S1 L4.2: Pulmonary Embolism Flashcards
T/F. Pulmonary Embolism
and Deep Venous Thrombosis
- encompass one disease entity: VTE (venothrombo embolism)
- DVT occurs about 2 times more often than PE
TF
(3 times)
T/F.
PE (pulmonary embolism) can be fatal or can cause chronic thromboembolic
pulmonary hypertension
- Patients with PE are more likely to suffer recurrent
VTE than patients with DVT alone
TT
Identify the wrong statement about DVT
Postphlebitic syndrome.
A. major adverse outcome of DVT alone, without PE
B. occurs in less than half of patients with DVT
C. a late adverse effect of DVT
D. caused by permanent damage to the venous valves of the leg
E. valve incompetence and exudation of interstitial
fluid
B. occurs in more than half of patients with DVT
Identify the wrong statement about DVT
Postphlebitic syndrome.
A. may not become clinically manifest until several years after the initial DVT
B. no effective medical therapy
C. chronic ankle swelling and calf swelling
and aching (especially after prolonged
standing), skin ulceration
D. None of the above
D
True about Pulmonary Embolism and DVT, except:
A. afflict millions of individuals worldwide
B. account for hundred thousand deaths
annually in the US
C. 15% mortality rate, exceeds mortality rate of AMI
D. still remain difficult to detect
E. None of the above
E
True about Pulmonary Embolism and DVT, except:
A. death rate from PE increases with age
B. higher in African-american than in whites
C. men > women
D. ≈50% are idiopathic
C. men = women
Choose the wrong letter about Pulmonary Infarction.
A. Pleuritic chest pain that may be unremitting or may wax and wane
B. Hemoptysis
C. Embolus lodges in the contralateral pulmonary arterial tree, near the pleura
D. Tissue infarction occurs 3-7d after embolism
E. Fever, leukocytocis, elevated ESR and radiologic evidence of infarction
C. Embolus lodges in the peripheral pulmonary arterial tree, near the pleura
Identify the wrong letters about pulmonary infarction syndrome
A. Cause by a tiny peripheral PE
B. Pleuritic chest pain, often responsive to narcotics
C. High-grade fever
D. Pleural rub
E. Occasional scant hemoptysis
F. Leukocytosis
B. Pleuritic chest pain, often not responsive to narcotics
C. Low-grade fever
T/F. The 5 Most Common Co-morbidities in PE are:
- hypertension
- surgery within 3 months
- immobility within 30 days
- cancer
- obesity
T
T/F in Classic Dichotomy in PE Pathogenesis
* inherited/ primary – uncommon
* acquired/secondary - usual
FF
inherited/ primary – unusual
* acquired/secondary - common
What are the virchow’s triad
Circulatory stasis
Endothelial injury
Hypercoagulable state
T/F. The ff. Are major acquired risk factors for VTE:
- advancing age
- arterial disease including carotid & coronary disease
- obesity
-cigarette smoking
- COPD
- personal/family hx of VTE
-recurrent surgery, trauma/immobility including stroke
- acute infarction
-long haul air travel
-cancer
-pregnancy, oral contraceptive pills/hormone replacement therapy
- pacemaker, implantable cardiac defibrillator leads/indwelling central venous catheter
T
Identify the major thrombophilias associated with venous thromboembolism
- Factor V Leiden resulting in activated protein C resistance
- prothrombin gene mutation 20210
- antithrombin III deficiency
- protein C&S deficiency
A. Inherited
B. Acquired
A
Identify the major thrombophilias associated with venous thromboembolism
- antiphospholipid antibody syndrome
-hyperhomocysteinemia
A. Inherited
B. Acquired
B
The ff. Results to increased pulmonary vasculature resistance except
A. Vascular obstruction
B. Neurohormonal agents
C. Pulmonary artery baroreceptor
D. Hypoxemia
D. Hypoxemia
T/F. Impaired gas exchange are caused by:
*Increased alveolar dead space
*Hypoxemia
T
T/F.
Alveolar hyperventilation is caused by
* Bronchoconstriction
Increased airway resistance is caused by
* Reflex stimulation of irritant receptors
FF
Alveolar hyperventilation is caused by
*Reflex stimulation of irritant receptors
Increased airway resistance is caused by
*Bronchoconstriction
Decreased pulmonary compliance is caused by
A. Lung edema
B. Lung hemorrhage
C. Loss of surfactant
D. All
D
Identify the 6 syndromes of acute pulmonary embolism.
Breathlessness, syncope, & cyanosis with persistent systemic arterial hypotension; typically >50% obstruction of pulmonary vasculature
A. Massive
B. Moderate to large (submassive)
C. Small to mod
D. Pulmonary infarction
E. Paradoxical embolism
F. Nonthrombotic embolism
A
- PRESENT right ventricular dysfunction
- Therapy - Heparin plus thrombolytic therapy/mechanical intervention
Identify the 6 syndromes of acute pulmonary embolism.
Normal systemic arterial blood pressure; typically >30% perfusion defect on lung scan
A. Massive
B. Moderate to large (submassive)
C. Small to mod
D. Pulmonary infarction
E. Paradoxical embolism
F. Nonthrombotic embolism
B
- PRESENT right ventricular dysfunction
- Therapy - Heparin plus or minus thrombolytic therapy/mechanical intervention
Identify the 6 syndromes of acute pulmonary embolism.
Normal arterial blood pressure
A. Massive
B. Moderate to large (submassive)
C. Small to mod
D. Pulmonary infarction
E. Paradoxical embolism
F. Nonthrombotic embolism
C
- ABSENT right ventricular dysfunction
- Therapy - Heparin
Identify the 6 syndromes of acute pulmonary embolism.
