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RC Test 2 > B4.030 - CBCL Pulmonary Embolism > Flashcards

B4.030 - CBCL Pulmonary Embolism Flashcards

1
Q

If you suspect a patient has DVT what should you use in your assessment

A

Wells criteria

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2
Q

If the patient has a low probability for DVT what should you do

A

Obtain D-dimer to exclude DVT if normal

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3
Q

If the patient has a high probability for DVT what should you do

A

Obtain a lower extremity ultrasound (highly sensitive and specific) to evaluate for presence of a DVT and its site of involvement/thrombus burden if present

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4
Q

if you suspect a patient has PE what should you do

A

Obtain CXR

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5
Q

if you suspect a PE and the CXR doesn’t demonstrate an obvious reason for the patient symptoms that would exclude PE

A

get a CTA of the chest or V/Q lung scan if CTA is contraindicated

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6
Q

if a patient has experienced blunt thoracic trauma what should you start with

A

CXR

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7
Q

if a patient has experienced blunt thoracic trauma that was low to moderate and the CXR is normal

A

It can stop here if nothing concerning on CXR

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8
Q

if a patient has experienced blunt thoracic trauma and X ray is positive

A

procede to CT

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9
Q

how should penetrating chest trauma be evaluated

A

by both CXR and CT

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10
Q

what do the green and blue arrow point to

A

blue - true lumen

green - false lumen

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11
Q

what are the yellow arrows pointing to

A

pericardial effusion

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12
Q

what is pictured here

A

intimal flap dissection involving the ascending and descending thoracic aorta

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13
Q

what is a type A aortic dissection

A

involves ascending aorta

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14
Q

what is a type B aortic dissection

A

involves descending aorta (originating after takeoff of brachiocephalic artery)

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15
Q

epidemiology of aortic dissection

A

peak age 50-65

male>female

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16
Q

signs and symptoms of aortic dissection

A

Tearing/ripping chest pain

back pain

aortic insufficiency

BP difference between arms

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17
Q

complications from aortic dissection

A

cardiac tamponade

carotid involvement

coronary involvement

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18
Q

management of type A artic dissection

A

surgical management

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19
Q

type B aortic dissection management

A

usually medical

consider surgery if organ hypoperfusion or shock

20
Q

if you have a patient (older male with tearing chest pain radiating to the back) what should you do

A
  1. obtain CXR
  2. if CXR does not demonstrate an obvious reason for pain it excludes dissection
  3. obtain CTA
21
Q

what is this + for

A

Pulmonary embolism

22
Q

what is this + for

A

right heart strain sign of hemodynamically significant PE

23
Q

what is an IVC filter

A

metallic basket placed in IVC to catch emboli from lower body veins

can be placed in patients with DVT to prevetn PE

or
PE with or without DVT

24
Q

what are absolute indications for IVC filter in patients with DVT/PE

A

contraindication for anticoagulation

recurrent PE in spite of anticoagulation

anticoagulation-related complication

25
Q

what are relative indications for IVC filter

A
  1. free floating thrombus in IVC or iliofemoral segments
  2. pE and limited cardiac reserve
  3. prophylaxis in pts wiht severe trauma who cant walk
  4. prophylaxis for surgery in pts with DVT
  5. poor compliance with anticoagulation
  6. protection druing DVT
26
Q

where should IVC filters be placed

A

below renal veins because they dont have collateral flow

27
Q

when do IVC filters come out

A

when no longer needed

28
Q

IVC filter complications

A

migration

limb fracture

IVC rupture

Pierce adjacent viscera/aorta

IVC thrombiss lead sot increased lower exterminty venous stasis and DVTs

29
Q

what are Wells criteria

A
30
Q

what does a D Dimer test for in the body

A

fibrin

31
Q

What imaging study will be the most sensitive and specific in detection of mediastinal hematoma?

A

CT of chest

32
Q

What is a common presentation for infants with severe aortic coarctation?

A

Weak femoral pulse and possible cardiac murmur

33
Q

Describe the conditions at the top of the normal upright lung?

