A & C
  • All of the above

Question 18

Question
Which of the following clinical signs of PE is shown on this x-ray?
Image:
67b197a6-86bd-413c-924d-7671c05c1d8c (image/jpeg)
Answer
  • Westermark's sign
  • Hampton's hump

Question 19

Question
Which of the following clinical signs of PE is shown on this x-ray?
Image:
93acb618-5fae-488a-8402-fce80d3f93cc (image/png)
Answer
  • Westermark's sign
  • Hampton's hump

Question 20

Question
Which of the following is NOT true regarding use of CT angiography in dx of PE? (select any that apply)
Answer
  • Bolus radiocontrast injection given intravenously.
  • High speed, multi-slice CT scanner takes thin section images.
  • Excellent definition of main and lobar.
  • May detect central and peripheral emboli.
  • May provide bonus information about the lungs and mediastinal structures.

Question 21

Question
CT scanning has excellent (~90%) positive predictive values.
Answer
  • True
  • False

Question 22

Question
Pulmonary angiography is considered the "gold standard" for dx of PE.
Answer
  • True
  • False

Question 23

Question
Which of the following statements is/are NOT accurate regarding pulmonary angiography.
Answer
  • Considered the "gold standard" in dx PE
  • Allows measurement of pulmonary artery pressures
  • It is both invasive and expensive
  • Frequently used to confirm dx of PE
  • Requires administration of intravenous radiocontrast

Question 24

Question
Which of the following is/are NOT true in regards to V/Q scanning in dx of PE: (select any that apply)
Answer
  • perfusion scanning uses venous injection with radiolabeled- macroaggregated albumin (technetium 99)
  • ventilation scanning requires Iinhalation of a gas mixture containing a radiotracer (xenon 133)
  • it is sensitive for decreased flow to areas of the pulmonary vascular bed, but not specific
  • a normal perfusion scan excludes the diagnosis of PE.
  • in PE cases, areas of vascular obstruction should show decreased ventilation but preserved perfusion

Question 25

Question
A "high probability" V/Q scan result, coupled with high clinical suspicion, gives a > 95% likelihood of PE.
Answer
  • True
  • False

Question 26

Question
A negative (i.e. normal) D-Dimer result may be used to rule-out DVT and PE, regardless of clinical presentation and probability scores.
Answer
  • True
  • False

Question 27

Question
Which of the following labs is LEAST helpful in the dx of PE?
Answer
  • CBC
  • ABG
  • BNP
  • Troponin
  • INR, PTT

Question 28

Question
Which of the following labs/results are NOT properly matched, in regards to dx PE.
Answer
  • ABG: hypoxemia, widened alveolar-arterial gradient, and respiratory alkalosis
  • BNP: may be elevated due to right heart strain
  • Troponin: may be decreased in 30-50% of cases
  • PTT: needed for baseline when considering tx options

Question 29

Question
A D-Dimer test could be positive in which of the following cases?
Answer
  • Pregnancy
  • Infection
  • Post-Op
  • Trauma
  • All of the above

Question 30

Question
According to the diagnostic algorithm for pulmonary embolism, if the pt's Wells score exceeds 4, what is the next step?
Answer
  • D-Dimer
  • CT angiography
  • Pulmonary Angiography
  • Ultrasound (serial venous doppler)
  • V/Q scan

Question 31

Question
According to the diagnostic algorithm for pulmonary embolism, if the pt's Wells score is below 4, what is the next step?
Answer
  • No treatment (PE dx excluded)
  • D-Dimer to confirm
  • Chest X-ray to confirm
  • Serial Venous Doppler (US) to rule-out DVT
  • Labs to confirm (BNP, LFT, CBC, etc.)

