[Resp] Pulmonary Embolism

Question 1

what can PEs be defined as?

Answer 1

provoked or unprovoked

Question 2

what is a provoked PE?

Answer 2

when PE occurs after:

• surgery / trauma in last 3 months
• significant immobility in the last 3 months
• pregnancy / puerperium
• COCP / HRT use
• active cancer

Question 3

do you need to request further ix in a provoked PE?

Answer 3

no

Question 4

what is an unprovoked PE?

Answer 4

when there are no risk factors for a PE

Question 5

in an unprovoked PE, if there are sx consistent with cancer, what should be done next?

Answer 5

• bloods: FBC, U+E, LFTs, clotting and physical exam

- CT TAP

Question 6

in an unprovoked PE, if there are no sx consistent with cancer, what should be done next?

Answer 6

• bloods: FBC, U+E, LFTs, clotting and physical exam

- consider thrombophilia screen

Question 7

what is included in a thrombophilia screen?

Answer 7

• anti-phospholipid syndrome

- hereditary thrombophilia (especially in those with unprovoked DVT with FH of 1˚ relative with unprovoked DVT)

Question 8

what is the most common ECG change in PE?

Answer 8

sinus tachycardia

Question 9

what are signs of poor Px on ECG for PE?

Answer 9

• new complete/incomplete RBBB
• S1Q3T3 pattern
• right ventricular strain pattern
• atrial arrhythmias

Question 10

how do you manage PE with haemodynamic instability?

Answer 10

urgent thrombolysis

Question 11

how do you manage provoked PE if there is a cancer Dx?

Answer 11

6 months DOAC (Apixaban or Rivaroxaban)

Question 12

how do you manage provoked PE if there is no cancer Dx?

Answer 12

3 months DOAC (Apixaban or Rivaroxaban)

Question 13

how do you manage unprovoked PE?

Answer 13

6 months DOAC (Apixaban or Rivaroxaban)

Question 14

the PE Mx for adults does not apply to which group of pts?

Answer 14

• pregnant
• poor renal function
• antiphospholipid

Question 15

recurrent miscarriages, prolonged APTT and thrombocytopenia. dx?

Answer 15

antiphospholipid syndrome

Question 16

ECG showing ST depression / T wave inversion V1-V4 and II, III and AVF. dx?

Answer 16

R ventricular strain pattern

Question 17

skin necrosis after warfarin. dx?

Answer 17

protein C deficiency