SOMANZ PE 2021

Question 1

Differentials to PE

Answer 1

Anaemia - ferritin
GORD
MSK
Anxiety
Arrythmia - HCG/holter
Cardiac failure - echo
Pericarditis
Asthma - spirometry
Pneumonia CXR
Pneumothorax- CXR
MI - ECG, trop, Echo
Thyrotoxicosis - TSH/T3/T4
Phaemochromocytoma - fasting plasma

Question 2

Risk factors for PE

Answer 2

Hx of recurrent mc
Recent complications: PET, IUGR, PTL, abruption, APH
Ongoing preg/fetal concerns
Hx of recent birht/CS

PRE pregn
Immediate fam hx, previous VTE, thrombophilia, OHSS, Smoking

AN: >35, >p3, ART, PTB, HTN w protein, APH, gross veins, immobility, hyperemesis, sepsis

PN: IUFD, CS, PPH

Question 3

InVx for PE and why

Answer 3

ECG - low sens and spec, deviation QRS, increased Q waves lead 2,3,avF (rules out MI or pericard)

CXR - may direct choice of imaging, helps rule out other differentials

FBC, UECA< LFT, Ferritin - infection/anaemia/acidosis

ABG - Aa gradient poor positive predictive, does not exclude PE. Sp02 <94% increase likelihood OR 4.37

Question 4

Fetal risks with pulmonary imaging

Answer 4

Below 1mSv
If cumulative >10mSv, leads to increase fom 20 per 10 000 to 21 per 10 000, for every 1667 epxosures to 10mGy, additional 1 cause of leukemia.

Question 5

Maternal risk pulmonary imaging

Answer 5

CTPA in 30yo: 20mSv –> 1 in 2000

VQ of 1.0 mSV –> 1 in 40 000 additional risk.

Not high, but 7x higher than non pregnant.