Deep Vein Thrombosis and Pulmonary Embolism

Question 1

what is a thrombus?

Answer 1

a clot arising in the wrong place

Question 2

what is a thromboembolism?

Answer 2

movement of a clot along a vessel

Question 3

what is virchow’s triad?

Answer 3

> stasis
hypercoagulability
vessel damage

Question 4

give some examples of venous thromboembolism

Answer 4

> limb deep vein thrombosis
> pulmonary embolism
> visceral venous thrombosis
> intracranial venous thrombosis
> superficial thrombophlebitis

Question 5

what is a venous thrombus principally due to?

Answer 5

stasis and hypercoagulability

Question 6

what cells make a venous red thrombus?

Answer 6

fibrin and red cells

Question 7

what vessel does a white clot form?

Answer 7

arteries

Question 8

what cells make up a white thrombus?

Answer 8

platelets and fibrin

Question 9

what results from an arterial thrombus?

Answer 9

ischaemia and infarction

Question 10

what are the symptoms and signs of deep vein thrombosis?

Answer 10

> unilateral limb swelling
> persisting discomfort
> calf tenderness
> warmth
> redness
> it may be clinically silent

Question 11

what are the symptoms and signs of a pulmonary embolism?

Answer 11

> pleuritic chest pain
> breathlessness
> haemoptysis
> tachycardia
> pleural rub on auscultation

Question 12

what are the signs and symptoms of massive pulmonary embolism?

Answer 12

> severe sudden onset dyspnoea
> collapse
> central cyanosis
> tachycardia
> low blood pressure
> raised JVP
> altered heart sounds
> may cause sudden death

Question 13

what is post-phlebitis syndrome?

Answer 13

a potential long-term consequence of long-term DVT causing: swelling, discomfort, pigmentation and ulceration.

Question 14

what is a potential long term consequence of pulmonary embolism?

Answer 14

pulmonary hypertension

Question 15

name some risk factors of venous thrombosis

Answer 15

> increased age
> tissue trauma
> immobility
> obesity
> smoking
> cancer
> pregnancy
> exogenous oestrogen

Question 16

what is heritable thrombophilia?

Answer 16

an inherited predisposition to venous thrombosis

Question 17

what is the most prevalent heritable thrombophilia?

Answer 17

factor v leiden

Question 18

what would you use to diagnose deep vein thrombosis

Answer 18

> clinical assessment
blood test: d dimer
compression ultrasound

Question 19

what would you use to diagnose pulmonary embolism?

Answer 19

> clinical assessment
> d-dimer
> isotope ventilation
> perfusion scan
> CT pulmonary angiogram

Question 20

how can you prevent venous thrombosis embolism in hospital?

Answer 20

> early mobilisation
anti-embolism stockings
daily injections of low molecular weight heparin

Question 21

what do anti-embolism stockings provide at the ankle?

Answer 21

18mmHg

Question 22

what do anti-embolism stockings provide at the mid-calf?

Answer 22

14mmHg

Question 23

what do anti-embolism stockings provide at the upper thigh?

Answer 23

8mmHg

Question 24

what are the indications for graduated compression stockings?

Answer 24

> prevention of DVT
> chronic venous insufficiency
> oedema
> lymphoedema
> prevention of post-phlebtic syndrome

Question 25

what is the treatment for venous thromboembolism?

Answer 25

low molecular weigh heparin for 5 or more days then oral anti-coagulant (warfarin). thrombolysis is for massive pulmonary embolism.