Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic SocietyDisclosure: Nothing to disclose. Ann Intern Med. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. [Medline]. 2011 Jul. 2003 May 27. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. Pulmonary embolism can be diagnosed using a high D-dimer result combined with confirmatory results from other tests, such as ultrasounds and CT … . 363(26):2499-510. Söhne M, Ten Wolde M, Boomsma F, Reitsma JB, Douketis JD, Büller HR. 2013 Jul 2. Because the embolus blocks an artery, which in turn prevents the exchange of oxygen into the bloodstream, PE will cause a decrease of oxygen delivered to the organs and body systems. [Medline]. [Medline]. J Natl Med Assoc. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Aksay E, Yanturali S, Kiyan S. Can elevated troponin I levels predict complicated clinical course and inhospital mortality in patients with acute pulmonary embolism?. Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, et al. 375 (6):534-44. What is the incidence of pulmonary embolism (PE) in the US? Patient History: Pulmonary Examination. [Medline]. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. Pulmonary embolism (PE) can occur without deep vein thrombosis (DVT). ACXR shows pulmonary infiltration and pleural effusions, but it does not diagnose a PE. When is physical activity recommended for pulmonary embolism (PE)? Remy-Jardin M, Remy J, Deschildre F, Artaud D, Beregi JP, Hossein-Foucher C, et al. 19(3):202-7. Chest. Cost-effectiveness of lower extremity compression ultrasound in emergency department patients with a high risk of hemodynamically stable pulmonary embolism. van den Heuvel-Eibrink MM, Lankhorst B, Egeler RM, Corel LJ, Kollen WJ. Which acute disorders increase the risk of pulmonary embolism (PE)? Am J Emerg Med. What is the role of thrombolytic therapy in the management of patients at intermediate risk of embolism (PE)? 2012 Mar 20. A pulmonary embolism (PE) is the sudden blockage of a blood vessel in the lungs by an embolus. Tick LW, Nijkeuter M, Kramer MH, Hovens MM, Büller HR, Leebeek FW, et al. How much does elevated BNP levels increase the risk of mortality and complications in acute pulmonary embolism (PE)? [Full Text]. 2015 Nov 3. Which hereditary factors are increase the risk of pulmonary embolism (PE)? A study in 2009 reported that in 1 in 4 patients with a PE, the first manifestation will be sudden-unexpected death. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. [Medline]. Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J, et al. What is the mortality rate of pulmonary embolism (PE) in the US? Kuklina EV, Meikle SF, Jamieson DJ, Whiteman MK, Barfield WD, Hillis SD, et al. What is the role of MRI in the diagnosis of pulmonary embolism (PE)? 379 (12):1118-1127. [Full Text]. What are the signs and symptoms of massive pulmonary embolism (PE)? JAMA. 29(3):278-82. 334(7595):674. 2009 Feb. 113(2 Pt 1):293-9. What is the treatment for pulmonary embolism (PE) after hospital discharge? 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. Physical inactivity and idiopathic pulmonary embolism in women: prospective study. Boutitie F, Pinede L, Schulman S, Agnelli G, Raskob G, Julian J, et al. This is a close-up view. J Intern Med. Radiology. 35 (43):3033-69, 3069a-3069k. What are the indications for fondaparinux therapy in acute pulmonary embolism (PE)? 2012 Jun. In fact, clinical examination can be absolutely normaland unless you consider a PE as the cause of your patient’s ch… 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. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Women. Oral apixaban for the treatment of acute venous thromboembolism. [Medline]. What does D-dimer testing measure in patients with suspected pulmonary embolism (PE)? A pulmonary angiogram shows the abrupt termination of the ascending branch of the right upper-lobe artery, confirming the diagnosis of pulmonary embolism. What are the advantages of LMWH therapy for pulmonary embolism (PE)? 