Question 32

Question
Small emboli discovered in the course of dx are relatively benign and do not require tx.
Answer
  • True
  • False

Question 33

Question
Which three signs/sxs are most indicative of an acute PE?
Answer
  • Hemodynamic instability (hypotension)
  • AMS
  • Shock
  • Hemoptysis
  • Tachycardia

Question 34

Question
Prompt use of heparin in pt's w/ a DVT helps to lyse the clot and reduce mortality.
Answer
  • True
  • False

Question 35

Question
Mortality of PE after the initiation of heparin decreases to <5%
Answer
  • True
  • False

Question 36

Question
Which of the following anticoagulants is the treatment of choice in pt's w/ a bleeding risk?
Answer
  • Low molecular weight heparin
  • Unfractionated heparin
  • High molecular weight heparin
  • Fractionated heparin
  • None of the above (Anticoagulants are contraindicated in pt's w/ bleeding risk)

Question 37

Question
Which of the following statement is NOT accurate?
Answer
  • Unfractionated Heparin requires frequent lab monitoring
  • Unfractioned Heparin requires continuous infusion due to a short half-life
  • Unfractionated Heparin is reversible
  • LMW Heparin is administered via intramuscular injections
  • LMW Heparin does not require frequent monitoring and may be managed at home

Question 38

Question
Which of the following is NOT true regarding Rivaroxaban & Dabigatran?
Answer
  • they are oral medications approved by the FDA for the tx of PE
  • their risk of causing bleeding events is comparable or less than that of coumadin
  • they are both reversible
  • neither require close monitoring
  • they are both thrombin inhibitors

Question 39

Question
Thrombolytics are only indicated in hemodynamically stable patients.
Answer
  • True
  • False

Question 40

Question
Thromolytic tx may cause an intracranial hemorrhage.
Answer
  • True
  • False

Question 41

Question
Thrombolyics are typically administered by a vascular surgeon and/or radiologist.
Answer
  • True
  • False

Question 42

Question
Which of the following might necessitate the use of an IVC ?
Answer
  • Pt. w/ bleeding problems
  • Pt. allergic/intolerant to anticoagulants
  • Pt. in need of acute stabilization
  • A & B only
  • All of the above

Question 43

Question
Which of the following are predictors of poor outcomes for pt's w/ hx of PE? (choose all that apply)
Answer
  • Hypotension
  • Hypoxemia
  • Coexisting DVT
  • Decreased lactate
  • Decreased WBC

Question 44

Question
A resting pulmonary artery pressure of ________ is considered pulmonary hypertension.
Answer
  • more than 25mmHg
  • more than 35mmHg
  • more than 45mmHg
  • more than 55mmHg

Question 45

Question
Pulmonary hypertension may be:
Answer
  • familial
  • arise from areas affected by PE
  • related to drug toxicity
  • secondary to pulmonary venous congestion (e.g. left ventricular failure)
  • All of the above

Question 46

Question
Pulm. HTN is due to hypoxia and hypoxemia and may be seen in diseases such as COPD.
Answer
  • True
  • False

Question 47

Question
An increase in blood flow, such as one experiences while exercising, will cause a proportional increase across the pulmonary vascular bed.
Answer
  • True
  • False

Question 48

Question
Which of the following may cause pulm HTN (via chronic hypoxemia): (select all that apply)
Answer
  • Chronic high altitude
  • COPD
  • Pulmonary fibrosis
  • Obstructive sleep apnea
  • Chronic Asthma

Question 49

Question
Which of the following may also cause pulm HTN: (select all that apply)
Answer
  • Parasitic infections
  • Recurrent/unresolved PE
  • Cocaine use
  • HIV
  • Syphilis
  • Liver disease
  • Allergies

Question 50

Question
Idiopathic pulm HTN is most common in women, ages 20-45 years old, and is due to medial hypertrophy and intimal proliferation and fibrosis.
Answer
  • True
  • False

Question 51

Question
Common symptoms of Pulm HTN may include: (choose all that apply)
Answer
  • Dyspnea
  • Dysphagia
  • Peripheral edema
  • Syncope
  • Chest pain

Question 52

Question
Possible signs of pulm HTN may include:
Answer
  • Carvahlo's sign (tricuspid murmur, regurg. w/ inspir.)
  • Prominent pulmonic component of second heart sound
  • Right ventricular (S3) gallop
  • JVD
  • Transient periods of tachycardia
  • Distended spleen
  • Left ventricular hypertrophy
  • Corrigan's pulse (alternates weak and bounding)

