Pulmonary Embolism

Question 1

where does massive PE occur

Answer 1

near centre of lung

Question 2

do PE symptoms come on suddenly or gradually

Answer 2

suddenly

Question 3

symptoms of small PE

Answer 3

breathlessness
pleuritic chest pain
haemoptysis
fever
tachycardia

could be asymptomatic

Question 4

symptoms of massive PE or multiple emboli

Answer 4

severe breathlessness
central chest pain
feeling faint/collapse
cardiac arrest

Question 5

what score assesses risk of PE

Answer 5

Well’s score

Question 6

what 8 things does Well’s score incorporate

Answer 6

clinical features of DVT
tachycardia
immobility
surgery
previous DVT or PE
haemoptysis
recent cancer treatment
alternative diagnoses less likely

Question 7

how can ultrasound be used in PE diagnosis

Answer 7

can look for DVT in leg

Question 8

what is concluded if DVT found

Answer 8

that PE is cause of breathlessness or pain

treatment for DVT and PE is begun

Question 9

what happens if DVT is not found on ultrasound

Answer 9

further investigations are needed

Question 10

what does the d-dimer test detect

Answer 10

breakdown products of a blood clot

Question 11

how is d-dimer interpreted

Answer 11

the higher the level, the more likely there is a blood clot in your veins
but can be positive in lots of situations so doesn’t definitively say it’s a PE
a negative result can rule out PE

Question 12

when might d-dimer be high

Answer 12

surgery
pregnancy
PE

Question 13

what investigation can be done for those with massive PE and why

Answer 13

echocardiogram
because massive puts massive strain on right side of the heart

Question 14

isotope scan aka

Answer 14

ventilation/perfusion (V/Q) scan

Question 15

treatment for PE

Answer 15

anticoagulant
oxygen

Question 16

when is anticoagulation therapy started

Answer 16

as soon as PE is suspected

Question 17

what anticoagulant therapy is used for PE

Answer 17

apixaban or rivaroxaban

or low molecular weight heparin for 5 days, followed by dabigatran or edoxaban tablets
if not suitable

Question 18

which patients are given heparin

Answer 18

those at high risk of PE
those with medical conditions e.g. CKD

Question 19

how long are anticoagulants continued

Answer 19

3 months normally
sometimes longer

Question 20

how long postnatally is PE risk increased

Answer 20

6 weeks

Question 21

treatment for PE in pregnancy

Answer 21

heparin
(not warfarin as can cause birth defects)

Question 22

can breastfeeding mothers use warfarin

Answer 22

yes

Question 23

prevention of PE

Answer 23

assessed for DVT before surgery
prophylactic heparin
treatment continued for 3 months after to prevent second