358(10):1037-52. [Medline]. [Medline]. 4. Acute pulmonary embolism: diagnosis with MR angiography. Pulmonary embolism is a common disorder that is related to deep vein thrombosis (DVT). , 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. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. [Medline]. What chest radiography findings suggest the presence of pulmonary embolism (PE)? Spyropoulos AC, Ageno W, Albers GW, Elliott CG, Halperin JL, Hiatt WR, et al. Am J Respir Crit Care Med. 2014 Jun 18. 2014 Feb 18. The ventilation scan findings were normal; therefore, these are mismatches, and this is a high-probability scan. Circulation. How is echocardiography used for the diagnosis of right ventricular dysfunction in suspected pulmonary embolism (PE)? [Medline]. [Medline]. [Full Text]. Thromb Haemost. Patel S, Kazerooni EA. OVERVIEW. The superficial femoral vein (lateral vein) has the appearance of 2 parallel veins, when in fact, it is 1 lumen containing a chronic linear thrombus. 2012 Mar. Pulmonary embolism and deep venous thrombosis. 1994 Dec 15. Eur Heart J. The role of risk factors in delayed diagnosis of pulmonary embolism. 2005 Dec. 20(4):373-80. What is the difference between central, peripheral, and massive pulmonary embolism (PE)? 2006 Jun 6. How is massive pulmonary embolism (PE) defined and what is the associated mortality rate? Presented at: 54th Annual Meeting and Exposition of the American Society of Hematology; December 8, 2012; Atlanta, Ga. [Full Text]. Basic Pathology. N-terminal pro-B-type natriuretic peptide predicts the burden of pulmonary embolism. [Medline]. Circulation. What differential diagnoses should be considered in suspected pulmonary embolism (PE)? The pathophysiology of pulmonary embolism. What are the ACEP guidelines for the diagnosis of pulmonary embolism (PE)? Pulmonary embolism refers to the obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart. Clinical history helps to distinguish the potential causes of abnormal lung sounds. How is duplex ultrasonography used to diagnose pulmonary embolism (PE)? Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Computed tomography angiography in a young man who experienced acute chest pain and shortness of breath after a transcontinental flight. Ann Intern Med. hip fracture ; elective total hip arthroplasty. Jiménez D, Uresandi F, Otero R, Lobo JL, Monreal M, Martí D, et al. CT scan of the same chest depicted in Image 18. Pulmonary embolism incidence is increasing with use of spiral computed tomography. Becattini C, Agnelli G, Vedovati MC, et al. How effective is rivaroxaban (Xarelto) in the treatment of pulmonary embolism (PE)? The nurse noticed that breath sound is diminished on both lung bases of the patient with chronic obstructive pulmonary disease (COPD). 140(7):667-71. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. As you’ll see, we’ve listed out a ton of practice questions that will teach you everything you need to know about the disease and some of the important nuances to look for in the treatment and prevention of a pulmonary embolism. 2011 May 24. N Engl J Med. Am Heart J. A pulmonary embolism is a blood clot that becomes lodged in the lung. 2008 Mar 6. What is the role of angiography in the diagnosis of pulmonary embolism? 60-80. 2008 Apr. 107(20):2545-7. Minor forms of pulmonary embolism after abdominal operations. 1997 May 15. This patient's risk factors for pulmonary embolism include advanced age, surgery, and prolonged bedrest. 361(24):2342-52. 57 (6):628-652.e75. Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, et al. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. What is the role of CT scanning in the diagnosis of pulmonary embolism (PE)? c. Young women. [Medline]. Crit Care. J Emerg Med. If you looking for pulmonary embolism practice questions then this study guide is for you. What increases the risk of recurrent pulmonary embolism (PE)? What are the ACR recommendations for the use of chest radiography in suspected pulmonary embolism (PE)? [Medline]. Accessed: October 28, 2013. 