Pulmonary Thromboembolic Disease Flashcards
(18 cards)
1
Q
from where do these emboli rise?
A
iliofemoral veins
2
Q
risk factors for venous thromboembolism
A
- age >60 years
- one or more significant medical comorbidities
- obesity
- major abdominal/pelvic surgery
- active cancer
- pregnancy
- OCP/HRT
- significant immobility
- varicose veins with phlebitis
- hyperosmolar hyperglycaemic states
- history of VTE
- thrombophilia
- Protein C/S and Antithrombin deficiency
- inflammatory bowel disease
- nephrotic syndrome
3
Q
how would a PE present?
A
- breathlessness
- pleuritic chest pain
- haemoptysis and cough
- syncope
- sweating
- raised JVP
- loud S2
- pulmonary infarction
- cor pulmonale
4
Q
investigations for PE
A
- D dimer
- ABGs
- ECG
- CXR
- CTPA
- Spiral CT with intravenous contrast
- Radionuclide lung scan
- ultrasound to exclude DVT in the pelvic/iliofemoral
veins - pulmonary angiography
5
Q
management of PE
A
- high flow oxygen if hypoxaemic
- thrombolysis
- analgesia
- LMWH and oral warfarin
- IV fluids to raise the filling pressure
6
Q
how can you classify PE?
A
with the Geneva rules
7
Q
components of Virchow’s triad?
A
- damage or abnormality in the vessel wall
- reduced blood flow
- increase in blood coagulability
8
Q
what can be seen in CXR of a PE patient?
A
- normal in 10%
- oligoaemia
- plate atelectasis
- wedge shaped peripheral opacity
- pleural opacity
- enlargement of the descending pulmonary artery
- elevated diaphragm
- enlarged heart shadow
- small pleural effusion
9
Q
results of an ABG in PE
A
- non specific
- hypoxaemia
- hypocapnia
10
Q
clinical presentation of DVT
A
- sometimes silent
- swelling of the leg
- tenderness of the calf muscles
- increased warmth of leg
- calf pain on passive dorsiflexion
11
Q
how would do diagnose DVT?
A
- venography
- doppler ultrasound
- colour duplex imaging
- radionuclide - labelled fibrinogen
- thermography
- D-dimers; breakdown product of cross-linked fibrin
12
Q
how can air travel cause DVT?
A
- dehydration
- excessive alcohol consumption
- poor air quality
- immobility
- cramped seats
13
Q
signs of PE
A
general: pallor, cyanosis and fever
cardiovascular: tachycardia, hypotension, neck vein distension, S2 increase
respiratory: tachypnea, reduction in breath sounds, crackles, pleural rub
14
Q
signs on the ECG in PE
A
- sinus tachycardia
- signs of RV overload
- precordial T-wave inversion
- transient right bundle branch block
- S1Q3T3
15
Q
Which substances are used for V/Q scans
A
- Technetium-99 for Perfusion testing
- Xenon gas for Ventilation test
16
Q
prevention of PE
A
- before surgeries, stop OCP and smoking, weight loss, treat heart failure and varicose veins
- during surgery, use heparin, intermittent external pneumatic compression, anti-thrombosis stockings
after surgery, early mobilisation and breathing exercises - treat any other predisposing medical conditions: special reference to trauma and casts
17
Q
prevention of recurrent DVT
A
- long-term anticoagulation
- mechanical filters
- stents used if warfarin is contraindicated
18
Q
treatment of PE
A
- measure PT regularly
- unfractionated heparin/LMWH and warfarin for 5 days with discharge on warfarin alone when the INR reaches 2
- NOACs
- embolectomy
- thrombotic endarterectomy
- treatment can be stopped after a few months, depending on the underlying risks
