Pulmonary Embolism

Question 1

Normal V/Q scan and any pretest probability of PE

Answer 1

PE excluded

Question 2

Low probability V/Q scan and low pre test probability of PE

Answer 2

PE excluded

Question 3

High probability (for PE) V/Q scan and high pre test probability of PE

Answer 3

PE confirmed

Question 4

all other combinations of V/Q and pre test probabilities

Answer 4

need additional testing to make a call (CTA or LE u/s)

Question 5

Massive PE is

Answer 5

hypotension with SBP<90 or drop in SBP of >40 for >15 minutes

Question 6

What is the best way to confirm hemodynamically unstable pt who may have a PE?

Answer 6

bedside TTE for right ventricular overload.

Question 7

can people who have anaphylaxis with seafood or serious seafood allergies get iodinated radiocontrast?

Answer 7

yes. and people who get CT with iodinated contrast do not need pretreatment with steroids or antihistamines.

Question 8

can people who have anaphylaxis to iodinated contrast eat seafood

Answer 8

yes. There is no cross over with iodinated contrast and seafood.

Question 9

why do we avoid high osmolar radiocontrast

Answer 9

increased rates of allergic reactions and contrast induced nephropathy

Question 10

V/Q scan is meant for pts with suspected PE who have

Answer 10

renal insufficiency, true contast allergy or those who have inconclusive CTPA.

Initial test of choice for pregnant women with normal CXR.

Question 11

who gets long term aspirin after a VTE?

Answer 11

unprovoked VTE in whom anticoagulation is discontinued start aspirin

shown to reduce risk for recurrence PE by 30-40%

Question 12

Modified PESI score for out patient treatment of VTE:

Answer 12

pts <80 yrs

no significant comorbidity

HR<110/min

SBP>100

oxygen saturation >90 on RA

low risk for bad outcomes

Question 13

if someone has established PE, do they need routine duplex imaging of lower extremities?

Answer 13

no.

Question 14

if someone has acute DVT do they need a CT angiography to look for PE?

Answer 14

no. Get a TTE to evaluate for acute pulmonary artery hypertension and right ventricular strain that may signify massive PE

get serial troponins and BNP to help categorize

Question 15

treatment of massive PE and shock

Answer 15

thrombolytic therapy is better than traditional anticoagulative.

Question 16

thrombolysis for DVT is indicated when

Answer 16

massive thrombus leading to impaired venous drainage, severe edema and acute limb ischemia

Question 17

purpose of IVC filter

Answer 17

prevent death from PE

only for those who have contraindication to AC who have acute PE or acute proximal (above the knee) DVT

Question 18

does distal DVT need AC?

Answer 18

isolated distal DVT can be monitored with serial doppler ultrasound that is done 5 to 7 days after initial event in otherwise healthy people

if no progression no AC

Question 19

if you have superficial vein thrombosis treatment is primaryily

Answer 19

supportive care , analgesia, warm compresses and NSAIDS

get imaging if there is progressive symptoms or swelling occurs

Question 20

cannulated veins of hands and arms often thrombose after infusions or IV catheter placement and this

Answer 20

does not need AC

Question 21

if there is a superficial vein thrombosis of the great saphrenous vein this may need

Answer 21

a U/S to evaluate if it’s close enough to deep vein system and need AC

if lower extremity SVT <5 cm in length OR <5 cm to deep vein system, needs AC (fondaparinux is ok)

also need AC if pt has cancer or prior DVT

Question 22

people who have a superficial venous thrombosis should get

Answer 22

follow up in 1 week to look for any advancement in symptoms

get imaging if any changes