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PEs Flashcards

(19 cards)

1
Q

Risk factors for PE

A
Known DVT 
HRT/OCP
Pregnancy
Malignancy
Immobility
Hx of DVT/PE
Thrombophilia
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2
Q

Treatment of PE?

And: if renal impairment?

Follow up?

A

LMWH or fondaparinux, for at least 5 d or until INR >2 for at least 24hr

Split dose if renal impairment (may montior factor 10a levels) or increased risk of bleeding

Thrombolysis: alteplase or reteplase
Other drugs: rivaroxaban (fXa inhibitor), ? embolectomy

Bring back within a week and initiate on warfarin

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3
Q

What is the Well’s score cut off (for immediate CTPA or anticoagulation therapy then CTPA)?

Geneva score = alternative, used in USA - less subjective but takes longer.

A

4 - if below this do a d-dimer first.

Clinical signs and symptoms of DVT = +3,
PE being more likely than an alternative diagnosis = +3

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4
Q

What are the 3 types of pulmonary fibrosis?

A

replacement fibrosis (after damage eg. infarction, Tb, pneumonia)

focal fibrosis - coal dust, silica

diffuse parenchymal lung disease - in fibrosing alveolitis (IPF) and EAA.

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5
Q

Which cells are damaged in IPF?

A

alveolar epithelial cells _> fibroblasts enter the alveoli -> excess accumulation of ECM -> scarring, thickening, wall fibrosis.

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6
Q

Drugs for IPF?

A

Conservative: Oxygen, pulmonary rehab

Opiates

Cyclophosphamide
Pirfenidone - not a lot of evidence

Anti-coagulation = important, esp. if travelling

Some types can respond to steroids

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7
Q

Drugs to avoid in IPF

A
Co-trimoxazole
Mycophenelate mofetil
Bosentan
Azathioprine
Prednisolone
Sildenafil
Warfarin
Ambrisentan
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8
Q

Main parts of best supportive care in all IPF?

A

information and support (see recommendation 1.3.1) symptom relief
management of comorbidities
withdrawal of ineffective therapies
end of life care

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9
Q

If the person (pt. with IPF) is breathless on exertion consider:

A

assessment for ambulatory oxygen therapy and long-term oxygen therapy
and/or
assessment for pulmonary rehabilitation.

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10
Q

If the person (pt. with IPF) is breathless at rest consider:

A

assessment for ambulatory oxygen therapy and long-term oxygen therapy and/or
benzodiazepines and/or
opioids.

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11
Q

If they have a cough what other causes are possible?

A

gastro-oesophageal reflux disease,

post-nasal drip

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12
Q

Disease modifying treatment in IPF?

A

Advise the person with idiopathic pulmonary fibrosis that oral N- acetylcysteine4 is used for managing idiopathic pulmonary fibrosis, but its benefits are uncertain.

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13
Q

Characteristic chest pain in a PE?

A

Pleuritic

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14
Q

Offer antihypertensive drug treatment to people aged under 80 years with stage 1 hypertension who have one or more of the following:

A
- target organ damage
− established cardiovascular disease
− renal disease
− diabetes
− a 10-year cardiovascular risk equivalent to 20% or greater.
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15
Q

Offer antihypertensive drug treatment to people of any age with stage … hypertension.

A

2

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16
Q

If the clinic blood pressure is 140/90 mmHg or higher, what should you do?

A

Offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension.

17
Q

When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that:

A

for each blood pressure recording, two consecutive measurements are taken, at least 1 min apart and with the person seated

18
Q

Causes of upper zone fibrosis (and mnemonic)

A
Berylliosis
Radiation
Ext. allergic alveolitis
ank spond
Sarcoid (middle zone)
TB
19
Q

Causes of lower zone fibrosis

A

SLE/RA
UIP - usual int. pneumonia
NSIP - nonspecific int. pneumonia

Drugs -
MTX, Amiodarone, Nitrofurantoin, Bleomycin