118(1):13-25. 185(1):135-49. When is thrombolytic therapy most beneficial in pulmonary embolism (PE)? Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Circulation. 2012 Feb. 141 (2 Suppl):7S-47S. Which test should be performed for patients with low-to-moderate probability of pulmonary embolism (PE)? 9:49. Medscape [serial online]. >>NCLEX Review Questions — Test Yourself! 347:f3368. procedures associated with pulmonary embolism. In: Kumar V, Cotran RS, Robbins SL, eds. Computed tomography angiogram in a 53-year-old man with acute pulmonary embolism. Why does pulmonary embolism (PE) often go untreated? Very low probability interpretation of V/Q lung scans in combination with low probability objective clinical assessment reliably excludes pulmonary embolism: data from PIOPED II. 2018 Nov 27. 4(3):552-6. a. When is thrombolytic therapy indicated in pulmonary embolism (PE)? Mayo Clin Proc. a. Sudden death. 2008 Aug. 264(2):195-200. A large pulmonary artery thrombus in a hospitalized patient who died suddenly. Klok FA, Mos IC, Huisman MV. How does venous stasis cause pulmonary embolism (PE)? Is the PO2 level on ABG analysis useful in diagnosing pulmonary embolism (PE)? Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Pulmonary embolism-experience at a single children's hospital. 2013 Feb 21. Br J Haematol. 2014 Apr 10. [Medline]. Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness. What is the evidence that right ventricular dilatation on bedside echocardiography aids in the diagnosis of pulmonary embolism (PE)? Circulation. 2009 Mar 26. Am J Med. What are alternatives to warfarin for prophylaxis and treatment of pulmonary embolism (PE)? Sequential images demonstrate treatment of iliofemoral deep venous thrombosis due to May-Thurner (Cockett) syndrome. Far left, after stent placement, image shows wide patency and rapid flow through the previously obstructed region. Middle right, after 24 hours of thrombolysis, a bandlike obstruction is seen; this is the impression made by the overlying right common iliac artery. [Medline]. 1993 Sep. 123(3):337-46. Severe obstetric morbidity in the United States: 1998-2005. Ann Fam Med. 353(9162):1386-9. December 13, 2012. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Kearon C, Ginsberg JS, Douketis J, Turpie AG, Bates SM, Lee AY, et al. Case 3. Diagnosis of pulmonary embolism with magnetic resonance angiography. 2.] How is V/Q scanning used for the diagnosis of pulmonary embolism (PE)? MRI is a noninvasive test that detects a deep vein thrombosis, but it does not diagnose a pulmonary embolus. The diagnosis of a PE cannot be made on examination alone. Her D-Dimer is 200 mg/ml fibrinogen units. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. [Guideline] Raja AS, Greenberg JO, Qaseem A, Denberg TD, Fitterman N, Schuur JD, et al. 2011 Jan. 18(1):22-31. What role does autopsy have in the understanding of pulmonary embolism (PE)? [Medline]. 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). Chest. If you log out, you will be required to enter your username and password the next time you visit. 163(14):1711-7. Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients. [Guideline] Fesmire FM, Brown MD, Espinosa JA, Shih RD, Silvers SM, Wolf SJ, et al. A 25 year old woman complains of shortness of breath after 10 hours of travel by air. Pediatr Clin North Am. 1. Helical CT for the evaluation of acute pulmonary embolism. Chest. [Medline]. 2007 Sep. 48(9):1411-5. N Engl J Med. 2010 Nov 1. [Medline]. What is the duration of long-term anticoagulation for pulmonary embolism (PE)? J Nucl Med. When is consultation with a cardiac surgeon necessary for pulmonary embolism (PE)? Her vital signs include T 37.9 C, P 80/minute, RR 25/minute, and BP 110/60 mm Hg. What is the risk of thromboembolic disease during pregnancy? What are the high-probability criteria for V/Q scanning diagnosis of pulmonary embolism (PE)? 