DVT and VE (VTE)

Question 1

How does the location of embolus differ between DVT and PE

Answer 1

DVT = Deep leg vein
PE = Pulmonary artery circulation

Question 2

Which lower calf veins are affected by DVT

Answer 2

Anterior and Posterial Tibial veins

Question 3

Which upper calf veins are affected by DVT

Answer 3

Superficial femoral

Question 4

What are the 3 components of Virchow’s Triad

Answer 4

Hypercoagulability
Venous stasis
Endothelial Injury

Question 5

What are some factors affecting hypercoagulability

Answer 5

Pregnancy
Obesity
Sepsis
Malignnacy

Question 6

What is venous stasis

Answer 6

Aggregation of clotting factors affecting laminar flow

Question 7

What factors affect venous stasis

Answer 7

Immobility (flights and surgery)

Question 8

What can cause endothelial injury

Answer 8

Smoking
Trauma
Surgery

Question 9

What does the endothelium secrete and what happens if it is damaged

Answer 9

Can no longer secrete Anticoagulant chemicals

Question 10

What complication can arise from PE

Answer 10

Cor Pulmonale

Question 11

How does Cor Pulmonale occur as a result of PE

Answer 11

Increase PVR
Increase RV strain
RVH
RV fails (Increased Pulmonary pressure)

Question 12

What kind of Chest pain does PE present with

Answer 12

Pleuritic chest pain

Question 13

What are the Presentations of PE

Answer 13

Sudden Pleuritic chest pain
Dyspnoea (+-Haemoptysis)
DVT evidence
Tachycardia w/Hypotension
Raised JVP and Ankle oedema
Wells >4

Question 14

What are the presentations of DVT

Answer 14

Unilateral swollen calf
Warm veins with oedema
Complete leg occlusion = Phlegmasia cerulean dolens
Wells >1

Question 15

What is phlegamsia Cerulean dolens

Answer 15

Complete leg vein occlusion by DVT

Question 16

How does the Wells Score for diagnosis change between PE and DVT

Answer 16

PE >4

DVT >1

Question 17

How can PE be diagnosed

Answer 17

D Dimer and CT Pulmonary Angiography
ECG (S1 Q3 T3) = Cor Pulmonale
-T Inversion of anterior/inferior leads
-New RBBB
CXRAY = Normal

Question 18

How can DVT be diagnosed

Answer 18

D Dimer and Duplex Ultrasound

Wells Score

Question 19

How is a patient manage if they have a wells score less than 1 for DVT

Answer 19

D Dimer

-If raised do Duplex Ultrasound

Question 20

How is a patient managed if they have a Well’s score 1+

Answer 20

Duplex Ultrasound

Question 21

What is the gold standard investigation fro DVT

Answer 21

Duplex ultrasund

Question 22

What is the gold standard investigation for PE

Answer 22

D Dimer and CTPA

Question 23

How is a patient managed if they have a PE Wells score greater than 4

Answer 23

CTPA (Gold)

Question 24

How is a PE Patient managed if they have a Wells Score less than 4

Answer 24

D dimer

-If raised do CTPA

Question 25

What does the D Dimer test for

Answer 25

Measures Clot Burden

-Protein released if blood clot fibrolyses

Question 26

Why is D Dimer not diagnostic

Answer 26

It is raised in many conditions (Not specific)

But it is Sensitive

Question 27

How is non massive PE treated

Answer 27

DOAC (Anticoagulation)
1st = Apixaban/Rivoroxaban
If CI w/ renal impairment give LMWH

Question 28

How is a massive PE treated

Answer 28

Clot buster Alteplase (Thrombolytics)

Question 29

How is a DVT treated (Like non massive PE)

Answer 29

DOAC Anticoagulation
1st = Apixaban/Rivoroxaban
CI w/Renal impairment give LMWH

Question 30

How can a DVT patient be non medically managed

Answer 30

Compression stocking

Mobilisation

Question 31

What is the Differential for DVT

Answer 31

Cellulitis (Skin infection by S Aureus and S Pyogenes)

-Tender inflamed calf w/ Leukocytosis (DVT will have D Dimer and normal inflammation levels)