DVT and PE

Question 1

90% of emboli come from where

Answer 1

Deep vein thrombosis in the legs

Question 2

Non blood clot emboli: air…common cause

Answer 2

drug use, placement of central veinous line during inspiration

Question 3

Tumor emboli

Answer 3

renal cell carcinoma

Question 4

talc embolism

Answer 4

drug abuse

Question 5

Predisposing factors to clot formation

Answer 5

VIRCHOWS TRIAD: Stasis, Hypercoagulability, Endothelial injury

Question 6

Genetic disorder that predisposes to hypercoagulability

Answer 6

Factor V Leiden Mutation…resistance to activated protein C

Other predisposing factors: prothrombin mutation, protein c and s deficiency, antithrombin III deficiency

Question 7

Acquired hypercoagulable states

Answer 7

pregnancy, estrogen use, malignancy, nephrotic syndrome, Heparin Induced Thrombocytopenia

Question 8

Physiologic consequences of PE

Answer 8

• Increased vascular resistance (dependent on the size of the obstruction and the presence of things like enothelin which is a vasoconstrictor)
• Impaired gas exchange due to increased dead space
• ALveolar hyperventilation due to reflex stimulation
• increased airway resistance doe to bronchoconstriction
• decreased pulmonary compliance doe to edema, hemorrhage, or loss of surfactant

Question 9

Compensation by the circulation during PE

Answer 9

vasodilation of uninvolved vasculature, Helps to decrease the increase in pulmonary vascular resistance

Question 10

Circulatory consequences

Answer 10

tachycardia, decrease in cardiac output, systemic hypotension, pulmonary hypertension and cor pulmonale, pulmonary infarction

Question 11

S1Q3T3

Answer 11

Found in a minority of pts

Question 12

Gold Standard for PE

Answer 12

Pulmonary angiography