1) pulmonary embolism - definition , risk factors , classification , clinical presentation

Question 1

what is pulmonary embolism ?

Answer 1

occlusion in the pulmonary arteries , that has arrived most commonly from deep vein thrombosis -
greater than 25mmhg at rest

Question 2

what does pulmonary embolism lead to ?

Answer 2

reduced blood flow of the lung

Question 3

aetiology of pulmonary embolism ?

Answer 3

deep vein thrombosis - VIRCHOW TRIAD

• venous stasis
• hypercoagubility (factor 5 , AT3 , protein c and s deficiency / acquired - antiphospholpid syndrome , myeloproliferative disorder)
• endothelial injury

or surgery , limited mobility , atrial fibrillation
chronic resp failure
oral contraceptive drugs

fracture of the bones
air emoblism - decompression diving
tumor embolism
amniotic embolism

Question 4

what is the risk factors for fat embolism ?

Answer 4

osteoperosis , fracture of the bone

surgery orthopedics

Question 5

classification of pulmonary embolism

Answer 5

massive and non massive pulmonary embolism

saddle emboli - main pulmonary arterial trunk

Question 6

how to differentiate massive and non massive embolism

Answer 6

cardiogenic shock
hypotension - systolic pressure below 90
cor pulmonale - right ventricle hypertrophy

Question 7

clinical symptoms of small pulmonary embolism ?

Answer 7

tend to lodge in more peripheral areas without collateral circulation they are more likely to cause lung infarction and small effusions (both of which are painful), but not hypoxia, dyspnea or hemodynamic instability such as tachycardia

Question 8

clinical symptoms of medium pulmonary embolism

Answer 8

phsyical examination :
pleural friction rub 
pulmonary infiltration - precussion - dull 
tachycardia 
decreased vocal fremitus

respiratory symptoms ?
pleural pain 
hemoptysis 
dyspnea 
tachypnea

Question 9

clinical signs and symptoms for large pulmonary embolism

Answer 9

in physical examination of massive PE :
cyanosis 
pale , weak and sweaty 
tachypnea , tachycardia 
systemic hypotension 
neck vein distension 
S3 gallop
S2 splitting 

symptoms- often painless because no infraction due to collateral blood supply
dyspnea
syncope

Question 10

what are the effects of pulmonary embolism ?

Answer 10

depends on:
how much of the vascular bed is obliterated
the size of the vessels affected
nature of the emboli

lead to
cor pulmonale

intrapulmonary shunts - increased dead space -it is little or no blood going into the alveoli - hypoxemia

local edema due to redistrabution of blood

hypotension

Question 11

what is the clinical symptoms for recurrent PE ?

Answer 11

progressive dyspnea

Question 12

what are the clinical; signs for recurrent PE ?

Answer 12

progressive right hand sided heart failure
reoccuring pulmonary infractions
pneumonia