Pulmomary Embolism

Question 1

Pulmonary embolism

Answer 1

Thrombus usually formed in systemic veins or right heart

Question 2

main causes of pulmonary embolism

Answer 2

stasis of blood, endothelial injury, hypercoagualability

Question 3

Pathophysiology of pulmonary emboli

Answer 3

Lung tissue is ventilated but not perfused-producing intrapulmonary dead space and impaired
gas exchange- non perfused lung no longer produce surfactant- collapse, decreased cardiac
output

Question 4

clinical features of pulmonary emboli

Answer 4

sudden onset unexplained dyspnea, pleuritic chest pain and haemoptysis ,
pleural rub, exudative pleural effusion +- fever

Question 5

clinical features of a massive plumonary embolism

Answer 5

tachycardia , hypotension, Increased JVP with prominent A wave, RV heave, gallop
rhythm, widely split S2

Question 6

the test done to exclude Pulmonary embolism

Answer 6

D dimer. If the levels are undetectable can exclude PE

Question 7

Mx of PE

Answer 7

High flow oxygen
IV Fluids
Inotropes
Fibrinolytic therapy
Surgical embolectomy

Question 8

Gold standard test for PE

Answer 8

CT pulmonary angiogram

Question 9

S1 Q3 T3?

Answer 9

Lead I deep S wave
Lead III Q wave and T inversion

Question 10

Main Rx principle in PE

Answer 10

Is the patient hemodynamically stable?
Yes- give heparin ( Unfractionated or LMWH)
No ( reduced BP) - Lyse the ( streptokinase or RT-PA)

Question 11

Hypotension and increased JVP DDs

Answer 11

LV infarction
Pneumothorax
Large PE

Question 12

Prevention steps of PE

Answer 12

LMWH
IVC filters- to prevent thrombus from going to lung, put into inf vena cava