Pulmonary thromboembolic Disease

Question 1

what is pulmonary oedema

Answer 1

fluid accumulation in the tissue and airspaces of the lungs

Question 2

what does pulmonary oedema lead to with regards to gas exchange

Answer 2

impaired gas exchange

Question 3

is pulmonary oedema restrictive or obstructive

Answer 3

restrictive

Question 4

pulmonary oedema is a cardinal feature of what condition

Answer 4

congestive (L)HF

Question 5

what are the causes of pulmonary oedema (4)

Answer 5

LV HF (cardiogenic)
injury (non-cardiogenic)
aspiration
severe infection/inflammation

Question 6

what type of pulmonary oedema is caused by pneumonia

Answer 6

localised

Question 7

what type of pulmonary oedema is caused by ARDS

Answer 7

generalised

Question 8

how is pulmonary oedema diagnosed

Answer 8

CXR = presence of fluid

Question 9

treatment of pulmonary oedema (2)

Answer 9

improve resp function (O2)

treat underlying cause

Question 10

what is PE

Answer 10

blockage of a pulmonary artery by a blood clot (most common), fat, tumour, or air

Question 11

what causes PE

Answer 11

DVT of lower limbs

Question 12

presentation of LARGE PE (4)

Answer 12

cardiovascular shock
low BP
central cyanosis
sudden death/collapse

Question 13

presentation of SMALL, RECURRENT PE (3)

Answer 13

progressive SOB
pulmonary hypertension
RH failure

Question 14

what type of pain is associated with PE

Answer 14

pleuritic

Question 15

what general symptoms are associated with PE (2)

Answer 15

haemoptysis

SOB

Question 16

risk factors for PE

Answer 16

VIRCHOW’S TRIAD

Question 17

risk factors for DVT

Answer 17

VIRCHOW’S TRIAD

Question 18

what is VIRCHOW’S TRIAD

Answer 18

1. stasis of blood flow
2. endothelia injury
3. hyper coagulability

Question 19

first line investigation for PE

Answer 19

CTPA

Question 20

first line investigation for PE + renal impairment

Answer 20

V/Q scan

Question 21

what should D dimers be if PE is present

Answer 21

high

Question 22

what other investigations could be done in suspected PE (excluding CTPA, V/Q scan, D-dimers)

Answer 22

CXR
ECG
Ultrasound

Question 23

treatment of PE and DVT

Answer 23

anticoagulation

Question 24

list anticoagulation medications (3)

Answer 24

1. LMW heparin
2. NOAC
3. oral warfarin

Question 25

1st line treatment of LARGE PE

Answer 25

thrombolysis

Question 26

1st line treatment for RECURRENT PE

Answer 26

IVC filter

Question 27

give examples of NOACs

Answer 27

Dabigatran | Rivaroxaban/Apixaban

Question 28

mechanism of action of Rivaroxaban/Apixaban

Answer 28

direct inhibitor of activated factor Xa

Question 29

mechanism of action of Dabigatran

Answer 29

direct thrombin inhibitor

Question 30

give an example of thrombolysis

Answer 30

tissue plasminogen activator (tPA) = tenecteplase

Question 31

mechanism of action of oral warfarin

Answer 31

antagonises vitamin K dependent prothrombin

Question 32

clinical presentation of DVT

Answer 32

hot swollen red tender

Question 33

1st line investigation of DVT

Answer 33

ultrasound doppler leg scan

Question 34

investiagtions for DVT (excluding US)

Answer 34

CT scan

Question 35

what would you take a CT of in a suspected DVT (3)

Answer 35

ileo-femoral veins IVC pelvis

Question 36

method of prevention of DVT (5)

Answer 36

``` early post-op mobilisation TED compression stocking calf muscle exercises LMW heparin peri-op NOACS ```

Question 37

what is a pulmonary infarction

Answer 37

pulmonary tissue death due to compromised blood flow and oxygen supply

Question 38

what causes pulmonary infarction

Answer 38

emboli + compromised bronchial supply

Question 39

what is cor pulmonale

Answer 39

RH disease secondary to lung disease usually RHF due to chronic pulmonary hypertension

Question 40

clinical signs of cor pulmonale

Answer 40

RV hypertrophy RV distension RV failure

Question 41

what genetic condition is associated with cor pulmonale

Answer 41

Cystic fibrosis

Question 42

describe the pulmonary system (flow and pressure)

Answer 42

HIGH flow | LOW pressure

Question 43

what is normal mean pulmonary arterial pressure

Answer 43

12-20mmHg

Question 44

what value(s) is pulmonary hypertension

Answer 44

>25mmHg

Question 45

causes of pulmonary VENOUS hypertension (3)

Answer 45

LV ischaemic disease mitral regurgitation/stenosis cardiomyopathy

Question 46

causes of pulmonary arterial hypertension (7)

Answer 46

``` primary hypoxic (COPD, fibrosis) multiple PE vasculitis drugs HIV cardiac L to R shunt (ASD, VDS) ```

Question 47

describe PRIMARY pulmonary hypertension

Answer 47

rare | occurs in young women

Question 48

how is PRIMARY pulmonary hypertension diagnosed

Answer 48

exclusion of other secondary causes

Question 49

symptoms of PRIMARY pulmonary hypertension

Answer 49

progressiveSOB | signs of RH failure

Question 50

treatment of PRIMARY pulmonary hypertension (3)

Answer 50

anti-cogulation pulmonary vasodilators (Ca2+ blockers) lug translant

Question 51

investigations of pulmonary hypertension

Answer 51

ECG | CXR

Question 52

clinical signs of pulmonary hypertension

Answer 52

central cyanosis dependent oedema raised JVP

Question 53

what conditions commonly cause Cor pulmonale

Answer 53

COPD | emphysema (alveolar collapse)

Question 54

what would Cor pulmonale look like on CXR

Answer 54

enlarged pulmonary arteries | R atrial/ventricular enlargement