PE + DVT

Question 1

What is sensitivity?

Answer 1

Ability to identify positive results in people with condition
Sensitivity rules out

Question 2

What is specificity?

Answer 2

Ability to identify negative results in people that don’t have condition
Test rules in

Question 3

What is the definitive diagnosis for PE?

Answer 3

CTPA or V/Q scan

Need CXR before both

Question 4

What else is a D dimer positive in?

Answer 4

Pregnancy
After major surgery
After trauma
After infection

Question 5

Is a D dimer sensitive or specific?

Answer 5

Sensitive - good to rule out PE

Poor specificity - other things raise it

Question 6

What is the rule of 15 + syncope?

Answer 6

15% if life threatening conditions present with syncope:
PE
Aortic dissection 
ACS
Ectopic 
Ruptured AAA
SAH

Question 7

Investigations for ?DVT

Answer 7

Use 2 level DVT Wells scoreScore >2, DVT likely - Give LMWH, proximal leg vein USS within 4 hrs. If negative, D dimer.Score <2 = unlikely. D dimer + if positive arrange venous USS

Question 8

Management of confirmed DVT

Answer 8

LMWH or fondaparinuxGive warfarin within 24 hrsContinue LMWH for 5 days until INR is 2Continue warfarin for 3 months then assessIn unprovoked DVT, offer cancer screen (exam, CXR, bloods, urine)§

Question 9

What signs do you see on CXR of PE?

Answer 9

Usually nothing
Westermarks sign = abrupt tapering of vessel
Hampton’s hump = wedge shaped infiltrate that abuts the pleura