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A. MLA Map Acute and Emergency > Deep Vein Thrombosis > Flashcards

Deep Vein Thrombosis Flashcards

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1
Q

Deep vein thrombosis (DVT) is the formation of a thrombus (blood clot) in a deep vein, which partially or completely obstructs blood flow. What is the incidence of DVT?

1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000

A

3 - 100 cases per 100,000

Equally as likely in men and women

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2
Q

Deep vein thrombosis (DVT) is the formation of a thrombus (blood clot) in a deep vein, which partially or completely obstructs blood flow. What age does the incidence of DVT typically peak?

1 - 20-30
2 - 30-40
3 - 50-60
4 - 60-70

A

4 - 60-70

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3
Q

What is an embolism?

1 - blockage of an artery
2 - blood clot blocking a deep vein
3 - atherosclerotic development in a deep vein
4 - part of blood clot that has broken off into blood

A

4 - part of blood clot that has broken off into blood

  • original clot is formed by primary and secondary haemostasis
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4
Q

There are a number of risk factors that increase the risk of a DVT. Which of the following are NOT part of Virchows triad?

1 - circulatory stasis
2 - fatty streaks identified
3 - hypercoagulablestate
4 - endothelial injury

A

2 - fatty streaks identified

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5
Q

Virchow’s triad relates to stasis, hypercoagulable state and endothelial damage. All of the following are risk factors for PE that can cause stasis, EXCEPT which one?

1 - immobility
2 - sepsis
3 - obesity
4 - pregnancy
5 - long haul flight
6 - low cardiac output

A

2 - sepsis

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6
Q

Virchow’s triad relates to stasis, hypercoagulable state and endothelial damage. All of the following are risk factors for PE that can cause hypercoagulable state, EXCEPT which one?

1 - malignancy
2 - thrombophilia
3 - obesity
4 - pregnancy
5 - post-partum
6 - OCP
7 - Sepsis

A

3 - obesity

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7
Q

Virchow’s triad relates to stasis, hypercoagulable state and endothelial damage. All of the following are risk factors that can lead to endothelial damage, EXCEPT which one?

1 - previous DVT
2 - thrombophlebitis
3 - lower limb trauma
4 - low cardiac output

A

4 - low cardiac output

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8
Q

The 3 key risk factors for deep vein thrombosis (DVT) are circulator stasis, endothelial injury and a hypercoagulablestate, all part of Virchows triad. There are additional risk factors, but which of the following is NOT a typical risk factor?

1 - pregnancy
2 - increasing age
3 - gender
4 - synthetic oestrogen
5 - cancer
6 - previous DVT
7 - obesity

A

3 - gender

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9
Q

Where are DVTs most common in the body?

1 - thigh
2 - calf
3 - abdomen
4 - upper limbs

A

2 - calf

Typically occur in popliteal and tibial veins

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10
Q

The calf is the most common location for a DVT, but they can also occur in the thigh. Which 2 veins are the most likely location for the DVT to occur in the thigh?

1 - popliteal and tibial veins
2 - popliteal and iliac veins
3 - dorsal pedis and tibial veins
4 - femoral and iliac veins

A

4 - femoral and iliac veins

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11
Q

50% of VTEs occur within 90 days following what?

1 - surgery
2 - antibiotic medication
3 - stop anti-coagulant medication
4 - hospital discharge

A

4 - hospital discharge

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12
Q

What are the 2 most typical features of a patient experiencing a DVT?

1 - pain and dizziness
2 - dizziness and swelling
3 - swelling and pain
4 - pain and confusion

A

3 - swelling and pain

Pain is throbbing/cramping in nature

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13
Q

In DVT, pain and swelling are the 2 most common symptoms, are these typically unilateral or bilateral?

A
  • unilateral
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14
Q

In DVT, pain and swelling are the 2 most common symptoms, is the severity of the pain associated with the severity of the DVT?

A
  • n0
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15
Q

In DVT, pain and swelling are the 2 most common symptoms. Is swelling isolated to the calves typically, or does it spread through the leg?

