Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General med - Cardiovascular > DVT/PE > Flashcards

DVT/PE Flashcards

1
Q

Typical signs and symptoms of DVT

A

Unilateral localised pain(usually throbbing in nature) that occurs when walking or bearing weight, and calf swelling

Tenderness

Skin changes, which include oedema, redness and warmth

Vein distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tool to assess likelihood of DVT

A

two-level DVT Wells score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which patients should be referred for same-day assessment if DVT is suspected

A

In a woman who is pregnant or has given birth within the past 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Next steps of management for patients who are likely to have DVT based on Wells score

A

Offer a proximal leg vein ultrasound scan with results available within 4 hrs if possible

If proximal leg vein ultrasound cannot be carried out, request for D-dimer test, then
interim therapeutic anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Next steps of management for patients who are unlikely to have DVT based on the results of two-level DVT Wells score

A

Offer a D-dimer test with results available within 4 hrs

Offer interim therapeutic anticoagulation while awaiting the result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management if D-dimer test is positive

A

Offer a proximal leg vein ultrasound with the results available within 4 hrs if possible

Interim anticoagulation while waiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management if D-dimer test is negative

A

Stop interim therapeutic anticoagulation

Consider an alternative diagnosis

Tell the person that it is likely they do not have DVT, discuss signs and symptoms of DVT, and when and where to seek further medical help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

First line and second line interim therapeutic anticoagulation for suspected DVT

A

Offer apixaban or rivaroxaban first line

LMWH followed by dabigatran or vitamin K antagonist for at least 5 days if above are not appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tests which should be carried out for people starting interim anticoagulation therapy

A

Baseline blood tests including FBC, renal and hepatic function, prothrombin time(PT), and APTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Maintenance treatment for people with a confirmed DVT

A

Oral anticoagulant(warfarin, apixaban, dabigatran etc) following acute treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long is maintenance treatment usually continued for DVT

A

For at least 3 months, but duration may be longer depending on whether DVT was unprovoked or provoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Usual INR target for patients being treated with warfarin

A

Target of 2.5, keeping within the range of 2.0-3.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should be investigated in patients with unprovoked DVT

A

Possibility of an undiagnosed cancer if they are not already known to have cancer

Thrombophilia testing as appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When should you suspect a PE

A

Dyspnoea
Tachypnoea
Pleuritic chest pain
Features of DVT including leg pain and swelling(usually unilateral), lower abdominal pain, redness, increased temperature, and venous distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Risk factors for PE

A 
DVT 
Previous VTE 
Active cancer 
Recent surgery 
Significant immobility 
Lower limb trauma or fracture 
Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of PE

A

Death
Hypotension(clinically massive PE)
Chronic thromboembolic pulmonary hypertension
Right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should you suspect a PE

A 
Dyspnoea 
Tachypnoea 
Pleuritic chest pain 
\+/- Features of DVT including leg pain and swelling(usually unilateral) 
Lower abdo pain 
Redness 
Increased temperature 
Venous distension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Signs of PE

A 
Tachycardia 
Hypoxia 
Pyrexia 
Elevated JVP 
Gallop rhythm 
Pleural rub 
Hypotension
19
Q

CXR features that may be present in a PE

A

Atelectasis
Pleural effusion
Elevation of a hemidiaphragm

20
Q

ECG signs indicative of a PE

A

Sinus tachycardia
Non-specific ST-segment and T-wave abnormalities
Right axis deviation
Incomplete or complete right bundle-branch block
T-wave inversion in leads V1-V3
P pulmonale or the classical S1, Q3, T3

21
Q

When should you arrange immediate admission for people with suspected pulmonary embolism

A

Signs of haemodynamic instability(pallor, tachycardia, hypotension, shock and collapse)

Pregnant or have given birth within past 6 weeks

22
Q

Which scoring system can be used to assess likelihood of a PE

A

Two-level PE Wells score

23
Q

Management of patients with a Wells score of more than 4 points(PE likely)

