Pulmonary Embolus

Question 1

What is a pulmonary embolus (PE)?

Answer 1

• blockage of one or more pulmonary a. (large or small)

Question 2

Where do 5% of PE’s occur?

Answer 2

• bifurcation of the pulmonary a.

Question 3

What is the MC source of PE?

Answer 3

• pelvic/deep thigh v. clot

Question 4

What are the other uncommon causes of PE?

Answer 4

• air
• amniotic fluid
• fat
• FB/septic
• parasite eggs
• tummor

Question 5

How do 50% of PE patients present?

Answer 5

• asymptomatically

Question 6

What is the pathophysiology of PE?

Answer 6

• clot obstructs pulm a. which increases pulm vascular resistance
• vasoactive substances released which further increase pulm vascular resistance
• increased pulm vascular resistance leads to V/Q mismatch
• V/Q mismatch impairs gas exchange

Question 7

signs and symptoms of PE

Answer 7

• dyspnea (shortness of breath, SOB)
• pleuritic chest pain-
• hemoptysis
• cough
• LE pain/swelling
• sense of impending doom
• syncope
• palpitations

Question 8

What are the risk factors for PE?

Answer 8

• Virchow triad (venous stasis, vessel wall injury, hypercoagulability)

Question 9

What are the general findings on PE exam?

Answer 9

• dyspnea or pleuritic pain
• anxious
• cyanosis

Question 10

What are the vital finding on PE exam?

Answer 10

• tachypnea
• tachycardia
• hypotension

Question 11

What are the ascultative findings on PE exam?

Answer 11

• nothing vs. wheezing/rales

- tachycardia

Question 12

What are the findings on the extremities on PE exam?

Answer 12

• pain
• swelling
• Homan’s sign

Question 13

How is a diagnosis of PE made?

Answer 13

• PERC

- Wells Criteria

Question 14

What are the CXR findings on PE exam?

Answer 14

• Fleischner sign
• Westermark sign
• Hampton hump

Question 15

What is Fleischner sign?

Answer 15

• seen on CXR

- distended central pulmonary artery d/t presence of a large clot

Question 16

What is Westermark sign?

Answer 16

• seen on CXR

- oligemia (less vascular) distal to the embolism

Question 17

What is a Hampton hump?

Answer 17

• seen on CXR

- pleural-based wedge shaped consolidation found anywhere in the lung

Question 18

What is the work-up for PE?

Answer 18

• *D-dimer
• CT Angiography (CTA)
• V/Q Scan
• ECHO (US)
• labs as dictated by DDX

Question 19

What is the treatment for PE?

Answer 19

• anticoagulation
• thyrombolytics/thrombectomy
• IVC filter

Question 20

What is the anticoagulation therapy for PE?

Answer 20

• coumadin/warfrin + LMWH x 5d or until INR b/t 2-3

- factor Xa inhibitors (newer agent - preferred)

Question 21

How long does anticoag therapy for PE last?

Answer 21

• 3-6mo

Question 22

What is the anticoag treatment for moderate to severe cases of PE?

Answer 22

• heparin

Question 23

What are the strongest predictors of PE?

Answer 23

• (+) hx DVT/PE

- metastatic disease

Question 24

What are risk factors of PE?

Answer 24

• chemo & radiation
• central venous access device
• Hb < 10 & WBC > 11 = 2x risk
• platless > 350

Question 25

What patient population is 4x more likely to have a DVT or PE?

Answer 25

- 3rd trimester pregers | - post-partum

Question 26

Why is it that the patient pop who is 4x more likely to have DVT or PE gets one?

Answer 26

- hypercoagulable state - additional risk : preeclampsia, c-section, anemia, hemorrhage, post partum infection, & IVF - compression of iliac v. from gravida uterus

Question 27

When is a D-dimer useful in the dx of PE?

Answer 27

- only when negative

Question 28

What do you do with a positive LE US in the patient population that is 4x more likely to have a DVT/PE?

Answer 28

- treat

Question 29

______ (test) is preferred over ______ (test) in the patient population that is 4x more likely to have a DVT/PE because it is ______ sensitive with _____ radiation.

Answer 29

- CTA - V/Q Scan - more - less

Question 30

What is the plan for a PE diagnosis?

Answer 30

- uncomplicated cases can go home | - pregers or CA admitted

Question 31

**Who are at risk for PE?**

Answer 31

- cancer patients

Question 32

**What is the most common CC of PE?**

Answer 32

- dyspnea

Question 33

**What does an EKG read for a PE?**

Answer 33

- S1Q3T3

Question 34

pulmonary embolism (DDX)

Answer 34

- MI - PNA - effusion - pericarditis - PTX - costochondritis