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Common Pulmonary Embolus (PE)exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

What are the risk factors for pulmonary embolus (PE)?

  • Previous VTE
  • Patient
    • Age > 60
    • Obesity
  • Situation
    • Immobility
    • Prolonged travel
  • Condition
    • Acute medical illness
    • Surgery – especially lower limb orthopaedic surgery
    • Malignancy
    • Thrombophilia
    • Pregnancy
    • OCP/HRT

 

Question 2.

What is the Well’s score in pulmonary embolism (PE)?

  • The Well’s score assesses the probability of PE with given presentations.
  • The score it gives defines probability of PE
  • This then dictates further investigations.
Factor Points
Clinically suspected DVT 3
Alternative diagnosis less likely than PE 3
Tachycardia 1.5
Immobilisation/surgery in previous four weeks 1.5
History of DVT or PE 1.5
Haemoptysis 1
Malignancy (treatment in preceding 6 months or palliative stage) 1
  • 0-4: PE unlikely
    • Do a D-Dimer – if negative, look for other causes of symptoms·
  • > 4 = PE likely
    • Do a CTPA or V/Q scan

 

Question 3.

What are the chances of malignancy in pulmonary embolus?

  • 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

 

Question 4.

What potential strategies are there for patients who develop PE despite adequate anti-coagulation?

  • Increase INR target to 3-4
  • Switch to LMWH
  • IVC filter

 

Question 5.

Who should have thrombophilia testing after a PE?

  • 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

 

Question 6.

Is there any evidence for thrombolysis in stable patients who have evidence of right ventricular dysfunction?

  • 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