A

At the top of the lung, PAO2 and VA/Q are higher than at the bottom of the lung, while alveolar ventilation and PACO2 are lower than at the bottom of the lung.

34
Q

A 22-year-old woman with previously normal pulmonary function is admitted to the ER at KUMC and now has the following data breathing room air:

PaO2 = 85 mm Hg

PaCO2 = 43 mm Hg

Arterial pH = 7.36

PECO2 = 14 mm Hg

Respiratory frequency = 24 breaths / min (normal for this person: 14 / min)

Tidal volume 700 ml (normal for this person: 450 ml)

These data indicate that this patient has what condition?

A

Acute Pulmonary Embolism

The key variable here is the high VD/VT = (PaCO2 - PECO2) / PaCO2 = 0.6 (normal 0.20 - 0.35). The air coming from the alveolithat are not perfused (because of the embolism) has no CO2 and “dilutes” the PECO2.

35
Q

Aortic dissection is suspected in a 64-year-old male. What is the most appropriate test to confirm the diagnosis?

A

CTA, MRA, and TEE have similar sensitivity and specificity for evaluation and confirmation of aortic dissection. CTA is usually obtained because fast and cost-efficient. MRA may be used with renal failure or iodine allergy. TEE is user dependent and may take longer to obtain. A chest x-ray is often performed initially in order to rule out other causes of the chest pain, but is not confirmatory for aortic dissection.

36
Q

describe the usefulness of a D dimer

A

high negative predictive value

37
Q

The American College of Radiology’s (ACR) Appropriateness Criteria take into account a given study’s what 2 features when making a recommendation regarding what particular imaging study should be ordered for a patient?

A

Safety

diagnostif efficacy

38
Q

JJ is a 40-year-old female with history and physical examination findings suspicious for lower extremity DVT. She undergoes a lower extremity ultrasound examination for further evaluation. A typical lower extremity ultrasound examination utilizes how many different tests to evaluate for a DVT?

A

3

A standard lower extremity ultrasound examination ordered for the evaluation of DVT includes:

Venous compression

Color Doppler

Duplex Doppler

39
Q

what imaging studies is the most accurate for diagnosing a PE?

A

A chest radiograph can be performed to evaluate for pneumonia or pneumothorax, but a CTA of the chest is most accurate for diagnosing PE. If the patient is allergic to IV contrast or has renal insufficiency (placing them at increased risk for renal failure from IV contrast) a V/Q lung scan may be performed.

40
Q

where is the appropriate place to place an IVC filter

A

B

41
Q

when would be the most appropriate time/setting to schedule a patient to have his/her retrievable IVC filter removed?

A

At the time of discharge to home from a rehabilitation facility after recovering from traumatic intracranial hemorrhage.

The IVC should be removed when the hemorrhage has been resolved, and surgery and rehabilitation has been completed.

42
Q

absolute indications for placing an IVC filter

A

Absolute indications for IVC include:

contraindication for anticoagulation (not poor patient compliance),

recurrent PE in spite of anticoagulation,

and anticoagulation-related complication.

43
Q

KF is a 30-year-old male who presents with right lower extremity pain. He was recently released from the hospital after being admitted for several days for treatment following a motor vehicle accident. What factor places him at greatest risk for a lower extremity DVT?

A

Obesity, smoking, and varicose veins are minor risk factors for developing DVT. Age is not a significant risk factor for DVT in patients less than 60 years of age. Recent trauma is a major risk factor for developing DVT.

44
Q

SH is a 34-year-old-female who presents with a massive PE and evidence of right heart strain. What is the most appropriate next step in the treatment of this patient?

A

Emergent catheter-directed thrombolytic therapy/embolectomy.

This is performed in cases where systemic signs of right heart failure are observed.

45
Q

JW is a 58-year-old-male who presents with chest pain. He is diagnosed with a type B aortic dissection. What was his biggest risk factor for developing an aortic dissection?

A

Hypertension is considered as the most important risk factor for aortic dissection and is present in about 80% of patients with aortic dissection.

RC Test 2 (19 decks)

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