Pulmonary Embolism

Question 1

what is a PE

Answer 1

condition where blood clot forms in pulmonary arteries

• usually a result of a DVT that has embolised
• blocks blood flow to the lungs and creates strain on right side of the heart

Question 2

risk factors for developing a PE

Answer 2

Previous DVT/PE or thrombophilia
Immobility leading to venous stasis e.g. recent surgery or long haul travel
Cancer - particularly ovarian / prostate
Oestrogen - pregnancy / contraceptive pill / HRT / obesity

Question 3

classical symptoms of a PE

Answer 3

acute onset SOB, pleuritic chest pain, cough +/- haemoptysis

Question 4

signs of a PE

Answer 4

raised respiratory rate
tachycardia 
RHF: raised JVP, hypotension
mild fever
signs of DVT - unilateral tender, swollen, red leg

Question 5

what score is used to calculate likelihood of PE

Answer 5

Wells score

Question 6

what wells score indicates a PE is likely

Answer 6

> 4

<4 = PE unlikely

Question 7

next step if patient has wells score >4

Answer 7

urgent CTPA

Question 8

next step if patient has wells score <4

Answer 8

perform D-Dimer and if positive arrange CTPA

- if -ve then PE unlikely and another diagnosis should be considered

Question 9

if there is a delay in getting a CTPA for patient with a high suspicion of PE what should be given

Answer 9

interim anticoagulation - a DOAC is given e.g. abixipan / rivaroxiban

Question 10

what patients should receive a V:Q scan instead of CTPA

Answer 10

patients with renal impairment

patients with allergy to contrast

Question 11

what blood gas is typically seen in PE

Answer 11

respiratory alkalosis

Question 12

most common ECG change in PE

Answer 12

sinus tachycardia

Question 13

best investigation for suspected PE in pregnancy

Answer 13

duplex USS to look for DVT

- If present treat + no further investigations needed

Question 14

first line treatment for a PE

Answer 14

DOAC - rivaroxaban / apixaban

Question 15

how long should anticoagulation continue in a

• provoked PE
• unprovoked PE
• PE in cancer patient

Answer 15

provoked (i.e direct cause such as surgery) = 3 months
unprovoked = 6 months
cancer patients = 6 months

Question 16

what imaging can be done in massive PE where patient is too sick to undergo CTPA

Answer 16

bedside echo

- will show evidence of raised pulmonary pressure in PE e.g dilated right ventricle

Question 17

tx of massive PE with haemodynamic instability

Answer 17

thrombolysis e.g. IV Alteplase 10mg stat + 90mg infusion over 120 mins

Question 18

what is given for VTE prophylaxis

Answer 18

LMWH e.g. enoxaparin