273 - Deep Venous Thromboembolism and Pulmonary Thromboembolism

Question 1

What are the common complications of PE and DVT? (3)

Answer 1

Chronic pulmonary HTN
Exertional dyspnea
Venous insufficiency

Question 2

What does the Virchow triad include?

Answer 2

1. Venous stasis
2. Hypercoagulability
3. Endothelial damage

Question 3

What are the two common autosomal dominant mutation leading to prothrombotic states?

Answer 3

1. Factor V Leiden

2. Prothrombin mutations

Question 4

What is the deficiency in Factor V Leiden?

Answer 4

Resistance to the endogenic anticoagulant - Protein C

Question 5

What is the deficiency in prothrombin mutations

Answer 5

increases prothrombin concentration in the plasma

Question 6

What is the common cause for acquired thrombophilia?

Answer 6

APLA (Anti Phospholipid Antibodies)

Question 7

Name some of the common risk factors for thromboembolism (5)

Answer 7

1. Malignancy
2. Obesity
3. Smoking
4. HTN
5. COPD

Question 8

D-Dimer is very ____, but not _____ at all

Answer 8

Sensitive

Specific

Question 9

What are the common changes in ECG caused by PE? 4

Answer 9

S1Q3T3
sinus tachycardia
RBBB
Right axis

Question 10

______ is the main imaging test for PE

Answer 10

CT with contrast

Question 11

______ is the second line of imaging for PE patients who are intolerable for contrast fluid

Answer 11

Lung scan

Question 12

What are the 3 strategies for anticoagulation treatment?

Answer 12

1. Parenteral heparin/ LMWH/ fondaparinux
2. Parenteral treatment for 5 days followed by NOAC (edoxaban, dabigatran=Pradaxa)
3. Monotherapy with rivaroxaban (Xarelto) / apixaban (Eliquis)

Question 13

What is the antidote for heparin / LMWH?

Answer 13

Protamine sulfate

Question 14

What is the antidote for dabigatran (Pradaxa)?

Answer 14

Idarucizumab

Question 15

In provoked thromboembolism treatment will last for __ months

Answer 15

3

Question 16

Cancer patients will be treated with LMWH for ____ or ____

Answer 16

Their entire life

Until the cancer is resolved

Question 17

In unprovoked thromboembolism treatment will last for __

Answer 17

The patient’s entire life

Question 18

IVC filters is given when: (2)

Answer 18

1. Active bleeding which prevents anticoagulation

2. Recurrent venous thrombosis under pharmaceutical treatment

Question 19

_____ is the preferred drug for fibrinolysis in massive PE

Answer 19

tPA

Question 20

tPA is C/I in (3):

Answer 20

1. Intracranial disease
2. Recent surgery
3. Trauma