4177427
Descripción
Test por campbellpa2017, actualizado hace más de 1 año
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Creado por campbellpa2017
hace casi 9 años
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Pregunta 1
Pregunta
Mortality rates in the first 3 months following a PE dx are:
Respuesta
-
1.5%
-
5%
-
15%
-
30%
-
50%
Pregunta 2
Pregunta
Emboli begin as thrombi which may consist of:
Respuesta
-
fat
-
air
-
tumor
-
Only A & B
-
All of the above
Pregunta 3
Pregunta
Venous thromboembolism may originate from:
Respuesta
-
DVTs
-
catheters
-
infections
-
A & C only
-
All of the above
Pregunta 4
Pregunta
Which of the following are physiologic anticoagulants that oppose thrombosis?
Respuesta
-
AT-III
-
Fibrin
-
Protein C
-
A & C only
-
All of the above
Pregunta 5
Pregunta
Which of the following are the most common sources for clinically important pulmonary emboli? (select all that apply)
Respuesta
-
Subclavian veins
-
Right Atrium/Ventricle
-
Femoral vein
-
Iliac vein
-
Pelvic vein
Pregunta 6
Pregunta
Which of the following compose Virchow's Triad:
Respuesta
-
Factors in the vessel wall (e.g. tissue damage)
-
Abnormal blood flow (e.g. venous stasis)
-
Abnormal/Hypercoagulable states
-
Abnormal/Hypocoagulable states
-
Abnormal branching of vessels
Pregunta 7
Pregunta
Which of the following may cause venous stasis?
Respuesta
-
Surgery
-
Congestive Heart Failure
-
Pregnancy
-
Only A & B
-
All of the above
Pregunta 8
Pregunta
Which of the following may cause hypercoagubility? (select all that apply)
Respuesta
-
Oral contraceptives
-
Hormone Replacement Therapy
-
Pregnancy
-
Malignancy
-
Excesses of Proteins C or S
Pregunta 9
Pregunta
Over 95% of pulmonary emboli are thromboemboli.
Respuesta
- True
- False
Pregunta 10
Pregunta
Which of the following are NOT true regarding the natural history of a venous thomboembolism?
Respuesta
-
Non-extended distal DVTs rarely cause PE
-
80% of symptomatic DVTs have extended into the distal veins
-
60% of pts w/ symptomatic DVTs w/ will have a PE
-
70% of pts with symptomatic PE will have asymptomatic DVTs
-
DVTs most often start in the calf (distal) veins
Pregunta 11
Pregunta
Of the following sxs, which are all associated w/ PE, which is the least common?
(choose one)
Respuesta
-
Dyspnea
-
Cough
-
Leg Pain/Swelling
-
Pleuritic chest pain
-
Hemoptysis
-
Wheezing
-
Orthopnea
Pregunta 12
Pregunta
Which of the following is the most common sign associated with PE?
(found in approximately 54% of PE presentations)
Respuesta
-
Tachypnea
-
Calf swelling/tenderness
-
Tachycardia
-
Decreased breath sounds
-
Crackles
Pregunta 13
Pregunta
Which of the following is NOT part of the PERC clinical decision tool (i.e. HADCLOTS) used for diagnosing PE?
Respuesta
-
Surgery/trauma w/in past 28 days
-
Coughing blood
-
Lower extremity swelling unilaterally
-
O2 Saturation <95%
-
All of the above are associated with PERC
Pregunta 14
Pregunta
Which of the following pairs would have the HIGHEST Wells score?
Respuesta
-
1) PE most likely dx (on ddx), 2) Hemoptysis
-
1) Clinical signs and sxs of DVT, 2) Immobilization for > 3 consecutive days or surgery in previous 4 weeks
-
1) Previous Dx of PE or DVT, 2) Cancer (tx w/in past 6 mo)
-
1) Tachycardia (>100bpm), 2) Immobilization for > 3 consecutive days or surgery in previous 4 weeks
-
1) PE most likely dx (on ddx), 2) Cancer (tx w/in past 6 mo)
Pregunta 15
Pregunta
An EKG & Chest X-ray can be helpful tools in diagnosing a PE.
Respuesta
- True
- False
Pregunta 16
Pregunta
Which of the following may be found on a chest x-ray of a pt w/ PE?
(note: these are neither sensitive nor specific findings)
Respuesta
-
Decreased vascular markings in an area of lung (i.e. Westermark’s sign)
-
Wedge-shaped infiltrate extending to the pleural surface (i.e. Hampton’s hump)
-
Normal (no abnormal findings)
-
Only A & B
-
All of the above
Pregunta 17
Pregunta
Which of the following may be found on an EKG of a pt w/ PE?
