4c Int Med Day 2 Pulmonary hypertension

Додано: 21 березня 2021
Предмет:
Тест виконано: 48 разів
15 запитань
Запитання 1

Which one of the following is most accurate about the etiology and epidemiology of Pulmonary Arterial Hypertension?


варіанти відповідей

Worldwide, the most common cause of PAH is collagen-vascular disease

PAH is typically diagnosed in elderly patients, with a mean age at diagnosis of >70 years

The most common drug that leads to PAH is metformin

Women are more likely than men to develop PAH

Запитання 2

Which one of the following is more commonly associated with ulmonary Arterial Hypertension?


варіанти відповідей

Raynaud phenomenon

Syncope without any exertion

Decrease in the pulmonic component of the second heart sound (P2)

Hypothyroidism

Запитання 3

According to Guidelines for Diagnosis and Treatment of Pulmonary Hypertension from the American College of Cardiology, which one of the following characteristics is suggestive of high risk?


варіанти відповідей

6-minute walk distance of 465 m

Right atrial pressure of 7 mm Hg

A B-type natriuretic peptide level of 300 ng/L

Cardiac index of 3 L/min/m2

Запитання 4

Which one of the following is recommended as an initial screening measure in patients with suspected pulmonary hypertension and right ventricular dysfunction, based on history, physical examination, chest radiography, and ECG?


варіанти відповідей

Right-sided cardiac catheterization

Ventilation-perfusion lung scanning

Two-dimensional transthoracic echocardiography with Doppler analysis

Pulmonary angiography

Запитання 5

Which one of the following is most accurate regarding the treatment of PAH?


варіанти відповідей

Patients with PAH whose conditions are progressing or who are poorly responsive to initial therapy should have an additional agent within the same drug class added to their treatment regimen

Influenza and pneumococcal pneumonia vaccination is contraindicated in patients diagnosed with PAH

Guidelines suggest that balloon atrial septostomy may be considered as first-line therapy before medical therapy in many patients with PAH

Diuretics are indicated in patients with PAH who have signs of right-sided heart volume overload

Запитання 6

COPD patient with pulmonary hypertension and acute RHF. Which is TRUE?


варіанти відповідей

100% oxygen will decrease the pulmonary artery pressure

Sildenafil will be useful for treating RHF

Noradrenaline is an appropriate inotrope for this patient

All correct

Запитання 7

In chronic obstructive pulmonary disease (COPD), the variable most closely associated with prognosis is


варіанти відповідей

arterial carbon dioxide partial pressure (PaC02)

arterial oxygen partial pressure (Pa02)

forced expiratory volume in one second (FEV1)

forced vital capacity (FVC)

response to bronchodilators

Запитання 8

Unilateral diaphragmatic paralysis causes


варіанти відповідей

no change in total lung capacity

a decrease in forced vital capacity

no change in maximum voluntary ventilation

a decrease in inspiratory reserve volume

Запитання 9

A 56-year-old woman is evaluated during an appointment to establish care. She has a developmental delay, and she is known to have pulmonary hypertension due to a congenital cardiac condition. There is no history of cardiac surgery. She is on low-dose aspirin and thyroid replacement therapy.

On physical examination, blood pressure is 110/70 mm Hg, pulse rate is 68/min and regular, and respiration rate is 18/min. BMI is 32. The central venous pressure is elevated with a prominent a wave. The apical impulse is normal. There is a prominent parasternal impulse at the left sternal border. The S1 is normal; the S2 is loud. There is a grade 1/6 holosystolic murmur at the left lower sternal border. The toes demonstrate cyanosis and digital clubbing; her hands appear normal. The remainder of the physical examination is unremarkable.

Which of the following is the most likely cause of this patient's pulmonary hypertension?

варіанти відповідей

Atrial septal defect

Patent ductus arteriosus

Tetralogy of Fallot

Ventricular septal defect

Запитання 10

Pulmonary hypertension is characterized by which of the following conditions?

варіанти відповідей

The pressure in the pulmonary arteries is too high

The pressure in the pulmonary arteries is too low

The heart has stopped pushing blood through the lungs

The heart is pushing too much blood through the lungs

Запитання 11

What is the connection between pulmonary hypertension and chronic obstructive pulmonary disease (COPD)?


варіанти відповідей

Pulmonary hypertension can cause COPD

COPD can cause pulmonary hypertension

Both conditions are caused by heart failure

Non-smokers do not develop either condition

Запитання 12

In primary pulmonary hypertension basic abnormality in gene lies in


варіанти відповідей

Bone morphogenetic protein receptor II

Endothelin

Homeobox gene

PAX-1 1

Запитання 13

A 53-year-old woman with a 20-year history of Raynaud's phenomenon develops increasing fatigue and, for the past seven months, progressive dyspnea on exertion. She now must stop and rest while making her bed. She does not have chest pain, dizziness or palpitations. Her only medication is nifedipine, 30 mg/d.

On physical examination, pulse rate is 80/min, respiration rate is 18/min, and blood pressure is 115/78 mm Hg. Jugular venous pressure is not elevated, and there are no abnormal jugular venous waves. Lungs are clear to auscultation. On cardiac examination, the pulmonic component of the S2 is accentuated. There is a grade 2/6 holosystolic murmur heard loudest at the left lower sternal border that increases with inspiration. Skin examination reveals sclerodactyly and digital pitting. There is no lower-extremity edema, and the abdominal examination is unremarkable. Laboratory studies find hemoglobin of 11.3 g/dL (113 g/L), leukocyte count of 5500/µL (5.5 × 109/L), and platelet count of 155,000/µL (155 × 109/L).

Chest radiograph is normal. On pulmonary function testing, forced vital capacity is 82% of predicted, DLCO is 48% of predicted, and FEV1/forced vital capacity is 75%. Echocardio-gram shows normal chamber sizes, and valvular function is normal except for moderate tricuspid regurgitation. There is no pericardial effusion, and the estimated peak right ventricular systolic pressure is 60 mm Hg. On a six-minute walk test, oxygen saturation at rest and after exercise is 98% and 93%, respectively. She is able to walk 1300 ft.

Which of the following is the most appropriate next step in this patient's management?

варіанти відповідей

Pulmonary artery catheterization.

High-resolution CT of the chest

Prednisone, 60 mg/d.

Intravenous unfractionated heparin.

Запитання 14

Mitral stenosis is associated with:

варіанти відповідей

subacute bacterial endocarditis

rheumatic fever

pulmonary hypertension

systolic murmur at the apex

Запитання 15

Patients with malignant hypertension may have:


варіанти відповідей

increased risk of pulmonary oedema

decreased creatinine clearance

proteinuria

right bundle branch block

pulmonary hypertension

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