B4-030 CBCL: Venous Thromboembolism

Question 1

treatment for superficial vein thrombosis

Answer 1

• warm compress
• anti-inflammatory
• follow up visit

Question 2

homozygosity for Factor V Leiden or APLS require

Answer 2

long term anticoagulation

Question 3

in a young patient with DVT and no known predisposition, what further testing should be done?

Answer 3

hypercoagulable work up for both inherited and non inherited disorders

Question 4

unusual sites of thrombosis require

Answer 4

more extensive testing

malignancies and other underlying states

Question 5

APLS should be managed with long term anticoagulation with

Answer 5

vitamin K antagonists

Question 6

for patients over 50, the d dimer cutoff should be

Answer 6

10x their age

Question 7

• arterial blood flow to the limb is acutely compromised from severe arterial occlusion
• painful, pale leg

Answer 7

phlegmasia alba dolens

Question 8

• severe and extensive acute DVT resulting in limb threatening emergency
• venous blood unable to return to heart causing severe edema

Answer 8

phlegmasia cerulea dolens

Question 9

occurs months/years after acute DVT has resolved

Answer 9

post thrombotic syndrome

Question 10

catheter directed thrombolytic therapy reduces

Answer 10

the incidence of post thrombotic syndrome in some patients

Question 11

results most often from compression of left iliac vein from right iliac artery

Answer 11

may thurner syndrome

Question 12

associated with pelvic inflammatory disease, pregancy, or pelvic fx/surgery

Answer 12

pelvic vein thrombosis

Question 13

occurs following long bone fx requiring surgery

Answer 13

fat embolization

Question 14

acute PE with severe tachycardia and hypotension, non pleuritic chest pain

think…

Answer 14

RV strain/RV infarction

Question 15

PE with pleuritic pain, hemoptysis

think..

Answer 15

pulmonary infarction

Question 16

if clinical probability of PE is very high, first step is

Answer 16

start heparin therapy, then testing

Question 17

in a patient with renal failure, what test can be done to dx PE?

Answer 17

VQ scan

Question 18

in a pregnant patient with suspected PE, what test should be done to diagnose PE?

Answer 18

duplex of lower extremity

Question 19

a large, acute PE can result in

Answer 19

RV dilation and flattened interventricular septum

Question 20

classify risk of PE

hemodynamically unstable
PESI >1
RV dysfunction
Elevated troponin

Answer 20

high

Question 21

classify risk for PE

stable
PESI >1
RV dysfunction
elevated troponin

Answer 21

intermediate high

Question 22

classify risk of PE

stable
PESI >1
RV dysfunction OR elevated troponin

Answer 22

intermediate low

Question 23

classify risk of PE

stable
negative on all assessments

Answer 23

low

Question 24

needed to decide if patient is at high risk of acute mortality

Answer 24

RV/LV ratio

Question 25

if you do not have echocardiogram, you can get RV/LV ratio from

Answer 25

CT scan

Question 26

intervention that does not require thrombolytics and can remove large amounts of thrombus quickly

Answer 26

catheter directed mechanical pulmonary thrombectomy

Question 27

recent bleeds and active malignancy are contraindications for

Answer 27

thrombolytic therapy

Question 28

pose the highest risk of DVT

Answer 28

orthopedic surgery

Question 29

a palpable cord is likely to be from

Answer 29

thrombosis of superficial vein

Question 30

symptoms of DVT

Answer 30

painful, swollen leg eythema, warmth

Question 31

patient complains of pain when dorsiflexing foot

Answer 31

homan's sign | non specific for DVT

Question 32

indwelling central line is a risk factor for

Answer 32

DVT

Question 33

considerations for outpatient DVT treatment

Answer 33

* compliance to anticoagulants * do not have the potential to worsen

Question 34

pleuritic pain is concerning for

Answer 34

pulmonary infarct

Question 35

significant leg swelling is concerning for

Answer 35

large thrombus with potential to embolize

Question 36

patients with malignancy are high risk for VTE and require

Answer 36

long term anticoagulation

Question 37

best efficacy for long term anticoagulation is seen with

Answer 37

enoxaparin injections

Question 38

unexplained weight loss is concerning for

Answer 38

malignancy

Question 39

if you cannot find obvious cause of DVT follow up with

Answer 39

scans to rule out cancer

Question 40

does heterozygosity for factor V leiden increase the risk of recurrent embolism?

Answer 40

no

Question 41

increasing incidence and decreasing mortality of PE is due to

Answer 41

increase in use of CTA chest for mild suspicion of PE

Question 42

when should IVC filters be removed

Answer 42

as soon as no longer necessary

Question 43

risks of IVC filters

Answer 43

* migration * fragmentation * infection

Question 44

when should an IVC filter be left in place long term?

Answer 44

patients who have ongoing high risk for VTE and contraindication for anticoagulation

Question 45

if risk of recurrence is low and factors are reversible, how long should the patient take anticoagulants?

Answer 45

3 months

Question 46

risk of VTE increases significantly at what age

Answer 46

55

Question 47

are men or women more affected by VTE?

Answer 47

men

Question 48

key driver in OCCs for increased VTE risk

Answer 48

estrogen

Question 49

virchow's triad

Answer 49

* hypercoagulability * stasis * vessel wall damage

Question 50

how does a DVT cause stroke?

Answer 50

embolized DVT can enter arterial circulation via patent foramen ovale

Question 51

direct thrombin inhibitor

Answer 51

dabigatran

Question 52

do IVC filters reduce mortality?

Answer 52

no

Question 53

do IVC reduce recurrence rate of PE?

Answer 53

yes | not DVT

Question 54

antiphospholipid syndrome requires

Answer 54

lifelong anticoagulation

Question 55

thromboxane and serotonins cause

Answer 55

pulmonary vasocontriction | leads to RV strain

Question 56

in patients with a low pretest probability of DVT or PE, what test should be done first?

Answer 56

d dimer

Question 57

right ventricular stain causes decreased

Answer 57

cardiac output

Question 58

right ventricular strain is caused by

Answer 58

increased PA pressure and RV wall ischemia from hypoxia

Question 59

used to indentify severity of PE by showing RV strain

Answer 59

echocardiogram

Question 60

in critically ill patients with massive PE, what two therapies are life saving?

Answer 60

surgical embolectomy ECMO

Question 61

severe and life threatening condition that can be seen years after PE

Answer 61

chronic thromboembolic pulmonary hypertension

Question 62

CTEPH results in

Answer 62

pulmonary hypertension

Question 63

CTEPH is more likely following

Answer 63

incomplete resolution of thrombus due to: -high thrombus burden -repeated PE episodes