DVT & PE

Question 1

Two types of clot

Answer 1

Arterial

Venous

Question 2

Where do arterial thrombi originate?

Answer 2

In arteries and left heart chambers

Question 3

How does arterial thrombosis occur?

Answer 3

Rupture of atherosclerotic plaque

Question 4

Consequence of arterial thrombosis

Answer 4

Ischaemia and infarction

ACS, Ischaemic stroke, Limb claudication/ischaemia

Question 5

What colour is an arterial thrombus and what are its components?

Answer 5

White

Platelets and fibrin

Question 6

What is Virchow’s triad?

Answer 6

Stasis, Hypercoagulability, Endothelial injury

Question 7

How does venous thrombosis occur?

Answer 7

Elements of virchows triads
Back pressure
DVT and PE

Question 8

What colour is a venous thrombus and what are its components?

Answer 8

Red

RBC and fibrin

Question 9

Factors leading to stasis in blood

Answer 9

Immobility

Long haul travel

Question 10

Factors that contribute to endothelial dysfunction

Answer 10

Hypertension
Smoking
High cholesterol

Question 11

Factors that cause endothelial damage

Answer 11

Indwelling venous catheters
Trauma
Surgery

Question 12

3 states of acquired hypercoagulability

Answer 12

Pregnancy
Cancer
Sepsis

Question 13

4 types of venous thromboembolism

Answer 13

Limb DVT
PE
Visceral venous thrombosis
Intramural

Question 14

Risk factors for VTE

Answer 14

Surgery
Obstetrics
Lower limb fracture
Varicose veins
Malignancy
Reduced mobility
Previous VTE
Cardiovascular history
Oestrogens - OCP, HRT
COPD
Neurological disability
Obesity

Question 15

Signs and symptoms of DVT

Answer 15

Unilateral limb swelling
Erythema
Calf tenderness
Hot to touch
Prominent collateral veins
Unilateral pitting oedema

Question 16

Potential long term consequences of DVT

Answer 16

Post thrombotic syndrome
Damage to venous valves
- swelling, discomfort, pigmentation, ulceration

Question 17

Diagnosis of DVT

Answer 17

Clinical assessment and pretest probability - Wells score
Blood test - D dimer if low Wells score
Imaging - Compression ultrasound if positive D-dimer/high pretest score

Question 18

What is D-dimer?

Answer 18

Fibrin degradation product

High sensitivity but low specificity

Question 19

What other indications will also exhibit levels of D-dimer?

Answer 19

Trauma
Malignancy
Sepsis
Bleeding
Recent surgery

Question 20

Symptoms and signs of PE

Answer 20

Dyspnoea
Pleuritic chest pain 
Haemoptysis
Tachycardia
Pleural rub

Question 21

Signs of massive PE

Answer 21

Severe dyspnoea sudden onset
Cyanosis
Collapse
Tachycardia
Hypotension
Raised JVP

Question 22

Investigations for PE

Answer 22

Ventilation/perfusion V/Q scan

CT pulmonary angiogram

Question 23

Long term consequence of PE

Answer 23

Pulmonary arterial hypertension

Question 24

Aim of treatment in PE

Answer 24

Prevent clot extension
Prevent clot embolisation
Prevent current clot

Question 25

Management of PE

Answer 25

Anticoagulants - unfractionated or LMWH (Cancer associated VTE), Warfarin, DOAC - rivaroxaban, apixaban (FIRST LINE)
Thrombolysis by alteplase reserved for massive PE

Question 26

Prevention of venous thrombosis in hospital

Answer 26

Early mobility
Anticoagulants
Compression stockings
All patients assessed for risk on admission and reassessed within 24 hours of any clinical change

Question 27

Inherited cause of hypercoagulability

Answer 27

Factor V leiden

Question 28

Length of anticoagulant treatment following VTE

Answer 28

3 months if provoked

6 months if unprovoked - high risk may require lifelong

Question 29

Differential for pulmonary embolism

Answer 29

Myocardial infarction

Aortic dissection

Question 30

Signs of PE on ECG

Answer 30

Sinus tachycardia most commonly
S1Q3T3
RBBB
RV strain