Pathology: Pulmonary Embolism

A blood clot that forms and remains in a vein is called a ____.
thrombus

A blood clot that becomes dislodged and travels to another part of the body is called an ____.
embolus

If the embolus significantly disrupts pulmonary bloody flow, pulmonary infartion develops and causes what three things?
-alveolar atelectasis
-consolidation
-tissue necrosis

_____ occasionally accompanies pulmonary embolism.
Bronchial smooth muscle contraction

An embolus may originate from one large thrombus or occur as a shower of small thrombi and may or may not interfere with the right side of the heart’s ability to ____ the lungs adequately.
perfuse

When a large embolus detaches from a thrombus and passes through the right side of the heart, it may lodge in the ______ of the pulmonary artery, where it forms what is known as a _____ which is often fatal.
bifurcation of the pulm. artery
saddle embolus

What are the major pathologic or structure changes of the lungs associated with pulmonary embolism? (5)
-Blockage of the pulmonary vascular system
-Pulmonary infarction
-Alveolar atelectasis
-alveolar consolidation
-bronchial smooth muscle constriction (bronchospasm)

A pulmonary embolus is a clinically ____ disorder. Meaning that it gradually, subtley and slowly develops.
insidious

If the pulmonary embolus is relatively small, the early signs and symptoms of its presence are often ___ and ____
vague and nonspecific

A large pulmonary embolus can cause ____.
sudden death

A massive pulmonary embolism is one of the most common causes of sudden and unexpected dealth in ___ age groups.
all age groups

Many pulm. emboli are undiagnosed and therefore ____.
untreated

What are the other possible sources of pulmonary emboli? (5)
-fat
-air
-amniotic fluid
-bone marrow
-tumor fragments

What source of pulmonary embolism is the most common?
blood clot BY FAR

Pulmonary blood clots originate or break away from sites of ______ in the lower part of the body such as the __ and ___ veins and the _____.
deep venous thrombosus (DVT)
leg and pelvic veins and inferior vena cava

When a thrombus or piece of a thrombus breaks loose in a deep vein, the blood clot, now an embolus is carried through the venous system to the (right/left)? atrium and ventricle of the heart and ultimately lodges in the _____ arteries or arterioles.
right atrium
pulmonary arteries or arterioles

There are three primary factors associated with the formation of deep venous thrombosus. What are they and what are they known as?
-venous stasis
-hypercoagulability
-injury to the endothelial cells that line the vessels
They are known as the Virchow’s Triad

What 4 things can cause venous stasis, a risk factor associated with pulmonary embolism
-inactivity (prolonged bed rest or sitting)
-congestive heart failure
-varicose veins
-thrombophlebitis

What surgical procedures are risk factors associated with pulmonary embolism?
-Hip surgery
-Pelvic surgery
-Knee surgery
-Certain obstetric or gynecologic procedures

What traumas are risk factors associated with pulmonary embolism?
-Bone fractures
-Extensive injury to soft tissue
-Postop to postpartum states
-Extensive hip or abdominal operations
-Phlegmasia alba dolens peurperarum (WTF)

What hypercoagulation disorders are risk factors associated with pulmonary embolism?
-Oral contraceptives
-Polycythemia
-Multiple myeloma

What other risk factors are associated with pulmonary embolism?
-obesity
-pacemakers or venous catheters
-pregnancy and childbirth
-supplemental estrogen
-family history of venous thromboembolism
-smoking
-malignant neoplasms
-burns

Pulmonary embolism signs and symptoms can very greatly depending on what 3 things?
-How much of the lung is involved
-The size of the embolism
-the overall health of the patient

What are the signs and syptoms commonly associated with pulmonary embolism? (13)
-suddent SOB
-tachycardia
-weak pulse
-lightheadedness or fainting
-anxiety
-excessive sweating
-cyanosis
-cool or clammy skin
-chest pain (ressembles heart attack)
-cough
-blood-streaked sputum
-wheezing
-leg swelling

What are 11 different ways a pulmonary embolism can be detected?
-Chest x-ray
-Spiral (helical) computed tomography scan
-electrocardiogram
-ventilation-perfusion scan
-pulmonary angiogram
-D-dimer blood test
-duplex venous ultrasonography
-extremity venography
-magnetic resonance imaging
-magnetic resonance angiography
-blood tests

A chest x-ray is often ____ in patients with a pulmonary embolism, but it can be used to rule out conditions that mimic a pulmonary embolism such as ____ and _____.
normal
pneumonia and pneumothorax

On a chest x-ray; ____ or ___ will be seen in about 50% of the pulmonary embolism cases and an elevated ___ occurs in about 40% of the cases.
infiltrates or atelectasis
hemidiaphragm

