Pulmonary Embolism

Question 1

What is a blood clot that forms and remains in a vein called?

Answer 1

A thrombus

Question 2

What is a blood clot that becomes dislodged and travels to another part of the body?

Answer 2

Embolus

Question 3

What can happen if an embolus significantly disrupts pulmonary blood flow?

Answer 3

Pulmonary infarction develops and causes atelectasis, consolidation and tissue necrosis

Question 4

Although the precise mechanism is not known, how does an embolism cause bronchoconstriction?

Answer 4

The embolism causes the release of cellular mediators such as seratonin, histamine, and prostaglandins from platelets

Question 5

What is a saddle embolus?

Answer 5

A fatal condition in which a large embolus is lodged in the bifurcation of the pulmonary artery

Question 6

What are the pathologic and structural changes of the lungs associated with pulmonary embolism?

Answer 6

Blockage of the pulmonary vascular system, pulmonary infarction, alveolar atelectasis, alveolar consolidation, bronchial smooth muscle constriction

Question 7

Approximately, how many cases of pulmonary embolism is reported each year in the US?

Answer 7

650,000

Question 8

About how many Americans die annually from Pulmonary Embolism?

Answer 8

50,000

Question 9

What are some possible sources of pulmonary embolism?

Answer 9

Fat, air, amniotic fluid, bone marrow, tumor fragments

Question 10

Where do most pulmonary blood clots originate or break from?

Answer 10

Sites of Deep Venous Thrombosus (DVT); lower parts of the body

Question 11

What is Virchow’s triad?

Answer 11

Three primary factors associated with the formation of DVT; venous stasis, hypercoagulation, and injury to the endothelial cells that line the vessels

Question 12

What are some diagnostic procedures used to diagnose a suspected pulmonary embolism?

Answer 12

Chest X-Ray Film, Spiral (Helical) Computed Tomography Scan, Electrocardiogram, Ventilation-Perfusion Scan, and Pulmonary Angiogram

Question 13

Which diagnostic procedure can be used to rule out conditions that mimic PE?

Answer 13

Chest x ray film

Question 14

Which diagnostic procedure can provide a three-dimensional image of any abnormalities with a high degree of accuracy?

Answer 14

Spiral (helical) computed tomography scan

Question 15

Which diagnostic procedure is is excellent for ruling out pericarditis and myocardial infarction?

Answer 15

Electrocardiogram

Question 16

Which diagnostic procedure often raises more questions than it answers?

Answer 16

Ventilation-perfusion scan

Question 17

Which diagnostic procedure is extremely accurate for diagnosis of PE, but is invasive, time consuming and requires a high degree of skill to administer?

Answer 17

Pulmonary angiogram

Question 18

Inactivity, CHF, varicose veins, and thrombophlebitis are examples of what type of risk factors for PE?

Answer 18

Venous stasis

Question 19

What are some common surgical procedures associated with PE?

Answer 19

Hip, pelvic, knee, and certain obstetric or gynecologic procedures

Question 20

Bone fractures, extensive injury to soft tissue, postoperative or postpartum states, extensive honor abdominal operations, and phlegmasia alba dolens puerperarum are examples of what kind of risk factors associated with PE?

Answer 20

Trauma

Question 21

What are some hypercoagulation disorders commonly associated with PE?

Answer 21

Oral contraceptives, polycythemia, and multiple myeloma

Question 22

What are some tests used to detect venous thromboembolism (VTE)?

Answer 22

D-diner blood test, duplex venous ultrasonography, extremity venography, magnetic resonance imaging, magnetic resonance angiography, and blood tests

Question 23

Which test is used to check for an increased level of the protein fibrinogen?

Answer 23

D-diner blood test

Question 24

What values for results in the d-dimer blood test are considered positive?

Answer 24

D-dimer values higher than 500 ng/mL

Question 25

Which test uses high-frequency sound waves to detect blood clots in the thigh veins?

Answer 25

Duplex venous ultrasonography

Question 26

Which test is used to differentiate between blood, thromboemboli, and tumor emboli in patients with malignancy?

Answer 26

Magnetic resonance angiography

Question 27

Why are fast-acting anticoagulants used as general management of PE?

Answer 27

They are given to prevent existing blood clots from growing and to prevent the formation of new ones

Question 28

Enoxaparin, dalteparin, and tinzaparin are examples of what kind of drug?

Answer 28

Low-molecular-weight heparin

Question 29

What other drug is typically given following fast-acting anticoagulants such as heparin?

Answer 29

Warfarin (Coumadin, panwarfarin)

Question 30

What do fibrinolytic agents (or thrombokytic agents) do?

Answer 30

Dissolve blood clots

Question 31

Streptokinase, urokinase, alteplase and reteplase medications examples of?

Answer 31

Thrombolytic agents

Question 32

What are some preventative measures suggested for patients at high risk of thromboembolic diseases?

Answer 32

Walking, exercise while seated, drink fluids, and graduated compression stockings

Question 33

How may vasoconstriction be induced in PE?

Answer 33

Humoral agents and alveolar hypoxia

Question 34

How does the release of humoral agents cause vasoconstriction?

Answer 34

These agents induce smooth muscle constriction of the tracheobronchial tree and the pulmonary vascular system, reducing cross-sectional area

Question 35

How does alveolar hypoxia cause vasoconstriction in PE?

Answer 35

Humoral agents causes bronchoconstriction, and V/Q ratio and the PaO2 decline. Pulmonary Vasoconstriction is the compensatory mechanism.