Oxford handbook Of Clinical Medicine

Question 0

Risk factors for Pulmonary Embolus

X6

Answer 0

Recent surgery - NB abdo/knee hip replacement 
Thrombophilia
Leg fracture
Reduced mobility/bed rest
Malignancy
Pregnancy/COC/HRT
Previous PE

Question 1

Causes of pulmonary emboli

X6

Answer 1

DVT
Right ventricular thrombus (post MI)
Septic emboli
Fat, air or fluid embolism
Neoplasm
Parasites

Question 2

Small vs large pulmonary emboli clinical presentation

Answer 2

Small can be asymptomatic

Large can be fatal

Question 3

Findings on CXR with a pulmonary embolus

X6

Answer 3

Normal 
Show  oligaemia of affected segment
Dialated pulmonary artery
Linear atelexasis
Small effusion
Wedge shaped opacities

Question 4

Finding on ECG in a pulmonary embolus

X5

Answer 4

Normal
Tachycardia 
RBBB
Right ventricular strain (inverted T in V1 to V2)
SI QIII TIII pattern

Question 5

Blood tests in a Pulmonary embolus

Answer 5

FBC,
Urea, creatinine and Nitrogen
Clotting factors
ABG - ⬇️PO2 and ⬇️PCO2

Question 6

Signs of a Pulmonary Embolism
- as seen by Doctor
X6

Answer 6

Pyrexia
Cyanosis
Tachycardia and tachypnoea
Hypotension
Raised jvp
Pleural rub / plural effusion

Question 7

Management of Pulmonary embolus

Answer 7

Anticoagulate:
Low molecular weight heparin
Start warfarin
Stop heparin when INR >2 and continue warfarin for at least 3 months
Aim for INR of 2-3
Thrombolyse a massive PE (50mg bolus of alteplase)

Question 8

How to prevent a Pulmonary Embolus

Answer 8

Give heparin to immobilized patients
Compression stockings and encourage mobilization
Consider other contraception or stop COC or HRT preop
Investigate for thrombophilia if there is a significant history