Pulmonary vascular disease

Question 1

CTEPH Risk factors

Answer 1

Idiopathic PE
Large PE + RV dysfunction on echo
splenectomy
thormbophilia disorders
hypothyroidism
cancer
myeloproliferative disorders
IBD
osteomyelitis
shunts
non o blood group
infected line or PPM

Question 2

not suitable for CTPA as outpatient

Answer 2

Sats <90%
BP <100
HR >110
pain needing opiates
INR >2, on anticoag, active bleeding, recent bleeding, plt <75, stroke <10 days, GIB <14 days
HIT
CRCL <30, liver disease
obesity >150kg
social/medical reasons

Question 3

Simplified PESI

Answer 3

Age >80
Cancer
cardiorespiratory disease
HR >110
BP <100
sats <90%

0 = 30 day mortality 1%
>1 = 30 day mortality 11%

Question 4

Wells score DVT

Answer 4

Active cancer <6 months
immobilisation of lower limbs
bedridden >3 days or major surgery <12 weeks
localised tenderness in DVT distribution
entire leg swollen
calf swelling >3cm on one side
unilateral pitting oedema
collateral superficial vein
previous DVT
alternate diagnosis at least as likely (-2)

DVT likely >2
unlikely <2

Question 5

Wells score PE

Answer 5

features of DVT
no alternate diagnosis
HR >100
immobilisation >3 days or surgery <4 weeks
previous vte
haemoptysis
malignancy < 6 months

likely >4
unlikely <4