PEs

Question 1

Risk factors for PE

Answer 1

Known DVT 
HRT/OCP
Pregnancy
Malignancy
Immobility
Hx of DVT/PE
Thrombophilia

Question 2

Treatment of PE?

And: if renal impairment?

Follow up?

Answer 2

LMWH or fondaparinux, for at least 5 d or until INR >2 for at least 24hr

Split dose if renal impairment (may montior factor 10a levels) or increased risk of bleeding

Thrombolysis: alteplase or reteplase
Other drugs: rivaroxaban (fXa inhibitor), ? embolectomy

Bring back within a week and initiate on warfarin

Question 3

What is the Well’s score cut off (for immediate CTPA or anticoagulation therapy then CTPA)?

Geneva score = alternative, used in USA - less subjective but takes longer.

Answer 3

4 - if below this do a d-dimer first.

Clinical signs and symptoms of DVT = +3,
PE being more likely than an alternative diagnosis = +3

Question 4

What are the 3 types of pulmonary fibrosis?

Answer 4

replacement fibrosis (after damage eg. infarction, Tb, pneumonia)

focal fibrosis - coal dust, silica

diffuse parenchymal lung disease - in fibrosing alveolitis (IPF) and EAA.

Question 5

Which cells are damaged in IPF?

Answer 5

alveolar epithelial cells _> fibroblasts enter the alveoli -> excess accumulation of ECM -> scarring, thickening, wall fibrosis.

Question 6

Drugs for IPF?

Answer 6

Conservative: Oxygen, pulmonary rehab

Opiates

Cyclophosphamide
Pirfenidone - not a lot of evidence

Anti-coagulation = important, esp. if travelling

Some types can respond to steroids

Question 7

Drugs to avoid in IPF

Answer 7

Co-trimoxazole
Mycophenelate mofetil
Bosentan
Azathioprine
Prednisolone
Sildenafil
Warfarin
Ambrisentan

Question 8

Main parts of best supportive care in all IPF?

Answer 8

information and support (see recommendation 1.3.1) symptom relief
management of comorbidities
withdrawal of ineffective therapies
end of life care

Question 9

If the person (pt. with IPF) is breathless on exertion consider:

Answer 9

assessment for ambulatory oxygen therapy and long-term oxygen therapy
and/or
assessment for pulmonary rehabilitation.

Question 10

If the person (pt. with IPF) is breathless at rest consider:

Answer 10

assessment for ambulatory oxygen therapy and long-term oxygen therapy and/or
benzodiazepines and/or
opioids.

Question 11

If they have a cough what other causes are possible?

Answer 11

gastro-oesophageal reflux disease,

post-nasal drip

Question 12

Disease modifying treatment in IPF?

Answer 12

Advise the person with idiopathic pulmonary fibrosis that oral N- acetylcysteine4 is used for managing idiopathic pulmonary fibrosis, but its benefits are uncertain.

Question 13

Characteristic chest pain in a PE?

Answer 13

Pleuritic

Question 14

Offer antihypertensive drug treatment to people aged under 80 years with stage 1 hypertension who have one or more of the following:

Answer 14

- target organ damage
− established cardiovascular disease
− renal disease
− diabetes
− a 10-year cardiovascular risk equivalent to 20% or greater.

Question 15

Offer antihypertensive drug treatment to people of any age with stage … hypertension.

Answer 15

2

Question 16

If the clinic blood pressure is 140/90 mmHg or higher, what should you do?

Answer 16

Offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension.

Question 17

When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that:

Answer 17

for each blood pressure recording, two consecutive measurements are taken, at least 1 min apart and with the person seated

Question 18

Causes of upper zone fibrosis (and mnemonic)

Answer 18

Berylliosis
Radiation
Ext. allergic alveolitis
ank spond
Sarcoid (middle zone)
TB

Question 19

Causes of lower zone fibrosis

Answer 19

SLE/RA
UIP - usual int. pneumonia
NSIP - nonspecific int. pneumonia

Drugs -
MTX, Amiodarone, Nitrofurantoin, Bleomycin