[pulmonary embolism]

Answer 1

pelvis

leg

Answer 2

pulmonary circulation

Answer 3

right ventricular thrombus

Answer 4

right sided infective endocarditis

Answer 5

surgery
thrombophilia
malignancy
pregnancy/pill/HRT
prolonged rest

Answer 6

pyrexial 
pleural rub
tachypnoea
cyanosis
raised JVP
hypotensive

Answer 7

ECG
CXR
ABG

Answer 8

tachycardia
right bundle branch block
right ventricular strain

(or normal!)

Answer 9

oligaemia of affected segment 
dilated artery
linear atelectasis
wedge shaped cavities
small pleural effusion

Answer 10

reduction in blood volume

Answer 11

minimal degree of collapse cf. lobular atelectasis

Answer 12

to the lungs

Answer 13

inflamed pleural surfaces rubbing together

Answer 14

low PaCO2
low PaO2

hyperventilation + poor gas exhange

Answer 15

PE occurence (many causes of raised D-Dimer)

Answer 16

there is no PE

i.e. high sensitivity low specificity

Answer 17

CTPA (CT pulmonary angiography)

Answer 18

LMWH
TED stockings (thromboembolic deterrent)
vena caval filters

Answer 19

contraceptive pill

Answer 20

LMWH (tinzaparin 175u/kg/24h SC)
OR
UFH 10,000 IU bolus IV (then IVI guided by APTT)

Answer 21

Warfarin 5-10mg PO (*if BP >90mmHg)

Answer 22

colloid infusion

Answer 23

colloid infusion

Answer 24

alteplase 50mg bolus

i.e. immediate thrombolysis

Question 25

[PE]: Mx: 2nd step in Mx for PE if BP

Answer 25

colloid infusion 500mL

Question 26

[PE]: Mx: if BP is less than 90mmHg after colloid infusion

Answer 26

Dobutamine 2.5-10ug/kg/min IV

Question 27

[PE]: Mx: how does dobutamine work

Answer 27

b1 agonist - increased CO and increased renin release

Question 28

[PE]: what should patients be advised to stop prior to surgery

Answer 28

combined contraceptive pill

Question 29

[PE]: Mx: how does dobutamine work

Answer 29

b1 agonist - increased CO and increased renin release

Question 30

[PE]: Mx: for how long should warfarin be administered

Answer 30

minimum of 3 months

Question 31

[PE]: Dx: the ... score is used to determine the probability of a patient developing a DVT

Answer 31

Wells

Question 32

[PE]: Dx: what is the only point in the Wells score which results in -2

Answer 32

an alternative Dx is likely or more likely than DVT

Question 33

[PE]: Dx: what are the 9 criteria

Answer 33

``` cancer within last 6 months lower limb immobility major surgery in last 4 weeks/bed ridden >3days localised tenderness along veins entire leg swollen increased calf circumference >3cm pitting oedema in asymptomatic leg collateral superficial veins alternative Dx likely (-2) ```

Question 34

[PE]: Dx: what Wells score = moderate liklihood

Answer 34

1-2

Question 35

[PE]: Dx: what Wells scores = high liklihood

Answer 35

>=3

Question 36

[PE]: A negative D-Dimer in low to intermediate probability Wells score patients likely means that ...

Answer 36

there is no PE | i.e. high sensitivity low specificity

Question 37

[PE]: Dx: what is the minimum Wells score required for D-Dimer indication

Answer 37

high (>=3)

Question 38

[PE]: Dx: what constitutes a low Wells score

Answer 38

0

Question 39

[PE]: Dx: A D-dimer which is + is indicative of which further Ix

Answer 39

imaging (CTPA)

Question 40

[PE]: Dx: in what circumstance is a CTPA indicated (2)

Answer 40

+ D-Dimer test | high clinical probability (Wells score)

Question 41

[PE]: Dx: can you perform a CTPA if d-dimer is -

Answer 41

yes if high clinical risk (Wells score)

Question 42

[PE]: Dx: in what 1 circumstance is a CTPA indicated

Answer 42

+ D-Dimer test

Question 43

[PE]: Dx: can you perform a CTPA if d-dimer is -

Answer 43

no

Question 44

[PE]: Mx: if BP is less than 90mmHg after dobutamine infusion

Answer 44

noradrenaline IV

Question 45

[PE]: what defines a massive PE

Answer 45

circulatory collapse | hypotensive, raised JVP