Lungemboli Flashcards by Ola Ghah

What is pulmonary embolism (PE)?

A) Obstruction of coronary arteries
B) Luminal obstruction of pulmonary arteries
C) Blockage of the carotid artery
D) Peripheral arterial occlusion

B) Luminal obstruction of pulmonary arteries

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What does venous thromboembolism (VTE) encompass? A) Pulmonary embolism and DVT;
B) Only pulmonary embolism;
C) Only deep vein thrombosis;
D) None of the above

A) Pulmonary embolism and DVT

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What is recurrent VTE?
A) A second VTE after completing 2 weeks of therapy;
B) VTE that resolves within 2 weeks;
C) VTE without risk factors;
D) VTE caused by tumor embolism

A) A second VTE after completing 2 weeks of therapy

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What is the definition of provoked VTE?
A) VTE without any risk factors;
B) VTE occurring due to at least one risk factor;
C) VTE caused by bacterial embolism; D) VTE exclusive to older adults

B) VTE occurring due to at least one risk factor

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What is the incidence of VTE in the US per year?
A) ∼10 per 1,000;
B) ∼1–2 per 1,000;
C) ∼5 per 1,000;
D) ∼0.5 per 1,000

B) ∼1–2 per 1,000

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What is the most common cause of PE?
A) Fat embolism;
B) Amniotic fluid embolism;
C) Deep vein thrombosis;
D) Air embolism

C) Deep vein thrombosis

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What is the primary mechanism behind PE?
A) Obstruction of coronary arteries; B) Formation of thrombus in leg veins;
C) Blockage of carotid arteries;
D) Vasoconstriction of pulmonary vessels

B) Formation of thrombus in leg veins

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Which symptom is caused by infarction and inflammation in PE?
A) Pleuritic chest pain;
B) Bilateral leg swelling;
C) Loss of consciousness;
D) Bradycardia

A) Pleuritic chest pain

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What pathophysiological response leads to respiratory alkalosis in PE?
A) Hyperventilation and tachypnea;
B) Surfactant dysfunction;
C) Decreased cardiac output;
D) Hemodynamic instability

A) Hyperventilation and tachypnea

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What does mechanical vessel obstruction in PE cause?
A) Ventilation-perfusion mismatch;
B) Bradycardia;
C) Decreased blood viscosity;
D) Peripheral cyanosis

A) Ventilation-perfusion mismatch

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What is pulmonary embolism (PE)?

A) Obstruction of coronary arteries by an embolic material
B) Obstruction of one or more pulmonary arteries by an embolic material
C) Obstruction of pulmonary veins by an embolic material
D) Obstruction of systemic veins by an embolic material

A) Obstruction of coronary arteries by an embolic material
B) Obstruction of one or more pulmonary arteries by an embolic material
C) Obstruction of pulmonary veins by an embolic material
D) Obstruction of systemic veins by an embolic material

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What is the most common cause of PE?

A) Arterial thrombus
B) Venous thrombus from legs or pelvis
C) Embolic gas
D) Cardiac thrombus

What is the most common cause of PE?

A) Arterial thrombus
B) Venous thrombus from legs or pelvis
C) Embolic gas
D) Cardiac thrombus

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Through which structure does a thrombus from the legs reach the lungs?

A) Superior vena cava
B) Aorta
C) Inferior vena cava
D) Pulmonary veins

Through which structure does a thrombus from the legs reach the lungs?

A) Superior vena cava
B) Aorta
C) Inferior vena cava
D) Pulmonary veins

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Which is NOT a risk factor for PE?

A) Immobility
B) Inherited hypercoagulability disorders
C) Chronic obstructive pulmonary disease (COPD)
D) Recent surgery

Which is NOT a risk factor for PE?

A) Immobility
B) Inherited hypercoagulability disorders
C) Chronic obstructive pulmonary disease (COPD)
D) Recent surgery

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What is the clinical presentation of PE?

A) Always symptomatic with severe chest pain
B) Ranges from asymptomatic to obstructive shock
C) Limited to cough and shortness of breath
D) Only tachycardia and fever

What is the clinical presentation of PE?

