DVT and PE Flashcards

1
Q

Most common preventable cause of death among hospitalized patient (Harrison pp 1631)

A

Pulmonary Embolism

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2
Q

Compromises Virchow’s triad (Harrison pp 1631)

A

Endothelial injury
Hypercoagulability
Inflammation

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3
Q

Microparticles contain proinflammatory mediators that bind neutrophils and forms web like extracellular matrix (Harrison pp 1631)

A

Neutrophil extracellular traps

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4
Q

Two most common autosomal dominant genetic mutations (Harrison pp 1631)

A

Factor Leiden V

Prothrombin gene mutation

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5
Q

Most common acquired cause of thrombophilia (Harrison pp 1631)

A

Antiphospholipid antibody syndrome

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6
Q

Predisposing factors for DVT (Harrison pp 1631)

A
Cancer 
COPD
CKD
Obesity 
Cigarette smoking
Systemic Arterial hypertension 
Blood transfusion
Long haul air travel 
Oral contraceptives 
Pregnancy
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7
Q

Most common gas exchange abnormalities in Pulmonary Embolism (Harrison pp 1631)

A

Arterial hypoxemia

Increased alveolar arterial O2 tension gradients

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8
Q

What other pathophysiologic abnormalities found in PE? (Harrison pp 1631)

A
AID
Alveolar hyperventilations
Increased pulmonary vascular resistance
Impaired gas exchange
Increased airway resistance 
Decreased pulmonary compliance
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9
Q

Affect half of the pulmonary vasculature

Hallmark: dyspnea, syncope, hypotension and cyanosis (Harrison pp 1632)

A

Massive PE

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10
Q

RV dysfunction despite Normal systemic arterial pressure (Harrison pp 1632)

A

Submassive PE

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11
Q

Upper DVT is precipated by the following: (Harrison pp 1632)

A

Pacemaker
Internal cardiac defibrillator
Indwelling central venous

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12
Q

Palpable cord with DVT (Harrison pp 1632)

A

Superficial venous thrombosis

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13
Q

Most common symptom of PE (Harrison pp 1632)

A

Unexplained breathlessness

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14
Q

Most common symptom of DVT (Harrison pp 1632)

A

Crampy

Charley Horse

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15
Q

What is the sensitivity of D-dimer? (Harrison pp 1632)

A

DVT > 80%

PE > 95%

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16
Q

What conditions are associated with elevated D-dimer? (Harrison pp 1632)

A
Myocardial Infarction
Sepsis 
Pneumonia 
Cancer
Post operative states
2nd to 3rd trimester of pregnancy
17
Q

Clinical variables associated with DVT (Harrison pp 1632)

A

Active Cancer
Paralysis, paresis and recent cast
Bedridden for 3 days, Underwent MAJOR surgery < 12 weeks
Tenderness along distribution of deep vein
Entire leg swelling
Unilateral calf swelling ≥ 3 cm
Pitting edema
Collateral superficial non varicose veins

18
Q

Clinical variables associated with PE (Harrison pp 1632)

A
Signs and symptoms of DVT
Alternate diagnosis less likely 
HR > 100/min
Immobilization > 3 days
Surgery within 4 weeks
Prior PE or DVT 
Hemoptysis
Cancer
19
Q

Most frequently cited ECG with PE (Harrison pp 1633)

A

Sinus tachycardia

20
Q

12 lead ECG findings relatively specific but insensitive of PE (Harrison pp 1633)

21
Q

What is the primary criterion for DVT in venous ultrasonography? (Harrison 1633)

A

NO Wink

Loss of vein compressibility

22
Q

What chest findings seen in Pulmonary embolism? (Harrison pp 1633)

A

Western’s mark - focal oligemia
Hampton’s hump - wedge shape
Palla’s sign - inc R pulmonary artery

23
Q

What is the primary/principal imaging test for PE? (Harrison pp 1633)

A

Chest CT Scan

24
Q

Best known indirect sign of PE on TEE (Harrison pp 1634)

A

Mc Connell’s sign: Hypokinesis of the RV free wall or hyperkinetic motion of the RV apex.

25
Stocking for DVT should be prescribed with ____ mmHg (Harrison pp 1634)
30-40 mmHg for 2 years
26
What is the treatment of choice for normotension with RV hypokinesis? (Harrison pp 1634)
Individualized therapy (primary or secondary)
27
What is the management for pulmonary thromboembolism with hypotension? (Harrison pp 1634)
Primary therapy 1. Anticoagulation plus thromboembolysis 2. Embolectomy catheter/ surgery
28
How should unfractionated heparin be given? (Harrison pp 1635)
80 u/kg via bolus then 18 u/kg/hr
29
Anti Xa pentasaccharides (Harrison pp 1635)
Fondaparinux
30
The most serious adverse effect of anticoagulation (Harrison pp 1635)
Hemorrhages
31
What is the duration of anticoagulant for DVT of upper extremities? (Harrison pp 1635)
3 months
32
What is the duration of anticoagulant for proximal DVT or PE? (Harrison pp 1635)
3-6 months
33
What is the duration of anticoagulant with CANCER and VTE? (Harrison pp 1635)
Indefinitely
34
What are the 2 principal indications for insertion of IVC filter? (Harrison pp 1636)
Active bleeding the precludes anticoagulation | Recurrent venous/ thrombosis despite intensive anticoagulation
35
Most common IVC filter described as marked bilateral swelling (Harrison 1636)
Caval thrombosis
36
What is the 1st line inotropic agents for treatment of PE related shock? (Harrison pp 1636)
Dopamine and Dobutamine
37
Only food and drug administration approved indications for PE fibrolysis (Harrison pp 1636)
Massive PE
38
Most common form of in hospital prophylaxis (Harrison pp 1636)
Low dose of UFH or LMWH