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Pulmonology > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

Principal imaging test for the diagnosis of Pulmonary embolism. (Harrison’s 19th edition, pp 1633)

A

Chest CT scan with contrast

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2
Q

Second line diagnostic test for Pulmonary embolism. (Harrison’s 19th edition, pp 1633)

A

Lung Scanning

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3
Q

Most common ECG abnormality in Pulmonary embolism. (Harrison’s 19th edition, pp 1633)

A

T-wave inversion in leads V1 to V4 (Due to RV strain and ischemia)

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4
Q

Most frequent ECG abnormality in pulmonary embolism. (Harrison’s 19th edition, pp 1633)

A 
Sinus tachycardia
S1Q3T3
(S1 wave in lead I
Q wave in lead III
Inverted T wave in lead III)
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5
Q

Specific but insensitive ECG finding in Pulmonary embolism. (Harrison’s 19th edition, pp 1633)

A

S1Q3T3
(S1 wave in lead I
Q wave in lead III
Inverted T wave in lead III)

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6
Q

The usual cause of death in Pulmonary embolism. (Harrison’s 19th edition, pp 1632)

A

RV failure

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7
Q

Most common gas exchange abnormality in Pulmonary embolism. (Harrison’s 19th edition, pp 1633)

A

Arterial hypoxemia

Increased alveolar-arterial O2 tension gradient

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8
Q

Pathophysiology abnormalities in pulmonary embolism. (Harrison’s 19th edition, pp 1633)

A 
Arterial hypoxemia
Increased alveolar-arterial O2 tension gradient
Increased pulmonary vascular resistance
Impaired gas exchange
Alveolar hyperventilation
Increased airway resistance
Decreased pulmonary compliance
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9
Q

High risk for of an adverse clinical outcome in Pulmonary embolism. (Harrison’s 19th edition, pp 1634)

A

Hemodynamic instability
RV dysfunction (echo)
RV enlargement (CT)
Elevation of the troponin level (microinfarction)

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10
Q

Good clinical outcome in pulmonary embolism with anticoagulation alone. (Harrison’s 19th edition, pp 1634)

A

RV function remains normal in a hemodynamically stable patient.

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11
Q

Recommended initial diagnostic modality to use in patients suspected to have deep vein thrombosis. (Harrison’s 19th edition, pp 1634)

A

Venous ultrasound

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12
Q

Primary criterion for the diagnosis of DVT. (Harrison’s 19th edition, pp 1635)

A

*Lack of vein compressibility (no wink sign)
Direct visualization of the thrombus (definite)
Manual calf compression causes augmentation of the Doppler flow pattern

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13
Q

The best known indirect sign of Pulmonary embolism on transthoracic echocardiography. (Harrison’s 19th edition, pp 1634)

A

McConnell’s sign

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14
Q

Hypokinesis of the RV free wall with normal or hyperkinetic motion of RV apex. (Harrison’s 19th edition, pp 1634)

A

McConnell’s sign

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15
Q

Focal oligemia on Chest radiograph. (Harrison’s 19th edition, pp 1633)

A

Westermark’s sign

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16
Q

Peripheral wedged-shaped density above the diaphragm on chest radiograph. (Harrison’s 19th edition, pp 1633)

A

Hampton’s hump

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17
Q

Enlarged right descending pulmonary artery on chest radiograph. (Harrison’s 19th edition, pp 1633)

A

Palla’s sign

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18
Q

Most common preventable cause of death among hospitalized patients. (Harrison’s 19th edition, pp 1631)

A

Pulmonary embolism

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19
Q

Also known as chronic venous insufficiency. (Harrison’s 19th edition, pp 1631)

A

Postthrombotic syndrome

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20
Q

Damages the venous valves of the leg and causes ankle or calf swelling and leg aching, especially after prolonged standing. (Harrison’s 19th edition, pp 1631)

A

Postthrombotic syndrome

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21
Q

Virchow’s triad. (Harrison’s 19th edition, pp 1631)

A

Inflammation
Hypercoagulability
Endothelial injury

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22
Q

Two most common autosomal dominant genetic mutations in VTE. (Harrison’s 19th edition, pp 1631)

A

Factor V leiden

Prothrombin gene mutation

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23
Q

Causes resistance to the endogenous anticoagulant, activated protein C. (Harrison’s 19th edition, pp 1631)

A

Factor V leiden

24
Q

Increases the plasma prothrombin concentration. (Harrison’s 19th edition, pp 1631)

A

Prothrombin gene mutation

25
Q

Most severe form of postthrombotic syndrome causes? (Harrison’s 19th edition, pp 1631)

A

Skin ulceration

26
Q

Most common acquired cause of thrombophilia and is associated with venous or arterial thrombosis. (Harrison’s 19th edition, pp 1631)

A

Antiphospholipid antibody syndrome

27
Q

Characterized by extensive thrombosis affecting at least half of the pulmonary vasculature. (Harrison’s 19th edition, pp 1632)

A

Massive pulmonary embolism

Accounts for 5-10%

28
Q

Hallmarks of massive pulmonary embolism. (Harrison’s 19th edition, pp 1632)

A

Dyspnea
Syncope
Hypotension
Cyanosis

29
Q

Characterized by RV dysfunction despite normal systemic arterial pressure. (Harrison’s 19th edition, pp 1632)

A

Submassive pulmonary embolism

Accounts for 20-25%

30
Q

Indicates an increased likelihood of clinical deterioration in submassive pulmonary embolism. (Harrison’s 19th edition, pp 1632)

