Sun21November0437PM 17

In a patient with a suspected pulmonary embolus (PE), which of the following is true?

True / False

Pulmonary embolectomy is contraindicated with a peripheral PE Incorrect answer selected

A positive ventilation-perfusion (VQ) scan shows absent ventilation in a region with persistent perfusion Correct

Electrocardiogram (ECG) changes include an S1, Q3, T3 pattern and signs of left ventricular strain Correct

An increased alveolar-arterial oxygen gradient and hypercarbia occurs following a PE Incorrect answer selected

The presence of a pleural rub can distinguish a PE from pneumonia Correct

Explanation

A pulmonary embolus can present with dyspnoea, pleuritic chest pain (with an audible pleural rub), haemoptysis, cyanosis, pulmonary hypertension, right ventricular failure or cardiac arrest. They can also be asymptomatic. A pleural rub may be found on auscultation in pneumonia, so it cannot be used to confirm a PE.

The associated ECG changes in a PE are not diagnostic, but include signs of right (not left) ventricular strain with right axis deviation, right bundle branch block and the S1, Q3, T3 pattern (S wave in lead I, Q wave and inverted T wave in lead III).

The classical findings on arterial blood gas analysis show hypoxia, hypocarbia (not hypercarbia) and an increased alveolar-arterial oxygen gradient.

A positive ventilation-perfusion scan will show persistent ventilation in a region with absent perfusion (not ventilation). The presence of coexisting pulmonary pathology reduces the sensitivity of this investigation.

Treatment of a PE requires systemic anticoagulation (heparin followed by warfarin), and in selected cases only (central PE) surgical embolectomy may be performed.

Answer Statistics

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Average score: 80.34%

Times answered: 293