Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Resp conditions > Pulmonary embolisms > Flashcards

Pulmonary embolisms Flashcards

1
Q

Name two examples of Thromboembolic disease

A
  • Pulmonary embolism

- Deep venous thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a pulmonary embolism?

A

A blockage of a pulmonary artery by a blood clot, fat, tumour or air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a pulmonary infarction?

A

If blood flow and oxygen to the lung tissues is compromised, the lung tissue may die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the characteristics of a Proximal DVT?

A
  • known as ileo-femoral
  • Most likely to embolise
  • most likely to lead to chronic venous insufficiency and venous leg ulcers
  • High risk DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the characteristics of a distal DVT

A
  • known as popliteal
  • least likely to embolise
  • low risk DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical presentations of DVT?

A
  • whole leg or calf involved depending on site

- leg swollen. hot, red, tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the differential for these symptoms?

  • whole leg or calf involved depending on site
  • leg swollen. hot, red, tender
A
  • Popliteal synovial rupture (Baker’s cyst)
  • Superficial thrombophlebitis
  • Calf cellulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a thrombophlebitis?

A

Inflammation of vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the characteristics of a proximal DVT?

A
  • Ileo-femoral
  • most likely to embolise
  • most likely to lead to chronic venous insufficiency and venous leg ulcers
  • High risk DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the charcateristics of a distal DVT?

A
  • popliteal
  • least likely to embolise
  • low risk DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations should be carried out when suspect DVT?

A
  • Ultrasound Doppler leg scan

- CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the properties of a Ultrasound Doppler leg scan in relation to DVT?

A
  • 1st line
  • non invasive
  • exclude popliteal cyst, pelvic mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the regions that a CT scan will find a DVT?

A
  • ilio-femoral veins
  • IVC
  • pelvis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical presentations of a large PE?

A
  • cardiovascular shock
  • low BP
  • central cyanosis
  • sudden death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the clinical presentations of a medium PE?

A
  • pleuritic pain
  • haemoptysis
  • breathlessness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical presentations of a small recurrent PE?

A
  • progressive dyspnoea
  • pulmonary hypertension
  • Right heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can be used to find pulmonary hypertension to aid in diagnosis of PE?

A

ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the risk factors for DVT and PE?

A
  • Thrombophilia
  • Contraceptive pill (esp if smokes)
  • Hormone replacement therapy
  • Pregnancy
  • Pelvic obstruction eg uterus, ovary, lymph nodes
  • Trauma
  • surgery
  • immobility (long flights)
  • malignancy
  • pulmonary hypertension
  • obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why is obesity a risk factor for DVT and PE?

A

Compression of veins centrally can cause distal problems causing PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the clinical features of PE?

A
  • tachycardia
  • tachypnoea
  • cyanosis
  • fever
  • low BP
  • crackles
  • rub
  • pleural effusion
21
Q

What would the ABG look like in PE?

A

-low PaO2
-Low sats
-Normal or low PaCO2 in type one resp failure
-

22
Q

What would the CXR look like in a PE?

A
  • most times will have a normal CXR. You cant see a PE on CXR but can see the complications further down the line ie
  • consolidation
  • pleural effusion
23
Q

What investigations can aid in diagnosis of PE?

A
  • ECG (acute right heart strain pattern)
  • D dimers usually raised. (unlikely to be PE if D -dimers are negative)
  • isotope lung scan (used mostly for well appearing people, detects perfusion defects where there are no ventilation defects. )
24
Q

What is PESI?

A

Pulmonary embolism severity index

25
Q

other investigations used to diagnose PE?

A
  • CT pulmonary angiogram to image pulmonary artery filling defects (to pick up larger clots in proximal vessels)
  • leg and pelvic ultrasounds (detect silent DVT)
  • ECG to measure dilatation
26
Q

Outline for Treatment of DVT/PE

A
  • Anticoagulation prevents clot propagation.
  • therapeutic dose of heparin
  • rarely IV heparin
27
Q

What is thrombolysis and what’s its context with treatment of DVT/PE?

A

-thrombolysis is the process by which the body breaks down a clot. So essentially heparin rather than breaking down the clot, informs the body to do so.

28
Q

Initial treatment of DVT/PE

A
  • low molar heparin once daily via injection
  • start warfarin at same time
  • or use an oral thrombin inhibitor (dabigatran) or factor X inhibitor (rivaroxaban) on its own from start as less hassle and just as effective.
29
Q

What is the second stage of treatment?