(note: these are neither sensitive nor specific findings)
Respuesta
-
Ventricular arrhythmias
-
Left bundle branch block
-
S1 Q3 T3 pattern
-
Only A & C
-
All of the above
Pregunta 18
Pregunta
Which of the following clinical signs of PE is shown on this x-ray?
Respuesta
-
Westermark's sign
-
Hampton's hump
Pregunta 19
Pregunta
Which of the following clinical signs of PE is shown on this x-ray?
Respuesta
-
Westermark's sign
-
Hampton's hump
Pregunta 20
Pregunta
Which of the following is NOT true regarding use of CT angiography in dx of PE?
(select any that apply)
Respuesta
-
Bolus radiocontrast injection given intravenously.
-
High speed, multi-slice CT scanner takes thin section images.
-
Excellent definition of main and lobar.
-
May detect central and peripheral emboli.
-
May provide bonus information about the lungs and mediastinal structures.
Pregunta 21
Pregunta
CT scanning has excellent (~90%) positive predictive values.
Respuesta
- True
- False
Pregunta 22
Pregunta
Pulmonary angiography is considered the "gold standard" for dx of PE.
Respuesta
- True
- False
Pregunta 23
Pregunta
Which of the following statements is/are NOT accurate regarding pulmonary angiography.
Respuesta
-
Considered the "gold standard" in dx PE
-
Allows measurement of pulmonary artery pressures
-
It is both invasive and expensive
-
Frequently used to confirm dx of PE
-
Requires administration of intravenous radiocontrast
Pregunta 24
Pregunta
Which of the following is/are NOT true in regards to V/Q scanning in dx of PE:
(select any that apply)
Respuesta
-
perfusion scanning uses venous injection with radiolabeled- macroaggregated albumin (technetium 99)
-
ventilation scanning requires Iinhalation of a gas mixture containing a radiotracer (xenon 133)
-
it is sensitive for decreased flow to areas of the pulmonary vascular bed, but not specific
-
a normal perfusion scan excludes the diagnosis of PE.
-
in PE cases, areas of vascular obstruction should show decreased ventilation but preserved perfusion
Pregunta 25
Pregunta
A "high probability" V/Q scan result, coupled with high clinical suspicion, gives a > 95% likelihood of PE.
Respuesta
- True
- False
Pregunta 26
Pregunta
A negative (i.e. normal) D-Dimer result may be used to rule-out DVT and PE, regardless of clinical presentation and probability scores.
Respuesta
- True
- False
Pregunta 27
Pregunta
Which of the following labs is LEAST helpful in the dx of PE?
Respuesta
-
CBC
-
ABG
-
BNP
-
Troponin
-
INR, PTT
Pregunta 28
Pregunta
Which of the following labs/results are NOT properly matched, in regards to dx PE.
Respuesta
-
ABG: hypoxemia, widened alveolar-arterial gradient, and respiratory alkalosis
-
BNP: may be elevated due to right heart strain
-
Troponin: may be decreased in 30-50% of cases
-
PTT: needed for baseline when considering tx options
Pregunta 29
Pregunta
A D-Dimer test could be positive in which of the following cases?
Respuesta
-
Pregnancy
-
Infection
-
Post-Op
-
Trauma
-
All of the above
Pregunta 30
Pregunta
According to the diagnostic algorithm for pulmonary embolism, if the pt's Wells score exceeds 4, what is the next step?
Respuesta
-
D-Dimer
-
CT angiography
-
Pulmonary Angiography
-
Ultrasound (serial venous doppler)
-
V/Q scan
Pregunta 31
Pregunta
According to the diagnostic algorithm for pulmonary embolism, if the pt's Wells score is below 4, what is the next step?
Respuesta
-
No treatment (PE dx excluded)
-
D-Dimer to confirm
-
Chest X-ray to confirm
-
Serial Venous Doppler (US) to rule-out DVT
-
Labs to confirm (BNP, LFT, CBC, etc.)
Pregunta 32
Pregunta
Small emboli discovered in the course of dx are relatively benign and do not require tx.
Respuesta
- True
- False
Pregunta 33
Pregunta
Which three signs/sxs are most indicative of an acute PE?
Respuesta
-
Hemodynamic instability (hypotension)
-
AMS
-
Shock
-
Hemoptysis
-
Tachycardia
Pregunta 34
Pregunta
Prompt use of heparin in pt's w/ a DVT helps to lyse the clot and reduce mortality.
