Pulmonary Embolism Flashcards

1
Q

The majority of PE originates in the ____ ____ veins of the leg

A

originates in the PROCIMAL DEEP VEINS OF THE LEG.

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2
Q

clinical features of PE

A

right heart failure, right ventricular dilation on diagnostic imaging, positive troponin and elevated BNP.

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3
Q

lab results indicating PE

A

positive troponin, and elevated BNP

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4
Q

the pre-test probability can be assessed by a validated clinical prediction rule like Simplified Wells score for PE. If PE has an unlikely pre-test probability, what can rule out PE?

A

a negative D-dimer rules out the diagnosis of PE. However, a positive D-dimer test must be followed up with a definitive test to confirm/refute the diagnosis of PE.

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5
Q

methods of imaging for PE

A

CTPA (substantial radiation but better that direct pulmonary angiography), Ventilation-Perfusion lung scanning (sometimes non-diagnostic test results, but should be done in pregnancy women or people with renal insufficiency, contrast allergy or in young patients with a normal chest Xray), or CUS.

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6
Q

when should treatment for PE be initiated

A

if evidence of right heart strain is present. However, RV dysfunction alone does not prove PE.

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7
Q

classical symptoms of PE

A
dyspnea
chest pain
cough 
hemoptysis
palpitaitons
syncope
sudden death
tachypnia
hypoxia
tachycardia
arrhythmia (right bundle branch block)
hypotension 
Cardiac arrest
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8
Q

Differential Diagnosis for PE

A

Pulmonary Disease
Cardiac Disease
Musculoskeletal Disease
Abdominal Disorders

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9
Q

a score higher of ____ on the simplified wells score means a PE is likely

A

higher than 4

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10
Q

contraindications for CTPA

A

contraindicated for renal insufficiency, for pregnant or baby patients, or with contract allergy.

there is also a higher false positive.

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11
Q

what should you use it CTPA is contraindicated for the patient

A

Ventilation perfusion scanning.

  • use where CTPA contraindicated
  • high negative predictive vlaue
  • limitations include the fact that there’s a high rate of non-diagnostic test results in plans V/Q
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12
Q

ancillary testing in PE are tests that:

A

determine severity of PE once its been diagnosed.

  • they look for evidence of right ventricular strain/dysfunction.
  • does when there’s elevated troponin, elevated BNP
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13
Q

differentiate between massive, sub-massive and non-massive

A

massive PE; –  Hypotension / Hemodynamic Instability
–  Signs of Right Ventricular dysfunc=on
–  Cardiac Arrest

SUBMASSIVE PE

  • no hypotension/instability
  • signs of right ventricular dysfunction

NON-MASSIVE PE

  • no hypotension or hemodynamic instability
  • no signs of right ventricular dysfunction.
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