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What are the 3 components of the virchow's triad and name 3 examples each.
- Venous stasis - immobility, AF, LV dysfunction
- Vascular injury - catheter, trauma, surgery
- Hypercoagulability -protein C & S deficiencies, malignancy, anti-thrombin deficiency, smoking
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For suspected PE, what are the 4 essential investigations and what is the golden standard test to perform?
- Essential
- CXR (focal oligemia, peripheral wedged-shaped density)
- ECG - AF, tachycardia, large PE (S1Q3T3)
- V/Q scan - mismatch
- ABC - decrease in PaO2
Golden standard to Dx - CTPA
Other tests: doppler ultrasound, DVT venogram, D-dimer, helical CT
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What drug therapies are needed?
- LMWH - enoxaparin OR dalteparin may be used
- Oral anticoag - warfarin
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Name 4 pathological findings at autopsy of a smoker woman died of saddle embolus after a DVT/PE.
- Large saddle embolus located in the pulmonary artery or at the bifurcation
- Haemorrhagic infarction – lower right lobe, wedge shaped (apex point towards the hilus)
- Anthracosis due to smoking
- Coronary artery disease / atherosclerosis e.g. aorta, carotid and vertebrobasilar system
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What are 3 complications if she didn't die?
- Recurrence of thrombus formation
- Cor-pulmonale (right heart overload) with pulmonary hypertension
- V/Q mismatching -- changed pneumocytes type II's function & reduced compliance
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What 6 investigations would be perform if brochial ca. is suspected?
- Aspiration of pleural effusion
- CXR
- CT
- PET scan
- Bronchoscopy
- FBC, LFT
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What are the 4 types pf histopathology of bronchial/lung cancer?
- Small cell - metastasise early, scant scytoplasm, small hyperchromatic nuclei, paraneoplastic syndromes, central lesions
- - NSCC (respond to surgery):
- *Squamous - associated with PTH-like peptide and hypercalcemia
- *Adenocarcinoma - peripheral lesions
- *Large cell
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Describe the natural Hx and prognosis of lung cancer (4 points).
- Direct spread to pleura and ribs
- Lymphatic and haematogenous spread - bone, brain,liver
- Paraneoplastic syndromes e.g. hypercalcemia
- Clubbing, HPOA
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The lung cancer pt died of pneumonia. What would you find at autopsy (2 points)?
- DVT/PE saddle embolus
- Cerebral mets/ herniation
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