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Flashcards in PE Deck (23)
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0
Q

Well’s Score Interpretation?

A

Low chance if 4

Low chance it =4

1
Q

Wells score criteria?

A

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

2
Q

Wells score for DVT’s?

A

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
Q

Wells score for DVT’s interpretation?

A

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

6
Q

Use Inferior Vena cava filter if?

A
  1. Active bleeding or other contraindication for anticoagulation
  2. Recurrent DVT/PE despite therapeutic anticoagulation
9
Q

PE – most common symptom, most frequently observed sign?

A

Dyspnea, tachypnea

11
Q

Most appropriate diagnostic step for patient with suspected PE?

A

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

13
Q

The most common inherited hypercoagulable disorders?

A

Factor V Leiden and prothrombin gene mutations

14
Q

Why is malignancy a predisposing condition for DVT’s?

A

Thought to generate thrombin or secrete procoagulants

15
Q

Most common site of Clot formation?

A

The deep, proximal lower extremity veins

16
Q

Obstruction to the pulmonary arteries cause?

A
  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
Q

Signs of massive PE versus smaller PE?

A

Syncope, hypertension, cyanosis

versus

pleuritic pain, cough, hemoptysis

18
Q

Classical physical exam findings of PE?

A
  1. Tachycardia
  2. Right ventricular dysfunction – Tachypnea, left parasternal lift, accentuated pulmonic component of second heart sound, systolic murmur increases that with inspiration
19
Q

Course to initiate warfarin therapy?

A

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

20
Q

Treatment length for warfarin?

A

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
Q

D-dimer value in patients with PE?

A

> 500

22
Q

Most common ECG findings in PE?

Other findings?

A

Sinus tachycardia

#New Onset AFIB 
#T-wave conversions in anterior leads (V1 – V4)
#S1 Q3 T3
23
Q

Most common CXR abnormality in PE?

Others?

A

Usually normal but If abnormality - atelectasis

  1. Westermark sign – prominence of central pulmonary artery with decreased pulmonary vascularity
  2. Hampton hump – a peripheral wedge shaped density above diaphragm
  3. Palla sign - Enlargement of right descending pulmonary artery
24
Q

Primary therapy for PE?

A

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

Otherwise: anticoagulation With unfractionated heparin or Lovenox or Fondaparinux

25
Q

Usual cause of death from PE?

A

Right heart failure

39
Q

Virchow’s Triad?

A

Trauma, hypercoagulability, venostasis

40
Q

Prerequisite for a V/Q scan?

A

Normal CXR (if abnormal, get CT)

41
Q

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

A

Heparin-induced thrombocytopenia

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