This test is fast becoming the first-line test for diagnosing suspected pumonary embolism.
Spiral (helical) computed tomography scan

Because the spiral CT scanner rotates continuously around the body, it can provide a _____ of any abnormalties with a higher degree of accuracy.
3D image

A ___ is usually used to help visualize the structures of the lungs.
dye (contrast medium)

A spiral CT scan only takes about ____ as opposed to ____ for the standard CT scan.
20 seconds
20 minutes

Because the spiral CT scan is fast, it is easier to capture the dye while it is still in the _____.
Pulmonary arteries

The spiral CT scan is considered to be more sensitive than the ____ and _____
ventilation-perfusion scan and pulmonary angiogram

The most common electrocardiogram abnormality in pulmonary embolism is nonspecific ____ changes.
ST-T wave changes

___ tachycardia is the most commonly seen rhythm disturbance.
Sinus tachycardia (normal rythym and >100bpm)

The ECg is an excellent test for ruling out disorders such as ____ or _____.
pericarditis and myocardial infarction

A V/Q scan is reliable only at the ____ of interpretation. It confirms that the lungs are normal or that there is a ____ of a pulmonary embolism.
extremes of interpretation
high probability of a pulmonary embolism

The V/Q test is slowly being ____ by more sensitive and rapid tests such as the _____.
replaced
spiral CT scan

A ___ _____ provides a clear image of the blood flow in the lung’s arteries. It is an extremely ___ test for diagnosis of pulmonary embolism.
pulmonary angiogram
accurate

Is a pulmonary angiogram invasive?
yes

How long does a pulmonary angiogram take to perform?
about 1 hr

What are some other disadvantages of the pulmonary angiogram?
-takes a high degree of skill to perform
-time consuming
-invasive (catheter and dye injection)

A pulmonary angiogram is usually performed when other tests _______.
have failed to provide a definitive diagnosis

Which pulmonary embolism tests are used to detect a blood clot in the vein? (6)
-D-dimer blood test
-duplex venous ultrasonography
-extremity venography
-magnetic resonance imaging
-magnetic resonance angiography
-blood tests

A blood clot in a vein is called a ____
venous thromboembolism (VTE)

The D-dimer blood test is also called the ___
fribrinogen test

This test is used to check for an increased level of the protein fibrinogen.
D-dimer blood test

The protein fibrinogen is an integral component of the _____ process.
blood clotting

D-dimer values high than ___ng/mL are considered positive which may suggest the possibitlity of ____.
500ng/mL
blood clots

Besides blood clots, what other condition would cause an increase in D-dimer levels?
recent surgery

The D-dimer test is used to ____ other clinical information and a normal D-dimer level rules out the possibility of a _____
supplement
blood clot

This test uses high-frequency sound waves to detect blood clots in the thigh veins.
duplex venous ultrasonography test

Is the duplex venous ultrasonography test invasive or noninvasive?
noninvasive

How long does the duplex venous ultrasonography test take to perform?
about 30 minutes or less

Duplex venous ultrasonography testing is very accurate for the diagnosis of blood clots behind the ___ or ____. Although it is relatively sensitive in detecting DVT above the knee, it is insensitive in detecting DVT ___ the knee.
knee or thigh
below the knee

This test is a complex and invasive procedure, a catheter is inserted into a vein of the patient’s arm or leg and a contrast dye is injected into the vein to make it visible on x-ray examination.
Extremity venography

Although extremity venography can accurately detect DVT, it has been largely replaced by ____.
duplex venous sonography

A magnetic resonance imaging (MRI) scan of the chest may be used for individuals whose ___ may be harmed by dyes used in x-ray tests and for women who are ____
kidneys
pregnant

This test may be used to differentiate between blood (usual) thromboemboli and tumor emboli in patients with malignancy.
Magnetic resonance angiography

For what three reasons would you use a blood test to detect a pulmonary embolism?
-pts who have a family history of blood clots
-pts who have had more than one epidosde of blood clots
-pts who have experienced blood clots for no known reason.

