DVT

Question 1

What is a deep vein thrombosis?

Answer 1

Formation of thrombi within the lumen of the vessels that make up the deep venous system

Question 2

What is a pulmonary embolism?

Answer 2

A thrombus that has embolised and lodged in the pulmonary circulation

Question 3

What is venous thromboembolic disease?

Answer 3

A term that covers both DVT and PE

Question 4

Where do thrombi predominantly form?

Answer 4

In the venous valve pockets and other sites of presumed stasis

Question 5

Distal vein thrombosis

Answer 5

DVT of the calves

Question 6

Proximal vein thrombosis

Answer 6

DVT of the popliteal vein or the femoral vein

Question 7

Virchow’s triad

Answer 7

Hypercoagulability state, endothelial injury, circulatory stasis

Question 8

Factors relating to hypercoagulability state that can lead to DVT

Answer 8

Malignancy, pregnancy and peripartum period, oestrogen therapy, inflammatory bowel disease, sepsis, thrombophilia

Question 9

Factors relating to endothelial injury that can lead to DVT

Answer 9

Venous disorders, venous valvular damage, trauma or injury, indwelling catheters

Question 10

Factors relating to circulatory stasis that can lead to DVT

Answer 10

Left ventricular dysfunction, immobility or paralysis, venous insufficiency or varicose veins, venous obstruction from tumour, obesity or pregnancy

Question 11

Exposing risk factors for VTE

Answer 11

Surgery, trauma, acute medical illness, acute respiratory failure, central venous catheterisation

Question 12

Predisposing risk factors for VTE

Answer 12

History of VTE, chronic heart failure, advanced age, varicose veins, obesity, immobility or paresis, myeloproliferative disorders, pregnancy/peripartum period, inherited or acquired thrombophilia, hormone therapies, renal insufficiency

Question 13

Presentation of deep vein thrombosis

Answer 13

Painful and swollen limb with redness and heat. Tenderness along the vein. Sub-acute development with no other obvious cause. Leg can appear shiny.

Question 14

Presentation of pulmonary embolism

Answer 14

Sudden SOB with pleuritic pain +/- collapse, +/- haemoptysis. Hypoxia and tachycardia on observations. Blood pressure may be low

Question 15

What is a D-dimer test useful for

Answer 15

Ruling out the possibility of VTE

Question 16

Gold-standard test for VTE

Answer 16

CT pulmonary angiogram

Question 17

What diagnostic test can be offered to pregnant women and children with a high probability of VTE?

Answer 17

VQ scan as it doesn’t involve radiation

Question 18

Which score is used to determine the likelihood that a patient is suffering from VTE?

Answer 18

Wells score

Question 19

What can be used to assess severity of PE?

Answer 19

PESI (pulmonary embolism severity index) score and patient characteristics

Question 20

Signs and symptoms of post thrombotic syndrome

Answer 20

Pain, oedema, hyperpigmentation, eczema, varicose collateral veins, venous ulceration

Question 21

Management of DVT

Answer 21

Oral anticoagulation

Question 22

Management of PE

Answer 22

Thrombolysis then oral anticoagulation

Question 23

First line therapy for oral angicoagulation

Answer 23

Direct oral anticoagulant e.g. apixaban or rivaroxaban

Question 24

When should warfarin be used as anticoagulation treatment

Answer 24

When a patient has a metallic heart valve and atrial fibrillation, or in patient with antiphospholipid syndrome

Question 25

When should low molecular weight heparin injections be used as anticoagulation treatment

Answer 25

Patients with active cancer and PE

Question 26

Duration of treatment for provoked VTE with reversible factor

Answer 26

3-6 months

Question 27

Duration of treatment for provoked VTE with irreversible factor

Answer 27

3-6 months or lifelong depending on patient factors

Question 28

Duration of treatment for unprovoked VTE

Answer 28

Lifelong

Question 29

Which score can be used to assess whether it is necessary to continue treatment for women?

Answer 29

HERDOO2 score