A) Always symptomatic with severe chest pain
B) Ranges from asymptomatic to obstructive shock
C) Limited to cough and shortness of breath
D) Only tachycardia and fever

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Why is PE challenging to diagnose?

A) Symptoms are always severe
B) Symptoms are nonspecific, such as chest pain or tachycardia
C) Symptoms only appear during physical exertion
D) It can only be diagnosed post-mortem

Why is PE challenging to diagnose?

A) Symptoms are always severe
B) Symptoms are nonspecific, such as chest pain or tachycardia
C) Symptoms only appear during physical exertion
D) It can only be diagnosed post-mortem

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What should be suspected in all patients with acute dyspnea?

A) Myocardial infarction
B) Pulmonary embolism
C) Pneumothorax
D) Pulmonary hypertension

What should be suspected in all patients with acute dyspnea?

A) Myocardial infarction
B) Pulmonary embolism
C) Pneumothorax
D) Pulmonary hypertension

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What is the gold standard diagnostic test for PE?

A) Chest X-ray
B) CT pulmonary angiography (CTPA)
C) Ventilation-perfusion scan
D) Ultrasound of the lungs

What is the gold standard diagnostic test for PE?

A) Chest X-ray
B) CT pulmonary angiography (CTPA)
C) Ventilation-perfusion scan
D) Ultrasound of the lungs

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What may arterial blood gas analysis (ABG) show in PE?

A) Low partial oxygen pressure and respiratory acidosis
B) High partial oxygen pressure and respiratory alkalosis
C) Low partial oxygen pressure and respiratory alkalosis
D) Normal levels only

What may arterial blood gas analysis (ABG) show in PE?

A) Low partial oxygen pressure and respiratory acidosis
B) High partial oxygen pressure and respiratory alkalosis
C) Low partial oxygen pressure and respiratory alkalosis
D) Normal levels only

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What is the role of the serum D-dimer test in PE diagnosis?

A) Confirm the diagnosis of PE
B) Rule out the diagnosis due to high sensitivity
C) Replace imaging studies
D) Measure oxygen levels

What is the role of the serum D-dimer test in PE diagnosis?

A) Confirm the diagnosis of PE
B) Rule out the diagnosis due to high sensitivity
C) Replace imaging studies
D) Measure oxygen levels

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What is the initial treatment for PE?

A) Antibiotics
B) Therapeutic anticoagulation
C) Thrombolytic agents only
D) Embolectomy

What is the initial treatment for PE?

A) Antibiotics
B) Therapeutic anticoagulation
C) Thrombolytic agents only
D) Embolectomy

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What is the treatment for massive PE with hemodynamic instability?

A) Anticoagulation only
B) Thrombolytic agents and/or embolectomy
C) Oxygen therapy alone
D) Serum D-dimer monitoring

What is the treatment for massive PE with hemodynamic instability?

A) Anticoagulation only
B) Thrombolytic agents and/or embolectomy
C) Oxygen therapy alone
D) Serum D-dimer monitoring

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What is the preferred management for PE in pregnancy?

A) Thrombolytic therapy only
B) Special guidelines for anticoagulation
C) Embolectomy as first-line treatment
D) D-dimer and CTPA only

What is the preferred management for PE in pregnancy?

A) Thrombolytic therapy only
B) Special guidelines for anticoagulation
C) Embolectomy as first-line treatment
D) D-dimer and CTPA only

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What is a common symptom of PE?

A) Severe abdominal pain
B) Chest pain
C) High fever
D) Visual changes

What is a common symptom of PE?

A) Severe abdominal pain
B) Chest pain
C) High fever
D) Visual changes

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Which diagnostic tool is least specific for PE? A) Serum D-dimer test B) CTPA C) Arterial blood gas analysis D) Ventilation-perfusion scan

Which diagnostic tool is least specific for PE? **A) Serum D-dimer test** B) CTPA C) Arterial blood gas analysis D) Ventilation-perfusion scan

What is the most sensitive blood test for PE? A) D-dimer B) Troponin C) Complete blood count D) Lactate

Front: What is the most sensitive blood test for PE? **A) D-dimer** B) Troponin C) Complete blood count D) Lactate

