Heme Onc

Question 1

Symptoms of pulmonary embolism?

Answer 1

There are no specific ones

Things that are suspicious:

• dypsnea
• pleuritic chest pain
• tachypnea
• tachycardia

Question 2

Risk factors for VTE?

Answer 2

Age >40
Hx of VTE
Surgery >30min
Prolonged immobilization
Cerebrovascular accident
CHF
Cancer
Fx of pelvis, femur, tibia
Obesity
Pregnancy or recent delivery
Estrogen therapy
Inflammatory bowel disease
Genetic or acquired thrombophilia
- antithrombin III
- protein C/S deficiency
- prothrombin G20210A mutation
- Factor V Leiden 
- Anticardiolipin antibody syndrome
- lupus anticoagulant

Question 3

Classification of VTE risk?

Answer 3

Approximate prevalence of pulmonary embolism
Clinical probability:
1. Low (10% or less)
2. Intermediate (30%)
3. High (70%)

Question 4

D dimer test is good for?

Answer 4

Ruling out VTE, it is highly sensitive but not very specific
Also raised by:
- embolism
- age
- pregnancy
- trauma
- postoperative period
- inflammatory states
- cancer

Question 5

Ventilation perfusion scanning?

Answer 5

Like D-dime, good at ruling out but not so good at ruling in

Question 6

Best diagnostic test for VTE?

Answer 6

CT - you can actually visualize the embolus

Question 7

Downside to CT scan for VTE?

Answer 7

If you see a defect it is positive, however a negative doesnt actually r/o VTE, unlike a normal ventilation-perfusion scan

Its kind of the opposite of a D-dimer/perfusion scan

Question 8

Leg vein scan?

Answer 8

Also great if you find one and its definitive finding, but cant r/o

Question 9

Gold standard for diagnosing VTE?

Answer 9

Pulmonary angiography

Question 10

Downside of pulmonary angiography?

Answer 10

Requires expert interpretation
It’s invasive
Surgery risks

0. 5% died and
1. 8% had major nonfatal complications (resp/renal failure, hematoma etc)

Question 11

High clinical probability for VTE gets?

Answer 11

CT angiography or Ventilation perfusion scanning

If negative = negative
If positive = positive

If negative but still suspect - get an US of legs
- If neg but still suspect - pulmonary angiography

Question 12

Low clinical probability of VTE gets?

Answer 12

D dimer

If negative - r/o
If positive - VTE/CT

Question 13

Intermediate probability of VTE?

Answer 13

25-45% chance of having it so treat like high probability

Question 14

Preferred test for DM pts?

Answer 14

Contrast from the CT has high risk of nephropathy in DM pts so they get tested in this order:

• duplex US
• Ventilation-perfusion
• angiography

Question 15

VTE and pregnancy?

Answer 15

A leading cause of death

• But fetuses dont like rads so start w US

Question 16

Prediction of VTE risk calculator?

Answer 16

Wells Score

Question 17

Wells Score is?

Answer 17

clinically suspected DVT — 3.0 points
alternative diagnosis is less likely than PE — 3.0 points
tachycardia (heart rate > 100) — 1.5 points
immobilization (≥ 3d)/surgery in previous four weeks — 1.5 points
history of DVT or PE — 1.5 points
hemoptysis — 1.0 points
malignancy (with treatment within six months) or palliative — 1.0 points
Traditional interpretation[29][30][35]

Question 18

Well score interpretation

Answer 18

Score >6.0 — High (probability 59% based on pooled data)

Score 2.0 to 6.0 — Moderate (probability 29% based on pooled data)

Score <2.0 — Low (probability
15% based on pooled data)