Pulmonary Embolism Flashcards
Principal imaging test for the diagnosis of Pulmonary embolism. (Harrison’s 19th edition, pp 1633)
Chest CT scan with contrast
Second line diagnostic test for Pulmonary embolism. (Harrison’s 19th edition, pp 1633)
Lung Scanning
Most common ECG abnormality in Pulmonary embolism. (Harrison’s 19th edition, pp 1633)
T-wave inversion in leads V1 to V4 (Due to RV strain and ischemia)
Most frequent ECG abnormality in pulmonary embolism. (Harrison’s 19th edition, pp 1633)
Sinus tachycardia S1Q3T3 (S1 wave in lead I Q wave in lead III Inverted T wave in lead III)
Specific but insensitive ECG finding in Pulmonary embolism. (Harrison’s 19th edition, pp 1633)
S1Q3T3
(S1 wave in lead I
Q wave in lead III
Inverted T wave in lead III)
The usual cause of death in Pulmonary embolism. (Harrison’s 19th edition, pp 1632)
RV failure
Most common gas exchange abnormality in Pulmonary embolism. (Harrison’s 19th edition, pp 1633)
Arterial hypoxemia
Increased alveolar-arterial O2 tension gradient
Pathophysiology abnormalities in pulmonary embolism. (Harrison’s 19th edition, pp 1633)
Arterial hypoxemia Increased alveolar-arterial O2 tension gradient Increased pulmonary vascular resistance Impaired gas exchange Alveolar hyperventilation Increased airway resistance Decreased pulmonary compliance
High risk for of an adverse clinical outcome in Pulmonary embolism. (Harrison’s 19th edition, pp 1634)
Hemodynamic instability
RV dysfunction (echo)
RV enlargement (CT)
Elevation of the troponin level (microinfarction)
Good clinical outcome in pulmonary embolism with anticoagulation alone. (Harrison’s 19th edition, pp 1634)
RV function remains normal in a hemodynamically stable patient.
Recommended initial diagnostic modality to use in patients suspected to have deep vein thrombosis. (Harrison’s 19th edition, pp 1634)
Venous ultrasound
Primary criterion for the diagnosis of DVT. (Harrison’s 19th edition, pp 1635)
*Lack of vein compressibility (no wink sign)
Direct visualization of the thrombus (definite)
Manual calf compression causes augmentation of the Doppler flow pattern
The best known indirect sign of Pulmonary embolism on transthoracic echocardiography. (Harrison’s 19th edition, pp 1634)
McConnell’s sign
Hypokinesis of the RV free wall with normal or hyperkinetic motion of RV apex. (Harrison’s 19th edition, pp 1634)
McConnell’s sign
Focal oligemia on Chest radiograph. (Harrison’s 19th edition, pp 1633)
Westermark’s sign
Peripheral wedged-shaped density above the diaphragm on chest radiograph. (Harrison’s 19th edition, pp 1633)
Hampton’s hump
Enlarged right descending pulmonary artery on chest radiograph. (Harrison’s 19th edition, pp 1633)
Palla’s sign
Most common preventable cause of death among hospitalized patients. (Harrison’s 19th edition, pp 1631)
Pulmonary embolism
Also known as chronic venous insufficiency. (Harrison’s 19th edition, pp 1631)
Postthrombotic syndrome
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)
Postthrombotic syndrome
Virchow’s triad. (Harrison’s 19th edition, pp 1631)
Inflammation
Hypercoagulability
Endothelial injury
Two most common autosomal dominant genetic mutations in VTE. (Harrison’s 19th edition, pp 1631)
Factor V leiden
Prothrombin gene mutation
Causes resistance to the endogenous anticoagulant, activated protein C. (Harrison’s 19th edition, pp 1631)
Factor V leiden
Increases the plasma prothrombin concentration. (Harrison’s 19th edition, pp 1631)
Prothrombin gene mutation
Most severe form of postthrombotic syndrome causes? (Harrison’s 19th edition, pp 1631)
Skin ulceration
Most common acquired cause of thrombophilia and is associated with venous or arterial thrombosis. (Harrison’s 19th edition, pp 1631)
Antiphospholipid antibody syndrome
Characterized by extensive thrombosis affecting at least half of the pulmonary vasculature. (Harrison’s 19th edition, pp 1632)
Massive pulmonary embolism
Accounts for 5-10%
Hallmarks of massive pulmonary embolism. (Harrison’s 19th edition, pp 1632)
Dyspnea
