Pulmonary Embolism

Question 1

define pulmonary embolism?

Answer 1

blocking material in lung vessel

Question 2

define embolism etymologically?

Answer 2

emballein (greek) = insert

Question 3

from femoral vein how does a dvt clot get to the pulmonary vasculature?

list the venous pathway.

Answer 3

femoral vein, external iliac vein, common iliac vein, IVC, SVC, RA, RV, pulmonary artery, small pulmonary vasculature

Question 4

what is a big blockage called?

Answer 4

Massive PE

Question 5

what can a Massive PE lead to in terms of heart?

and how?

Answer 5

cardiac arrest

Massive PE –> pulmonary HTN –> RV strained –> cor pulmonale –> cardiac arrest

Question 6

what is pulmonary infarction?

Answer 6

lung tissue dead from ischaemia

Question 7

which triad explain risk factors for PE?

Answer 7

Virchow’s triad

Question 8

cor pulmonale causes what to happen to RV size?

Answer 8

RV hypertrophy

Question 9

pt has cor pulmonale, what might you see around neck?

why?

Answer 9

↑JVP

backlog of venous pressure

Question 10

define provoked DVT?

Answer 10

transient RF present in last 3 months

Question 11

define unprovoked DVT?

Answer 11

no transient RF present in last 3 months

Question 12

pt has unprovoked DVT.

what must be on your differential radar because of this that you need to investigate?

what Ix do you use to investigate this?
-2

Answer 12

thrombophilia

Antiphospholipid antibodies + Thrombophilia screen

Question 13

what is best sign to check if massive PE on pt’s vital?

Answer 13

hypotension

Question 14

pt has suspected PE and seems likely based on Hx.
CXR has been done.

what Ix do you do now?

Answer 14

CTPA

Question 15

pt has suspected PE and positive D dimer.

what Ix do you do now?

Answer 15

CTPA

Question 16

Pt might have PE based on history but is unlikely.
CXR normal.

what Ix do you do now to check if it is PE?

Answer 16

D-dimer

Question 17

red flag symptoms or PE?

-1

Answer 17

Syncope

Question 18

symptoms of PE?

Answer 18

Pleuritic chest pain 
Dyspnoea 
Cough 
Haemoptysis 
Fever

Question 19

news chart results of pt with PE?

-4

Answer 19

↑RR
↑HR
↓O2
low BP

Question 20

if there is DVT what sign will you see on examination?

Answer 20

Red swollen calf

Question 21

if there is right ventricular strain what sign will you see on examination?

Answer 21

Right parasternal heave

Question 22

there are usually chest sounds if pt has PE.

true or false?

Answer 22

false

Question 23

two main IX for PE?

Answer 23

D-dimer

CTPA

Question 24

pt has PE history.

on ECG there is RBBB + right axis deviation.

what is this a sign of?

Answer 24

RV strain

Question 25

symptoms of PE?

Answer 25

``` Pleuritic chest pain Dyspnoea Cough Haemoptysis Fever ```

Question 26

Massive PE Mx?

Answer 26

Thrombolysis

Question 27

standard PE Mx? | how long for?

Answer 27

anticoagulation 3 months

Question 28

what drug do you use in thrombolysis? if Thrombolysis failed what is your 2nd option?

Answer 28

alteplase surgical embolectomy

Question 29

when is thrombolysis the first line Mx?

Answer 29

Massive PE

Question 30

MX for refractory PE?

Answer 30

IVC filter

Question 31

pt has PE, it is not massive PE. what is standard Mx? how long for?

Answer 31

anticoagulation 3 months

Question 32

Which anticoagulant do you use in PE 1st line? - give named e.g. what group of drugs do these drugs belong to moa of these drugs?

Answer 32

APIXABAN AND RIVAROXABAN DOAC factor X inhibitors

Question 33

Which anticoagulant do you use in PE if there is renal impairment?

Answer 33

LMWH

Question 34

Heparin side effect? | -1

Answer 34

thrombocytopaenia