A
  • typically isolated to the calf

Pitting oedema may be present

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16
Q

Is pallor or rubor more common in patients with DVT?

A
  • rubor

But pallor (pale) can occur

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17
Q

In addition to pain and swelling, all of the following may occur in DVT, but which is least likely?

1 - increased temperature
2 - increased calf size
3 - tender calf
4 - ulceration

A

4 - ulceration

Could occur, but least likely option

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18
Q

Does a patient with a DVT always present with symptoms?

A
  • No
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19
Q

A 2-level DVT Wells score can be calculated if a DVT is suspected. Using the image below, what 2-level DVT Wells score would suggest a DVT?

1 - >2
2 - >4
3 - >6
4 - >8

A

1 - >2

<2 suggest DVT is unlikely

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20
Q

If a patient has a score of >2 using the 2-level DVT Wells score, a DVT is likely. Which of the following should be used first to try and diagnose the patient?

1 - d-dimer
2 - CTPA
3 - ultrasound leg
4 - whole body MRI

A

3 - ultrasound leg
Performed in <4h

If negative a d-dimer is performed
If ultrasound of leg and d-dimer are negative, DVT is unlikely

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21
Q

If a patient has a score of <2 using the 2-level DVT Wells score, a DVT is unlikely. Which of the following should be used first to try and diagnose the patient?

1 - d-dimer
2 - CTPA
3 - ultrasound leg
4 - whole body MRI

A

1 - d-dimer

This can be a finger prick or a laboratory test

22
Q

If a patient is waiting for a leg ultrasound or results from a d-dimer, which of the following should be performed?

1 - admit to hospital for monitoring
2 - administer LMWH
3 - reassure and arrange outpatient appointment
4 - administer DOACs

A

4 - administer DOACs
Apixaban or Rivaroxaban

If ultrasound of leg is negative, but d-dimer is positive, offer another leg ultrasound <6-8 days later

23
Q

Which of the following is NOT included in the differential diagnosis of a DVT due to unilateral calf swelling?

1 - Cellulitis
2 - Baker’s cyst
3 - Peripheral nerve disease
4 - Muscular pain
5 - Lymphoedema
6 - Chronic venous insufficiency
7 - Superficial thrombophlebitis
8 - Trauma

A

3 - Peripheral nerve disease

24
Q

If a patient has a confirmed pulmonary embolism or a massive thrombolysis, they can be treated with which 2 of the following medications?

1 - Dabigatran
2 - Alteplase
3 - Tenecteplase
4 - Dalteparin

A

2 - Alteplase
3 - Tenecteplase

  • both are Tissue plasminogen activator (tPA)
  • streptokinase can also be used
25
Q

Alteplase and Tenecteplase are both issue plasminogen activators (tPA) that are able to break clots in when a patient has a pulmonary embolism. What time frame does this need to be performed in though?

1 - <2.5h
2 - <4.5h
3 - <6.5h
4 - <8.5h

A

2 - <4.5h

26
Q

Which 2 of the following are 1st line medications for patients with a confirmed or high clinical suspicion of DVT?

1 - Dalteparin
2 - Apixaban
3 - Rivaroxaban
4 - Fondaparinux

A

2 - Apixaban
3 - Rivaroxaban

Both are direct anti-coagulants

27
Q

In a confirmed diagnosis of DVT, how long should Apixaban or Rivaroxaban (DOACs) typically be given for?

1 - 7 days
2 - 4 weeks
3 - 3 months
4 - 12 months

A

3 - 3 months

This is 3-6 months for active cancer

Following this time, patients are reviewed for potentially stopping or continuing DOAC

28
Q

Apixaban or Rivaroxaban (DOACs) are 1st line for patients with DVT. If these are unsuitable, which 2 of the following can be offered?

1 - enoxaparin
2 - dalteparin
3 - fondaparinux
4 - clopidogrel

A

1 - enoxaparin
2 - dalteparin

Both are LMWH

Following this dabigatran should be given

29
Q

If a patient has active cancer, which 2 of the following should be used to treat confirmed DVT?