A

Arrange hospital admission for CTPA

Offer interim therapeutic anticoagulation if CTPA cannot be carried out immediately

24
Q

Management of patients with a Wells score of less than 4 points(PE unlikely)

A

D-dimer test with interim therapeutic anticoagulation while awaiting the result

If positive, arrange for immediate CTPA

25
Q

1st line interim therapeutic anticoagulation - PE

A

Offer apixaban or rivaroxaban

LMWH if not

26
Q

Appropriate baseline tests for people starting interim anticoagulation therapy

A

FBC
Renal and hepatic function
Prothrombin time
APTT

27
Q

Which investigation may be useful in pregnant women with a suspected PE

A

Lower limb compression venous ultrasound

28
Q

Pharmacological options for confirmed PE

A

LMWH
Fondaparinux
Unfractionated heparin
Oral anticoagulant treatment

29
Q

Mechanical(or physical) interventions in PE management

A

IVC filters

Thrombolytic therapy

30
Q

Examples of pharmacological thrombolytics

A

Streptokinase
Urokinase
rt-PA

31
Q

VTE risk factors

A 
advancing age
obesity
family history of VTE
pregnancy (especially puerperium)
immobility
hospitalisation
anaesthesia
central venous catheter: femoral >> subclavian
32
Q

Underlying conditions associated with VTE

A 
malignancy
thrombophilia: e.g. Activated protein C resistance, protein C and S deficiency
heart failure
antiphospholipid syndrome
Behcet's
hyperviscosity syndrome
33
Q

Medications associated with VTE

A

COCP

hormone replacement therapy: the risk of VTE is higher in women taking oestrogen + progestogen preparations compared to those taking oestrogen-only preparations

raloxifene and tamoxifen
antipsychotics (especially olanzapine) have recently been shown to be a risk factor

34
Q

What are thrombophilias

A

Conditions that predispose patients to blood clots such as:

Antiphospholipid syndrome
Factor V leiden
Antithrombin deficiency

35
Q

Main contraindication for anti-embolic compression stockings

A

PAD

36
Q

Initial anticoagulation choice for DVT/PE

A

Apixaban

Rivaroxaban

37
Q

Intervention recommended in patients with a symptomatic iliofemoral DVT

A

Catheter-directed thrombolysis

38
Q

How long should anticoagulation be continued for

A

3 months if there is a reversible cause (then review)
Beyond 3 months if the cause is unclear, there is recurrent VTE, or there is an irreversible underlying cause such as thrombophilia (often 6 months in practice)
3-6 months in active cancer (then review)

39
Q

What should be investigated in unprovoked DVT

A

Antiphospholipid syndrome (check antiphospholipid antibodies)

Hereditary thrombophilias (only if they have a first-degree relative also affected by a DVT or PE)

40
Q

When is thrombolysis recommended in management of PE

A

Massive PE where there is circulatory failure(hypotension)

41
Q

Factors considered in two level Wells criteria

A

Clinical signs and sx of DVT

PE is no.1 diagnosis or equally likely

HR > 100

Immobilisation at least 3 days or surgery in previous 4 weeks

HX of PE/DVT

Haemoptysis

Malignancy

42
Q

Criteria for PERC rule - to rule out PE

A 
Age > 50 
HR > 100 
O2 sats < 94%
Previous DVT or PE
Recent surg/trauma 
Haemoptysis 
Unilateral leg swelling 
Oestrogen use(HRT,contraception)
43
Q

Interpretation of wells score

A

PE likely - more than 4 points

PE unlikely - 4 points or less

44
Q

Definition of provoked PE

A

an antecedent (within 3 months) and transient risk factor, such as significant immobility, surgery, trauma, pregnancy or puerperium, and the use of the combined contraceptive pill or hormone replacement therapy.

General med - Cardiovascular (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions