Pulmonary embolism

Question 1

What is Virchow’s triad?

Answer 1

Hypercoagulable states ( malignancy, pregnancy, oestrogen therapy, trauma, sepsis, nephrotic syndrome)
Vascular wall injury ( trauma, chemical irritation)
Circulatory stasis (atrial fibrillation, immobility)

Question 2

What heart sign will be elicited by a PE?

Answer 2

Right ventricular strain

Question 3

What score is used to assess the likelihood of PE? What are the components of that score? What is the cutoff?

Answer 3

Two level Wells PE score
Clinical signs and symptoms of DVT.
An alternative diagnosis is less likely than PE
Heart rate>100
Immobilisation- for more than 3 days or surgery in the previous 4 weeks
Previous DVT/PE
Haemoptysis
malignancy
PE is considered likely if the score is above 4

Question 4

What ECG changes will be seen with PE?

Answer 4

S1Q3T3
Sinus tachycardia
Non-specific changes
RBBB
T wave inversion V1,2,3

Question 5

What CXR changes may be present with PE?

Answer 5

May be normal
Non-specific changes
Atelectasis
Small pleural effusions

Question 6

What is a CTPA?

Answer 6

Computed Tomography Pulmonary Angiogram

Question 7

What is the duration of anticoagulation treatment in VTE?

Answer 7

Provoked by a transient risk factor- 3 months
First unprovoked VTE- 3 months then reassess
Unprovoked VTE- Long term therapy
Second unprovoked VTE- Minimum of 3 months and then reassess for indefinite therapy.
Cancer associated VTE- Minimum of 3 months and then reassess