Respuesta
- True
- False
Pregunta 35
Pregunta
Mortality of PE after the initiation of heparin decreases to <5%
Respuesta
- True
- False
Pregunta 36
Pregunta
Which of the following anticoagulants is the treatment of choice in pt's w/ a bleeding risk?
Respuesta
-
Low molecular weight heparin
-
Unfractionated heparin
-
High molecular weight heparin
-
Fractionated heparin
-
None of the above (Anticoagulants are contraindicated in pt's w/ bleeding risk)
Pregunta 37
Pregunta
Which of the following statement is NOT accurate?
Respuesta
-
Unfractionated Heparin requires frequent lab monitoring
-
Unfractioned Heparin requires continuous infusion due to a short half-life
-
Unfractionated Heparin is reversible
-
LMW Heparin is administered via intramuscular injections
-
LMW Heparin does not require frequent monitoring and may be managed at home
Pregunta 38
Pregunta
Which of the following is NOT true regarding Rivaroxaban & Dabigatran?
Respuesta
-
they are oral medications approved by the FDA for the tx of PE
-
their risk of causing bleeding events is comparable or less than that of coumadin
-
they are both reversible
-
neither require close monitoring
-
they are both thrombin inhibitors
Pregunta 39
Pregunta
Thrombolytics are only indicated in hemodynamically stable patients.
Respuesta
- True
- False
Pregunta 40
Pregunta
Thromolytic tx may cause an intracranial hemorrhage.
Respuesta
- True
- False
Pregunta 41
Pregunta
Thrombolyics are typically administered by a vascular surgeon and/or radiologist.
Respuesta
- True
- False
Pregunta 42
Pregunta
Which of the following might necessitate the use of an IVC ?
Respuesta
-
Pt. w/ bleeding problems
-
Pt. allergic/intolerant to anticoagulants
-
Pt. in need of acute stabilization
-
A & B only
-
All of the above
Pregunta 43
Pregunta
Which of the following are predictors of poor outcomes for pt's w/ hx of PE? (choose all that apply)
Respuesta
-
Hypotension
-
Hypoxemia
-
Coexisting DVT
-
Decreased lactate
-
Decreased WBC
Pregunta 44
Pregunta
A resting pulmonary artery pressure of ________ is considered pulmonary hypertension.
Respuesta
-
more than 25mmHg
-
more than 35mmHg
-
more than 45mmHg
-
more than 55mmHg
Pregunta 45
Pregunta
Pulmonary hypertension may be:
Respuesta
-
familial
-
arise from areas affected by PE
-
related to drug toxicity
-
secondary to pulmonary venous congestion (e.g. left ventricular failure)
-
All of the above
Pregunta 46
Pregunta
Pulm. HTN is due to hypoxia and hypoxemia and may be seen in diseases such as COPD.
Respuesta
- True
- False
Pregunta 47
Pregunta
An increase in blood flow, such as one experiences while exercising, will cause a proportional increase across the pulmonary vascular bed.
Respuesta
- True
- False
Pregunta 48
Pregunta
Which of the following may cause pulm HTN (via chronic hypoxemia): (select all that apply)
Respuesta
-
Chronic high altitude
-
COPD
-
Pulmonary fibrosis
-
Obstructive sleep apnea
-
Chronic Asthma
Pregunta 49
Pregunta
Which of the following may also cause pulm HTN:
(select all that apply)
Respuesta
-
Parasitic infections
-
Recurrent/unresolved PE
-
Cocaine use
-
HIV
-
Syphilis
-
Liver disease
-
Allergies
Pregunta 50
Pregunta
Idiopathic pulm HTN is most common in women, ages 20-45 years old, and is due to medial hypertrophy and intimal proliferation and fibrosis.
Respuesta
- True
- False
Pregunta 51
Pregunta
Common symptoms of Pulm HTN may include:
(choose all that apply)
Respuesta
-
Dyspnea
-
Dysphagia
-
Peripheral edema
-
Syncope
-
Chest pain
Pregunta 52
Pregunta
Possible signs of pulm HTN may include:
Respuesta
-
Carvahlo's sign (tricuspid murmur, regurg. w/ inspir.)
