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Pulmonology > DVT and PE > Flashcards

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)

A

S1Q3T3

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
Q

Stocking for DVT should be prescribed with ____ mmHg (Harrison pp 1634)

A

30-40 mmHg for 2 years

26
Q

What is the treatment of choice for normotension with RV hypokinesis? (Harrison pp 1634)

A

Individualized therapy (primary or secondary)

27
Q

What is the management for pulmonary thromboembolism with hypotension? (Harrison pp 1634)

A

Primary therapy

  1. Anticoagulation plus thromboembolysis
  2. Embolectomy catheter/ surgery
28
Q

How should unfractionated heparin be given? (Harrison pp 1635)

A

80 u/kg via bolus then 18 u/kg/hr

29
Q

Anti Xa pentasaccharides (Harrison pp 1635)

A

Fondaparinux

30
Q

The most serious adverse effect of anticoagulation (Harrison pp 1635)

A

Hemorrhages

31
Q

What is the duration of anticoagulant for DVT of upper extremities? (Harrison pp 1635)

A

3 months

32
Q

What is the duration of anticoagulant for proximal DVT or PE? (Harrison pp 1635)

A

3-6 months

33
Q

What is the duration of anticoagulant with CANCER and VTE? (Harrison pp 1635)

A

Indefinitely

34
Q

What are the 2 principal indications for insertion of IVC filter? (Harrison pp 1636)

A

Active bleeding the precludes anticoagulation

Recurrent venous/ thrombosis despite intensive anticoagulation

35
Q

Most common IVC filter described as marked bilateral swelling (Harrison 1636)

A

Caval thrombosis

36
Q

What is the 1st line inotropic agents for treatment of PE related shock? (Harrison pp 1636)

A

Dopamine and Dobutamine

37
Q

Only food and drug administration approved indications for PE fibrolysis (Harrison pp 1636)

A

Massive PE

38
Q

Most common form of in hospital prophylaxis (Harrison pp 1636)

A

Low dose of UFH or LMWH

Pulmonology (9 decks)

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