2012 Oct. 40(4):919-24. [Full Text]. What is the role of leptin testing in the evaluation of pulmonary embolism (PE)? What are medicolegal concerns regarding pulmonary embolism (PE)? (Parts 1 … [Medline]. Ward MJ, Sodickson A, Diercks DB, Raja AS. How does HIV infection affect the risk of developing pulmonary embolism (PE)? [Medline]. [Medline]. Accessed: July 15, 2013. Order a V/Q scan [Medline]. True or false? Accessed: April 19, 2014. 342(25):1855-65. Ann Emerg Med. Pulmonary embolism MCQ. How is ECG used in the workup for pulmonary embolism (PE)? In most cases, the embolism is caused by … 2003 Jul 28. What are the causes of pulmonary embolism (PE)? How does the prevalence of pulmonary embolism (PE) vary among different age groups? 2012 Oct 4. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. N Engl J Med. 2011 Jun. [Medline]. When is fibrinolytic therapy initiated in patients with pulmonary embolism (PE)? Am J Respir Crit Care Med. 2001 May 22. [Full Text]. Henzler T, Roeger S, Meyer M, Schoepf UJ, Nance JW Jr, Haghi D, et al. 158(6):585-93. What atypical symptoms may be caused by pulmonary embolism (PE)? Who is at greater risk for pulmonary embolism ? Pulmonary embolism (PE) is the obstruction of one or more pulmonary arteries by solid, liquid, or gaseous masses. Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: the thrombo-embolism lactate outcome study. [Medline]. N Engl J Med. N Engl J Med. Pulmonary/Lung Study Questions_MAC_032020 What are some of the most common s/s of pulmonary disease? [Full Text]. Increased diagnosis of pulmonary embolism without a corresponding decline in mortality during the CT era. Lung infarction secondary to pulmonary embolism occurs rarely. 107(6):1035-43. Becattini C, Vedovati MC, Agnelli G. Diagnosis and prognosis of acute pulmonary embolism: focus on serum troponins. True or false? Middle left, after 12 hours of catheter-directed thrombolysis, an obstruction at the left common iliac vein is evident. Hippisley-Cox J, Coupland C. Development and validation of risk prediction algorithm (QThrombosis) to estimate future risk of venous thromboembolism: prospective cohort study. A. Malek J, Rogers R, Kufera J, Hirshon JM. What percentage of hospitalized patients have pulmonary embolism (PE)? What is the presentation of acute pulmonary infarction? [Medline]. A posteroanterior chest radiograph showing a peripheral wedge-shaped infiltrate caused by pulmonary infarction secondary to pulmonary embolism. Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction. 345:e6564. 2008 Dec. 34(12):2147-56. 1997 May-Jun. 2008 May 30. 121(7):611-7. In asking patients about dyspnea, the following types of questions are helpful: [Full Text]. [Full Text]. 36(5):1632-6. BMJ. EXAM Preparation. Dempfle CE, Elmas E, Link A, et al. 2000 Jun 22. When are compression stockings used as adjunctive treatment for pulmonary embolism (PE)? New York, NY: McGraw-Hill; 1955:. 1996 Sep. 200(3):699-706. 2. What is the incidence of physical signs in pulmonary embolism (PE)? What are hemodynamic consequences of pulmonary embolism (PE)? What are respiratory consequences of pulmonary embolism (PE)? What are the benefits of CT scanning in the diagnosis of pulmonary embolism (PE)? 370(15):1402-11. Apixaban for extended treatment of venous thromboembolism. Available at What are the ACCP guidelines for duration of anticoagulation therapy for recurring pulmonary embolism (PE)? Questions are similar to the PANCE questions about pulmonary matters aids in the of!, Anniccherico-Sánchez FJ, Abínzano-Guillén ML, Garcia-Sanchotena JL Advice from the Fleischner Society to enter your and. Postoperative death due to pulmonary embolism filters indicated in the diagnosis of pulmonary (! Outcome study, Archer SL, Cushman M, et al a, et.! 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