Pulmonary Embolism

Question 1

What is the most common cause of PE?

Answer 1

DVT that breaks off and migrates to the lungs

Question 2

Where do the DVT emboli originate?

Answer 2

Deep veins of the calf

Question 3

How does emboli propagate?

Answer 3

Via the popliteal and femoral veins

Question 4

Large thrombi lodge where upon reaching the lung?

Answer 4

The bifurcation of the main pulmonary artery

Question 5

Smaller thrombi move distally and do what?

Answer 5

They occlude smaller vessels in the lung periphery and thus produce “Pleuritic chest pain”.

Question 6

What causes Pulmonary infarction?

Answer 6

Obstruction of lobar pulmonary arteries

Question 7

What is the characteristic sign of Pulmonary Infarction?

Answer 7

Sudden onset of localized pleuritic chest pain

Question 8

Recurrent pulmonary embolisms present complications, what are they?

Answer 8

Cor pulmonale, pulmonary hypertension, increased RV stain

Question 9

Alveoli adequately ventilated but not perused are called?

Answer 9

High V/Q units

Question 10

Alveoli adequately perused but not ventilated are called?

Answer 10

Low V/Q units

Question 11

What is Massive PE?

Answer 11

hemodynamic instability from RV failure

Question 12

What is SubMassive PE?

Answer 12

Patients have evidence of RV dysfunction via CT of echo

Question 13

How do we diagnose PE?

Answer 13

D-dimer test and CT scan

Question 14

What wells score shows a likely PE?

Answer 14

If greater than 4

Question 15

What does a negative D dimer test show?

Answer 15

No PE

Question 16

Upon chest X-ray for a patient with PE, what do we see?

Answer 16

Westermark sign, an area of hypertranslucency. And a wedge shaped area in the right lower lobe

Question 17

What is the gold standard for PE diagnosis?

Answer 17

Pulmonary angiography

Question 18

What are advantages of a V/Q scan?

Answer 18

Less radiation, less allergens, and works for people with bad kidneys

Question 19

When we do an echo what do we look for?

Answer 19

RV enlargement and ofc dilated pulmonary arteries

Question 20

When a patient is at risk of a DVT, what preventative measure do we take?

Answer 20

The patient is given low dose Heparin 5000 every 8 hours till risk subsides

Question 21

What anticoagulant do we prescribe to treat VTE? (venous embolism)

Answer 21

LMWH (low molecular weight heparin)

Question 22

What is the most widely used regimen for VTE treatment?

Answer 22

80 units of unfractionated heparin, followed by 18 units IV infused guided with a PTT

Question 23

What is the alternative regimen for VTE treatment involving LMWHs?

Answer 23

1mg dose twice daily

Question 24

What advantages do LMWHs have over UFH?

Answer 24

Subcutaneous admin, no PTT, act longer.

Question 25

Warfarin is added on top of the regimen, how so?

Answer 25

Started on the first of heparin therapy at a dose of 10mg a day, guided with a PT and INR

Question 26

What type of heparin do we get a pregnant woman on?

Answer 26

LMWH, without warfarin

Question 27

When is Thrombolytic therapy indicated

Answer 27

In Massive PE

Question 28

What is an IVC filter?

Answer 28

A filter placed into the IVC to trap emboli but maintain blood flow

Question 29

Who are eligible for an IVC filter?

Answer 29

Patients with Acute VTE and an absolute contraindication to anticoagulant therapy

Question 30

A surgical catheter embolectomy is recommended for who?

Answer 30

Patients of massive PE