DVT

Question 1

Virchow’s Triad

Answer 1

Hypercoagulability, endothelial damage, venous stasis

Question 2

Most Important Hypercoagulability Disorder

Answer 2

Factor V Leiden (that’d make a great name for a rock band, although I’d change the spelling of Leiden to Leaden)

Question 3

4 Mechs Favoring Thrombosis from Stasis

Answer 3

Prevents dilution of thrombin/proteases
Retards inflow of plasma inhibitors
Delays hepatic clearance of active factors
Prevents physical disruption of fibrin

Question 4

Glass Tubes vs. Tissue Blood Coagulation

Answer 4

Takes way longer in bvs, endothelium has antithrombic properties

Question 5

Most Common Test for DVT Diagnosis

Answer 5

Duplex US

Question 6

PE Effect on Gas Exchange

Answer 6

Get dead space w/ normal ventilation but not perfusion. So low pCO2, which leads to vasoactive/airway constricting substances leading to wheezing and confusion w/ asthma - and then this leads to airway constriction in normally perfused areas

Question 7

PE Complication w/ COPD/CHF/similar respiratory problems

Answer 7

Normally have triple O2 supply (pulmonary, bronchial, airway), so PE won’t lead to infarction, but with these problems take an even bigger hit so might get ischemia/infarction

Question 8

4 Factors Influencing PE Manifestation

Answer 8

Size of embolism
Preexisting cardio-resp status
Location in pulm circ
Effects of endogenous lysis

Question 9

4 PE Symptoms (most-least common, notable point about 1)

Answer 9

Dyspnea
Chest Pain
Hemoptysis
Altered Consciousness - maybe from arrhythmia, Afib is a classic finding

Question 10

5 Mechs of Dyspnea from PE

Answer 10

Hypoxemia
Splinting (Pleural irritation thing)
Decreased lung compliance
R Stimulation
Anxiety

Question 11

2 Very Common Clinical Signs of PE

Answer 11

Tachycardia and tachypnea

Question 12

2 CXR Signs of PE

Answer 12

Hamptom’s Hump - wedge shape in periphery of lung

Westermark Sign - Lack of vasculature in large part of lung parenchyma, bc PE blocked it off

Question 13

Classical (but rare) EKG Sign of PE

Answer 13

S1Q3T3 Complex - big S in Lead I, big Q and inverted T in III

Question 14

FDP’s, D-Dimer Lab Test

Answer 14

Sensitive but not specific PE test

Question 15

Lung Scanning in PE Results

Answer 15

Perfusion segmental or greater has higher chance of embolism, and ventilation mismatch has higher chance of embolism. A normal scan excludes PE, but abnormal scan may or may not have PE

Question 16

Gold Standard of PE Test

Answer 16

Pulmonary angiography, but invasive

Question 17

3 Treatments after Dx of PE Depending on Status

Answer 17

Clinically Stable - Heparin
Anticoag Contraindication (bleeding out) - Interrupt IVC w/ filter to catch
Shock/Clinically Unstable - Thrombolytic therapy w/ streptokinase to break up thrombus, then heparin once stabilized