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Resp DRX > 04a: PE > Flashcards

04a: PE Flashcards

1
Q

“Virchow’s triad” is a list of (X). What’s included?

A

X = major risk factors for PE

  1. Blood stasis
  2. Hypercoagulable state
  3. Trauma to vessel wall
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2
Q

State the sources of pulmonary emboli as well as the percent of emboli that come from each source.

A
  1. Femoral veins (50%)
  2. Iliac-pelvic veins (40%)
  3. Calf veins (under 10%)
  4. Upper extremity central veins (rare)
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3
Q

Use of indwelling catheters is increasing, causing an increase in (X) from upper extremity (Y) vessels.

A 
X = PE
Y = central veins
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4
Q

Patients with which characteristics have highest mortality after PE?

A
  1. RV thrombus and dysfunction

2. Hypotensive

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5
Q

Patients with which characteristics have highest mortality after PE?

A
  1. RV thrombus and dysfunction

2. Hypotensive

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6
Q

T/F: Most (nearly 99%) of PE patients that survive will completely recover and clot will dissolve.

A

True

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7
Q

How might Pulmonary HT occur following PE?

A

Clot doesn’t dissolve, gets lodged and permanently obstructs pulmonary vasculature

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8
Q

T/F: All causes of PE are symptomatic.

A

False - range from imperceptible (30% no symptoms) to disastrous

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9
Q

Physiological effects of PE depend most importantly on:

A

Underlying status of CV and resp systems

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10
Q

List the physiological (not clinical) respiratory changes you would expect as effect of PE.

A
  1. Increased dead-space, minute, and alveolar ventilation

2. Shunt

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11
Q

List the physiological (not clinical) cardiac changes you would expect as effect of PE.

A
  1. Arrhythmia (tachycardia, RBBB)
  2. Pulmonary HT and systemic hypotension
  3. Decrease CO
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12
Q

Aside from Resp and cardiac symptoms, which physiological manifestations in patient would make you suspicious of PE?

A
  1. Hypothermia
  2. Cyanosis
  3. Altered mental status
  4. Decreased urine output
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13
Q

Which clinical symptoms/signs in high-risk patient would make you suspect PE?

A
  1. Dyspnea and cough
  2. Pleuritic or substernal chest pain
  3. Apprehension/feel impending doom
  4. Symptoms at source (leg swelling)
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14
Q

T/F: 50% of patients with PE present with dyspnea.

A

False - over 80%

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15
Q

If PE results in infarction, what can you say about the clot?

A

Lodged in area with little collateral blood flow (ex: periphery of lung)

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16
Q

56 y.o. smoker comes in with dyspnea, wheezing, chest pain, and HR of 140. He also has fever of 100. Which parts of history/physical will make you less suspicious of PE?

A

Wheezing (rare in PE)

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17
Q

T/F: PE is the most frequent cause of in-hospital unexpected death.

A

True

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18
Q

A PE causes (X), which can then lead to hypoxemia via which ways?

A

X = dead space

  1. Atelectasis
  2. Shunt

(V/Q Mismatch)

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19
Q

Wells Criteria is used to classify patients as low/moderate/high risk of (X). How many points is each category?

A

X = PE

Low: under 2
Mod: 2-6
High: over 6

20
Q

List the Wells Criteria and respective points for each risk factor.

A
  1. DVT signs (leg swelling/pain with palpation) - 3 pts
  2. Other diagnosis less likely than PE - 3 pts
  3. HR over 100 - 1.5 pts
  4. Immobilization over 3 days or surgery in past month - 1.5 pts
  5. Previous DVT/PE - 1.5 pts
  6. Hemoptysis - 1 pt
  7. Malignancy - 1 pt
21
Q

T/F: Blood tests and ABGs are very sensitive tests for PE diagnosis.

A

False - blood tests are of very little value; ABG is very sensitive, though

22
Q

Your patient may have a PE, so you order an ABG, a very (sensitive/specific) marker. You expect to see (X) results if PE present. (Y) will tell you that PE is very unlikely.