1 - Dalteparin
2 - Apixaban
3 - Rivaroxaban
4 - Fondaparinux

A

2 - Apixaban
3 - Rivaroxaban

30
Q

If a patient has significant renal impairment, which 2 of the following should be used to treat confirmed DVT?

1 - Dalteparin
2 - Apixaban
3 - Enoxaparin
4 - Fondaparinux

A

1 - Dalteparin
3 - Enoxaparin

Both are Low molecular weight heparins

31
Q

What can be offered to patients if they have recurrent DVTs and high risk of PEs?

1 - lifelong DOAC use
2 - lifestyle modification
3 - leg amputation
4 - inferior vena cava (IVC) filters

A

4 - inferior vena cava (IVC) filters

32
Q

If a patient has a confirmed pulmonary embolism or a massive thrombolysis, they can be treated with which 2 of the following medications?

1 - Dabigatran
2 - Alteplase
3 - Tenecteplase
4 - Dalteparin

A

2 - Alteplase
3 - Tenecteplase

  • both are Tissue plasminogen activator (tPA)
  • streptokinase can also be used
33
Q

Alteplase and Tenecteplase are both issue plasminogen activators (tPA) that are able to break clots in when a patient has a pulmonary embolism. What time frame does this need to be performed in though?

1 - <2.5h
2 - <4.5h
3 - <6.5h
4 - <8.5h

A

2 - <4.5h

34
Q

d-dimers are a byproduct of blood clots breaking down, and are suggestive of DVT and PE. Do d-dimers have a good sensitivity or specificity?

A
  • sensitivity of 95-98%

sensitivity = correctly identify people with a PE or DVT

specificity = correctly rule out people with no PE or DV

35
Q

Prior to starting patients on anti-coagulant medication, all of the following must be assessed, but which is least likely to be essential?

1 - liver function
2 - thyroid function
3 - clotting profile
4 - renal function
5 - FBC

A

2 - thyroid function

36
Q

Prior to starting any anti-coagulation medication, the patient should be screened. Which of the following poses the greatest risk for patients with a DVT, or increases the risk of developing DVT and PEs?

1 - Haemophilia A
2 - Haemophilia B
3 - Von Willebrand disease
4 - Antiphospholipid syndrome

A

4 - Antiphospholipid syndrome

This is a thrombophilia disease that increases the risk of clotting

All others are haemophiliac diseases that increase the risk of bleeding

37
Q

How does antiphospholipid syndrome (AS), which is an autoimmune condition lead to a hypercoagulable state and increase the risk of a PE?

1 - antibodies target von Willebrand factor
2 - antibodies target apolipoprotein H
3 - antibodies target lymphocytes
4 - antibodies target endothelium

A

2 - antibodies target apolipoprotein H

  • apolipoprotein H normally inhibits agglutination (clumping of RBCs)
  • in AS agglutination occurs more often and increases the risk of blood clots
38
Q

Prior to starting any anti-coagulation medication, the patient should be screened. Which of the following poses the least risk for patients with a DVT due to an increased risk of developing DVT and PEs?

1 - Prothrombin gene mutation (factor II)
2 - Factor V Leidans disease
3 - Von Willebrand disease
4 - Antiphospholipid syndrome
5 - protein S and C deficiency

A

3 - Von Willebrand disease
Haemophiliac diseases that increase the risk of bleeding

All others are thrombophilia disease that increases the risk of clotting

39
Q

3 - Factor V Leiden is the most common inherited form of thrombophilia. How does a mutation in the factor V (5) gene cause hypercoagulability?

1 - increases conversion of prothrombin to thrombin
2 - protein C is unable to modulate factor V (5) activity
3 - protein S is unable to inhibit factor V (5)
4 - prothrombin is not produced

A

2 - protein C is unable to modulate factor V (5) activity

  • prothrombin (factor II) is proteolytically cleaved to form thrombin
  • thrombin converts soluble fibrinogen into insoluble strands of fibrin, as well as catalysing many other coagulation-related reactions.
40
Q

What do proteins S and C produced by the liver bind with in the haemostasis?

