PANCE Blueprint Pulmonary (10%)

Pulmonary Circulation (PEARLS)

The NCCPA™ PANCE  Pulmonary Content Blueprint addresses three types of pulmonary circulation disorders

Cor pulmonale Right ventricular failure secondary to pulmonary hypertension

  • Etiology: COPD (most common), pulmonary embolism, acute respiratory distress syndrome
  • Physical Exam: Lower extremity edema, neck vein distention, hepatomegaly, parasternal lift, tricuspid/pulmonic insufficiency, loud S2
  • EKG: S1Q3T3


Pulmonary embolism (ReelDx) Dyspnea (most common) and pleuritic chest pain

  • Virchow’s triad: hypercoagulable state, venous stasis, vascular injury
  • Risk factors: Cancer, surgery, oral contraceptive pills, pregnancy, long bone fracture (fat emboli)
  • Homan’s sign: (Dorsiflexion of the foot causes pain in calf) indicative of deep vein thrombosis
  • EKG: Tachycardia (most common), ST changes, S1Q3T3 (Indicates cor pulmonale)


  • Spiral CT: Best initial test
  • Gold Standard is pulmonary arteriography
  • Chest radiograph: Westermark's sign and Hampton's Hump - triangular infiltrate secondary to intraparenchymal hemorrhage
  • Treatment: Heparin to Coumadin bridge. 3-6 mo treatment
Pulmonary hypertension Mean pulmonary artery pressure is ≥ 25 mmHg at rest (8-20 mmHg at rest is considered normal)

  • May cause right ventricular hypertrophy
  • Presentation: Dyspnea on exertion, fatigue, chest pain, edema
  • Diagnose with a right heart catheterization
  • Physical Exam: Loud P2, systolic ejection click, parasternal lift
Pneumothorax (ReelDx) (Prev Lesson)
(Next Lesson) Cor pulmonale
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NCCPA™ Content Blueprint

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