resp

Question 1

what are the most common features of PE?

Answer 1

tachypnoea
pleuritic chest pain
tachycardia
fever

Question 2

if your suspicion of PE is low (approx <15%) what tool do you use to rule out PE?

Answer 2

PERC - PE rule out criteria

all the criteria need to NOT be present for PERC to be negative and this gives a <2% probability of PE

Question 3

CRIteria in PERC

Answer 3

AGE >50
Heart rate> 100
oxygen sats < 94
unilateral leg swelling

previous DVT or PE
recent trauma or surgery in past 4 weeks
oestrogen use - HRT contraceptives

Question 4

when do you do a 2 level PE wells score

Answer 4

when you suspect PE and its > 15% suspicion lol or when PERC is positive

Question 5

criteria in 2 level wells score

Answer 5

3 POINTS -clinical signs and symptoms of DVT (swelling+ pain minimum)
3 POINTS– PE is most likely diagnosis compared to differentials
1.5 points -tachycardia
1 point - haemoptysis

1.5 points -immobilisation ? 3 days or surg in 4 weeks prev
1.5 points- previous DVT/ PE
1 point- malignancy

Question 6

when is a two level PE wells score positive and negative

Answer 6

MORE THAN 4 points - likely PE

4 OR LESS - PE unlikely (4 included here)

Question 7

what is first line investigation of PE if wells score >4

Answer 7

CTPA and if late start interim anticoagulation if delayed

Question 8

what to do if CTPA is negative after a positive wells score

Answer 8

consider a proximal leg vein ultrasound scan if DVT is suspected

Question 9

what investigation is first line if PE is unlikely so 4 points or less

Answer 9

D dimer test
and if positive immediate CTPA with interim anticoag if late ect and if scan negative consider alternative diagnosis

Question 10

when is a V/Q scan done instead of CTPA in PE?

Answer 10

If renal impairment since V/Q doesnt use contrast

Question 11

some ecg findings of pe

Answer 11

the classic ECG changes seen in PE are a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III - ‘S1Q3T3’. However, this change is seen in no more than 20% of patients
right bundle branch block and right axis deviation are also associated with PE
sinus tachycardia may also be seen

Question 12

can you see PE in chest x ray? is it done when pe is suspected

Answer 12

• a chest x-ray is recommended for all patients to exclude other pathology
• however, it is typically normal in PE
• possible findings include a wedge-shaped opacification