What clinical feature is a hallmark of massive PE? A) Obstructive shock B) Wheezing C) Hemoptysis D) Hypertension

What clinical feature is a hallmark of massive PE? **A) Obstructive shock** B) Wheezing C) Hemoptysis D) Hypertension

What is pulmonary embolism (PE)? A) Obstruction of pulmonary veins by blood thrombi B) Luminal obstruction of one or more pulmonary arteries, typically due to blood thrombi from deep vein thrombosis (DVT) C) Narrowing of pulmonary arteries due to plaque formation D) Obstruction of systemic veins due to thrombosis

What is pulmonary embolism (PE)? A) Obstruction of pulmonary veins by blood thrombi **B) Luminal obstruction of one or more pulmonary arteries, typically due to blood thrombi from deep vein thrombosis (DVT)** C) Narrowing of pulmonary arteries due to plaque formation D) Obstruction of systemic veins due to thrombosis

What does venous thromboembolism (VTE) encompass? A) Only pulmonary embolism (PE) B) Only deep vein thrombosis (DVT) C) Both pulmonary embolism (PE) and deep vein thrombosis (DVT) D) Hypercoagulable states

What does venous thromboembolism (VTE) encompass? A) Only pulmonary embolism (PE) B) Only deep vein thrombosis (DVT) **C) Both pulmonary embolism (PE) and deep vein thrombosis (DVT)** D) Hypercoagulable states

What is recurrent VTE? A) VTE that occurs without any risk factors B) VTE that recurs in a patient after the completion of the first 2 weeks of antithrombotic therapy C) VTE that resolves after 2 weeks of treatment D) VTE caused by nonthrombotic embolism

B) VTE that recurs in a patient after the completion of the first 2 weeks of antithrombotic therapy

What is provoked VTE? A) VTE occurring due to multiple embolic causes B) VTE in an individual with ≥ 1 risk factor for VTE C) VTE without any identifiable risk factors D) VTE caused by fat embolism

B) VTE in an individual with ≥ 1 risk factor for VTE

Which statement describes unprovoked VTE (idiopathic VTE)? A) VTE in an individual without risk factors for VTE B) VTE in an individual with known hypercoagulable states C) VTE caused by bacterial embolism D) VTE recurring after completion of treatment

A) VTE in an individual without risk factors for VTE

What is the approximate incidence of venous thromboembolism (VTE) in the United States? A) 1–2 VTE cases per 100,000 people per year B) 10–20 VTE cases per 1,000 people per year C) 1–2 VTE cases per 1,000 people per year D) 5–10 VTE cases per 1,000 people per year

C) 1–2 VTE cases per 1,000 people per year

Which group experiences a slight increase in VTE during the reproductive years? A) Men B) Women C) Children D) Older adults

B) Women

Which type of embolism is included in nonthrombotic embolism? A) Fat embolism B) Air embolism C) Amniotic fluid embolism D) All of the above

D) All of the above

What acronym summarizes the causes of PE? A) FATAL: Fat, Air, Thrombus, Amniotic fluid, Less common causes B) FAST: Fat, Air, Surgical, Thrombus C) SAFE: Surgery, Air, Fat, Embolism D) STOP: Surgery, Thrombus, Obstruction, Pulmonary embolism

A) FATAL: Fat, Air, Thrombus, Amniotic fluid, Less common causes

What is the most common origin of thrombus formation leading to PE? A) Femoral vein B) Iliac vein C) Superior vena cava D) Subclavian vein

B) Iliac vein

What does obstruction of pulmonary arteries in PE commonly lead to? A) Infarction and inflammation of the lungs and pleura B) Atherosclerotic plaque formation C) Alveolar fibrosis D) Bronchial constriction without hypoxemia

A) Infarction and inflammation of the lungs and pleura

What is a primary symptom caused by lung infarction and pleuritis in PE? A) Hemoptysis and pleuritic chest pain B) Cyanosis and dyspnea at rest C) Bradycardia and hypoventilation D) Persistent cough without pain

A) Hemoptysis and pleuritic chest pain

What does surfactant dysfunction in PE lead to? A) Bronchospasm B) Atelectasis and decreased PaO2 C) Increased A-a gradient and hypercapnia D) Reduced airway resistance

