Respiratory CIS high yield handout 2

Question 1

wells criteria 1.0 pts

Answer 1

malignancy

hemoptysis

Question 2

what does GTPAL for obstetrical history taking stand for

Answer 2

G= gravidity (# of pregnancies)

Term births (term deliveries (full) births (38 wks or more)

Preterm births (preterm deliveries from viability up to 37 wks

Abortions/miscarriages

Living children

Question 3

potential indications for thrombolytic therapy in venous thromboembolism

Answer 3

presence of hypotension related to PE
presence of severe hypoxemia
substantial perfusion defect
RV dysfunction assocaited with PE
extensive DVT

Question 4

labs to consider checking for inherited thrombophilia

Answer 4

activated protein C/factor V leiden
homocysteine level
antithrombin III/protein C/protein S assay
antiphospholipid antibodies

Question 5

what is tPA

Answer 5

clot buster
naturally occurring enzyme produced by endothelial cells
binds fibrin, increases its affinity for plasminogen and enhances its activation

Question 6

are hormones pro thrombotic

Answer 6

yes

HRT and estrogen

Question 7

S2 splitting during cardiac exam

Answer 7

physiologic splitting of S2 on inspiration can be normal

persistent splitting of S2 during inspiration and expiration can be sensitive and specific for

• heart disease in adults, most likely RBBB
• RV pressure overload situations such as acute massive PE

Question 8

managment if no personal or family history of VTE but have antithrombin deficiency

Answer 8

propylatic anticoag postop, during pregnacny, and postpartum

Question 9

types of shock

Answer 9

hypovolemic
cardiogenic
distributive
obstrucive (PE, tension pneumothorax) (pericardial tamponade)

Question 10

managment of thrombofilia with family history of VTE only (no personal history of it themselves)

Answer 10

if no other risk factor then routine care and education

if other risk factors: prophylactic antigcoag postoperatively, during pregnancy and postpartum

Question 11

what is virchow’s triad

Answer 11

alteration in blood flow
vascular endothelial injury
alteration in constituents of blood

VTE risk

Question 12

wells criteria 3.0 pts

Answer 12

clinical symptoms of DVT

other diagnosis less likely than pulmonary embolism

Question 13

what can be seen on ekg that is indicative of PE

Answer 13

S1 Q3 T3

S in lead 1
Q in III
inverted T in III

Question 14

management of acute VTE

Answer 14

anticoag for at least 3-6 months

possible indefinite anticoag if:

• unprovoked VTE
• life threat PE
• male
• VTE at odd site
• strong family history of VTE

Question 15

other risk factors of VTE

Answer 15

homozygous or compound heterozyougs for defect
or FVL or antithrombin defiecnicy
VTE in family member less than 50

Question 16

wells criteria traditional score

Answer 16

high >6
moderate 2-6
low <2

Question 17

wells criteria simplified

Answer 17

PE likely over 4

PE unlikely at or under 4

Question 18

gold standard imaging choice for PE

Answer 18

CT angiogram (CTA) of the chest
-consider stability of pt

Question 19

what is factor V leiden

Answer 19

• mutant form of coag factor V
• mutant is insensitive to actions of activated protein C (anticoag)
• these pts are at increased risk of venous thromboembolism
• common in population and many individulas with mutation will never have ven TE

Question 20

absolute contraindications of fibrinolytic therapy

Answer 20

prior intracranial hemorrhage
known structural cerebral vascular lesion
known malignant intracranial neoplasm
ischemic stroke within 3 months
suspected aortic dissection
active bleeding or bleeding diathesisis
significant closed head trauma or facial trauma

Question 21

what can be heard on pulmonary exam of pt with PE, 53% of time

Answer 21

rales

Question 22

what does total hysterectomy mean

Answer 22

take uterus and ovaires out, usually but not always they take cervix too

Question 23

what is MAP

Answer 23

mean arterial pressure

diastolic BP + ((systolic - diastolic)/3)

>65 = good perfusion to all organs
<65 = hypotension/hypoperfusion

Question 24

whsat is the most common findings on an EKG pt with a PE

Answer 24

nonspecific ST-T wave abnormalties and sinus tachy

Question 25

recall CAD risk factors

Answer 25

emotional stress

no exercise

Question 26

wells criteria 1.5 pts

Answer 26

HR over 100

immobiliztion for 3 or more days or surgery in previous 4 weeks

previous DVT/PE

Question 27

what is an invasive but hightlly accurate way of measuring BP constantly
good for what pts

Answer 27

arterial line

-excellent in pts with any type of shock