Pulmonary embolism

Question 1

Which diagnostic imaging study is considered the gold standard for diagnosing pulmonary embolism?

Answer 1

Chest CT with Pulmonary angiography.

Question 2

Which blood test can be used as an initial step in the evaluation of a suspected pulmonary embolism?

Answer 2

D-dimer.

Question 3

What is the most common early complication of a pulmonary embolism?

Answer 3

Recurrent embolization.

Question 4

What is a common symptom of pulmonary embolism?

Answer 4

Sudden onset of shortness of breath.

Question 5

Which medication is primarily used as the initial treatment for pulmonary embolism?

Answer 5

Anticoagulants.

Question 6

What is the name of the score used to clinically assess the probability of pulmonary embolism?

Answer 6

The Wells Score.

Question 7

What is the role of the D-dimer test in the context of pulmonary embolism?

Answer 7

To rule out pulmonary embolism in patients with a low probability, as it detects fibrin degradation products.

Question 8

Which type of ultrasound is typically used to detect DVT in patients suspected of having pulmonary embolism?

Answer 8

Doppler ultrasound.

Question 9

What complication can arise from untreated pulmonary embolism?

Answer 9

Pulmonary hypertension (group III PH, s.CTEPH - chronic thromboembolic pulmonary hypertension)

Question 10

What is the recommended treatment for pulmonary embolism causing hemodynamic instability?

Answer 10

Thrombolytic therapy.

Question 11

What blood test is routinely performed to monitor the therapeutic level of warfarin?

Answer 11

INR (International Normalized Ratio).

Question 12

Which blood test is essential for monitoring the therapeutic effect of unfractionated heparin?

Answer 12

aPTT (activated partial thromboplastin time).

Question 13

What is the target INR range for a patient on warfarin therapy for pulmonary embolism?

Answer 13

2.0 to 3.0.

Question 14

Which blood test is used to monitor kidney function before starting low molecular weight heparin for pulmonary embolism treatment?

Answer 14

Creatinine clearance.

Question 15

What complication related to heparin therapy must be monitored by regular blood tests?

Answer 15

Heparin-induced thrombocytopenia (HIT).

Question 16

What baseline blood tests are recommended before initiating anticoagulant therapy for pulmonary embolism?

Answer 16

Liver function tests, renal function tests, and a complete blood count.

Question 17

What is a major surgical risk factor for pulmonary embolism?

Answer 17

Hip or knee replacement surgery.

Question 18

How does pregnancy influence the risk of developing pulmonary embolism?

Answer 18

Pregnancy increases the risk of PE due to higher levels of estrogen and reduced blood flow from the legs to the pelvis.

Question 19

How does the use of combined oral contraceptives influence the risk of PE?

Answer 19

They increase the risk due to higher estrogen levels, which can lead to blood clot formation.

Question 20

What impact does a previous venous thromboembolism (VTE) have on the risk of pulmonary embolism?

Answer 20

A previous VTE significantly increases the risk of subsequent PE.

Question 21

What role does heart failure play in increasing the risk of pulmonary embolism?

Answer 21

Heart failure can lead to blood pooling and stasis, particularly in the lower limbs, enhancing the risk of clot formation.

Question 22

How does long-term immobility contribute to the risk of pulmonary embolism?

Answer 22

It leads to stasis of blood in the lower extremities, increasing the likelihood of clot formation.

Question 23

What are Direct Oral Anticoagulants (DOACs) commonly used for treating acute pulmonary embolism?

Answer 23

Rivaroxaban, Apixaban, Edoxaban, and Dabigatran.

Question 24

How does the treatment approach with DOACs differ from traditional warfarin therapy in pulmonary embolism?

Answer 24

DOACs do not require routine blood monitoring and have fewer dietary restrictions compared to warfarin.

Question 25

What is the initial treatment for a hemodynamically stable patient diagnosed with pulmonary embolism?

Answer 25

Anticoagulation therapy, typically starting with parenteral agents like heparin or using DOACs directly.

Question 26

In the treatment of pulmonary embolism, when is an inferior vena cava (IVC) filter indicated?

Answer 26

When anticoagulation is contraindicated or has failed, and the patient is at high risk for further emboli.

Question 27

What is the recommended duration of anticoagulation therapy for a first-time pulmonary embolism?

Answer 27

At least 3 to 6 months, with a reassessment afterward to consider the risk of recurrence versus the risk of bleeding.