A

Combination of right heart failure and release of cardiac biomarkers

31
Q

Constitutes about 70-75% cases of pulmonary embolism and have an excellent prognosis. (Harrison’s 19th edition, pp 1632)

A

Low risk PE

32
Q

Usually presents with erythema, tenderness and a palpable cord and patients are at risk for extension of the thrombosis to the deep venous system. (Harrison’s 19th edition, pp 1632)

A

Superficial venous thrombosis

33
Q

Most common symptom of DVT. (Harrison’s 19th edition, pp 1632)

A

Cramp or “charley horse in the lower calf that persists and intensifies over several days

34
Q

Initial diagnostic evaluation for patients with low-to-moderate likelihood of DVT or PE. (Harrison’s 19th edition, pp 1632)

A

D-dimer

35
Q

Differential diagnosis for DVT. (Harrison’s 19th edition, pp 1633)

A

Ruptured baker’s cyst
Cellulitis
Postphlebetic syndrome/venous insufficiency

36
Q

Differential diagnosis for PE. (Harrison’s 19th edition, pp 1633)

A 
Pneumonia, asthma, COPD
Congestive heart failure
Pericarditis
Pleurisy: “viral syndrome”, costochondritis, musculoskeletal discomfort
Rib fracture, pneumothorax
Acute coronary syndrome
Anxiety
37
Q

Recommended pressure and duration of the below-knee graduated compression stockings for secondary prevention for DVT. (Harrison’s 19th edition, pp 1634)

A

30-40mmHg

for 2 years after the DVT episode

38
Q

Contraidications to fibrinolysis in pulmonary embolism. (Harrison’s 19th edition, pp 1636)

A

Intracranial disease
Recent surgery
Trauma

39
Q

The only FDA-approved indication for PE fibrinolysis. (Harrison’s 19th edition, pp 1636)

A

Massive PE

40
Q

1st line inotropic agents for treatment of PE-related shock. (Harrison’s 19th edition, pp 1636)

A

Dopamine

Dobutamine

41
Q

Most common for of in-hospital prophylaxis. (Harrison’s 19th edition, pp 1636)

A

Low dose UFH

LMWH

42
Q

Duration of anticoagulation for DVT/PE. (Harrison’s 19th edition, pp 1635)

A

Provoked UE or calf – 3 months
Provoked proximal leg DVT or PE – 3 to 6 months
With cancer - indefinite
Unprovked DVT - indefinite

43
Q

Causes of provoked DVT. (Harrison’s 19th edition, pp 1635)

A

Surgery
Trauma
Estrogen
Indwelling central venous catheter or pacemaker

44
Q

Most serious adverse effect of anticoagulation. (Harrison’s 19th edition, pp 1635)

A

Hemorrhage

45
Q

Antidote for hemorrhage from Heparin or LMWH. (Harrison’s 19th edition, pp 1635)

A

Protamine sulfate

46
Q

Target INR for warfarin use. (Harrison’s 19th edition, pp 1635)

A

2.5 (range 2-3)

47
Q

Initial dose for warfarin. (Harrison’s 19th edition, pp 1635)

A

5mg

48
Q

Unfractionated heparin dosing for pulmonary embolism. (Harrison’s 19th edition, pp 1635)

A

80U/kg bolus then 18U/kg per hr

49
Q

Blood test use in assessing the anticoagulant effect of Unfractionated heparin and target range. (Harrison’s 19th edition, pp 1635)

A

Activated partial thromboplastin time (aPTT)

60-80 secs

50
Q

Usually begins in the calf and propagates proximally to the popliteal vein, femoral vein, and iliac veins. (Harrison’s 19th edition, pp 1632)

A

Lower extremity DVT

51
Q

Often precipitated by placement of pacemakers, internal cardiac defibrillators, or indwelling central venous catheters. (Harrison’s 19th edition, pp 1632)

A

Upper extremity DVT

52
Q

Variables for clinical likelihood of DVT. (Harrison’s 19th edition, pp 1632)

A

Active cancer (1)
Paralysis, paresis, or recent cast (1)
Bedridden for > 3 days; major surgery < 12 weeks (1)
Tenderness along distribution of deep veins (1)
Entire leg swelling (1)
Unilateral calf swelling > 3cm (1)
Pitting edema (1)
Collateral superficial nonvaricose veins (1)
Alternative diagnosis at least as likely as DVT (-2)

(Low < or = 0; Moderate 1-2; High >/= 3)

53
Q

Variables for clinical likelihood of PE. (Harrison’s 19th edition, pp 1632)

A

Signs and symptoms for DVT (3)
Alternative diagnosis less likely than PE (3)
Heart rate > 100 bpm (1.5)
Immobilization > 3 days; surgery within 4 weeks (1.5)
Prior PE or DVT (1.5)
Hemoptysis (1)
Cancer (1)

(high > 4)

54
Q

Web-like extracellular networks that were release and formed from neutrophils that was stimulated by the proinflamatory mediators from activated platelets microparticles. (Harrison’s 19th edition, pp 1631)

A

Neutrophil extracellular traps

55
Q

Anti Xa pentasaccharide. (Harrison’s 19th edition, pp 1635)

A

Fondaparinux

56
Q

Indications for insertion of an IVC filter. (Harrison’s 19th edition, pp 1636)

A

Active bleeding that precludes anticoagulation

Recurrent venous thrombosis despite intensive anticoagulation

57
Q

Common complication of IVC filters described as marked bilateral leg swelling. (Harrison’s 19th edition, pp 1636)

A

Caval thrombosis

Pulmonology (16 decks)

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