Deep Vein Thrombosis

Question 1

What is venous thromboembolism (VTE)?

Answer 1

A common and potentially fatal condition involving a blood clot developing in the circulation.

It usually occurs secondary to blood stagnation or hypercoagulable states.

Question 2

What is deep vein thrombosis (DVT)?

Answer 2

A thrombus that develops in a deep vein.

DVT is a component of venous thromboembolism.

Question 3

What is a pulmonary embolism (PE)?

Answer 3

A condition where a thrombus travels to the lungs and becomes lodged in the pulmonary arteries, blocking blood flow.

This can occur when a thrombus from the deep veins embolizes.

Question 4

What can happen if a thrombus passes through a septal defect in the heart?

Answer 4

It can travel to the left side of the heart and into the systemic circulation, potentially causing a large stroke.

Question 5

List three risk factors for venous thromboembolism (VTE).

Answer 5

• Immobility
• Recent surgery
• Long haul travel

Question 6

What are thrombophilias?

Answer 6

Conditions that predispose patients to develop blood clots.

Examples include antiphospholipid syndrome and Factor V Leiden.

Question 7

What is the main contraindication for anti-embolic compression stockings?

Answer 7

Peripheral arterial disease.

Question 8

What are common presentations of DVT?

Answer 8

• Calf or leg swelling
• Dilated superficial veins
• Tenderness to the calf
• Oedema
• Colour changes to the leg

Question 9

What is the Wells score used for?

Answer 9

To predict the risk of a patient presenting with symptoms having a DVT or PE.

Question 10

How is D-dimer used in the diagnosis of VTE?

Answer 10

It is a sensitive test to help exclude VTE when suspicion is low and is almost always raised if there is a DVT or PE.

Question 11

What is the first-line imaging investigation for pulmonary embolism?

Answer 11

CT pulmonary angiogram (CTPA).

Question 12

What are the initial anticoagulant options for suspected DVT or PE?

Answer 12

• Apixaban
• Rivaroxaban
• Low molecular weight heparin (LMWH)

Question 13

What is the target INR for warfarin when treating DVTs and PEs?

Answer 13

Between 2 and 3.

Question 14

What is an inferior vena cava filter?

Answer 14

A device designed to filter blood and catch blood clots traveling from the venous system towards the heart and lungs.

Question 15

What is Budd-Chiari syndrome?

Answer 15

Obstruction to the outflow of blood from the liver caused by thrombosis in the hepatic veins or inferior vena cava.

Question 16

What classic triad presents in Budd-Chiari syndrome?

Answer 16

• Abdominal pain
• Hepatomegaly
• Ascites

Question 17

What is the usual imaging investigation for establishing Budd-Chiari syndrome?

Answer 17

Doppler ultrasonography.

Question 18

Fill in the blank: The cause of recurrent venous thromboembolism to remember is _______.

Answer 18

antiphospholipid syndrome.

Question 19

What should be considered when investigating unprovoked DVT?

Answer 19

Reviewing medical history, baseline blood results, and physical examination for evidence of cancer.

Question 20

What is the recommended duration of anticoagulation for unprovoked VTE?

Answer 20

Long-term for unprovoked VTE, recurrent VTE, or an irreversible underlying cause.

Question 21

What are the treatment options for Budd-Chiari syndrome?

Answer 21

• Anticoagulation
• Endovascular procedures
• Transjugular intrahepatic portosystemic shunt (TIPS)
• Liver transplant

Question 22

Answer 22

DVT