DVT

Question 1

what percentage of proximal DVTs go to PE?

Answer 1

50

Question 2

Hx: patient who has been bedbound for the last week presents with localised leg pain & swollen tender left leg, with asymmetric pitting oedema and prominent superficial veins. Ex: irregular heartbeat.

+/- acute SOB, pleuritic chest pain, haemoptysis, cough

Answer 2

DVT

Question 3

risk factors DVT? (VTE)

Answer 3

• D - DVT/PE in PMHx
• I - immbolility (surgery, travel, bed rest)
• C - cancer
• E - eostrogen (pregn, COCP, HRT, BMI)

Question 4

Ix DVT?

Answer 4

BEDSIDE:
• Wells DVT score (>2 +ve)
• ECG (AF, PE)

BLOODS:
• D-dimer
• ABG (PE)
• thrombophilia screen
• baseline coag (INR, PT)
• U+E, LFTs, FBC

IMAGING:
• US duplex + compression (w/n 4 hours, or if LMWH given, w/n 24 hours)
• CT AP contrast
• CXR
• suspected PE: CTPA, V/Q

Question 5

complications of DVT?

Answer 5

• cellulitis
• thrombophlebitis
• post-thrombotic syndrome

Question 6

ΔΔ DVT?

Answer 6

• cellulitis
• thrombophlebitis
• ruptured Baker’s cyst

Question 7

Tx DVT?

Answer 7

conservative
• TED stockings if proximal
• encourage physical activity

medical
• LMWH
• then DOAC or warfarin 3 months

surgical
• thrombectomy if ileofemoral and stable pt
• IVC filter

Question 8

Hx: patient with Hx of DVT 9 months previuos, presents with itch, swelling and dull pain in left leg (where previous DVT was)?

Answer 8

post-thrombotic syndrome

prevention = compression stocking on affected leg for 2 years after

Question 9

thrombophilia: which types cause both venous AND atrerial thrombi?

Answer 9

• antiphospholipid syndrome
• Behcets
• homocystinuria

Question 10

Ix: what PT or aPTT to expect in thrombophilia?

Answer 10

normal; forming at normal speed, but not breaking down