DVT and PE

Question 1

What is a ‘clot’ made up of?

Answer 1

Fibrin
Platelets
Red blood cells

Question 2

What forms ‘white’ arterial thrombus?

Answer 2

Platelets
Fibrin
(endothelial damage)

Question 3

What forms ‘red’ venous thrombus?

Answer 3

Red blood cells
Fibrin
(contact pathway)

Question 4

What is the typical mechanism for arterial thrombosis?

Answer 4

Rupture of atheromatous plaques

Question 5

What is the typical mechanism of venous thrombosis?

Answer 5

Virchows triad

Question 6

Virchow’s Triad is a combination of what?

Answer 6

Stasis
Hypercoagulability
Endothelial damage

Question 7

What are the biggest causes of blood stasis?

Answer 7

Immobility

Long Haul

Question 8

What are the biggest causes of acquired hypercoagulability?

Answer 8

Pregnancy
Cancer
Sepsis

Question 9

PE found in how many autopsies?

Answer 9

20%

Question 10

Risk factors for VTE

Answer 10

Surgery
Obstetrics
Lower limb issues
Reduced mobility
Previous VTE

Question 11

Symptoms of DVT

Answer 11

Unilateral limb swelling
Discomfort
Calf tenderness

Question 12

Signs of DVT

Answer 12

Warmth
Erythema
Prominent collateral veins
Unilateral pitting oedema

Question 13

What is the long term consequence of DVT? At what rate?

Answer 13

Post thrombotic syndrome

20-60% in 2yrs

Question 14

What is post-thrombotic syndrome?

Answer 14

Damage to venous valves

Question 15

What are the symptoms of post thrombotic syndrome?

Answer 15

Swelling
Dyscomfort
Pigmentation
Ulceration if severe

Question 16

How is DVT diagnosed?

Answer 16

Clinical assessment
Wells score
D-dimer
Compression ultrasound

Question 17

What is D-dimer?

Answer 17

Fibrin breakdown produced produced during fibrinolysis

Question 18

What, other than DVT, can D-dimer test positive for?

Answer 18

Trauma
Malignancy
Sepsis
Bleeding
Surgery

Question 19

Symptoms of PE

Answer 19

Pleuritic chest pain
Breathlessness
Haemoptysis
Tachycardia
Pleural rub

Question 20

Symptoms of massive PE

Answer 20

Severe dyspnoea
Collapse
Cyanosis
Tachycardia
Hypotension
Raised JVP

Question 21

Diagnosis of PE

Answer 21

Clinical assessment
Wells/Geneva score
Bloods: D-dimer
V/Q scan
CTPA

Question 22

When is D-dimer tested in DVT/PE?

Answer 22

Low Wells probability score

Question 23

When is imaging indicated in DVT/PE?

Answer 23

D-dimer positive
or
High pre-test probability score

Question 24

Potential long term consequence of PE

Answer 24

Pulmonary arterial hypertension

Question 25

What are the aims of VTE treatment?

Answer 25

Prevent clot extension/embolisation

Prevent recurrence

Question 26

What is the main treatment for VTE

Answer 26

Anticoagulation

Question 27

Parental anticoagulants used in VTE

Answer 27

Heparin

Question 28

Enteral anticoagulants used in VTE

Answer 28

Warfarin

Direct Oral Anticoagulants

Question 29

What treatment is reserved for massive PE

Answer 29

Thrombolysis

Alteplase

Question 30

How can VTE be prevented in hospital?

Answer 30

Early mobilisation
Compression stockings
Pharmacological thromboprophylaxis

Question 31

Why is pulmonary infarction rare?

Answer 31

Dual vascular supply to lungs with anastamoses

Question 32

What causes pulmonary infarction?

Answer 32

Severe PE causing increased pulmonary vascular pressure.
Force of bronchial arterial supply cant overcome this.
Blood leaks into alveolar space.