Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3(M) - Cardiology > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What is a typical presentation of a patient with a pulmonary embolism?

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What investigations would you do for a patient with pleuritic chest pain and acute SOB?

A

D-DIMER
ECG
FBC
ABG on air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for developing a PE?

A

Immobility
Long haul flights
Pregnancy
Combined oral contraceptive (oestrogen containing)
Malignancy
Recent surgery
Polycythaemia
Systemic Lupus Erythematous
Thrombophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the importance of D-dimer for investigating ?PE?

A

If D-dimer is not elevated then can rule out Pulmonary embolism

However if its elevated it does not mean its a PE can be other causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some causes of raised D-dimer?

A

Pulmonary embolism
Aortic dissection
Disseminated Intravascular Coagulation
Pneumonia
Malignancy
Pregnancy
Heart failure
Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some causes of raised D-dimer?

A

Pulmonary embolism
Aortic dissection
Disseminated Intravascular Coagulation
Pneumonia
Malignancy
Pregnancy
Heart failure
Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the best term to describe D-dimers for its diagnostics for PE?

Highly sensitive but not specific or Highly specific but not sensitive?

A

Highly sensitive but not specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What imaging methods are diagnostic for pulmonary embolism?

A

CTPA
V/Q scan

(Need to do CXR before requesting a CTPA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is considered a raised D-dimer?

A

If its more than x10 their age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are CTPAs good at identifying?

A

Large/massive pulmonary emboli that are in the main pulmonary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are V/Q scans good at identifying?

A

Smaller pulmonary emboli that aren’t in the large pulmonary arteries and are in the pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do we not just CTPA every patient with ?PE?

A

High radiation dose
Nephrotoxic contrast dye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is P02a?

How can you find this out?

A

Oxygen saturations in the arteries

Find from ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is P02A?

How do you find this out?

A

Oxygen saturation in the alveoli

P02A equation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the equation to work out P02A?
(Alveolar oxygen saturation)

A

P02A = atmospheric pressure of 20 - (pCO2)/0.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the relevance of having both PO2a and PO2A?

A

Can work out the alveolar arterial gradient

17
Q

What is the significance of being able to calculate an Aa gradient (alveolar arterial gradient)?

A

Can give an indication of impaired ventilation perfusion ratio

18
Q

What is a permissible Aa gradient?

A

Can have 1 point of Aa gradient per decade of life

24 year old can have a score of 2.4 and be fine

(Shouldn’t really be a gradient)

19
Q

Why would you lean towards doing a V/Q scan rather than a CTPA?

A

Patient has pleuritic chest pain, slightly hypoxic, slightly elevated d-dimer and relatively normal Aa

20
Q

How can you reduce a patients risk of VTEs in hospital?

A

LMWH (enoxaparin)
TED stockings
Mobilising.

21
Q

What are the classifications for Pulmonary embolisms?

A

High risk (massive)
Intermediate high risk (sub massive)
Intermediate low risk
Low risk

22
Q

What is the scoring system used to determine severity of pulmonary embolism?

A

PESI prognostic score

Pulmonary Embolism Severity Index

23
Q

Why is it always important to ask a patient if they lost consciousness when they had SOB and pleuritic chest pain?

A

Likely indicates a massive PE

24
Q

What medication do you give to a patient with ?PE?

A

Always give Anticoagulation ENOXAPARIN (LMWH) while waiting for diagnosis

If its severe want to give thrombolysis

25
Q

What is an example of a drug for thrombolysis in a patient with a massive PE?

A

Alteplase

26
Q

Why do we not give thrombolysis to every patient with a PE?

A

High risk of bleeding and high risk of death

27
Q

Who should you give thrombolysis to when they have a PE?

A

PESI class III, IV and V

When theres RV. Dysfunction

28
Q

How does 30day risk of mortality from lysis change as PESI score gets higher?

A

30 day lysis mortality Doesnt. Change with PESI score, it’s alway 1.8%

29
Q

When is thrombolysis contraindicated?

A

Active bleeding
Recent haemorrhagic stroke

30
Q

Would you thrombolyse (alteplase) a patient with an intermediate high risk PE?

A

Yes if they have either RV dysfunction or myocardial necrosis

31
Q

What are some ECG changes that might be visible in a PE patient?

A

S1Q3T3
Sinus tachycardia

Other signs of right sided heart strain
T wave inversion in V1-V3
T wave inversion II,III, avF (right ventricle)
Right axis deviation
RBBB

32
Q

What is S1Q3T3?

What does it indicate?

A

S1 = deep S wave in lead 1
Q3 = pathological Q wave in lead 3
T3 = t wave inversion in lead 3

Massive or submissive PE

33
Q

What are some heart changes that you might be able to see on CTPA?

A

R heart dilatation
Septal flattening
Tricuspid regurgitation
RV or RA thrombus

34
Q

What are some heart changes seen on Echocardiogram with PE?

A

RV enlargement
Tricuspid regurgitation
Right heart thrombus

35
Q

What are some relative contraindications for thrombolysis in patients with intermediate PESI score?

A

TIA in last 3 month
Existing anticoagulants with warfarin
Traumatic CPR

36
Q

Generally, how do you manage a PE?

A

Oxygen?
Analgesia?
Monitor for deterioration
Enoxaparin
? Thrombolysis (alteplase) if massive PE

Give long term VTE like DOACs (apixaban, rivaroxaban)
Warfarin if DOACs not suitable

37
Q

When do you not give DOACs (apixaban) to a patient as VTE prophylaxis?

A

Renal impairment
Pregnancy
Antiphospholipid syndrome

38
Q

What long term VTE can be given to a pregnant lady?

A

LMWH

39
Q

What is the first line medication given to patients as VTE prophylaxis with antiphospholipid syndrome?

A

Warfarin

Y3(M) - Cardiology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions