Pulmonary embolism

Question 1

Rarer causes of a pulmonary embolism (3)

Answer 1

Septic emboli from endocarditis
Right ventricular thrombus after MI
Fat/fluid/air embolism

Question 2

Risk factors for PE (5)

Answer 2

Recent surgery
Thrombophilia e.g. APS
Malignancy
Reduced mobility
Pregnancy/postpartum/Pill/HRT

Question 3

Symptoms of PE (3)

Answer 3

Acute SOB
Pleuritic chest pain
Haemoptysis

Question 4

Signs of PE (5)

Answer 4

Tachypnoea
Tachycardia
Raised JVP
Pleural rub
Leg swelling (DVT)

Question 5

ECG signs of PE (4)

Answer 5

Right bundle branch block
Tachycardia
Inverted T in V1-V4 (right heart strain)
S1 Q3 T3

Question 6

What is the S1 Q3 T3 pattern? (3)

Answer 6

Deep S waves in I
Pathological Q waves in III
Inverted T waves in III

Question 7

How is the D-dimer test interpreted?

Answer 7

Negative test excludes PE, but positive test does not confirm it

Question 8

What is first-line imaging for PE?

Answer 8

CTPA

Question 9

Management of a large pulmonary embolism (5)

Answer 9

Oxygen 100%
Morphine 10mg IV + anti-emetic
Consider thrombolysis e.g. with alteplase
Heparin + warfarin for 5 days
Warfarin for at least 3 months (INR aim 2.5)

Question 10

Prevention of PE (3)

Answer 10

TED stockings
Early post-op mobilization
LMWH prophylaxis (fragmin)

Question 11

When is thrombolysis indicated for massive PE?

Answer 11

Circulatory failure (i.e. hypotension)