DVT

Question 1

Give me the Well’s score for DVT without the interpretation of results

Answer 1

Question 2

The risk of DVT ultimately can be broken down into a triad. What is it?

Answer 2

Virchow’s triad
Hypercoagulability
Endothelial injury
Stasis

Question 3

Hypercoagulability is part of virchow’s triad. Give 5 examples of congenital/genetic conditions that bring rise to that?

Answer 3

Factor V leiden
Protein C&S deficiency
Anti-phospholipid syndrome
Anti-thrombin III deficiency
Any vasculitis, Any autoimmune disease

Question 4

Give me the list of RF for DVT

Answer 4

Question 5

Give me your differentials for DVT

Answer 5

Question 6

Patient walks in with sudden onset leg pain. (the only symptom for DVT). What signs would you be looking for to confirm the diagnosis?

What will you do from here?

Answer 6

Signs:
Peripheral oedema
Tenderness
Warmth
Erythema
Tachycardia (tachycardia alone = pain most likely)

Question 7

Whenever I bring up one, I just have to bring up the other. Whats the Well’s score for PE along with its interpretation

Answer 7

Question 8

A patient walks in with a hot, swollen, painful leg. Give me your differentials

Answer 8

Question 9

What is post-thrombotic syndrome?

Answer 9

Chronic venous insufficiency post-DVT => development of ulcers, varicose veins, paraesthesia etc… after a DVT

Question 10

What are the 3 main complications of DVT

Answer 10

Post-thrombotic syndrome = Chronic venous insufficiency post-DVT

Question 11

You are in a long case and consultant asks you to tell them all the ways you can help a patient for DVT prophylaxis. Go for it

Answer 11

+ IVC filter

Question 12

When is a DVT considered complicated

Answer 12

If it leads to an adverse event such as PE or Post-thrombotic syndrome

Question 13

How would you manage an uncomplicated DVT acutely?

Answer 13

Therapeutic SC LMWH 1.5mg/kg then switch to warfarin for 3-6 months

Question 14

When is an IVC filter indicated?

Answer 14

1) Recurrent PE despite tx
2) CI to anticoagulation during major surgery or in the tx of DVT

Question 15

How would you manage a complicated DVT acutely along with its escalations

Answer 15

1) IV unfractionated heparin 5000IU bolus then 1000IU/hr + monitor APTT (aim 60-90) every 4 hours (exactly like ALI)
2) Thrombolysis with alteplase/Thrombectomy if severe thrombosis

Later prevention with IVC (can be done acutely to prevent imminent PE)

Question 16

How would you manage a DVT acutely along with its escalations

Answer 16

Question 17

In one sentence describe the IVC filter insertion

Answer 17

Inserted percutaneously via jugular or femoral vein to catch and prevent PEs

Question 18

What are the specific complications with IVC filter?

Answer 18

You will get the infection and bleeding etc
1) Arrhythmias (still for every surgery tho)
2) Air embolism
3) Pneumothorax/haemothorax
4) IVC obstruction (thinking of it now, this is kinda the only specific one)

Question 19

Thrombolysis Crash course:
Agents used
Administration
Indications
Complications
Contraindications:

Answer 19

Contra-indications:
A) Bleed:
1) Trauma
2) ICH
3) Stroke/TIA
4) Recent surgery
5) GI bleed

B) Bleeding Diathesis
1) Thrombocytopenia (<100)
2) Anticoagulation (esp warfarin)
3) Raised APTT, INR, PT
4) Coagulation disorder

C) Others
1) Known AV malformation
2) Known Aneurysm
3) Known malignancy (esp if cerbral)
4) Uncontrolled HTN
5) Pregnancy