A
  • oral warfarin takes 3 days to stop clotting
  • after 3-5 days stop heparin when INR>2
  • or use novel oral anticoagulants without low molecular weight heparin
30
Q

Is rivaroxaban a NOAC?

A

Yes

31
Q

What is the third stage of treatment for DVT/PE?

A
  • continue warfarin for 3-6 months

- monitor INR range (target is between 2.5 and 3.5)

32
Q

What interactions should you be aware of when taking warfarin?

A
  • alcohol
  • antibiotics
  • asprin
33
Q

What is the difference between Pulmonary Venous hypertension and Pulmonary arterial hypertension

A

Pulmonary Venous hypertension differs from Pulmonary arterial hypertension in that high BP occurs when the heart cant efficiently carry blood away from the lungs.

34
Q

what are the causes of Pulmonary venous hypertension?

A
  • LVSD - ischaemic Left Ventricular Systolic dysfunction
  • Mitral Regurgitation / Stenosis
  • Cardiomyopathy-e.g. alcohol ,viral
35
Q

What is the treatment for severe DVT/PE?

A
  • thrombolysis
  • IVC filter used for recurrent PEs
  • thrombo-embolectamy
  • EKOS (ultrasound enhanced catheter thrombolysis)
  • Intra-catheter directed thrombolysis
36
Q

How does warfarin affect patients with cancer?

A

It affects how the liver metabolises

37
Q

What do you do if you over anticoagulant ?

A
  • address underlying causes eg drug interaction
  • if bleeding stop anticoagulant and reverse effects
  • may need cover with prothrombin complex concentrate or fresh frozen plasma.
  • reverse warfarin with vit k1
  • Reverse heparin with protamine
  • No reversal agent available for NOACs
38
Q

which drugs have long half lives?

A

–warfarin and low molar weight heparin

39
Q

What are the causes of secondary arterial hypertension?

A
  • Hypoxic – COPD , OSA , Pulmonary fibrosis
  • Multiple PE – chronic thromboembolic PH (CTEPH)
  • Vasculitis –e.g. SLE , PAN ,Systemic Sclerosis
  • Drugs e.g. appetite suppressants - fenfluramine and derivatives
  • HIV
  • Cardiac Left to right shunt – ASD, VSD
  • Primary pulmonary hypertension
40
Q

What is cor pulmonale?

A

when lung disease leads to right heart disease

(fluid retention due to hypoxia +/- right heart failure

41
Q

Cor pulmonale can complicate which diseases?

A

COPD, chronic PE, fibrotic lung disease etc

42
Q

What are the clinical signs of pulmonary hypertension and right heart failure?

A
  • Central cyanosis if hypoxic
  • Dependent oedema
  • Raised JVP with V waves (due to secondary tricuspid regurg)
  • Right ventricular heave at left parasternal edge
  • Murmur of tricuspid regurgitation
  • Load P2
  • Enlarged liver (pulsatile)
43
Q

What investigations should be carried out if you suspect PH?

A
  • ECG- rhythm , axis, p pulmonale, Right bundle branch block
  • CXR- cardiomegaly
  • SaO2 and arterial blood gases
  • Pulmonary function incl DLCO (diffusion capacity)
  • Echocardiogram – estimate right ventricular systolic pressure (RVSP)
  • Cardiac Catheterisation – measure mean pulmonary arterial pressure (mPAP)
  • D dimers and VQ scan if PE suspected
  • CT Pulmonary Angiogram
  • Cardiac MRI
  • Auto-antibodies if vasculitis suspected
44
Q

how do you diagnose Primary pulmonary hypertension?

A

by exclusion of other secondary causes

45
Q

What are two signs of primary pulmonary hypertension?

A
  • progressive SOBOE

- signs of right heart failure

46
Q

What is the prognosis of PPH?

A

poor if they dont have treatment within 3 years

47
Q

what is the pharmacological treatment for PPH?

A
  • warfarin

- O2 hypoxic

48
Q

What are examples of pulmonary vasodilators?

A
  • Ca2+ channel blockers (oral nifedipine ,diltiazem)
  • Endothelin antagonist (Oral Bosentan,Macitentan)
  • PDE5-inhibitor (Oral Sildenafil/Tadalafil)
  • Prostanoids (IV Epoprostenol or Inhaled Iloprost )
  • SolubleGuanylate Cyclase stimulator (oral Riociguat)
49
Q

What are the treatments for chronic thromboembolic pulmonary hypertension?

A

-Riociguat – pulmonary arterial vasodilator
-Pulmonary endarterectomy
curative (2% op. mortality)
-Balloon angioplasty?

Resp conditions (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions