Deep Vein Thombosis and Pulm Embolism

Question 1

Two types of DVT?

Answer 1

Proximal DVT (popliteal, femoral, iliac) or distal DVT (calf)

Question 2

Two most common places for DVT?

Answer 2

Posterior tibial vein and peroneal vein

Question 3

What is the most common form of DVT in pregnant womean?

Answer 3

Left lower extremity due to fetal compression of left iliac vein

Question 4

3 components of Virchow Triad?

Answer 4

Hypercoagulability, vessel injury, circulatory stasis

Question 5

Why are pregnant women at an increased risk of having a DVT or PE?

Answer 5

Increased coagulation factors

Question 6

What are inherited risk factors for DVT?

Answer 6

Factor V Leiden (most common), prothombin gene mutation, protein C/S deficiency, antithrombin deficiency, dysfibrinogenemia

Question 7

What are acquired risk factors for DVT?

Answer 7

Recent surgery (hip/knee), immobilization, malignancy, oral contraceptives, HRT, pregnancy, obesity, inflammation (AutoImmune)

Question 8

Clinical presentation of DVT?

Answer 8

Leg pain, tenderness and warmth, swelling, discoloration, palpable chord

Question 9

What is Phlegmasia cerulean dolens?

Answer 9

Clinical sign of severe DVT. Massive obstruction and cyanosis

Question 10

Calf circumference that measures ______ increases probability of DVT?

Answer 10

Greater than 3cm

Question 11

What is the preferred method of diagnosis of DVT? When should it be ordered?

Answer 11

Compression venous duplex ultrasound. Should be ordered same day

Question 12

What is the GOLD standard for diagnosis of DVT? What are some complications?

Answer 12

Ascending contrast venography. Uncomfortable, can induce DVT, only used if noninvasive test uncertainty

Question 13

What other test can be ordered if DVT suspected?

Answer 13

D-dimer, hypercoagulable state screening (CBC, TP, aTTP, protein C/S, antithrombin, factor V Leiden)

Question 14

These individuals should raise suspicion of hypercoagulable state?

Answer 14

Younger individuals with DVT

Question 15

All patients with _____ will require anticoagulation and 90% of ________ result from ________.

Answer 15

proximal DVT, PE, proximal DVT

Question 16

These individuals can be monitored every 2 weeks with ultrasound?

Answer 16

Distal DVT and high risk of bleeding

Question 17

________ score of >13% will require no antocoag.

Answer 17

HTN, abnormal liver or renal function, stroke, bleeding, labile INR, Eldery (>65), drugs or alc

Question 18

Individuals with recurrent DVT are treated for how long?

Answer 18

indefinitely or if they have multiple risk factors

Question 19

Individuals with first episode of DVT are treat for how long?

Answer 19

3 months (sx, high risk bleeding) OR 6 months if persisent risk factors not resolved (cancer, immobile)

Question 20

PE can arise from?

Answer 20

DVT, air, fat, tumor cells

Question 21

Pathophysiology of PE?

Answer 21

Emboli gets lodged in the arteries of lungs This leads to reduction of pulm circulation and infarcted areas. Tachypnea and hypoxia can result. Vasoconstriction and increased pulm resistance occur. This can cause atelectasis. If more than 50% pulm circ. occluded, right sided heart failure can occur.

Question 22

Clinical presentation of PE?

Answer 22

DYSPNEA (can be sudden & severe), CHEST PAIN, COUGH, hemoptysis, tachypnea, tachycardia, syncope, JVD, gallop can occur, cyanosis

Question 23

Typical physical examination findings of PE?

Answer 23

Rarely demonstrate specific findings

Question 24

Diagnostic testing for PE?

Answer 24

CBC, ESR, ABG (resp. alk & hypocapnia. Can progress to resp. acid & hypercapnia if shock), BNP, Troponins, Ddimer, check PT/aPTT

Question 25

ECG findings for PE?

Answer 25

S1Q3T3 sign of acute cor pulmonale

Question 26

Common CXR findings of PE?

Answer 26

Hampton’s hump, Westermark sign (blunting of pulm arteries) these are rare, atelectasia, pleural effusion

Question 27

What is the diagnostic test of choice for PE?

Answer 27

Multidetector CT pulmonary angiography

Question 28

In this disease, patients have autoantibodies that activate thombotic processes?

Answer 28

Antiphospholipid antibody syndrome (APS)

Question 29

Treatment for PE?

Answer 29

Anticoagulation therapy. Start LMWH (1mg/kg SC q12h) or unfractionated heparin (80U/kg bolus IV then 18U/kg/hr IV). Start coumadin 5mg qd.