-
Prominent pulmonic component of second heart sound
-
Right ventricular (S3) gallop
-
JVD
-
Transient periods of tachycardia
-
Distended spleen
-
Left ventricular hypertrophy
-
Corrigan's pulse (alternates weak and bounding)
Pregunta 53
Pregunta
All of the following are possible lab/diagnostic findings in Pulm HTN, EXCEPT:
Respuesta
-
Polycythemia
-
Decreased PaO2
-
Stenosis of main pulmonary (CXR)
-
Cardiomegaly (CXR)
-
Elevated Pulm Pressures (ECG & Echo)
Pregunta 54
Pregunta
Which of the following are potential treatments for Pulm HTN: (select all that apply)
Respuesta
-
Long-term anticoagulation (even when not due to chronic PE)
-
Vasodilators (especially for Primary Pulm HTN)
-
Lung Transplantation
-
Supplemental O2
-
Cardiopulmonary bypass
Pregunta 55
Pregunta
Of the vasodilators used to tx pulm HTN, which is the most controversial?
Respuesta
-
Calcium channel blockers
-
Prostacyclin
-
Endothelin receptor blockers
-
All vasodilators are controversial in tx of Pulm HTN
Pregunta 56
Pregunta
Which of the following statements is NOT accurate regarding Cor Pulmonale?
Respuesta
-
Right ventricular failure due to pulmonary disease
-
Usually accompanied by hypercapnia
-
Most commonly caused by pulm HTN, COPD, or pulm fibrosis
-
Chronic and progressive
Pregunta 57
Pregunta
Which are NOT common sxs associated with Cor Pulmonale:
Respuesta
-
Cough
-
Swelling of face/neck
-
Cyanosis
-
JVD
-
Dysphagia
-
Gallop S3 heart rhythm
Pregunta 58
Pregunta
Common lab findings in Cor Pulmonale include:
Respuesta
-
Westermark sign on CXR
-
RAD, RVH on EKG
-
Polycythemia on CBC
-
B & C only
-
All of the above
Pregunta 59
Pregunta
All of the following are used to tx Cor Pulmonale EXCEPT:
Respuesta
-
ACE Inhibitors/Angiotensin Receptor Blockers
-
Dopamine/dobutamine
-
Anticoagulants
-
Beta-2 Agonists
Pregunta 60
Pregunta
This is a rare autoimmune disease that affects the kidneys and lungs, causing necrosis of alveoli and loss of gas exchange.
Respuesta
-
Goodpasture's Syndrome
-
Wegener's Granulomatosis
Pregunta 61
Pregunta
While Goodpasture's may affect persons of all ages, it is found to be more common in younger males and older females.
Respuesta
- True
- False
Pregunta 62
Pregunta
Signs/Sxs that might differentiate Goodpasture's from diseases such as PE and Pulmonary HTN, include:
(select all that apply)
Respuesta
-
Hematuria
-
Pallor
-
Weight Loss
-
Myalgia
-
Proteinuria
Pregunta 63
Pregunta
Which of the following diagnostics are indicated in a work-up for Goodpasture's syndrome?
(Select all that apply)
Respuesta
-
Anti-glomerular basement membrane test
-
ABG
-
BUN
-
CXR
-
LFT
-
Lung & Kidney Biopsy
-
MRI
Pregunta 64
Pregunta
Goodpasture's Syndrome is treated with:
Respuesta
-
Plasma exchange to remove antibodies
-
Immunosuppressants
-
Steroids
-
A & B only
-
All of the above
Pregunta 65
Pregunta
This rare disease causes "geograpahic" necrosis and granulomatous inflammation of the airways.
Respuesta
-
Goodpasture's
-
Wegener's
Pregunta 66
Pregunta
Wegener's granulomatous is believed to be caused by cellular immune processes and may present w/ respiratory and renal involvement.
Respuesta
- True
- False
Pregunta 67
Pregunta
Which of the following statements concerning Wegener's granulomatous is FALSE ?
Respuesta
-
It is a rare disease
-
Equally prevalent in men and women
-
Typically occurs in the 4th-5th decade of life
-
Is fatal within one year if not treated
-
All of the above statements are TRUE
Pregunta 68
Pregunta
This rare disease can cause recurrent sinusitis, chronic ear infections, and a variety of flu-like sxs.
Respuesta
-
Wegener's
-
Goodpasture's
Pregunta 69
Pregunta
The work-up for this disease includes a blood test for anti-neutrophil cytoplasmic antibodies.
Respuesta
-
Wegener's
-
Goodpasture's
Pregunta 70
Pregunta
While many survivors may be dependent on dialysis, the 5-year survival rate for Wegener's granulomatous is about 70%
Respuesta
- True
- False
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