Pulmonary Embolism

Risk Factors

100

PE is a common complication of which condition, occurring in more than 50% of confirmed cases according to one study?

DVT (Deep Venous Thrombosis)

200

Women or men undergoing hormone therapy who take this medicine are at higher risk of developing DVT and subsequent PE

Estrogen-containing birth control pills (or hormone supplement)

300

This is the name of the classic sign of pain in the calf on passive dorsiflexion of the foot with the knee in extension

Homan's sign (never seen in real life)

400

A recent ____ within the last three months puts you at higher risk of developing a PE

Surgery (especially joint replacements) - Immobilization

500

Name one of three types of cancers that is associated with higher risk of PE

Pancreatic, ovarian, lung

Presentation

100

What are two most common symptoms that a patient with PE can present with?

Abrupt onset of shortness of breath and sharp chest pain that worsens with deep breathing/cough/movement.

200

Besides abrupt onset of dyspnea and chest pain that worsens with deep breathing, what are other symptoms? 

Leg pain or swelling, hypoxia, anxiety, tachypnea, tachycardia, low-grade fever, diaphoresis

300

TRUE/FALSE: A recent meta analysis demonstrated that most PEs in patients with DVTs are actually asymptomatic.

False, although approximately 1/3 of patients with DVTs can have silent PEs. This question is probably unfair, I apologize. Am J Med. 2010;123(5):426

400

PE patients may present with jugular venous distension and peripheral edema, which are signs of what?

Right-sided heart failure

500

I ran out of stuff to ask in this category, everyone gets free points.

Lame.

Testing

100

What is the name of the scoring system used to determine the pretest probability of a patient having a PE?

Wells Criteria

200

TRUE/FALSE: D-dimer has good sensitivity but poor specificity.

True. D-dimer also has good negative predictive value but poor positive predictive value. The d-dimer should not be used in patients with moderate or high pre-test probability, as a negative d-dimer in those patients does not result in a posttest probability low enough to comfortably rule out VTE.

300

What are the two strongest criteria when determining the Wells score?

1. Clinical symptoms of DVT 2. Other diagnoses are less likely than PE

400

The modified Wells criteria has a cutoff score of what number to determine whether a PE is likely or unlikely?

4

500

What is the classic EKG abnormality seen in a patient with PE?

S1Q3T3 pattern (never seen in real life)

Imaging

100

Patients should usually get imaging if they have a moderate or high pre-test probability with PE, which is a Wells score greater than what number?

2 (4 in simplified)

200

What usually constitutes a positive ultrasound finding in a patient with DVT?

Inability to fully compress the vein in the deep venous system

300

What is the now-commonly accepted and used imaging study in order to evaluate possible PE?

CT Pulmonary Angiography

400

TRUE/FALSE: Chest x-ray abnormalities are common in patients with PE.

True. However, they are not helpful diagnostically because they are similarly common in patients without PE. It is useful to rule out other processes though.

500

A recent study in JAMA of 3700 patients evaluated for PE suggested that what percentage of imaging is potentially avoidable? Choices are 10%, 25%, 33%, or 50%.

33% Arch Intern Med. 2012;172(13):1028-1032

Treatment

100

Without treatment, the mortality rate of a patient with PE is approximately: 10%, 20%, 30%, 40%?

30%

200

What is an alternative method of treatment for PE in patients who fail anticoagulation, develop complications from anticoagulation, or have high bleeding risk?

Inferior vena cava filter

300

What is the most widely accepted indication for which you would consider thrombolytics?

Presence of prolonged hypotension Others include: - Severe hypoxemia - Substantial perfusion defect - Right ventricular dysfunction - Extensive DVT

400

Of the three thrombolytic agents (tPA, streptokinase, urokinase) which is the least expensive but most commonly associated with adverse effects, notably allergic reactions?

Streptokinase

500

TRUE/FALSE: Anticoagulation therapy should never be given to a patient without first confirming the diagnosis on imaging.

False. Empiric treatment is acceptable in moderate-high risk patients where imaging would take longer than 4 hours, and in low risk patients where imaging would take longer than 24 hours.