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Pulmonary Embolism Flashcards

1
Q

What is Pulmonary Embolism (PE)?

A

It is when a blood clot (thrombus) becomes lodged in an artery in the lung and blocks blood flow to the lung.

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2
Q

What is the mortality rate of Pulmonary Embolism in pediatrics?

A

About 10%.

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3
Q

What is the incidence of Pulmonary Embolism in the pediatric population?

A

Unknown, but approximately 0.9 per 100,000 children per year.

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4
Q

What are the common age groups affected by Pulmonary Embolism?

A

Infants and adolescents.

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5
Q

What is the significance of central venous catheters in Pulmonary Embolism?

A

Presence of indwelling central venous line (CVL) plays a critical role in PTE development.

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6
Q

What are some acquired risk factors for Pulmonary Embolism?

A
  • Dehydration
  • Septicemia
  • Trauma
  • Malignancy
  • Nephrotic syndrome
  • Heart disease
  • Systemic lupus erythematosus
  • Shock.
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7
Q

What are some congenital pro-thrombotic risk factors in children?

A
  • Hyper-homocysteinemia
  • Factor V Leiden
  • Prothrombin G20210A mutations
  • Proteins C and S deficiency
  • Higher levels of lipoprotein A.
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8
Q

True or False: Hemoptysis is very common in children with Pulmonary Embolism.

A

False.

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9
Q

What are the most frequent symptoms of Pulmonary Embolism in children?

A
  • Dyspnea
  • Cough.
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10
Q

What does an arterial blood gas (ABG) analysis typically show in Pulmonary Embolism?

A

PO2 < 85 mmHg.

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11
Q

What is the role of D-dimer in the diagnosis of Pulmonary Embolism?

A

D-dimer is a sensitive but non-specific test; elevated levels indicate fibrin fragmentation.

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12
Q

What imaging test is considered the gold standard for diagnosing Pulmonary Embolism?

A

Pulmonary arteriography.

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13
Q

What is a common complication of Pulmonary Embolism in pediatric patients?

A

Right ventricular dysfunction.

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14
Q

Fill in the blank: The incidence of venous thrombosis in pediatric patients admitted to American hospitals has risen from 0.34% in 2001 to ______ in 2007.

A

0.50%.

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15
Q

What is the significance of echocardiography in diagnosing Pulmonary Embolism?

A

It can demonstrate indirect signs of PE such as tricuspidal regurgitation and right ventricle enlargement.

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16
Q

What are the criteria for thrombolytic therapy in Pulmonary Embolism?

A

Severe hypotension and cardiovascular instability.

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17
Q

What factors can lead to increased risk of Pulmonary Embolism in adolescents?

A
  • Use of oral contraceptives
  • Obesity (BMI > 25).
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18
Q

What is the common presentation of Pulmonary Embolism in children?

A

Unjustified tachypnea, chest pain, or shortness of breath.

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19
Q

What should clinicians consider when diagnosing Pulmonary Embolism in pediatric patients?

A

Coexistence of thrombo-embolic risk factors.

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20
Q

What does a Doppler echocardiogram estimate in Pulmonary Embolism cases?

A

Pulmonary arterial pressure and right ventricular acute failure.

21
Q

What is the importance of rapid diagnostic strategy in children for Pulmonary Embolism?

A

It should start with non-invasive tests, reserving invasive exams for inconclusive results.

22
Q

What are the main components of a thrombus?

A
  • Platelets
  • Fibrin
  • Trapped red and white blood cells.
23
Q

What is the incidence of venous thromboembolism in neonates per 100,000 births?

A

5.1 neonates per 100,000 births.

24
Q

What are vascular malformations?

25
What is sepsis?
26
What is vascular endothelial injury due to?
thrombophlebitis
27
What hormonal treatment can increase the risk of thrombus formation?
Estrogens
28
What is a thrombus composed of?
* platelets * fibrin * few trapped red and white blood cells
29
What leads to the formation of a thrombus in deep veins?
Hypercoagulability or obstruction (stasis)
30
What can happen as a thrombus propagates?
* Proximal extension * May dislodge or fragment * Embolize to the pulmonary arteries
31
What happens during pulmonary artery obstruction?
* Release of vasoactive agents (e.g., serotonin) by platelets * Increases pulmonary vascular resistance (PVR)
32
What does arterial obstruction increase?
Alveolar dead space
33
What is the effect of increased PVR on the right ventricle?
* Increases RV afterload * Tension rises in the right ventricular wall * May lead to dilatation, dysfunction, ischemia
34
What can occur with a patent foramen ovale or atrial septal defect?
Paradoxical embolism and right-to-left shunting of blood with severe hypoxemia
35
In adults, what is the most common source of pulmonary thromboembolism (PTE)?
Thrombi in the venous circulation of the legs and pelvic veins during and after pregnancy
36
What is the most common final site of PTE in children?
Segmental pulmonary arteries
37
What are the three components of Virchow's Triad that lead to thrombosis?
* Slowing of blood flow (stasis) * Changes in the vessel wall (vessel damage) * Susceptibilities arising from the blood (hypercoagulability)
38
What are common clinical features of PTE in adults and older pediatric patients?
* Sense of unease * Dyspnea * Pleuritic chest pain
39
What symptoms may infants and young children with PTE present?
* Irritability * Poor feeding * Inactivity
40
What can very large PTE lead to?
* Shock * Cyanosis * Low SpO2% * Cardiovascular collapse
41
What imaging modality is now the diagnostic imaging of choice for suspected PTE?
Multidetector computed tomography pulmonary angiography (CTPA)
42
What are the limitations of D-dimer testing?
* High negative predictive value * Low positive predictive value * Not useful for confirmation
43
What is the mainstay of treatment for hemodynamically stable patients with PTE?
Anticoagulation therapy
44
What are the common complications associated with pulmonary embolism?
* Recurrent thromboembolism * Chronic thromboembolic pulmonary hypertension * Right heart failure * Cardiogenic shock
45
What is diffuse alveolar hemorrhage (DAH)?
A rare life-threatening condition in children where bleeding originates from the pulmonary microvasculature
46
What is the classic triad of symptoms for DAH?
* Hemoptysis * Anemia * Diffuse pulmonary infiltrates
47
What is the most common primary immunodeficiency disorder (PID) in adults?
Common Variable Immunodeficiency Disorder (CVID)
48
What symptoms may accompany CVID?
* Repeated viral and bacterial infections * Granulomas * Fatigue * Poor growth * Autoimmune manifestations

Kendigs Respiratory Diseases (38 decks)

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