DVT and pulmonary embolism

Question 1

what is virchow triad ?

Answer 1

the factors that lead to the formation of thrombosis
endothelial injury
hypercoaguability
abnormal blood flow

Question 2

what are the congenital deficiencies that cause thrombophilia ?

Answer 2

1- congenital deficiency of anti-thrombin,
protein C or S
2- factor V leiden
3- prothrombin gene mutation

Question 3

what is an example of acquired thrombophilia ?

Answer 3

antiphospholipid syndrome

Question 4

what are the differential diagnosis of lower limb DVT ?

Answer 4

infective celulitits
erysipelas
ruptured bakers cyst.
calf hematoma
lymphatic problem
ortho problem

Question 5

what is the investigation of choice for DVT ?

Answer 5

duplex ultrasound

Question 6

what is the significance of the d-dimer test in VTE ?

Answer 6

high sensitivity but low specificity
its greatest utility id for its negative predictive value

Question 7

what is the treatment for confirmed uncomplicated proximal lower limb DVT ?

Answer 7

1- start immediately with heparin , start warfarin at the same time
2- continue the heparin for at least 5 days till the warfarin reaches peak effect
3- discontinue heparin once INR has reached the target of 2.5 for 2 days

Question 8

how long should warfarin be taken ?

Answer 8

1- in patients with DT provoked by surgery or non surgical transient factors, it should be taken for at least 3 months - irl 6 months

2- patients with cancer provoked DVT are at high risk off recurrence, so LMWH rather than warfarin for 6 months

Question 9

what are the complications of DVT ?

Answer 9

1- pulmonary embolism
2- post thrombotic syndrome
3- severe acute venous obstruction (phlegmasia cerulae dolens )
4- paradoxical embolism

Question 10

when is paradoxical embolism seen ?

Answer 10

rare
infarction is seen within the systemic circulation as a consequence of pulmonary embolism in an individual with atrial septal defect

Question 11

what is upper limit DVT ?

Answer 11

thrombosis of the subclavian, axillary or brachial branch

Question 12

what is the investigation of choice in cases of upper limb DVT ?

Answer 12

ultrasound imaging

Question 13

how can PE cause circulatory collapse ?

Answer 13

due to right sided heart failure

Question 14

what are the different levels of severity of PE ?

Answer 14

high risk - circulatory collapse due too right sided heart failure

intermediate risk - haemodynamically stable patient but with evidence of right ventricular strain

low risk - haemodynamically stable patient with no signs of right sided heart strain

Question 15

what is the first choice for investigations in PE ?

Answer 15

CTPA

Question 16

what is a good alternative to CTPA ?

Answer 16

ventilation perfusion scan
a normal V/Q scan excludes the diagnosis

Question 17

when can an echo be useful ?

Answer 17

in massive PE

Question 18

what is the most accurate imaging modality for the diagnosis of PE ?

Answer 18

pulmonary angiography

Question 19

what is the treatment of patient with low risk PE ?

Answer 19

the same as for acute DVT
give heparin and warfarin together

Question 20

what is the treatment for patients with intermediate risk PE ?

Answer 20

unfractionated heparin
followed by daily sc LMWH
follow with warfarin

Question 21

what is the treatment foor massive PE ?

Answer 21

thrombolysis is the first line treatment followed by unfractionated heparin then continue the patient in warfarin