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pulmonology > 08.25 - Venous Thromboembolism (Muthiah) - Questions > Flashcards

08.25 - Venous Thromboembolism (Muthiah) - Questions Flashcards

1
Q

S1Q3T3

A

Right Ventricular Strain - Pathognomonic for PE

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2
Q

2 classic tumors that grow into venous system

A

Renal Cell Carcinoma, Lung Primary

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3
Q

3 important congenital hypercoagulabilities that predispose to PE

A

Factor V Leiden, Prothrombin Mutation, Proteins C and S deficiency

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4
Q

Most common cause of thrombocytopenia in the ICU

A

DIC

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5
Q

Commonest cause of DIC

A

Sepsis

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6
Q

What is our concern in Heparin Induced Thrombocytopenia

A

Even though platelet count low, can still clot

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7
Q

2 Actions of Warfarin

A

Blocks vit-K-dependent factors; Decreases production of Proteins C and S

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8
Q

2 important acquired hypercoagulabilities

A

HIT, Nephrotic

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9
Q

Pulmonary Vascular resistance after PE

A

Increased - serotonin, endothelin

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10
Q

Gas Exchange after PE

A

Increased dead space (v/q mismatch), low DLCO, shunting in massive PE

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11
Q

PaCO2 after PE

A

Hypocapnea, trying to maintain oxygenation, and CO2 diffuses more readily than O2

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12
Q

Alveolar ventilation after PE

A

Alveolar Hyperventilation - reflex stimulation of irritant receptors

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13
Q

Airway resistance after PE

A

Increased - Bronchoconstriction - Serotonin

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14
Q

Pumonary Compliance after PE

A

Decreased - Edema, Hemorrhage, Loss of Surfactant

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15
Q

Circulatory Compensation after PE

A

Vasodilation of uninvolved vasculature helps decr the incr in PVR, also improves V/Q relationship

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16
Q

Gas Exchange abnormalities after PE

A

Hypocapnia, Hypoxemia, Wide A-a

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17
Q

Blood pressure after PE

A

Pulmonary HTN, Systemic Hypotension

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18
Q

When might patients get bradycardia after PE

A

Beta Blocker

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19
Q

What causes BNP release

A

Ventricular Stretch (higher BNP associated with adverse outcomes)

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20
Q

Commonest arrhythmias after PE

A

A Fib, A Flutter

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21
Q

Sign of RV strain

A

S1Q3T3

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22
Q

Most common complaint from patient with acute PE

A

SOB

23
Q

2 most common complaints after PE other than Dyspnea, Tachypnea, and Tachycardia

A

Pleuritic Pain, Loud P2

24
Q

Heparin Antidote

A

Protamine Sulfate

25
Q

A-a gradient after PE

A

Usually wide, but normal does not rule out

26
Q

Widened Mediastinum on CXR indicates

A

Ascending Aortic Aneurysm

27
Q

Most common CXR abnormality with PE

A

Atelectasis or decrease in lung volume

28
Q

New atrial arrhythmias with new onset dyspnea, think

A

PE

29
Q

EKG Findings in PE

A

S1Q3T3 (minority), Atrial Arrhythmias

30
Q

Atelectasis in PE is due to

A

decreased surfactant production

31
Q

Hampton’s Hump is buzzword for

A

PE

32
Q

Westermark’s Sign is seen in

A

PE

33
Q

Discoid Atelectasis is seen in

A

PE

34
Q

No pulmonary vasculature in right lung could be

A

PE, Pneumothorax

35
Q

If lack of pulmonary vasculature on CXR, if it was pneumothorax, we:

A

wouldn’t hear breath sounds; Tympanic on percussion; Likely see collapsed lung

36
Q

Majority of V/Q Lungs scans are

A

intermediate probability

37
Q

Gold standard for PE

A

Pulmonary Angiography - Invasive, Contrast Dye

38
Q

If perfusion scan is normal and d-dimer is ___, the possibility of PE or DVT is extremely low

A

<500

39
Q

Sensitivity and specificity of D-Dimer

A

Very Sensivitive, but not specific

40
Q

Negative D-Dimer means that PE

A

is highly unlikely

41
Q

Primary diagnostic modality for PE

A

Helical CT

42
Q

Homan’s Sign

A

Passive dorsiflexion of ankle will cause pain in calf

43
Q

Best diagnostic modality for lower extremity DVT:

A

Bilateral lower extremity B-Mode US to demonstrate non-compressability

44
Q

Gold stand, but not practical test for DVT

A

Bilateral LE contrast venography

45
Q

What are you looking for in DVT with B-Mode US

A

Non-compressability

46
Q

Best pharmacologic prophylaxis to prevent DVT in patient admitted to ICU

A

Heparin

47
Q

Test for Heparin

A

aPTT

48
Q

Test for Warfarin

A

PTT

49
Q

Assay to measure adequacy of anticoagulation with LMW Heparin (Enoxaparin)

A

Factor Xa Activity

50
Q

Most accepted situation for thrombolysis (t-PA)

A

Large PE w/ Shock

51
Q

If treated, mortality from PE is

A

uncommon

52
Q

What fraction of treated PE patients develop pulmonary hypertension

A

Very few

53
Q

Triad for Fat Embolism

A

Mental Status, Thrombocytopenia, Petechiae

pulmonology (31 decks)

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