Athermoma, Thrombosis and Embolism

Question 1

What are the consequences of an atheroma?

Answer 1

Stenosis
Dissection
Aneurysm
Thrombosis
Embolism
Ischaemia

Question 2

What causes arterial stenosis

Answer 2

loss of elasticity in the artery

Question 3

what causes cardiac fibrosis

Answer 3

consequence of ischaemia- reduced contractility

Question 4

What is an aneurysm

Answer 4

Abnormal dilation of an artery

Question 5

What is a dissection

Answer 5

Blood enters a tear in the intima creating a flase lumen

Question 6

What are the risk factors for a dissection?

Answer 6

Hypertension
Atheroma
Trauma
Coartication of the aorta 
Marfans
Pregnancy

Question 7

What are the risk factors for a DVT?

Answer 7

obesity
inactivity
pregnancy
surgery
after long flight or car journey
varicose veins
cancer
previous ischaemic event 
heart failure
sepsis

Question 8

What diseases can predisopose to a DVT

Answer 8

nephrotic syndrome
IBD
vasculitis
thrombocytosis
inheritied coagulation disorders, antithrombin deficiency etc

Question 9

What medications/drugs can predispose to a DVT

Answer 9

IVD
birth control pill
chemotherapy
heparin induced thrombocytopenia

Question 10

What is virchows triad

Answer 10

hypercoagulabolity
stasis
endothelial injury

Question 11

where do dvt’s mostly form

Answer 11

valves

Question 12

What are the symptoms of a DVT

Answer 12

pain
swelling
hot/inflammed
red
tender

Question 13

What blood test can be done to look for a dvt?

Answer 13

D dimer

not specific

Question 14

what imaging can be done to look for a dvt

Answer 14

duplex scan
venous plethosomography
ultrasound
venogram

Question 15

what is the treatment for a dvt

Answer 15

anticoagulate with LMWH and warfarin

compression stockings

Question 16

What emergency complication can arise from a DVT

Answer 16

phlegmasia dolens= DVT causes so much back pressure that it obstructs arterial flow
“venous gangrene”

Question 17

How could you treat phlegmasia dolens

Answer 17

IVC filter
femoral arterial line
amputation

Question 18

How can an acute PTE be classified?

Answer 18

massive= with shock/syncope
Major= RV dysfunction
Major- normal RV function
minor

Question 19

What signs could indicate a PTE

Answer 19

fourth heart sound

pleural rub

Question 20

What is the first test you do if a PE is suspected?

Answer 20

D dimer then CXR

Question 21

When do you do a VQ scan

Answer 21

if d dimer raised

Question 22

What can you do after a VQ scan

Answer 22

Ct pulmonary angiogram will give definitie diagnosis

Question 23

What is the usual treat ment of PE

Answer 23

anticoagulation

Question 24

What can be done in a major PE

Answer 24

thrombolytic therapy but higher risk of bleed

Question 25

What can be done to prevent recurrence?

Answer 25

IVC filter will decrease recurrent PE in short term nut may increase DVT and require long term anticoagulation

Question 26

When is warfarin contraindicated

Answer 26

Pregnancy
Drug or alcohol abuse
dementia and mental illness

Question 27

What foods are high in vitamen K

Answer 27

Spinach
brocolli
lettuce
soya beans

Question 28

When is lifelong anticoagulation indicated?

Answer 28

Recurrent PE
Antiphospholipid syndrome
Inherited thrombophilia 
malignancy
pulmonary hypertension

Question 29

How long should you be anti coagulated after a first PE

Answer 29

3-6 months