VTE + PE

Question 1

what score is used in suspected PE

Answer 1

wells

Question 2

features DVT scoring system

Answer 2

cancer // recent paralysis of lower legs // recently immobile // tenderness // swollen leg // >3cm than other leg // pitting oedema // collateral superficial veins // previous DVT

Question 3

what score indicates DVT is likely

Answer 3

2 or more

Question 4

invx if likely DVT

Answer 4

proximal leg USS within 4 hours

Question 5

invx if initial USS likely DVT negative

Answer 5

D dimer

Question 6

mx if USS for likely DVT not possible in 4 hours

Answer 6

D dimer and start DOAC

Question 7

mx of likely DVT if -ive USS but +ive DDimer

Answer 7

stop DOAC –> repeat USS 7 days later

Question 8

invx unlikely DVT

Answer 8

D dimer within 4 hours (if unavailable give DOAC) –> if +ive –> USS (if not in 4 hours give DOAC)

Question 9

1st line mx DVT

Answer 9

DOAC eg apixaban or rivaroxaban

Question 10

mx DVT in renal impairment

Answer 10

LMWH, unfractionated heparin, or LMWH –> warfarin

Question 11

mx DVT APS

Answer 11

LMWH –> warfarin

Question 12

how long is treatment given in DVT

Answer 12

3 months if provoked // 6 months unprovoked

Question 13

features PE

Answer 13

pleuritic pain // SOB // haemoptysis // fast HR + RR

Question 14

PE resp exam

Answer 14

clear chest + normal CXR

Question 15

common clinical signs PE according to PEIPOD study

Answer 15

RR >16 // crackles / tachycardic // fever >37.8

Question 16

what is Pulmonary embolism rule-out criteria

Answer 16

all criteria must be absent to rule out PE (reduced chance to <2%)

Question 17

scoring system PE + criteria

Answer 17

signs of DVT // top differential // tachycardia // immobile (3 days, surgery past 4 weeks) // previous DVT or PE // haemoptysis // cancer

Question 18

what score incidcates PE is likely

Answer 18

wells >4

Question 19

invx likely PE

Answer 19

CTPA (if delayed start DOAC)

Question 20

invx PE if CTPA -ive

Answer 20

leg USS

Question 21

invx unlikely PE

Answer 21

D dimer // if positive –> CTPA // if negative –> stop DOAC

Question 22

when is CTPA condraindicated

Answer 22

renal impairment –> V/Q scan

Question 23

ECG PE

Answer 23

S wave lead I + Q wave lead 3 + inverted T lead III (S1,Q3,T3) // RBBB /// sinus tachy

Question 24

CXR PE

Answer 24

normal or wedge opacification

Question 25

what score determines if PE can be managed as outpatients

Answer 25

PEPSI

Question 26

1st line mx PE

Answer 26

DOAC eg apixaban or rivaroxaban

Question 27

2nd line mx PE

Answer 27

LMWH –> dabigatran or edoxaban or warfarin

Question 28

mx PE renal impairment or APS

Answer 28

same as DVT // renal = LMWH, or unfractionated, or LMWH –> warfarin // APS: LMWH –> warfarin

Question 29

length of anticoag PE

Answer 29

provoked = 3 months // unprovoked = 6 months

Question 30

mx of PE if haemodynamically unstable

Answer 30

thrombolysis

Question 31

what score is used to calculate risk of bleed/ stroke if on a DOAC

Answer 31

orbit score