How is massive pulmonary embolism (PE) defined and what is the associated mortality rate? Hughes S. Rivaroxaban Stands up to standard anticoagulation for VTE treatment. Elliott CG. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 1998 Mar 23. What is the relationship between pulmonary embolism (PE) and cancer? [Guideline] Raja AS, Greenberg JO, Qaseem A, Denberg TD, Fitterman N, Schuur JD, et al. Block 11 Pulmonary Path Dr Bellot Prt 1 Block 11 Pulmonary Path Dr Bellot Prt 1 . Extended-Duration Betrixaban Reduces the Risk of Stroke Versus Standard-Dose Enoxaparin Among Hospitalized Medically Ill Patients: An APEX Trial Substudy (Acute Medically Ill Venous Thromboembolism Prevention With Extended Duration Betrixaban). 2009 Dec 10. Courtesy of Justin Wong, MD. What are the advantages of LMWH therapy for pulmonary embolism (PE)? Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. When should interventional radiology consultation be considered for pulmonary embolism (PE)? Mitchell RN, Kumar V. Hemodynamic disorders, thrombosis, and shock. [Medline]. The epidemiology of venous thromboembolism in the community. What are the ACOG guidelines on the diagnosis and management of thromboembolism during pregnancy? True or false? Ann Emerg Med. What is the evidence that right ventricular dilatation on bedside echocardiography aids in the diagnosis of pulmonary embolism (PE)? What are the treatment options for pulmonary embolism (PE) during pregnancy? Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, et al. 2010 Nov 1. Garcia D, Ageno W, Libby E. Update on the diagnosis and management of pulmonary embolism. Apixaban for extended treatment of venous thromboembolism. [Medline]. This is a close-up view. 2018 Nov 27. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle. Sequential images demonstrate treatment of iliofemoral deep venous thrombosis due to May-Thurner (Cockett) syndrome. Look for symptoms of infection or cardiac decompensation. N Engl J Med. Medscape Medical News. Prognostic value of ECG among patients with acute pulmonary embolism and normal blood pressure. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Kucher N, Printzen G, Goldhaber SZ. How effective is apixaban in the treatment of pulmonary embolism (PE)? [Medline]. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. N Engl J Med. [Medline]. In fact, clinical examination can be absolutely normaland unless you consider a PE as the cause of your patient’s ch… [Medline]. 57 (6):628-652.e75. The diagnosis of a PE cannot be made on examination alone. 336(20):1422-7. P = 90. [Medline]. [Medline]. A normal ventilation scan will make the noted defects in the previous image a mismatch and, hence, a high-probability ventilation-perfusion scan. Order a V/Q scan [Medline]. A pulmonary embolism (PE) is the sudden blockage of a blood vessel in the lungs by an embolus. Practice bulletin no. Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR. [Medline]. Comparison of 8 biomarkers for prediction of right ventricular hypokinesis 6 months after submassive pulmonary embolism. J R Soc Med. 1. Heparin is usually held or decreased until the PTT drops back into therapeutic range. What is the risk of thromboembolic disease during pregnancy? Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. When should a diagnosis of pulmonary embolism (PE) be actively considered? [Medline]. [Full Text]. A pulmonary embolism is a blood clot that becomes lodged in the lung. [Medline]. [Guideline] Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, et al. Chronic thromboembolic pulmonary hypertension; Right heart failure . In most cases, the embolism is caused by … 2007 Oct. 120(10):871-9. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study. 33(2):233-7. What is the next step: A. 343:d4656. How does venous stasis cause pulmonary embolism (PE)? Geersing GJ, Erkens PM, Lucassen WA, Büller HR, Cate HT, Hoes AW, et al. Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. 1997 May 15. , If patient over 40 then there is a 10-25% chance of malignancy, Therefore ensure thorough history, examination, CXR and bloods, Organise CT abdo/pelvis plus PSA in men, mammography in women, Do not offer to patients who are continuing on anti-coagulation treatment: only in patients whom there is a plan to stop anti-coagulation, Consider testing for anti-phospholipid in patients with unprovoked PE, Consider testing for hereditary thrombophilia in patient with unprovoked PE with first degree relatives who have a history of VTE, See haematology pages for further details, Solid evidence of the benefit of this is still lacking, However some centres have started to do it as it appears that the risks of thrombolysis may not be as great as previously thought. 1368-1382. 1. How does the prevalence of pulmonary embolism (PE) vary among different age groups? Arch Intern Med. Women. Worsley DF, Alavi A. A posteroanterior chest radiograph showing a peripheral wedge-shaped infiltrate caused by pulmonary infarction secondary to pulmonary embolism. How much does elevated BNP levels increase the risk of mortality and complications in acute pulmonary embolism (PE)? [Medline]. Stein PD, Matta F, Keyes DC, Willyerd GL. 163(14):1711-7. 2011 Apr 26. Becattini C, Agnelli G, Vedovati MC, et al. What are the indications for fondaparinux therapy in acute pulmonary embolism (PE)? 