Pulmonary Embolism

Question 1

The majority of PE originates in the ____ ____ veins of the leg

Answer 1

originates in the PROCIMAL DEEP VEINS OF THE LEG.

Question 2

clinical features of PE

Answer 2

right heart failure, right ventricular dilation on diagnostic imaging, positive troponin and elevated BNP.

Question 3

lab results indicating PE

Answer 3

positive troponin, and elevated BNP

Question 4

the pre-test probability can be assessed by a validated clinical prediction rule like Simplified Wells score for PE. If PE has an unlikely pre-test probability, what can rule out PE?

Answer 4

a negative D-dimer rules out the diagnosis of PE. However, a positive D-dimer test must be followed up with a definitive test to confirm/refute the diagnosis of PE.

Question 5

methods of imaging for PE

Answer 5

CTPA (substantial radiation but better that direct pulmonary angiography), Ventilation-Perfusion lung scanning (sometimes non-diagnostic test results, but should be done in pregnancy women or people with renal insufficiency, contrast allergy or in young patients with a normal chest Xray), or CUS.

Question 6

when should treatment for PE be initiated

Answer 6

if evidence of right heart strain is present. However, RV dysfunction alone does not prove PE.

Question 7

classical symptoms of PE

Answer 7

dyspnea
chest pain
cough 
hemoptysis
palpitaitons
syncope
sudden death
tachypnia
hypoxia
tachycardia
arrhythmia (right bundle branch block)
hypotension 
Cardiac arrest

Question 8

Differential Diagnosis for PE

Answer 8

Pulmonary Disease
Cardiac Disease
Musculoskeletal Disease
Abdominal Disorders

Question 9

a score higher of ____ on the simplified wells score means a PE is likely

Answer 9

higher than 4

Question 10

contraindications for CTPA

Answer 10

contraindicated for renal insufficiency, for pregnant or baby patients, or with contract allergy.

there is also a higher false positive.

Question 11

what should you use it CTPA is contraindicated for the patient

Answer 11

Ventilation perfusion scanning.

• use where CTPA contraindicated
• high negative predictive vlaue
• limitations include the fact that there’s a high rate of non-diagnostic test results in plans V/Q

Question 12

ancillary testing in PE are tests that:

Answer 12

determine severity of PE once its been diagnosed.

• they look for evidence of right ventricular strain/dysfunction.
• does when there’s elevated troponin, elevated BNP

Question 13

differentiate between massive, sub-massive and non-massive

Answer 13

massive PE; –  Hypotension / Hemodynamic Instability
–  Signs of Right Ventricular dysfunc=on
–  Cardiac Arrest

SUBMASSIVE PE

• no hypotension/instability
• signs of right ventricular dysfunction

NON-MASSIVE PE

• no hypotension or hemodynamic instability
• no signs of right ventricular dysfunction.