Question 1

Which of the following factors is considered a risk factor for deep venous thrombi?

Accepted Answer

All of these factors are considered risk factors for deep venous thrombi. Obesity can cause pressure on veins and slow down blood flow, estrogen-containing drugs can increase blood clotting factors, and postpartum status can cause changes in blood clotting factors and slowed blood flow.

Question 2

Which of the following is NOT responsible for causing hypoxemia in a patient with pulmonary embolism?

Accepted Answer

Hypercapnia refers to increased levels of carbon dioxide in the blood and is not responsible for causing hypoxemia in a patient with pulmonary embolism. The other choices (A, B, and C) can all contribute to hypoxemia in this condition.

Question 3

What percent of the pulmonary vascular bed must be occluded by emboli before cardiac output drops and hypotension is present?

Accepted Answer

When approximately 50% of the pulmonary vascular bed is occluded by emboli, there is a reduction in cardiac output, which can cause hypotension. This is because the lungs play a crucial role in oxygenation, and when the pulmonary vascular bed is obstructed, the ability of the lungs to oxygenate blood is compromised, leading to a decrease in cardiac output and hypotension.

Question 4

When a larger pulmonary thromboembolism occurs in the lung,why does cardiac output drop?

Accepted Answer

Decreased filling of the left ventricle occurs because a large pulmonary thromboembolism obstructs blood flow through the lungs, reducing the amount of blood reaching the left heart, thereby decreasing cardiac output.

Question 5

When is thrombolytic therapy most useful?

Accepted Answer

Thrombolytic therapy is most useful during the first five days after clot formation because it can help to dissolve the clot and restore blood flow.

Question 6

What finding is most common in the ECG of the patient with pulmonary thromboembolism?

Accepted Answer

The most common finding in the ECG of patients with pulmonary thromboembolism is a normal ECG. However, in some cases, there may be abnormalities such as sinus tachycardia, right ventricular strain pattern (T-wave inversion in leads V1 to V4), or new onset atrial fibrillation. Elevation of ST segments or frequent PVCs is less common in pulmonary thromboembolism. First-degree block may be present but is not the most common finding.

Question 7

What is the most common initial treatment for a patient with a small or moderate PTE?

Accepted Answer

The most common initial treatment for a patient with a small or moderate pulmonary embolism (PTE) is anticoagulation therapy, usually with intravenous heparin. This helps to prevent further clots from forming and reduces the risk of complications such as deep vein thrombosis and pulmonary infarction. Oxygen therapy may also be given to improve oxygenation, but it is not the most common initial treatment. Bronchodilators and streptokinase are not typically used in the treatment of PTE.

Question 8

Which of the following findings in a patient with PTE would cause you to most likely consider using thrombolytic therapy?

Accepted Answer

Thrombolytic therapy is considered in patients with pulmonary thromboembolism (PTE) who are hemodynamically unstable, as indicated by hypotension (blood pressure 80/45 mmHg in this case), which suggests a more severe form of the disease requiring aggressive treatment.

Question 9

Which of the following is NOT considered one of the three main factors associated with the formation of deep venous thrombi?

Accepted Answer

The three main factors associated with the formation of deep venous thrombi are venous status (e.g. immobility, varicose veins), hypercoagulability (e.g. factor V Leiden mutation), and damage to venous blood vessels (e.g. from surgery or injury). Thrombocytopenia, which is a decrease in the number of platelets in the blood, is not considered one of the main factors.

Question 10

In which of the following patients would thrombolytic therapy be contraindicated?

Accepted Answer

Thrombolytic therapy is contraindicated in patients who have recently given birth because of the increased risk of bleeding. Thrombolytic therapy dissolves blood clots and can increase the risk of bleeding complications, which can be dangerous for postpartum patients who may already have increased bleeding. Thrombolytic therapy may be used in patients with COPD, pneumonia or heart failure if considered appropriate and after weighing the risks and benefits.

Question 11

Which of the following is least useful for detecting a PTE?

Accepted Answer

An apical-lordotic chest radiograph is least useful for detecting a PTE as it is not a specific imaging test for PTE and has low sensitivity and specificity for detecting PTE compared to other imaging modalities such as pulmonary angiography and CT scan with contrast.

Question 12

Which of the following findings is/are typical for the chest radiograph in a patient with PTE?

Accepted Answer

- Normal chest radiograph is not typical for PTE.
- Signs of volume loss, such as a decrease in lung volume, may be present.
- Westermark's sign is a characteristic finding of PTE on chest radiograph, showing a localized area of oligemia.

Question 13

Where do most deep venous thrombi originate?

Accepted Answer

The lower extremities and pelvic region are the most common sites of origin for deep venous thrombi. This is due to factors such as reduced blood flow in the veins, damage to the veins, and the effects of gravity on blood flow. Deep venous thrombi can also originate in other areas of the body such as the upper extremities or the heart, but these are less common. Below the knees is also a possible site of origin for deep venous thrombi, but not the most common.

Question 14

What test is used to monitor oral anticoagulation therapy?

Accepted Answer

The PT (prothrombin time) test is used to monitor oral anticoagulation therapy. It measures the time it takes for blood to clot and is used to determine the effectiveness of drugs such as warfarin, which are used to prevent blood clots. The PTT (partial thromboplastin time) test is another type of test used to monitor coagulation, but it is not typically used to monitor oral anticoagulation therapy. Platelet count and sedimentation rates are not directly related to monitoring coagulation therapy.

Question 15

In which of the following conditions is pulmonary infarction more likely when a pulmonary embolism occurs?

Accepted Answer

Both left ventricular failure and COPD can lead to decreased blood flow to the lungs and increased risk of blood clots. This increases the likelihood of pulmonary infarction when a pulmonary embolism occurs.

Question 16

Your patient has a fairly large pulmonary thromboembolism.What physical exam finding(s)is/are expected?

Accepted Answer

A pulmonary thromboembolism (PTE) can cause increased pulmonary artery pressure and subsequent right ventricular strain. This can lead to loud P2 on auscultation, jugular venous distention due to increased central venous pressure, and hypotension due to decreased cardiac output. Therefore, all of the options are expected physical exam findings in a patient with a large PTE.

Question 17

How long is the patient with recurrent clots treated with anticoagulant therapy?

Accepted Answer

Patients with recurrent clots are typically treated with anticoagulant therapy for life to prevent future clotting events.

Question 18

What is the classic finding on the  scan for the patient with PTE?

Accepted Answer

The answer of What is the classic finding on the...

Question 19

What is the most common symptom associated with pulmonary thromboembolism?

Accepted Answer

Transient acute dyspnea is the most common symptom associated with pulmonary thromboembolism, as it reflects the sudden blockage in the pulmonary artery or its branches, leading to difficulty in breathing.

Question 20

Which of the following statements is true about the use of "D-dimer" in evaluating the patient for PTE?

Accepted Answer

A negative D-dimer test is good evidence that PTE is not present. However, a positive test does not confirm the presence of PTE and further diagnostic testing is required. A cutoff value for D-dimer varies depending on the clinical setting and specific assay used, but values >500 ng/mL are generally considered high. Therefore, option A and C are incorrect. Option D is incorrect as there is at least one correct statement about the use of D-dimer in evaluating the patient for PTE.

Quiz 7: Pulmonary Thromboembolic Disease