Pte

Question 1

Pesi

Answer 1

11 variables
5 xlasses
Leds than 65- class 1 - 1%mortality
Class 5 - 125- 25 percent mortality

Question 2

Simplified pesi
Variables
Interpretation

Answer 2

Age 80
Cancer
Chronic cardiopulmonary disease
Hr 110.
BP 100
Pao2 90

0 - no risk
>1 - high risk

Question 3

Non thrombotic

Answer 3

Fat
Air
Amniotic
Tumor

Question 4

Sources of embolism

Answer 4

Dvt
Pelvic.
Right ventricle
Renal and uterine vein
Sickle cell

Question 5

Virchows triad

Answer 5

Hypercoagulability
Stasis
Injury

Question 6

Risk factors

Answer 6

Immobility
Major surgery
Apla
Hyper coagulation states- malignancy, ocp, hit, essential thrombocytosis, pregamancy , protein c and s deficiency

Question 7

Pathophysiology

Answer 7

Pulmonary vascular bed obstruction
Increased rv afterload- dilattaion- dec contractility- output dec- lv input dec- co dec- bpdec- coronary perfusion dec- o2 deliver- shock- death

Question 8

Clinical prediction scores

Answer 8

Wells
Original geneva
Geneva
Pisa rule
Charlotte rule

Question 9

Wells cps

Answer 9

7 variables
Dvt symptoms3
Prior dvt/pe.1.5
Malignancy1
H/o immobilization surgery 4 wks1.5
Hr 100. 1.5
Hemoptysis 1
Alternate diagnosis less likely 3

6 - high

Question 10

Ecg pe

Answer 10

S1q3t3
Mc- tachy
Right strain pattern
Tall peaked t wavright axis deviation
Rbb

Question 11

Cxr
D-dimer fp

Answer 11

Westermark
Hanptons hump
Pallas

Fp- pregnant, malignant, ami, sepsis,hepatic
Age >50 -

Question 12

Angio

Answer 12

Cutoff sign
Intraluminal filling defect
Polo mint sign

Question 13

Other tests

Answer 13

Vq scan
Pulm angio
2d echo- 60-60 sign,mcconnel sign
Doppler

Question 14

Algorithm in shock

Answer 14

Ct available- do- pos-treat
Neg- search for other

Not available
Then echo- if no rv load- search
If plus- no other test available- rx

Question 15

Algorithm without shock

Answer 15

Assess probability clinically
Low/int or unlikely- d-dimer
Neg- no rx
Pos- ct angio and accordingly

Hogh/likely- angio

Question 16

Advantage sof ufh

Answer 16

Renal failure
Obesity
Monitoring easy
Pregnancy
Pt awaited for surgery

Question 17

Lmwh advantages

Answer 17

Longer half life
Early
No need of monitoring
Less complications

Question 18

Tx

Answer 18

Acute- lmwh/ufh/fondaparinux for 5-10 days
Overlap with warfarin or dabigatran or edoxaban- asap

UfhZ- 80/kg f/b 18/kg/hr infusion
Inr 1.5- 2.5

Question 19

Dose of warfarin

Answer 19

10mg in younger , healthy op
5mg in old , hospitalized
Dialy inr
Inr2-3

Side effects- skin necrosis, protein c def

Question 20

Oral xa inhibitors

Answer 20

Xaban

Question 21

Direct thrombin inhibitor

Answer 21

Dabigatran,lepirudin

Question 22

Lysis indications

Answer 22

Masive pe
BP <90 for 15 min

C/i- hmg7c stroke
Ischemic stroke - 6mon
Cns damage
trauma ,surgery in 3 wks
Git bleeding one month
High bleeding risk

Question 23

Agents for lysis

Answer 23

Streptokinase- 2.5 l f/b 1lakh over 12-24 hrs
Urokinase- 4400iu/kg loading 10 min f/b per hourc12-24 hrs
Rtpa- 100mg 2hr

Question 24

Duration

Answer 24

Reversible - 3 mon
Unprovoken- indefinite
Recurrent- indefinite

Question 25

Other

Answer 25

Interventional- causes fragments- paradoxical embolism- in pts where thrombolyis c/I
Filter- same indication and where ac is c/i

Question 26

Prophylaxis

Answer 26

Active leg movt
Pneumatuc compressions
Elastic compression
Ac