|
 Quiz
Answer Key
Q#l T,T,T,T,T
Q#2 T,T,F,F,T
Q#3 T,T,T,T,T
Q#4 T,F,F,T,T
Q#5 T,T,F,F,T
Q#6 F,F,F,T,T
Q#7 F,F,F,T,T
Q#8 T,T,F,F,T
Q#9 F,F,F,F,T
Q#10 T, T, T, T, T
For Further details you could refer to
the commentary and the
references
Illustrations:
Fig. 1.1 Chest X-ray with consolidation
patches on the LT. and RT. Lung (Pleural
based)
Fig. 2.1 ECG with S1, slight Rt axis deviation
&T wave inversion inVI-V4
Fig. 1.2 Venogram With multiple filling
defects
Fig. 3.1 V/Q Scan With segmental perfusion
defects
Discussion
and Comments:
-
"The Economy Class Syndrome "was
described by Cruickshank and colleagues
in 1988 (23)
-
In a recent case -control study
including 160 patients with VTE associated
with a history of prolonged travel
by air or other routes lasting 4 hours
or more can precipitate DVT/PE within
one month of presentation, although
the presence of other risk factors
for VTE increased the chance of the
event, some patients were found in
the study group had no risk factors
other than prolonged travel (24)
-
The diagnosis of venous thrombosis
is confirmed in only about one third
of Suspected cases when reliable objective
tests are performed. [1,2]
-
Many large potentially dangerous
venous thrombi are clinically silent.
[3]
-
Thrombophlebitis migrans was found
to be associated with GIT carcinoma
over 125 years ago by Trousseau. [4,5]
-
Not all neoplasms are associated
with venous thrombosis, of those that
are; pancreatic carcinoma is the most
notable, followed in descending order
of frequency by carcinoma of bronchus,
genitourinary tract, colon, stomach
& breast [6]
-
Dyspnoea & pleuritic chest pain
were most common symptoms in anigiographically
documented P. E. series
of over 300 patient [7]
-
In the prospective investigation
of pulmonary embolism diagnosis [PIOPED]
project using pulmonary angiography
as the gold standard, it was found
that a high probability V IQ scan
report correctly diagnosed pulmonary
embolism in about 92% of cases, where
as the frequency of pulmonary embolism
in low probability scans was 16% [8].
Whenever clinical likelihood of P. E
is high and V IQ scan is indeterminate
P. Angio is indicated before committing
the patient on a risky and may be
life long treatment on anticoagulants.
-
Plasma D- Dimer test has low specificity
for diagnosing pulmonary embolism,
with too many false positives to be
diagnostically useful [9,10] i.e.,
it may rule out VTE if it is negative.
-
Studies of [sub massive] P.
embolism, have suggested that in an appropriate
dosage, low molecular weight heparins
may be of similar efficacy to unfractionted
heparin, so that their use is becoming
accepted in uncomplicated cases [11,
12]
-
The British Society for Haematology
has recommended a target INR of 2.5
for treating deep venous thrombosis,
pulmonary embolism & ,symptomatic
inherited thrombophilia, and 3.5 in
the management of a recurrence of
either condition whilst on warfarin
[13].
-
Pulmonary angiography is the classic
way to demonstrate pulmonary emboli
radiographically; it is still regarded
as the gold standard for the diagnosis
of pulmonary embolism [14]. But it
is expensive, invasive. and, not readily
available in a lot of centres.
-
Bilateral Ascending venography as
described by Rabinov and Paulin is
the accepted reference standard in
the diagnosis of DVT [15, 16].
-
Patients with HIT (heparin associated
(Induced) thrombocytopenia) have significantly
greater platelet surface concentrations
of the immunoglobulin FcRll (CD3).
This suggests that these patients
are more susceptible for the development
of thrombocytopenia and both arterial
and venous thrombosis [17].
-
S1 QIII TIII is found in about 30%
of angiographically proven pulmonary
embolism [18,19].
-
Antiphospholipid syndrome is
defined
as recurrent thrombosis or recurrent
foetal death associated with anticardiolipid
or lupus anticoagulant antibodies
[20].
-
Anticoagulation for thrombosis in
anti phospholipid syndrome may need
to be continued for life [20, 22]
-
Catastrophic antiphospholipid syndrome
has a mortality rate over 50% and
may be triggered by discontinuation
of anticoagulation, by surgery or
by infection [20,22]
References
|