A blood test will determine if there are any ____ abnormalities in the blood-clotting system.
inherited

The treatment of a pulmonary embolism usually beings with treating the ___.
symptoms

What ways can a pulmonary embolism be treated/managed?
-Oxygen therpay
-Fast-acting anticoagulants
-Slow-acting, oral anticoagulants
-Thrombolytic agents
-Preventative measures
-vein filter
-pneumatic compression
-pulmonary embolectomy
-aerosolized medication

Fast-acting anticoagulants such as ____ are given to prevent exsisting blood clots from ___ and to prevent the formation of ____.
heparin
growing
new blood clots

Heparin, a fast-acting anticoagulant is administered ____ to achieve a rapid effect.
intravenously

Doctors strive to achieve a full anticoagulant effect within the first ___hrs of treatment.
24 hrs

Fast-acting anticoagulants are typically followed by what?
slow-acting oral anticoagulants

What are some examples of slow-acting oral anticoagulants?
-warfarin
-coumadin
-panwarfarin

___ and ___ are given together for 5-7 days, until blood tests show that the warfarin is effectively preventing clotting.
heparin and warfarin

The use of ___ agents such as streptokinase(streptase), urokinase (abbokinase), alteplase(activase) and reteplase(retavase) actually dissolve blood clots.
Thrombolytics

What are some examples of thrombolytics?
-streptokinase(streptase)
-urokinase(abbokinase)
-alteplase(activase)
-reteplase(retavase)

Thrombolytics are also known as _____ and have proved to be beneficial in treating ____ pulmonary embolism. These thrombolytic agents are sometimes used in conjuction with ____.
clot busters
acute pulmonary embolism
heparin

What measures can be taken to prevent a pulmonary embolism?
-walking
-exercising while seated
-drink fluids
-graduated compression stockings

A vein filter may be surgically placed in the _____ to prevent clots from being carried into the _____.
inferior vena cava
pulmonary artery

This treatment uses thigh-high cuffs that automatically inflate every few minutes to massage and compress the veins in a patients legs.
pneumatic compression

Studies show that pneumatic compression can significantly decrease the risk of ____, especially in pts who undergo ___ replacement surgery.
blood clots
hip replacement surgery

This procedure is the surgical removal of blood clots from the pulmonary circulation.
pulmonary embolectomy

A pulmonary embolectomy is generally a ____ in treating pulmonary embolism because of the mortality rate associated with the procedure and because of the availability of ____ agents to treat pulmonary embolism.
last resort
fibrinolytic agents (thombolytics)

Both _____ and ______ agents may be used to induce bronchial smooth muscle relaxation when wheezing is present.
sympathomimetic and parasympatholytic

What are the clinical data obtained at the bedside of a pt with pulmonary embolism?
-increased HR, RR,
-decreased BP
-hypoxemia
-cyanosis
-cough and hemoptysis
-peripheral edema and venous distention
-chest pain and decreased chest expansion
-syncope
-light headedness
-confusion
-abnormal heart sounds

What are the chest x-ray findings associated with pulmonary embolism
-increased density
-hyperradiolucency distal to the embolus
-dilation of the pulmonary arteries
-pulmonary edema
-right ventricular cardiomegaly
-pleural effusion (usually small)

Most pulmonary emboli originate from thombi in the
a. lung
b.right side of the heart
c. leg and pelvic veins
d. pulmonary veins
leg and pelvic veins

The aortic and carotid sinus baroreceptors initiate which of the following in respsonse to a decreased systemic blood pressure?
1.increased HR
2.increased RR
3. decreased HR
4.Decreased ventilatory rate
5. ventilatory rate is not affected by the aortic and carotid sinus baroreceptors.
1 and 2. Increased HR and RR

What is the upper limit of the normal mean pulmonary artery pressure?
a. 5mmhg
b. 10mmHg
c. 15mmHg
d. 20mmHg
d 20mmHg

Pulmonary hypertension develops in pulmonary embolism because of which of the following?
1. increased cross-sectional area of the pulmonary vascular system
2. vasoconstriction caused by humoral agent release
3. vosoconstriction induced by decreased arterial oxygen pressure
4. vasoconstriction induced by decreased alveolar oxygen pressure
2 and 4 only. Vasoconstriction caused by humoral agent release and decreased alveolar oxygenation pressure

In severe pulmonary embolism, which of the following hemodynamic indices is or are commonly seen?
1. decreased PVR
2. increase PA
3. decreased CVP
4. increased PCWP
2 only, increased PA

When humoral agents such as serotonin are released into the pulmonary circulation which of the following occur?
1. the broncnhial smooth muscles dilate
2. the v/q ratio decreases
3. the bronchial smooth muscles contract
4. the v/q ratio increases
2 and 3 only. The V/Q ratio decreases and the bronchial smooth muscles contract

Which of the following is or are thrombolytic agents
1. Urokinase
2. Heparin
3. Warfarin
4. Streptokinase
1 and 4. Urokinase and Streptokinase

Which of the following is the most prominent source of pulmonary emboli?
a. fat
b. blood clots
c. bone marrow
d. air
blood clots

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