B) Atelectasis and decreased PaO2

How does mechanical vessel obstruction in PE affect gas exchange? A) Causes ventilation-perfusion mismatch and arterial hypoxemia B) Improves oxygenation by increasing ventilation C) Results in systemic vasodilation and normoxia D) Does not impact oxygen exchange significantly

A) Causes ventilation-perfusion mismatch and arterial hypoxemia

What is the primary cardiovascular effect of elevated pulmonary artery pressure (PAP) in PE? A) Increased left ventricular output B) Right ventricular pressure overload C) Decreased pulmonary vascular resistance D) Increased cardiac output

What chemicals contribute to pulmonary vasoconstriction and bronchospasm in PE? A) Thromboxane A2, serotonin, and thrombin B) Histamine and acetylcholine C) Nitric oxide and prostacyclin D) Epinephrine and cortisol

A) Thromboxane A2, serotonin, and thrombin

What is a saddle thrombus? A) A thrombus located in the iliac vein B) A blood clot that lodges at the bifurcation of the pulmonary trunk C) A thrombus causing complete obstruction of the inferior vena cava D) A clot located in the subclavian artery

B) A blood clot that lodges at the bifurcation of the pulmonary trunk

What is the most common symptom of pulmonary embolism (PE)? A) Cough with hemoptysis B) Sudden pleuritic chest pain C) Acute dyspnea D) Upper abdominal pain

C) Acute dyspnea

What is an early intraoperative sign of PE? A) Decrease in EtCO2 B) Low-grade fever C) Cough and hemoptysis D) Decreased breath sounds

A) Decrease in EtCO2

Which auscultatory finding suggests a cause other than PE? A) Split S2 B) Bilateral rales or wheezes C) Decreased breath sounds D) Dullness to percussion

B) Bilateral rales or wheezes

What clinical feature is common in less severe PE? A) Acute circulatory collapse B) Dullness to percussion and low-grade fever C) Persistent tachycardia with cyanosis D) Obstructive shock

B) Dullness to percussion and low-grade fever

What is considered a high pretest probability (PTP) of pulmonary embolism (PE) according to the modified Wells score? A) ≤ 4 B) > 4 C) 2–6 D) < 2

B) > 4

according to the modified Wells score, what percentage of patients are likely to have PE with a total score > 4? A) 6% B) 8% C) 23% D) 34%

D) 34%

What is the PERC rule used for? A) To assess low pretest probability of PE B) To calculate the Wells score C) To confirm the diagnosis of PE D) To assess post-treatment recurrence risk

A) To assess low pretest probability of PE

Which component of the Wells criteria is assigned 1 point? A) Previous PE/DVT B) Surgery or immobilization in the past 4 weeks C) Malignancy D) Tachycardia (> 100 bpm)

C) Malignancy

What is the first step in managing hemodynamically unstable patients with suspected massive PE? A) Obtain a D-dimer test B) Begin management of massive PE prior to diagnostic confirmation C) Perform a V/Q scan D) Assess pretest probability (PTP)

B) Begin management of massive PE prior to diagnostic confirmation

What diagnostic tool is recommended for rapid assessment of right ventricular (RV) dysfunction in unstable PE patients? A) Chest X-ray B) Focused cardiac ultrasound (FoCUS) or bedside echocardiogram C) CT pulmonary angiography (CTPA) D) Complete cardiac MRI

B) Focused cardiac ultrasound (FoCUS) or bedside echocardiogram

What should be done if a stable patient with intermediate PTP of PE has an elevated D-dimer? A) No further testing; consider alternative diagnoses B) Begin anticoagulation therapy immediately C) Obtain confirmatory imaging D) Repeat D-dimer in 24 hours

C) Obtain confirmatory imaging

How is PE severity assessed after it has been confirmed? A) Based solely on pretest probability (PTP) B) Using ECG, cardiac biomarkers, and imaging such as CTPA or echocardiography C) With repeated D-dimer testing D) By measuring oxygen saturation levels

B) Using ECG, cardiac biomarkers, and imaging such as CTPA or echocardiography

What is the age-adjusted D-dimer cutoff for a 70-year-old patient? A) 500 ng/mL B) 700 ng/mL C) 1000 ng/mL D) 50 ng/mL

