P.E. and other emboli.

/10

An embolus is defined as---

First coined by Virchow in 1848

A solid, liquid or gaseous mass that is carried by the blood to a different place to it's point of origin.

A mass that breaks off and wedges distally.

Where fluid, air or thrombus is carried to the lungs.

An unattached mass that is capable of blocking a vessel.

/10

This CXR is from an IV drug user who suffered Staph emboli. Where are the emboli likely to have originated from?

She developed a vegetation on her tricuspid valve which repeatedly embolised septic material into her lungs.

Her mitral valve.

Her tricuspid valve.

Her right atrium.

The veins of her lower leg.

/10

Which of the following is TRUE about woman who develop amniotic fluid emboli.

It tends to occur in woman <25yrs age and in short labours. Amniotic fluid embolus is the number 1 cause of maternal mortality in Australia.

It occurs mainly in woman over 40yrs of age.

90% get shortness of breath.

It is the number 3 cause of maternal mortality in Australia.

It tends to occur in long labours.

/10

What is thought to be the increased risk of having a stroke if you have atrial fibrillation?

It is believed that atrial fibrillation causes 15% of strokes.

A 25 fold increase.

A 2 fold increase.

A 10 fold increase.

A 5 fold increase.

/10

Which is the following is FALSE about fat embolism?

It does of course occur after long bone and pelvic trauma---but not commonly. The GURD criteria has both major and minor parts.

It has occurred after a Brazilian butt lift.

There is a classical clinical triad of respiratory compromise, petechial rash and neurological abnormalities.

It commonly occurs after long bone and pelvic trauma.

Diagnosis uses the "GURD" criteria.

/10

Which one of these people did NOT die of a pulmonary embolus.

Serena Williams did suffer a pulmonary embolus after giving birth---but survived.

Theodore Roosevelt (President USA).

Frida Khalo (Mexican painter).

Serena Williams (Tennis player).

Jimmy Stewart (Actor).

/10

In acute decompression sickness what causes the emboli?

If these bubbles enter the lungs it is known as the "chokes". If they enter the joints you get the "bends".

Helium entering the circulation on ascent.

Carbon dioxide entering the circulation on ascent.

Nitrogen entering the circulation on ascent.

Oxygen entering the circulation on ascent.

/10

What is the most common ECG finding in a pulmonary embolus?

The ECG shows an S1Q3T3 and a right bundle branch pattern.

Sinus tachycardia.

S1Q3T3.

Right bundle branch block.

Left bundle branch block.

/10

You are asked to do an urgent ECHO on a patient with a possible large PE. Does this short axis view support the presumptive diagnosis of PE?

The right ventricle is on the left of the screen, the left ventricle on the right. You can see the right ventrcle is bigger than the left ventricle and it's high pressure is distorting the left ventricle shape.

Certainly not.

Not really as other options very likely.

Yes--on balance.

Yes certainly.

/10

What is a "paradoxical" embolus?

Model-sitting-on-the-wall-and-wearing-Dr-Martens-1460-1

Rare but can be devastating clinically.

The first person to correctly tell me why there is a picture of shoes for this question gets a free coffee-----answers to alan.giles@health.nsw.gov.au

When you think the patient has a PE but paradoxically they have pneumonia.

When an embolus from the veins goes through a VSD or ASD and causes an embolus in the systemic circulation.

When the PE comes from the right side of the heart not from a leg DVT.

When someone gets a PE despite being on an anticoagulant.

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