Pulmonary embolism

Question 1

Three risk factors for PE?

Answer 1

Immobility
Recent surgery
Pregnancy
Hormone therapy with oestrogen
Malignancy
SLE
Prev hx DVT/PE

Question 2

What is the prophylactic management of VTE?

Answer 2

LMWH e.g. enoxaparin

Question 3

Two contraindications to VTE prophylaxis?

Answer 3

active bleeding

existing anticoag e.g. warfarin or NOAC

Question 4

Three symptoms of PE?

Answer 4

dyspnoea
pleuritic chest pain
haemoptysis
syncope

Question 5

Three signs of PE?

Answer 5

Tachyopnoea
Fever
Cyanosis
Tachycardia
Hypotension
Evidence of DVT

Question 6

Which scoring system is used in PE?

Answer 6

Well’s score

Question 7

What is the function of Well’s score?

Answer 7

predicts risk of patient actually presenting with DVT or PE

Question 8

If Well’s score result is unlikely, how should you proceed?

Answer 8

D-dimer

Question 9

If well’s score if likely, how should you proceed with patient management?

Answer 9

CTPA

Question 10

Name two other conditions in which D dimer is raised

Answer 10

Pneumonia
malignancy
heart failure
surgery
pregnancy

Question 11

Which electrolyte disorder can arise from PE?

Answer 11

respiratory alkalosis

Question 12

PE and hyperventilation syndrome both can cause respiratory alkalosis. How can you distinguish between the two?

Answer 12

PE- low pO2

Hyperventilation- high pO2

Question 13

Three immediate aspects of management for non-massive PE?

Answer 13

15L trauma mask O2
Analgesia
LMWH
IV fluids if hypotensive still

Question 14

Two examples of LMWH?

Answer 14

dalteparin and enoxaparin

Question 15

What is the management of massive PE?

Answer 15

thrombolysis- alteplase, streptokinase

Question 16

Two ways in which thrombolysis can be performed?

Answer 16

IV via peripheral cannula

Catheter-directed thrombolysis- directly into pulmonary arteries

Question 17

Three options for long term management of PE/DVT?

Answer 17

LMWH, NOAC, warfarin

Question 18

Which anticoagulant is first line in pregnancy and cancer?

Answer 18

LMWH

Question 19

What is the INR target in long-term management VTE?

Answer 19

2-3

Question 20

Aside from CTPA, what is another imaging investigation for PE?

Answer 20

Ventilation-perfusion scan

Question 21

In which patients is V/Q scan indicated when investigation PE?

Answer 21

renal impairment
contrast allergy
risk from radiation e.g. pregnancy

Question 22

Three advantages of NOAC over warfarin

Answer 22

fixed dose, no monitoring, few drug-drug interactions

Question 23

For how long should acute PE patients be on anticoagulants for?

Answer 23

min 3 months

Question 24

For how long are provoked PE’s treated for?

Answer 24

3 months

Question 25

When would a patient for PE be treated for 6 months?

Answer 25

active cancer and unprovoked confirmed proximal DVT or PE.