Pleuritic chest pain, hemoptysis, pleural rub/ evidence of lung consolidation; typically small peripheral emboli
A. Massive
B. Moderate to large (submassive)
C. Small to mod
D. Pulmonary infarction
E. Paradoxical embolism
F. Nonthrombotic embolism
D
- RARE right ventricular dysfunction
- Therapy - Heparin & NSAIDS
Identify the 6 syndromes of acute pulmonary embolism.
Sudden systemic embolism event like stroke
A. Massive
B. Moderate to large (submassive)
C. Small to mod
D. Pulmonary infarction
E. Paradoxical embolism
F. Nonthrombotic embolism
E
- RARE right ventricular dysfunction
- Therapy - anticoagulation +/- closure of right to left cardiac shunt
Identify the 6 syndromes of acute pulmonary embolism.
Most commonly air, fat, tumor fragments, amniotic fluid
A. Massive
B. Moderate to large (submassive)
C. Small to mod
D. Pulmonary infarction
E. Paradoxical embolism
F. Nonthrombotic embolism
F
- RARE right ventricular dysfunction
- Therapy - Supportive
T/F
Dyspnea- most common sign
Tachypnea- most common symptoms
FF
Dyspnea- most common symptom
Tachypnea- most common sign
T/F
small PE (distal pulmonary arterial system) - Pleuritic chest pain
Massive PE- severe dyspnea, syncope, cyanosis, no chest pain
TT
Clinical decision rule. Identify the score points
A. DVT s/sx
B. An alternative Dx is less likely than PE
C. HR>100/min
D. Immobilization/surgery within 4 wk
E. Prior DVT/PE
F. Hemoptysis
G. Cancer treated within 6 mos/metastatic
A. 3
B. 3
C. 1.5
D. 1.5
E. 1.5
F. 1
G. 1
- > 4 points = high probability
<4 points = non-high probability
T/F. Differential/diagnosis of PE includes:
-myocardial infarction
-Pneumonia
-CHF (Left side)
-cardiomyopathy (global)
-Primary pulmonary hypertension
- asthma
- pericarditis
- intrathoracic cancer
-rib fx
-pneumothorax
-costochondritis
-MSK pain
-anxiety
T
Identify the wrong answer about the clinical predictors of increased mortality
- SBP less than or equal to 100mmHg
- age older than 70 y/o
- HR higher than 100 bpm
- CHF
-CLD
-cancer
-tumor
Tumor
Most common s/sx of PE. Choose if the answer is signs or symptoms
Chest pain, either pleuritic/atypical otherwise unexplained dyspnea
Sx
Most common s/sx of PE. Choose if the answer is signs or symptoms
Tachypnea
Tachycardia
Low grade fever
Tricuspid regurgitation murmur
Accentuated P2
Signs
T/F Components of Management of PE includes:
- Anticoagulation
- Fibrinolysis
- Embolectomy
- Vena Cava Filters
- Primary Prevention
- Secondary Prevention
T
- Anticoagulation
- Heparin
- Low molecular weight heparin
- coumadin
2. Fibrinolysis - Streptokinase
- Alteplase
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: A normal result in this rapid turnaround blood test makes PE exceedingly unlikely.
DISADVANTAGE: Level is elevated in patients with many systemic illnesses that mimic PE, such as pneumonia and myocardial infarction. Level is elevated in patients with sepsis, cancer, postoperative state, and pregnancy.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
A
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: Universally available; may indicate ominous acute cor pulmonale or benign pericarditis.
DISADVANTAGE: Acute cor pulmonale on electrocardiogram is not specific for PE; not a sensitive test.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
B
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: Usually has minor abnormalities but occasionally pathognomonic; may indicate alternative diagnoses such as pneumothorax.
DISADVANTAGE: Not specific.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
C
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: New-generation scanners constitute the new gold standard for diagnosis.
DISADVANTAGE: Older generation scanners are insensitive for
important but distal PE.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
D
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: High-probability scans are reliable for detecting PE; normal/near-normal scans are reliable for excluding PE.
DISADVANTAGE: Most scans are neither high probability nor normal/near-normal; lung scans are falling out of favor; most test results are equivocal.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
E
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: Excellent for anatomy and cardiac function; the
contrast agent does not cause renal failure.
DISADVANTAGE: In preliminary use; not widely available; experience
very limited.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
F
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: Excellent for identifying right ventricular dilation and dysfunction that is not obvious clinically, thus providing an early warning of potentially adverse outcome.
DISADVANTAGE: Not specific; many patients with PE have normal echocardiograms; the test cannot reliably
differentiate causes of right ventricular dysfunction.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
G
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: Necessary for catheter-based interventions.
DISADVANTAGE: Invasive, costly, uncomfortable.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
H
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: Excellent for detecting symptomatic proximal
DVT; surrogate for PE.
DISADVANTAGE: Cannot image iliac vein thrombosis; imaging of calf is operator dependent; DVT may have embolized completely, resulting in a normal finding.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
I
Identify the diagnostic test about the advantage and disadvantage of diagnostic tests for suspected PE
ADVANTAGE: Used to be gold standard; excellent for calf veins; necessary for catheter-based interventions.
DISADVANTAGE: Can cause chemical phlebitis; uncomfortable; costly: may fail to diagnose massive DVT because veins are filled with thrombus and cannot be opacified.
A. Plasma D-dimer ELISA
B. Electrocardiogram
C. Chest radiograph
D. Chest CT
E. Lung scanning
F. MRI
G. Echocardiography
H. Pulmonary angiography
I. Venous ultrasonography
J. Contrast venography
J
