OnlineMedEd: Pulmonology - "Pulmonary Embolism" Flashcards

1
Q

Review Virchow’s triad.

A
  • Stasis
  • Endothelial injury (e.g., surgery, catheter insertion, smoking)
  • Hypercoagulable state (e.g., estrogen use)
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2
Q

What is Hamand’s sign?

A

Calf tenderness

This has been demonstrated to be a poor predictor of DVT.

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3
Q

Why does pulmonary embolism cause pleuritic chest pain?

A

The clot induces a wedge-shaped infarction of the lung which causes necrosis of the visceral pleura. Breathing rubs the infarcted pleura.

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4
Q

____________ is diffusion limited.

____________ is perfusion limited.

A

Oxygen

CO2

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5
Q

How do pulmonary embolisms cause diffusion defects?

A

Platelet-derived factors cause inflammation around the pulmonary vessels that leads to an increased distance from the alveoli to the blood.

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6
Q

The ____________ criteria are used to calculate the probability of a PE.

A

Well’s

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7
Q

Why should you only get a D-dimer when the pre-test probability is high (greater than 4 on the Well’s criteria)?

A

D-dimers can be elevated due to many other things –inflammatory states, illness, etc.

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8
Q

The best scan for evaluating pulmonary embolisms is _________________.

A

CT scan with contrast

Note: pulmonary angiogram is actually better technically, but because it is invasive and takes longer you don’t actually do it in practice.

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9
Q

In the acute treatment of pulmonary embolisms, ______________ should be given.

A

heparin (or enoxeparin) and then warfarin

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10
Q

_________ should only be given in life-threatening PEs (indicated by hypotension).

A

tPA

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