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Flashcards in PE Deck (23):
0

Wells score criteria?

Clinical signs of DVT– 3 points
PE most likely – 3 points

Surgery in past 4 weeks – 1.5 points
Tachycardia– 1.5 points
Demobilization for the past three days – 1.5 points
Previous PE/DVT – 1.5 points

Hemoptysis – 1 point
Malignancy – 1 point

1

Well's Score Interpretation?

Low chance if 4

Low chance it =4

2

Wells score for DVT's?

Alternate diagnoses at least as likely: -2 points

Active cancer
Previous DVT
Calf Swelling >= 3 cm
Entire leg swelling
Unilateral Swollen superficial veins
Unilateral pitting edema
Paralysis or cast mobilization
Bedridden >3 days
Major surgery in past 12 weeks


Tenderness:

3

Wells score for DVT's interpretation?

High risk if >2
Moderate risk if 1 – 2
Low risk if <1

6

Use Inferior Vena cava filter if?

1. Active bleeding or other contraindication for anticoagulation
2. Recurrent DVT/PE despite therapeutic anticoagulation

9

PE – most common symptom, most frequently observed sign?

Dyspnea, tachypnea

11

Most appropriate diagnostic step for patient with suspected PE?

CT with contrast (In patient with severe renal disease or contrast allergy use V/Q scan)

13

The most common inherited hypercoagulable disorders?

Factor V Leiden and prothrombin gene mutations

14

Why is malignancy a predisposing condition for DVT's?

Thought to generate thrombin or secrete procoagulants

15

Most common site of Clot formation?

The deep, proximal lower extremity veins

16

Obstruction to the pulmonary arteries cause?

1. Platelets release serotonin – elevating pulmonary vascular resistance (RV Dilation)
2. V/Q mismatch
3. Reflex bronchoconstriction increases airway resistance
4. Edema/hemorrhage/loss of surfactant further decreases lung compliance

17

Signs of massive PE versus smaller PE?

Syncope, hypertension, cyanosis

versus

pleuritic pain, cough, hemoptysis

18

Classical physical exam findings of PE?

1. Tachycardia
2. Right ventricular dysfunction – Tachypnea, left parasternal lift, accentuated pulmonic component of second heart sound, systolic murmur increases that with inspiration

19

Course to initiate warfarin therapy?

Use unfractionated heparin, Lovenox, or fondaparinux for five days while overlapping with warfarin until INR is 2.5 for two days

20

Treatment length for warfarin?

Provoked DVT of calf or upper extremity: 3 months

PE or provoked DVT of the proximal leg: 6 months

unprovoked DVT/PE with ongoing risk factors (cancer, antiphospholipid): indefinite

21

D-dimer value in patients with PE?

>500

22

Most common ECG findings in PE?

Other findings?

Sinus tachycardia

#New Onset AFIB
#T-wave conversions in anterior leads (V1 – V4)
#S1 Q3 T3

23

Most common CXR abnormality in PE?

Others?

Usually normal but If abnormality - atelectasis

2. Westermark sign – prominence of central pulmonary artery with decreased pulmonary vascularity
3. Hampton hump – a peripheral wedge shaped density above diaphragm
4. Palla sign - Enlargement of right descending pulmonary artery

24

Primary therapy for PE?

Patients with right heart failure or hypotension (high risk): Thrombolysis or surgical embolectomy

Otherwise: anticoagulation With unfractionated heparin or Lovenox or Fondaparinux


25

Usual cause of death from PE?

Right heart failure

39

Virchow's Triad?

Trauma, hypercoagulability, venostasis

40

Prerequisite for a V/Q scan?

Normal CXR (if abnormal, get CT)

41

When to use direct thrombin inhibitor for anticoagulation instead of heparin?

Heparin-induced thrombocytopenia

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