B) 700 ng/mL

What is the most common finding on ECG in patients with PE? A) T-wave inversions or flattening B) Sinus tachycardia C) Sinus bradycardia D) Normal ECG

B) Sinus tachycardia

Which ECG finding is NOT typically associated with right heart strain in PE? A) SIQIIITIII-pattern B) New right bundle branch block C) ST elevation in aVR D) T-wave inversion in inferior leads

D) T-wave inversion in inferior leads

What does an elevated troponin level indicate in the context of PE? A) Pulmonary infarction B) Myocardial damage C) Chronic heart failure D) Complete resolution of PE

B) Myocardial damage

What echocardiographic finding is characteristic of the McConnell sign in PE? A) Hypercontractility of the mid-free RV wall B) Akinesia of the mid-free RV wall and hypercontractility of the apical wall C) Tricuspid regurgitation D) Dilatation of the left ventricle

B) Akinesia of the mid-free RV wall and hypercontractility of the apical wall

Which biomarker is used to identify RV strain in PE? A) Creatine kinase (CK) B) B-type natriuretic peptide (BNP) C) C-reactive protein (CRP) D) Lactate dehydrogenase (LDH)

B) B-type natriuretic peptide (BNP)

In which patients is thrombophilia evaluation indicated following PE? A) Patients with no history of venous thrombosis B) Older patients with recurrent DVT C) Younger patients with no or weak risk factors for PE D) Patients with elevated D-dimer

C) Younger patients with no or weak risk factors for PE

Which echocardiographic finding is associated with increased pulmonary artery systolic pressure (PASP) in PE? A) Normal tricuspid valve function B) Increased right atrial pressure C) Decreased RV contractility D) Pulmonary artery stenosis

B) Increased right atrial pressure

What is the first step in managing hypoxemic respiratory failure in massive PE? A) Start aggressive fluid resuscitation B) Optimize oxygenation with high-flow nasal cannula (HFNC) C) Begin thrombolysis immediately D) Administer vasopressors

B) Optimize oxygenation with high-flow nasal cannula (HFNC)

Why should volume overload be avoided during resuscitation in massive PE? A) It can increase the risk of pulmonary embolism recurrence. B) It can worsen impaired RV function and decrease cardiac output. C) It reduces the effectiveness of thrombolysis. D) It increases the risk of arrhythmias.

B) It can worsen impaired RV function and decrease cardiac output.

What should be done if thrombolysis is contraindicated or fails in massive PE? A) Administer a higher dose of vasopressors B) Begin aggressive fluid resuscitation C) Consult interventional radiology or surgery for embolectomy D) Switch to high-flow nasal cannula

C) Consult interventional radiology or surgery for embolectomy

Which vasopressor is commonly recommended for hemodynamic instability in massive PE? A) Epinephrine B) Norepinephrine C) Dopamine D) Milrinone

B) Norepinephrine

What is a key criterion for outpatient management of low-risk PE? A) Presence of severe RV dysfunction B) Hemodynamic stability and adequate room air oxygenation C) Requirement for opiates for pain relief D) Recent major surgery

B) Hemodynamic stability and adequate room air oxygenation

What is a contraindication to anticoagulation therapy in PE? A) Hemodynamic stability B) Severe thrombocytopenia C) Intermediate PTP of PE D) Presence of RV dysfunction

B) Severe thrombocytopenia

Which anticoagulant is preferred for patients with PE during pregnancy? A) Warfarin B) LMWH (e.g., enoxaparin) C) Rivaroxaban D) Dabigatran

B) LMWH (e.g., enoxaparin)

What is the therapeutic target INR for warfarin in long-term anticoagulation? A) 1.5–2 B) 2–3 C) 2.5–3.5 D) 3–4

B) 2–3

When is extended anticoagulation (> 3 months) recommended in PE patients? A) For provoked PE with a high risk of bleeding B) For unprovoked PE with a low to moderate risk of bleeding C) For PE secondary to a transient risk factor D) For all patients with a sPESI score of 0

B) For unprovoked PE with a low to moderate risk of bleeding

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