2012 Oct. 40(4):919-24. Ozsu S, Oztuna F, Bulbul Y, et al. How often does pulmonary embolism (PE) go undiagnosed and why? Blood Adv. What is the incidence of physical signs in pulmonary embolism (PE)? A pulmonary embolism is a blood clot that becomes lodged in the lung. For that reason, your doctor will likely order one or more of the following tests. When is consultation with a cardiac surgeon necessary for pulmonary embolism (PE)? 2009 Feb. 337(2):88-92. Br J Haematol. How effective is edoxaban (Savaysa) in the treatment of pulmonary embolism (PE)? A perfusion defect is present in the left lower lobe, but perfusion to this lobe is intact, making this a high-probability scan. Medscape Medical News. a. What is the incidence of symptoms of pulmonary embolism (PE)? Segmental Anatomy of the Lungs: Study of the Patterns of the Segmental Bronchi and Related Pulmonary Vessels. BMJ. What is the role of BNP testing in the evaluation of acute pulmonary embolism (PE)? Oral apixaban for the treatment of acute venous thromboembolism. c. High blood pressure. [Medline]. N Engl J Med. Physical inactivity and idiopathic pulmonary embolism in women: prospective study. Kabrhel C, Varraso R, Goldhaber SZ, Rimm E, Camargo CA Jr. J Nucl Med. Increased diagnosis of pulmonary embolism without a corresponding decline in mortality during the CT era. Konstantinides S. Clinical practice. What is the incidence of pulmonary embolism (PE) in the US? Ready T. Pulmonary Emboli Overdiagnosed by CT Angiography. Minor forms of pulmonary embolism after abdominal operations. 345:e6564. Also present is an infarction of the corresponding lung, which is indicated by a triangular, pleura-based consolidation (Hampton hump). Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. Correct answer: C. Pulmonary embolism. Questions; Post Page [Top] discussion drtayyab. [Medline]. [Medline]. Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients. [Medline]. [Medline]. 61(3):330-8. 2013 Aug 29. Am J Respir Crit Care Med. Why is knowledge of bronchovascular anatomy required to interpret CT scans in the evaluation of pulmonary embolism (PE)? 2011 Jan 17. 2012 Mar 20. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. [Full Text]. NCLEX review questions: Respiratory. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. When is anticoagulation therapy initiated for pulmonary embolism (PE)? What are the signs and symptoms of massive pulmonary embolism (PE)? [Medline]. Pulmonary embolism and deep venous thrombosis. How effective is pulmonary angiography in detecting multiple recurrences of pulmonary embolism (PE)? 2008 Jul. 368 (6):513-23. 2011 Jun. A pulmonary angiogram shows the abrupt termination of the ascending branch of the right upper-lobe artery, confirming the diagnosis of pulmonary embolism. 2014 Apr 10. What are acute respiratory consequences of pulmonary embolism (PE)? Pediatr Clin North Am. Remy-Jardin M, Remy J, Deschildre F, Artaud D, Beregi JP, Hossein-Foucher C, et al. [Medline]. What are the surgical options in the treatment of pulmonary embolism (PE)? Ann Intern Med. Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. What is the presentation of acute embolism without infarction? [Medline]. Her D-Dimer is 200 mg/ml fibrinogen units. Question 3 A 9-year-old girl has complained of difficulty breathing for over the past week. Lancet. Which medications in the drug class Anticoagulants are used in the treatment of Pulmonary Embolism (PE)? This image was obtained at the level of the lower lobes and shows perivascular segmental enlarged lymph nodes as well as prominent extraluminal soft tissue interposed between the artery and the bronchus. 1989 Apr. When is thrombolytic therapy indicated in pulmonary embolism (PE)? Obstet Gynecol. Dresden S, Mitchell P, Rahimi L, Leo M, Rubin-Smith J, Bibi S, et al. 121(7):611-7. . 1995 Dec. 36(12):2380-7. EXAM Preparation. 1994 Jun. Lung infarction secondary to pulmonary embolism occurs rarely. Rajpurkar M, Warrier I, Chitlur M, Sabo C, Frey MJ, Hollon W, et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants' data from seven trials. 2008 Mar 6. 2005 Nov. 131(3):301-12. What increases the risk of recurrent pulmonary embolism (PE)? When are vena cava filters indicated in the treatment of pulmonary embolism (PE)? The major symptom that raises suspicion of pulmonary disease is dyspnea. The cardiac monitor demonstrates a regular rhythm with a rate of 120 bpm. 2007 Nov. 245(2):315-29. Burge AJ, Freeman KD, Klapper PJ, Haramati LB. How is warfarin therapy used in the treatment of acute pulmonary embolism (PE)? How does HIV infection affect the risk of developing pulmonary embolism (PE)? A spiral CT scan shows thrombus in bilateral main pulmonary arteries. [Medline]. 368(8):699-708. 154(11):709-18. Massive pulmonary embolism has been defined by hemodynamic parameters and evidence of myocardial injury rather than anatomic findings because the former is associated with adverse outcomes. What is the significance of elevated serum troponin in patients with pulmonary embolism (PE)? In the Emergency Ward her respiratory rate is 25/min. If you looking for pulmonary embolism practice questions then this study guide is for you. Acute pulmonary embolism. When is fibrinolytic therapy initiated in patients with pulmonary embolism (PE)? Annie Harrington, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest PhysiciansDisclosure: Nothing to disclose. N Engl J Med. A chest radiograph with normal findings in a 64-year-old woman who presented with worsening breathlessness. Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial. December 13, 2012. Vol 2.: Boyden EA. What are ASH guidelines on optimal management of anticoagulation therapy for venous thromboembolism (VTE)? 57(6):613-21. Eur Heart J. 2011 Sep. 118 (3):718-29. [Guideline] Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. What are the very low-probability criteria, or normal findings, for V/Q scanning diagnosis of pulmonary embolism (PE)? 123: thromboembolism in pregnancy. A. Pulmonary embolism and pulmonary hypertension are two pulmonary circulation conditions that are high-yield for the Physician Assistant Exam (known as PANCE). Prolonged times of partial thromboplastin time in clients with pulmonary embolism (>75 sec) indicates that the client is at risk for serious spontaneous bleeding. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Vanni S, Viviani G, Baioni M, Pepe G, Nazerian P, Socci F, et al. [Full Text]. When is physical activity recommended for pulmonary embolism (PE)? [Guideline] Bettmann MA, Baginski SG, White RD, Woodard PK, Abbara S, Atalay MK, et al. What is the treatment of choice in children with pulmonary embolism (PE)? What are the low-probability criteria for V/Q scanning diagnosis of pulmonary embolism (PE)? [Full Text]. Vena cava filter devices. [Medline]. Prognosis of pulmonary embolism (PE) 30% overall mortality but very dependent on severity . N Engl J Med. 9(7):841-4. b. Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement From the American Heart Association. What are the differential diagnoses for Pulmonary Embolism (PE)? 113(4):577-82. Pulmonary embolism MCQ. Malek J, Rogers R, Kufera J, Hirshon JM. Ann Emerg Med. 2014 Apr 10. 119(6):699-703. What are the new or revised recommendations in the updated ACCP guidelines on antithrombotic therapy and prevention of thrombosis? Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism. I am confident that if you use this study guide to it’s fullest potential, you can easily ace your exams and even pass the board exams when that time comes. Am Heart J. N Engl J Med. Computed tomography venograms in a 65-year-old man with possible pulmonary embolism. What are complications of pulmonary embolism (PE)? 2013 Mar. OVERVIEW. What are the consequences of pulmonary embolism (PE)? [Medline]. CT scan of the same chest depicted in Image 18. 2013 Sep 23. [Medline]. Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, et al. Am J Respir Crit Care Med. What is the treatment for pulmonary embolism (PE) after hospital discharge? Lower-extremity venogram shows outlining of an acute deep venous thrombosis in the popliteal vein with contrast enhancement. [Medline]. 2005 Jul. Am J Med. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Restrepo CS, Artunduaga M, Carrillo JA, Rivera AL, Ojeda P, Martinez-Jimenez S, et al. Barclay L. Fibrinolysis for Pulmonary Embolism Effective but Risky. There may also b 1993 Sep. 123(3):337-46. What are respiratory consequences of pulmonary embolism (PE)? 50(5):1062-4. What chest radiography findings suggest the presence of pulmonary embolism (PE)? What causes a person to be at-risk for developing deep vein thrombosis or pulmonary embolism? [Full Text]. [Medline]. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Available at http://www.medscape.com/viewarticle/807439. 2013 Jul 2. [Guideline] Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. 2.] Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. [Medline]. Diagnosis of pulmonary embolism with magnetic resonance angiography. [Medline]. 2012 May 24. [Medline]. What are the AHA guidelines for catheter-based interventions in pulmonary embolism (PE)? A large pulmonary artery thrombus in a hospitalized patient who died suddenly. This patient most likely has a pulmonary embolism. What are the ACEP guidelines for the diagnosis of pulmonary embolism (PE)? [Medline]. [Medline]. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. 2011 Jun 7. JAMA. What is the presentation of acute pulmonary infarction? What are the high-probability criteria for V/Q scanning diagnosis of pulmonary embolism (PE)? Far left, after stent placement, image shows wide patency and rapid flow through the previously obstructed region. Which medications in the drug class Direct Thrombin Inhibitors and Factor Xa Inhibitors are used in the treatment of Pulmonary Embolism (PE)? Posteroanterior and lateral chest radiograph findings are normal, which is the usual finding in patients with pulmonary embolism. 2011 Jan. 18(1):22-31. 82(4):203-5. 8(3):339-49. This website also contains material copyrighted by 3rd parties. What is the role of long-term anticoagulation therapy for pulmonary embolism (PE)? Circulation. [Medline]. What is the duration of long-term anticoagulation for pulmonary embolism (PE)? [Medline]. Sleep-disordered breathing in deep vein thrombosis and acute pulmonary embolism. 129(7):764-72. What are the ACR recommendations for the use of chest radiography in suspected pulmonary embolism (PE)?