A

Sensitive (few false neg);

X = hypoxemia and hypocapnia
Y = norma A-a gradient
23
Q

D-dimer test is a very (sensitive/specific) test used for (X) diagnosis. It measures product of (Y). A negative test is (above/below) (Z) value.

A 
Sensitive (95% neg predictive value);
X = PE
Y = fibrin degradation
Below;
Z = 500 mg/L
24
Q

Which test is used in the ED to screen patients with suspected PE?

A

D-dimer

25
Q

T/F: BNP and Troponin are routine tests for PE.

A

False - insensitive assays that are not recommended for routine measurement

26
Q

Most common EKG finding in PE patient:

A

Sinus tachycardia

27
Q

Most common CXR finding in PE patient:

A

Normal (or super subtle)

28
Q

Gold standard test for PE diagnosis.

A

Pulmonary angiography (dye injected into pulm vasculature)

29
Q

List 4 key abnormal findings on CXR associated with PE.

A
  1. Hypoperfusion (causing hyperlucency in part of lung)
  2. Atelectasis
  3. Pleural effusion
  4. “Hampton’s hump” (infarction)
30
Q

V/Q Scan: what would you expect to find in PE?

A

No perfusion to area of lung that is being ventilated (V/Q mismatched, dead space)

31
Q

T/F: Normal V/Q scan effectively excludes clinically significant PE.

A

True

32
Q

(X) treatment should be initiated in all patients when there is high index of suspicion for PE.

A

X = anticoagulation

33
Q

List the anticoagulation drugs used for PE.

A
  1. Heparin (short-term)
  2. Warfarin (long-term)
  3. Direct Oral antigcoag (DOACs)
34
Q

List the first-line drug used in hemodynamically unstable PE patient.

A

Heparin (unfractionated)

35
Q

List the advantages for using V/Q scan when suspecting PE.

A
  1. Excellent NPV (over 95%)
  2. Non-invasive, low risk and no dye injection (ok for renal pts)
  3. Sensitive for peripheral emboli
36
Q

Currently, most commonly used test for PE is (X). What are its advantages?

A

X = CTPA (with contrast)

  1. Easy/fast
  2. Provides imaging into lungs to help diagnose other pulmonary issues
  3. High specificity; pretty sensitive for moderate-sized emboli
37
Q

(Low MW/unfractionated) heparin is preferred for most hemodynamically stable PE treatment, except in which patients?

A

Low MW;

Morbidly obese, renal impairment, hypotensive

38
Q

(X) agents are used to treat hemodynamically stable PE if first-line treatment, (Y), is contraindicated.

A 
X = thrombin inhibitors
Y = heparin
39
Q

T/F: IVC filter should be placed for PE therapy as soon as heparin therapy started.

A

False! Not indicated initially unless anticoagulants can’t be given

40
Q

T/F: Thrombolytic agents are not indicated at all in hemodynamically stable PE patients.

A

True

41
Q

Do patients with irreversible causes of PE, such as (X), need to be on long-term therapy?

A

X = cancer, genetics

Yes - warfarin (oral anticoagulant) for 6 months to lifetime

42
Q

List the 4 conditions that require lifelong therapy for PE.

A
  1. Antiphospholipid syndrome
  2. Malignancy
  3. Second clot
  4. Previous massive PE
43
Q

Long-term treatment of PE typically involves (X) drug. List the exceptions.

A

X = warfarin (oral anticoagulant)

  1. Malignancy (heparin works better)
  2. Pregnancy (heparin until delivery)
44
Q

List the types of DVT prophylaxis.

A
  1. External pneumatic leg compression
  2. Heparin (minidose or full dose)
  3. Warfarin
45
Q

Chronic thromboembolic pulmonary disease (CTPD) occurs in (X)% of patients and is due to body’s inability to (Y).

A 
X = 3
Y = lyse clot (dysfunctional fibrinolytic system)

Resp DRX (9 decks)

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