Question 53

Question
All of the following are possible lab/diagnostic findings in Pulm HTN, EXCEPT:
Answer
  • Polycythemia
  • Decreased PaO2
  • Stenosis of main pulmonary (CXR)
  • Cardiomegaly (CXR)
  • Elevated Pulm Pressures (ECG & Echo)

Question 54

Question
Which of the following are potential treatments for Pulm HTN: (select all that apply)
Answer
  • Long-term anticoagulation (even when not due to chronic PE)
  • Vasodilators (especially for Primary Pulm HTN)
  • Lung Transplantation
  • Supplemental O2
  • Cardiopulmonary bypass

Question 55

Question
Of the vasodilators used to tx pulm HTN, which is the most controversial?
Answer
  • Calcium channel blockers
  • Prostacyclin
  • Endothelin receptor blockers
  • All vasodilators are controversial in tx of Pulm HTN

Question 56

Question
Which of the following statements is NOT accurate regarding Cor Pulmonale?
Answer
  • Right ventricular failure due to pulmonary disease
  • Usually accompanied by hypercapnia
  • Most commonly caused by pulm HTN, COPD, or pulm fibrosis
  • Chronic and progressive

Question 57

Question
Which are NOT common sxs associated with Cor Pulmonale:
Answer
  • Cough
  • Swelling of face/neck
  • Cyanosis
  • JVD
  • Dysphagia
  • Gallop S3 heart rhythm

Question 58

Question
Common lab findings in Cor Pulmonale include:
Answer
  • Westermark sign on CXR
  • RAD, RVH on EKG
  • Polycythemia on CBC
  • B & C only
  • All of the above

Question 59

Question
All of the following are used to tx Cor Pulmonale EXCEPT:
Answer
  • ACE Inhibitors/Angiotensin Receptor Blockers
  • Dopamine/dobutamine
  • Anticoagulants
  • Beta-2 Agonists

Question 60

Question
This is a rare autoimmune disease that affects the kidneys and lungs, causing necrosis of alveoli and loss of gas exchange.
Answer
  • Goodpasture's Syndrome
  • Wegener's Granulomatosis

Question 61

Question
While Goodpasture's may affect persons of all ages, it is found to be more common in younger males and older females.
Answer
  • True
  • False

Question 62

Question
Signs/Sxs that might differentiate Goodpasture's from diseases such as PE and Pulmonary HTN, include: (select all that apply)
Answer
  • Hematuria
  • Pallor
  • Weight Loss
  • Myalgia
  • Proteinuria

Question 63

Question
Which of the following diagnostics are indicated in a work-up for Goodpasture's syndrome? (Select all that apply)
Answer
  • Anti-glomerular basement membrane test
  • ABG
  • BUN
  • CXR
  • LFT
  • Lung & Kidney Biopsy
  • MRI

Question 64

Question
Goodpasture's Syndrome is treated with:
Answer
  • Plasma exchange to remove antibodies
  • Immunosuppressants
  • Steroids
  • A & B only
  • All of the above

Question 65

Question
This rare disease causes "geograpahic" necrosis and granulomatous inflammation of the airways.
Answer
  • Goodpasture's
  • Wegener's

Question 66

Question
Wegener's granulomatous is believed to be caused by cellular immune processes and may present w/ respiratory and renal involvement.
Answer
  • True
  • False

Question 67

Question
Which of the following statements concerning Wegener's granulomatous is FALSE ?
Answer
  • It is a rare disease
  • Equally prevalent in men and women
  • Typically occurs in the 4th-5th decade of life
  • Is fatal within one year if not treated
  • All of the above statements are TRUE

Question 68

Question
This rare disease can cause recurrent sinusitis, chronic ear infections, and a variety of flu-like sxs.
Answer
  • Wegener's
  • Goodpasture's

Question 69

Question
The work-up for this disease includes a blood test for anti-neutrophil cytoplasmic antibodies.
Answer
  • Wegener's
  • Goodpasture's

Question 70

Question
While many survivors may be dependent on dialysis, the 5-year survival rate for Wegener's granulomatous is about 70%
Answer
  • True
  • False
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