Syncope
Hypotension
Cyanosis
Characterized by RV dysfunction despite normal systemic arterial pressure. (Harrison’s 19th edition, pp 1632)
Submassive pulmonary embolism
Accounts for 20-25%
Indicates an increased likelihood of clinical deterioration in submassive pulmonary embolism. (Harrison’s 19th edition, pp 1632)
Combination of right heart failure and release of cardiac biomarkers
Constitutes about 70-75% cases of pulmonary embolism and have an excellent prognosis. (Harrison’s 19th edition, pp 1632)
Low risk PE
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)
Superficial venous thrombosis
Most common symptom of DVT. (Harrison’s 19th edition, pp 1632)
Cramp or “charley horse in the lower calf that persists and intensifies over several days
Initial diagnostic evaluation for patients with low-to-moderate likelihood of DVT or PE. (Harrison’s 19th edition, pp 1632)
D-dimer
Differential diagnosis for DVT. (Harrison’s 19th edition, pp 1633)
Ruptured baker’s cyst
Cellulitis
Postphlebetic syndrome/venous insufficiency
Differential diagnosis for PE. (Harrison’s 19th edition, pp 1633)
Pneumonia, asthma, COPD Congestive heart failure Pericarditis Pleurisy: “viral syndrome”, costochondritis, musculoskeletal discomfort Rib fracture, pneumothorax Acute coronary syndrome Anxiety
Recommended pressure and duration of the below-knee graduated compression stockings for secondary prevention for DVT. (Harrison’s 19th edition, pp 1634)
30-40mmHg
for 2 years after the DVT episode
Contraidications to fibrinolysis in pulmonary embolism. (Harrison’s 19th edition, pp 1636)
Intracranial disease
Recent surgery
Trauma
The only FDA-approved indication for PE fibrinolysis. (Harrison’s 19th edition, pp 1636)
Massive PE
1st line inotropic agents for treatment of PE-related shock. (Harrison’s 19th edition, pp 1636)
Dopamine
Dobutamine
Most common for of in-hospital prophylaxis. (Harrison’s 19th edition, pp 1636)
Low dose UFH
LMWH
Duration of anticoagulation for DVT/PE. (Harrison’s 19th edition, pp 1635)
Provoked UE or calf – 3 months
Provoked proximal leg DVT or PE – 3 to 6 months
With cancer - indefinite
Unprovked DVT - indefinite
Causes of provoked DVT. (Harrison’s 19th edition, pp 1635)
Surgery
Trauma
Estrogen
Indwelling central venous catheter or pacemaker
Most serious adverse effect of anticoagulation. (Harrison’s 19th edition, pp 1635)
Hemorrhage
Antidote for hemorrhage from Heparin or LMWH. (Harrison’s 19th edition, pp 1635)
Protamine sulfate
Target INR for warfarin use. (Harrison’s 19th edition, pp 1635)
2.5 (range 2-3)
Initial dose for warfarin. (Harrison’s 19th edition, pp 1635)
5mg
Unfractionated heparin dosing for pulmonary embolism. (Harrison’s 19th edition, pp 1635)
80U/kg bolus then 18U/kg per hr
Blood test use in assessing the anticoagulant effect of Unfractionated heparin and target range. (Harrison’s 19th edition, pp 1635)
Activated partial thromboplastin time (aPTT)
60-80 secs
Usually begins in the calf and propagates proximally to the popliteal vein, femoral vein, and iliac veins. (Harrison’s 19th edition, pp 1632)
Lower extremity DVT
Often precipitated by placement of pacemakers, internal cardiac defibrillators, or indwelling central venous catheters. (Harrison’s 19th edition, pp 1632)
Upper extremity DVT
Variables for clinical likelihood of DVT. (Harrison’s 19th edition, pp 1632)
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)
Variables for clinical likelihood of PE. (Harrison’s 19th edition, pp 1632)
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)
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)
Neutrophil extracellular traps
Anti Xa pentasaccharide. (Harrison’s 19th edition, pp 1635)
Fondaparinux
Indications for insertion of an IVC filter. (Harrison’s 19th edition, pp 1636)
Active bleeding that precludes anticoagulation
Recurrent venous thrombosis despite intensive anticoagulation
Common complication of IVC filters described as marked bilateral leg swelling. (Harrison’s 19th edition, pp 1636)
Caval thrombosis
