PE

Question 1

state 4 Embolism causes

Answer 1

• mycotic (infection)
• air
• fat
• Thrombotic (usually from DVT)

Question 2

Mycotic def
one classic source
may present with 3/5

Fat emboli
usual cause
and this leads to…

Air emboli
usual cause
but the lungs… to combat

Answer 2

mycotic-> transfer of infected pathogens to lungs from distant source
- non-sterile equipment with IV injection, iatrogenic
present with:
- bacterial endocarditis
- splinter haemorrhages
- janeway lesions or oslers nodes
- roth spots

fat-> from long bne fracture, extra fat marrow produced whoch travels to lungs
leads to multi focal inflam.

Air emboli-> air caught in cannulation
the lungs combat as it i a FILTER

Question 3

Thrombus
explain Vichow’s triad

-
-

-

3)

• primary
• secondary

Answer 3

1) Endothelial Injury/ Disruption
- promotion of platelet agg + adhesion
- pro-coag factors (Tissue factor)
- atherosclerosis

2) Venous Stasis
- prevents the dilution of clotting factors
- allows platelets to come in contact with endothelium

3) Hypercoagulatable State (absence of clotting inhibition)
- primary -> congenital lack of antithrombin
- secondary -> inc. conc. of fibrinogen + prothrombin

Question 4

Mechanism of PE (DVT already travelled to pulmonary arteries) 
1
2
3
4
5
6 potential...
7

Answer 4

1) lung tissue ventilated but not perfused
2) intra-pulmonary dead space inc. so impaired gas exch
3) dec. cross-section area of pul. arterial bed
4) inc. pulmonry pressure
5) dec. CO
6) -> pulmonary circ. collapse, RV fibrillation …. cardiac arrest
7) alveolar collapse due to local inflammation, dec. in surfactant production worsening hypoxia

Question 5

D-dimer blood test
what is D-dimer?
what is a +ve test and what would it show?
number…

Wells Scoring System

• Clinical…. (_)
• Alternative diagnosis (_)
• …. > (_)
• (_)
• P
• Haemoptysis (_)
• Active … (_)

if greater than… if less than or equal to then not

Answer 5

D-dimer-> a product of fibrinolysis, usually v.low
+ve if significantly high then it shows a clotting episode has recently occurred (< 500ng/l)

Wells Scoring System

• Clinical S + S (3)
• Alternative diagnosis (3)
• HR > 100 (1.5)
• Immobile for more than 3 days or surgery 4 weeks (1)
• Previous DVT or PE (1)
• Haemoptysis (1)
• Active cancer (1)

greater then 4 means likely

Question 6

What is used and score given to assess severity risk
4/7

v low risk is <
low risk is

Answer 6

PESI -> Pulmonary Embolism Severity Index

• age
• sex
• cancer
• HF
• pulse >110bpm
• RR > 33/min
• O2 sats < 90%
• altered mental state

v low < 1.6%
low < 3.6%

Question 7

3 scans used to try diagnose PE

1) standard and it assess’….
2) ___ aka what does it show?
3) ___ aka P___ III, worse than 2) because? and also takes…..
4) Echocardiogram -> what is this? what can you see? (2)
5) CPTA -> 2/3 +ve’s!! 1 -Ve

treatment for PE
initially -> (2)
then…. but look at!

Answer 7

1) Doppler ultrasound -> looks at compressability of veins
2) V/Q scan (pul. ventilation and perfusion scan) and it shows blood flwing through the lungs to RULE OUT PE
3) MRI scan aka PIOPED III, worse than 2) because worse accuracy and also takes a long scan time so not good for v.ill
4) Echocardiogram -> ultrasound heart and sees haemodynamic effect + RV strain
5) CPTA ->
+ve’s!!
- much higher sensitivity and specificity
- can give contrast
- can TREAT ON SITE! (warfarin)

• Ve’s
• too available and presentation often unclear

treatment

• LMWH then Warfarin
• NOAC but check bleeding risk

Question 8

Submassive PE
cardiac biomarkers include (3)

Massive PE
3 things occuring

CTEPH stands for and what is it?

Answer 8

cardiac biomarkers
1) BNP 2) N terminal BNP (NpBNP) 3) Troponin assesy

Massive PE
haemodynamic compromise
systemic + pulmonary arterial hypetension
RV dysfunction

CTEPH -> Chronic Thromboembolitic Pulmonary Hypertension
pulmonary hypertension caused by blood clots