Pulmonary embolism

Question 1

What is the first line treatment for patient with a PE who is haemodynamically unstable?

Answer 1

Thrombolysis e.g. alteplase

Question 2

What is the first line management for a provoked PE?

Answer 2

DOAC for 3 months.

Question 3

What is the first line management for an unprovoked PE?

Answer 3

DOAC for 6 months.

Question 4

What is the most common ECG finding in pulmonary embolism?

Answer 4

Sinus tachycardia

Question 5

Wells score of >4 (PE likely). What test should you arrange?

Answer 5

CTPA

Question 6

Wells score <4 (PE unlikely). What test should you arrange?

Answer 6

D-dimer (if this is positive then arrange CTPA). If negative then PE is unlikely.

Question 7

What is the investigation of choice for a suspected PE in a patient with renal impairment?

Answer 7

V/Q scan (doesn’t require the use of contrast unlike CTPA).

Question 8

What other ECG changes apart from sinus tachycardia might be seen with PE?

Answer 8

A large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III - ‘S1Q3T3’.
Right bundle branch block and right axis deviation.

Question 9

What is a saddle PE?

Answer 9

An embolus lodged at the bifurcation of the pulmonary arteries.

Question 10

List the causes of pleuritic chest pain

Answer 10

Pneumonia, PE, pneumothorax, mesothelioma.
MSK conditions e.g. costochondritis can mimic pleuritic chest pain.

Question 11

If the CTPA is negative in a suspected PE, what other investigation should be considered?

Answer 11

Proximal leg vein Doppler ultrasound.

Question 12

In a PE, will there be a deficit in ventilation or perfusion?

Answer 12

Perfusion due to thrombus blocking blood flow to lungs.