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Egyptian Board Thoracic Diseases study materials
Egyptian Board Thoracic Diseases study resources

Egyptian Board Thoracic Diseases: Thromboembolism and Sleep-Disordered Breathing

Egyptian Board Thoracic Diseases · Work through your exam, one topic at a time.

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Thromboembolism and Sleep-Disordered Breathing

Domain 7 - Thromboembolism and Sleep-Disordered Breathing

This domain tests risk stratification and evidence-based management of venous thromboembolism, plus recognition and treatment of obstructive sleep apnoea and obesity hypoventilation. Expect questions on Wells score, age-adjusted D-dimer, CTPA, thrombolysis, AHI thresholds and CPAP.

Core rules

  • Pretest probability: Wells score for PE. Score >4 means PE likely; go to CTPA. Score ≤4 means PE unlikely; use PERC to rule out without testing, or D-dimer. Age-adjusted D-dimer uses age × 10 µg/L for patients over 50.
  • CTPA is first-line imaging; V/Q scan is used in renal failure, contrast allergy or pregnancy when CTPA is not suitable.
  • Anticoagulation: DOACs are first-line for most patients without cancer, pregnancy or antiphospholipid syndrome; LMWH is used in pregnancy and cancer-associated thrombosis.
  • High-risk PE with hypotension requires systemic thrombolysis or embolectomy. Intermediate-risk PE with RV dysfunction and elevated troponin is managed with anticoagulation and monitoring, not routine thrombolysis.
  • OSA diagnosis: AHI 5–15 mild, 15–30 moderate, >30 severe, with symptoms. CPAP is first-line for moderate-severe OSA and for mild OSA with significant symptoms or comorbidity. Obesity hypoventilation requires CPAP or NIV plus weight management.

Worked example

A 58-year-old woman has pleuritic chest pain, tachycardia and recent knee surgery. Wells score is 5.5, so PE is likely. CTPA shows bilateral segmental PE. BP is 118/70 mmHg, troponin is elevated, and RV/LV ratio is 1.2. This is intermediate-risk PE. Start therapeutic anticoagulation with a DOAC after bleeding risk review, admit for monitoring, and do not give thrombolysis because she is haemodynamically stable. Investigate for provoking factors and plan 3 months of anticoagulation if the surgery-related trigger resolves.

Traps that cost marks

  • Ordering D-dimer in a high-probability patient instead of CTPA.
  • Using PERC in a patient with any positive criterion.
  • Missing pregnancy as a reason to avoid DOACs and use LMWH.
  • Giving thrombolysis to a stable patient with intermediate-risk PE.
  • Diagnosing OSA without sleep study confirmation.

Key points

  • Wells >4: PE likely, proceed to CTPA.
  • Age-adjusted D-dimer: age × 10 µg/L for age >50.
  • High-risk PE with hypotension needs thrombolysis or embolectomy.
  • DOACs first-line except pregnancy, cancer-associated thrombosis and antiphospholipid syndrome.
  • OSA: AHI 5–15 mild, 15–30 moderate, >30 severe; CPAP for moderate-severe.