1 - initiate the intrinsic cascade
2 - bind with von willebrans factor
3 - bind factor X (10) in common pathway
4 - bind thrombin bound to thrombomodulin

A

4 - bind thrombin bound to thrombomodulin

  • thrombin binds to thrombomodulin on undamaged endothelial cells
  • protein S and C also bind inactivating thrombin
  • protein C also cleaves factors V (5) and VIII (8) in secondary haemostasis

Without proteins S and C, the risk of blood clot formation increases, which is bad in DVT and PE

41
Q

Which 2 of the following are 1st line medications for patients with a confirmed or high clinical suspicion of PE?

1 - Dalteparin
2 - Apixaban
3 - Rivaroxaban
4 - Fondaparinux

A

2 - Apixaban
3 - Rivaroxaban

Both are direct anti-coagulants

42
Q

In a confirmed diagnosis of PE, how long should Apixaban or Rivaroxaban (DOACs) typically be given for?

1 - 7 days
2 - 4 weeks
3 - 3 months
4 - 12 months

A

3 - 3 months

This is 3-6 months for active cancer

Following this time, patients are reviewed for potentially stopping or continuing DOAC

43
Q

If a patient has an unprovoked occurrence of DVT (no trauma, bed rest, active cancer, etc), how long should they be placed on a DOAC?

1 - 1 month
2 - 3 months
3 - 6 months
4 - 12 months

A

2 - 3 months

If it is provoked this is 3 months, but will then be reviewed appropriately

44
Q

Apixaban or Rivaroxaban (DOACs) are 1st line for patients with PE. If these are unsuitable, which 2 of the following can be offered?

1 - enoxaparin
2 - dalteparin
3 - fondaparinux
4 - clopidogrel

A

1 - enoxaparin
2 - dalteparin

Both are LMWH

Following this dabigatran should be given

45
Q

If a patient has active cancer, which 2 of the following should be used to treat confirmed PE?

1 - Dalteparin
2 - Apixaban
3 - Rivaroxaban
4 - Fondaparinux

A

2 - Apixaban
3 - Rivaroxaban

46
Q

If a patient has significant renal impairment, which 2 of the following should be used to treat confirmed PE?

1 - Dalteparin
2 - Apixaban
3 - Enoxaparin
4 - Fondaparinux

A

1 - Dalteparin
3 - Enoxaparin

Both are Low molecular weight heparins

47
Q

What can be offered to patients if they have recurrent PEs?

1 - lifelong DOAC use
2 - lifestyle modification
3 - leg amputation
4 - inferior vena cava (IVC) filters

A

4 - inferior vena cava (IVC) filters

48
Q

If a patient has unprovoked PE or Thrombophilia (blood clotting diseases), typically how long would their anticoagulation be for?

1 - 12 months
2 - <3 months
3 - lifetime
4 - 3-6 months

A

3 - lifetime

49
Q

In pregnant women who are suspected of having a DVT what is the treatment of choice?

1 - Warfarin
2 - Apixaban
3 - LMWH
4 - Rivaroxaban

A

3 - LMWH

  • Warfarin (teratogenic) and DOACs cross the placenta and should not be used
  • Rivaroxaban and Apixaban are both DOACs
  • PE is the biggest cause (23-30%) of maternal death in the UK
50
Q

Which 2 of the drugs below have been shown to be safe in women who are breastfeeding?

1 - DOACs
2 - Warfarin
3 - LMWH
4 - Heparin

A

2 - Warfarin
3 - LMWH

  • DOACs are new so not data on this yet
51
Q

Which 2 of the following can be offered to a patient with antiphospholipid syndrome experiencing a DVT?

1 - LMWH
2 - warfarin
3 - DOACs
4 - vitamin K antagonist

A

1 - LMWH
4 - vitamin K antagonist

A. MLA Map Acute and Emergency (42 decks)

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