DVT

Question 1

DDx lower extremity edema

Answer 1

DVT
Venous Insufficiency
Venous Obstruction (Baker’s Cyst, Mass, Position, Compression)
Lymphatic Obstruction
Compartment Syndrome
Trauma
Cellulitis
Allergic Reaction
Cirrhosis
Hypoalbuminuria (nephrotic, malnutrition, enteropathy)
Medications (CCBs, NSAIDs, Thiazolidinediones)
Pre-Eclampsia/Eclampsia
Myxedema
Lymphatic Filariasis
Eosinophilic Fasciitis
Congestive Heart Failure
Pericardial Effusion
Pericarditis
Valvular Issues (stenosis, regurgitation)
Pulmonary Hypertension
Cor Pulmonale

Question 2

Most common thrombophilia causing DVT

Answer 2

Factor V Leiden

Question 3

RF

Answer 3

Virchow’s triad: endothelial damage, venous stasis, hypercoagulability
Hospitalisation
Immobility
Trauma
Prev VTE
OCP
Postpartum
Pregnancy
Cancer
FDR

Question 4

Complications

Answer 4

PE
Chronic venous insufficiency

Question 5

Chronic venous insufficiency rx

Answer 5

exercise, compression stockings, leg raises

Question 6

Chronic arterial insufficiency sx

Answer 6

Decreased Pulses, Loss of Hair, Hypertrophic Nails, Decreased Cap Refill, Rubor, Cool Skin, Arterial Ulcers

Question 7

Acute arterial insufficiency sx

Answer 7

pale, pulseless, pain, paresthesia, polar, paralysis

Question 8

DDx bilateral leg pain with activity

Answer 8

Arterial claudication
Neurogenic Claudication/Spinal Stenosis
Radiculopathy
Osteoarthritis
Popliteal Mass (Baker’s Cyst, Cancer, Trauma)
Varicose Veins
Deep Venous Thrombosis
Post Thrombotic Syndrome
Neuropathy (Diabetic, Peripheral)

Question 9

Ix for claudication

Answer 9

ABPI
Doppler Ultrasound
CT Angiography
MR Angiography
Angiogram

Question 10

What ABPI is abnormal, and when do you see rest pain?

Answer 10

<0.9
<0.3

Question 11

Where do you see arterial ulcers on lower limb?

Answer 11

Lateral foot

Question 12

Sx DVT

Answer 12

Unilateral edema, erythema, warmth, tenderness
Palpable cord

Question 13

Ix

Answer 13

D dimer - for low risk Well’s score <2
US - for high risk Well’s score

Question 14

Rx

Answer 14

LMWH or IV heparin for 5d + warfarin until INR >2
Apixaban 10mg PO BID x 7/7 then 5mg BID

Question 15

What are the hypercoagulability syndromes causing DVT

Answer 15

Factor V leiden
Prothrombin
Protein C or S deficiency
Antithrombin defiency

Question 16

Prophylaxis for DVT

Answer 16

Risk assess all hospitalised pts
Early ambulation
Compression stockings
Intermittent pneumatic compressions
LMWH for high risk (pregnant woman w/ >2 RF)

Question 17

DDx for unilateral edema

Answer 17

Deep vein thrombosis
Venous insufficiency
Lymphedema
pretibial myxedema

Question 18

When do you see brown hemosiderin deposits?

Answer 18

venous insufficiency

Question 19

What is the Kaposi-Stemmer sign?

Answer 19

inability to pinch a fold of skin at dorsum proximal second toe is a sign of lymphedema

Question 20

Post phlebitic syndrome rx

Answer 20

r/o DVT w/ duplex doppler US, compression stockings, elevation, exercise, topical meds for skin changes, refer for vein ablation excision, horse chestnut seed oil

Question 21

What is the best way to investigate ?DVT?

Answer 21

Wells <2 = D Dimer, wells >2 = proximal leg compression US. If US negative in high risk person, do D dimer. If negative, do US again in few days time

Question 22

RF for DVT

Answer 22

stasis, trauma (recent central line, pacemaker, surgery), hypercoagulable states (cancer, pregnancy, meds (hormonal), IBD, CHF, nephrotic syndrome, thrombophilia)

Question 23

When to test for thrombophilia in DVT?

Answer 23

Fam hx of clots, young, multiple/ recurrent

Question 24

Upper arm DVT diagnostic score

Answer 24

CONSTANS: central line/ pacemaker, localised pain, unilateral edema, other diagnosis plausible

Question 25

When to Rx while awaiting US for DVT?

Answer 25

If US is delayed, mod-high suspicion, no CI

Question 26

How to rx DVT if US delayed

Answer 26

1 dose oral Xa inhibitor or 1 dose of LMWH

Question 27

When to give heparin as a bridge in DVT?

Answer 27

Direct thrombin inhibitor or warfarin

Question 28

Rivaroxaban class

Answer 28

factor 10a

Question 29

Dabigatran class

Answer 29

direct thrombin inhibitor