Pulmonary Embolism

Question 1

In Well’s score, what is given 3 points?

Answer 1

clinical signs and symptoms of a DVT
PE is the most likely diagnosis

Question 2

In We’s score, what is given 1.5 points?

Answer 2

tachycardia (heart rate >100 beats/minute)
immobility > 3 days or major surgery within 1 month
previous PE or DVT

Question 3

What is given 1 point in Well’s score?

Answer 3

haemoptysis
current malignancy

Question 4

Which bedside tests should be performed?

Answer 4

ECG and ABG

Question 5

What will ECG show?

Answer 5

P pulmonale Wave
Right axis deviation and right bundle branch block

Question 6

What will ABG show for pulmonary embolism?

Answer 6

Type 1 respiratory failure
Hyperventilation

Question 7

What imaging investigation is used for severe renal impairment or contrast allergy?

Answer 7

V/Q scan

Question 8

What is the management of pulmoanry embolism?

Answer 8

Oxygen
Fluid resuscitation
Analgesia

Question 9

What is the management of provoked PE?

Answer 9

3 months minimum of anticoagulation

Question 10

What is the management of unprovoked PE?

Answer 10

6 months minimum

Question 12

What additional medication other than anticoagulation should be given for a massive PE?

Answer 12

Massive PE is hypotension over 15 minutes which should be given THROMBOLYSIS with IV BOLUS OF ALTEPLASE

Question 13

What is given when thrombolysis is contraindicated?

Answer 13

Emboletomy

Question 14

When is a DOAC not given for PE treatment?

Answer 14

For patients with antiphospholipi syndrome, and they require warfarin and LMWH combination for at least 5 days

Question 15

What is a risk after a PE?

Answer 15

Heparin induced thrombocytopenia, causing reduced platelets and hypercoagulable state with new bruising and calf swelling a few days after treatment of PE

Question 16

What is given for haemodynamically unstable patients?

Answer 16

Antifibinolytic like IV alteplase

Question 17

When are DOACs not reccomended?

Answer 17

Pregnancy

Question 18

When is IVC filter given?

Answer 18

For recurrent PEs

Question 19

What is the ideal long term management for PE?

Answer 19

Warfarin

Question 20

What is the ideal initial management post-surgery for PE?

Answer 20

Start with LMWH due to its short half life that is easily reversible
and then long-term DOAC and then warfarin

Question 21

What is an indicator for using IV alteplase for definitive management?

Answer 21

Haemodynamically instability being shock with tachycardia and hypotension

Question 22

What s the ECG for PE?

Answer 22

Sinus tachycardia with right ventricular strain

Question 23

What causes D-diner to falsely rise?

Answer 23

Pregnant
Rheumatoid arthritis
Heart disease
Recent surgery
Immobility

Question 24

What is the ideal investigation for PE in pregnancy?

Answer 24

V/Q scan

Question 25

What is an absolute contraindication for thrombolysis?

Answer 25

Haemorrhagic stroke which will have a increased risk with thrombolysis

Question 26

What is the most specific ECG finding other than sinus tachycardia?

Answer 26

The most specific finding is S1 Q3 T3 - a deep S wave in lead 1, with Q waves and inverted T waves in lead 3.

Question 27

What to do if Wells score is less than 4 and D-dimmer is negative?

Answer 27

Stop anticoagulation and consider alternative diagnosis

Question 28

What to do if CT P is negative and patient has features indicating DVT?

Answer 28

Proximal leg ultrasound

Question 29

What to do if D-diner is positive ?

Answer 29

give interim therapeutic anticoagulation until the scan is performed

Question 30

What can cause mismatch in V/Q scan?

Answer 30

old pulmonary embolisms, AV malformations, vasculitis, previous radiotherapy COPD gives matched defects

Question 31

Which PE might be missed in CTPA?

Answer 31

peripheral emboli affecting subsegmental arteries may be missed