PTE

Question 1

Define pulmonary embolism [1]

Answer 1

Obstruction of the pulmonary arteries by clot from the veins of the systemic circulation usually arising from DVT in pelvic or leg veins

Question 2

What are the risk factors for pulmonary embolism? [7]

Answer 2

1. Surgery < 12 weeks previously
2. Immobilisation > 3 days in previous 4 weeks
3. Previous DVT/PTE or positive family history
4. Lower limb fracture
5. Pregnancy or postpartum
6. Long distance travel
7. Oestrogen-containing OCP use

Question 3

What are the signs [5] and symptoms [5] of pulmonary embolism?

Answer 3

• Symptoms
  
  • pleuritic chest pain
  • dyspnoea
  • cough
  • haemoptysis
  • syncope
• Signs
  
  • tachypnoea (fast breathing)
  • crackles
  • tachycardia (>100bpm)
  • fever (>37.8°C)
  • signs of peripheral DVT

Question 4

What investigations would you order for a patient with suspected pulmonary embolism? [6]

Answer 4

1. D-dimer
   
   • raised in PTE (> 230 mg/L)
2. Arterial blood gases
   
   • usually respiratory alkalosis with ↓PaCO₂
   • Hypoxaemia is only seen with large PTE
3. Troponin level
4. ECG
   
   • Sinus tachycardia,
   • Atrial fibrillation
   • RV strain, new RBBB
5. Echocardiogram
   
   • to look for RV strain
6. Radiology
   
   • CXR,
   • CT-pulmonary angiogram (CT PA),
   • V/Q scan

Question 5

Name this imaging test and describe what it shows [2]

Answer 5

1. ventilation perfusion scan
2. it shows that ventilation of the lungs is fine but there are massive gaps showing a lack of perfusion in those areas

Question 6

What and where is the abnormality in the following CT scan? [1]

Answer 6

clot in the left main bronchus

Question 7

What are the treatment options for pulmonary embolism?

1. standard immediate [2]
2. for massive PE? [3]
3. for mild PE? [1]

Answer 7

1. Oxygen
2. Fluids
3. Massive PE
   
   • IV un-fractioned heparin
   • Subcutaneous low-molecular weight heparin (LMWH)
   • Warfarin
4. Mild PE
   
   • Warfarin