PE + pulmonary blood flow

Question 1

What is a pulmonary embolism?

Answer 1

obstruction in pulmonary arterial tree

Question 2

What is virchow’s triad?

Answer 2

Vessel wall damage
Venous stasis
Hypercoagulability

Question 3

Risk factors for DVT

Answer 3

Surgery+reduced mobility
Pregnancy
Malignancy
HRT/contraceptive pill
Long distance sedentary travel

Question 4

Symptoms of PE?

Answer 4

Dyspnoea, pleuritic chest pain, cough, haemoptysis, syncope, DVT, tachypnoea, tachycardia,

Question 5

How does the heart sound in PE?

Answer 5

Gallop - widely split second heart sound

Question 6

Signs of PE?

Answer 6

Raised JVP
Pleural rub
Hypotension

Question 7

What do you do if you suspect PE?

Answer 7

Calculate WELLS score

Question 8

What is WELLS score

Answer 8

Assessment of the clinical probability of venous thromboembolism

Question 9

A WELLS score <4

Answer 9

D-dimer

Question 10

A WELLS score >4

Answer 10

CTPA

Question 11

Who can’t have CTPA? what do they get instead?

Answer 11

Kidney failure or contrast allergy, V/Q spect

Question 12

Unprovoked PE?

Answer 12

Malignancy - do physical examination, CXR, blood tests, urinalysis

Question 13

ECG in PE?

Answer 13

S1, Q3, T3 - deep S waves, Q waves and inverted T waves

Question 14

Initial resuscitation for PE?

Answer 14

Oxygen
IV access
Analgesia
LMWH
If unstable or massive PE give alteplase

Question 15

Who can’t have LMWH?

Answer 15

Renal impairment

Increased bleeding risk or harm-dynamically unstable

Question 16

Continued PE management?

Answer 16

Anti-coagulate for 3 months - longer for unprovoked PE

Question 17

What is a massive pulmonary embolism?

Answer 17

Clinically compromised - large clot burden, elevated lactate, BNP and troponin, haemodynamically unstable

Question 18

What is a pleural effusion?

Answer 18

Excess fluid in pleural space

Question 19

Difference between exudative and transudative?

Answer 19

Exudative protein rich + LDH rich

Transudative not

Question 20

Causes of exudative pleural effusion?

Answer 20

Pneumonia
Malignancy
Tuberculosis
Pulmonary infarction (massive PE)
Autoimmune disease
Pancreatitis
Yellow nail syndrome
Drugs

Question 21

Causes of transudative pleural effusion?

Answer 21

Left ventricular failure
Hepatic failure
Nephrotic syndrome
Peritoneal dialysis
Hypoalbuminemia
Pulmonary embolism
Hypothyroidism
Ovarian hyperstimulation
Constrictive pericarditis
SVC obstruction

Question 22

Criteria for exudative effusion?

Answer 22

Pleural protein:serum protein >0.5

Pleural LDH:serum LDH >0.6

Question 23

Signs of pleural effusion?

Answer 23

Absent breath sounds
Dull to percussion
Decreased tactile fremitus
Decreased vocal resonance