Category II - Pulmonary Thromboembolism

Question 1

It is the most common cause of preventable death among hospitalized patients.

Answer 1

Pulmonary thromboembolism

Question 2

Two most common autosomal dominant genetic mutations, producing prothrombotic states.

Answer 2

Factor V Laden

Prothrombin gene mutation

Question 3

Most common cause of acquired thrombophilia

Answer 3

APAS

Question 4

Give risk factors to DVT/PTE

Answer 4

Cancer
Systemic arterial HTN
COPD
Long-haul air travel
Air pollution
Obesity
Cigarette smoking
Eating large amounts of red meat
OCPs
Pregnancy
Postmenopausal HRT
Surgery
Trauma

Question 5

Most common gas exchange abnormalites in DVT/PTE

Answer 5

Hypoxemia

Increased alveolar-arterial O2 tension gradient

Question 6

The usual cause of death of patients with PTE

Answer 6

Progressive right heart failure

Question 7

A 75/F patient with breast cancer came in for sudden onset of DOB, no chest pain noted. ECG revealed sinus tachycardia, CRBBB, BP 60/40. She was then diagnosed to have PTE. How will you treat the px?

Answer 7

Give primary therapy - Anticoagulation plus thrombolysis OR embolectomy (catheter/surgical)

Normotension with normal RV - secondary prevention (anticoagulation alone or IVC filter)

Normotension plus RV hypokinesis - individualize therapy

Question 8

In massive PE, how many percent of the pulmonary vasculature is already involved?

Answer 8

At least 50%

Massive PE: dyspnea, syncope, hypotension, cyanosis
Submassive PE: RV dysfunction with normal BP

Question 9

It is called the “great masquerader”

Answer 9

Pulmonary embolism

Question 10

Mot common symptom of pulmonary embolism

Answer 10

Breathlessness

Question 11

Most common symptom of DVT

Answer 11

Cramp or “charley horse” in the lower calf that persists and intensifies over several days

Question 12

This diagnostic test for DVT/PE is useful to rule out DVT/PE but has low specificity because it may also elevate in other diseases (AMI, pneumonia, sepsis, cancer, post-surgical, 2nd/3rd trimester of pregnancy)

Answer 12

D dimer

Question 13

The most frequently cited ECG abnormality in PE?

Answer 13

Sinus tachycardia

Also seen: S in lead I, Q wave in lead III, inverted T wave in lead III

Question 14

An xray finding in which a peripheral wedge shaped density is seen above the diaphragm.
A. Westermark’s sign
B. Hampton’s hump
C. Palla’s sign

Answer 14

B. Hampton’s hump

Westermark’s sign: focal oligemia
Palla’s sign: enlarged right descending pulmonary artery

Question 15

The primary criterion in the ultrasonographic finding in DVT?

Answer 15

Loss of vein compressibility or “wink” finding

Question 16

This diagnostic test replaced CT scan with IV contrast as the principal imaging test used to diagnose PE?

Answer 16

Pulmonary angiography

Question 17

Give diagnostic findings that would denote an increase in mortality from PE

Answer 17

RV hypokinesis
Enlarged RV
Increased troponin

*Will benefit from PRIMARY THERAPY - anticoagulation with thrombolysis or embolectomy

Question 18

Approved as monotherapy for acute VTE without parenteral “bridging”

Answer 18

NOACs

Rivaroxaban: Factor Xa inhibitor
Apixaban: factor Xa inhibitor
Dabigatran: direct thrombin inhibitor (anti factor IIa)

Question 19

Duration of anticoagulation for DVT of upper extremity or calf provoked by trauma.

Answer 19

3 months

Duration of anticoagulation for DVT of upper extremity or calf provoked by trauma, surgery, estrogen exposure, indwelling catheter/device

Provoked proximal leg DVT or PE: 3-6 months

Cancer and VTE: use LMWH indefinitely until “cancer-free”

Moderate or high levels of antiphospholipid antibodies: indefinite

Question 20

Common complication of IVC filter?

Answer 20

Caval thrombosis

Question 21

If with MAJOR bleeding due to warfarin, what will you give?

Answer 21

Cryoprecipitate or FFP or rFVIIa

Warfarin with minor bleeding: oral vitamin K

Question 22

First line inotropic agents for treatment of PE-related shock

Answer 22

Dopamine and Dobutamine