DVT/PE Flashcards
If a patient has a low clinical likelihood of DVT, what is the next step?
A) Perform an imaging test.
B) Measure D-dimer levels.
C) Diagnose as “No DVT.”
D) Refer for specialist evaluation.
Measure D-dimer levels.
If the D-dimer result is normal in a patient with low clinical likelihood of DVT, what is the diagnosis?
A) Imaging test needed.
B) No DVT.
C) Possible PE.
D) Repeat clinical assessment.
No DVT.
What should you do if a patient has a high D-dimer result and a low clinical likelihood of DVT?
A) Perform an imaging test.
B) Diagnose as “No DVT.”
C) Prescribe anticoagulation therapy.
D) Refer for surgery.
Perform an imaging test.
For PE, what is the next step if the clinical likelihood is not high?
A) Measure D-dimer levels.
B) Order imaging tests.
C) Diagnose as “No PE.”
D) Start anticoagulation treatment immediately.
Measure D-dimer levels.
In a patient with a high clinical likelihood of PE, what is the appropriate next step?
A) Perform imaging tests.
B) Measure D-dimer levels.
C) Rule out PE based on symptoms.
D) Monitor without intervention.
Perform imaging tests.
What is the most common genetic mutation associated with venous thromboembolism (VTE)?
A) Factor V Leiden
B) Prothrombin gene mutation
C) Protein C deficiency
D) Both A and B
Both A and B
Which naturally occurring coagulation inhibitors are associated with VTE when deficient?
A) Protein C, protein S, and antithrombin
B) Factor V, protein C, and fibrin
C) Prothrombin, fibrinogen, and protein S
D) Antithrombin, fibrinogen, and plasmin
Protein C, protein S, and antithrombin
Which of the following is NOT a clinical risk factor for VTE?
A) Estrogen-containing contraceptives
B) Long-haul air travel
C) High-protein diet
D) Obesity
High-protein diet
What increased likelihood of fatal PE is associated with every additional 2 hours of daily television watching?
A) 20%
B) 30%
C) 40%
D) 50%
40%
What is the MOST COMMON gas exchange abnormality in PE?
A) Decreased pulmonary compliance
B) Increased alveolar-arterial O2 tension gradient
C) Increased physiologic dead space
D) Alveolar hyperventilation
Increased alveolar-arterial O2 tension gradient
What is the most common symptom of DVT?
A) Unexplained breathlessness
B) Persistent lower calf cramp (“charley horse”)
C) Chest pain
D) Cyanosis
Persistent lower calf cramp (“charley horse”)
What is the primary diagnostic imaging modality for PE?
A) Lung scanning
B) Venous ultrasonography
C) Chest CT scan with intravenous contrast
D) Chest X-ray
Chest CT scan with intravenous contrast
Which chest X-ray sign is associated with PE?
A) McConnell’s sign
B) Westermark’s sign
C) Rouleaux formation
D) Hampton’s hump
Westermark’s sign and D) Hampton’s hump (both are correct)
* Westermark’s sign - Focal oligemia
* Hampton’s hump - a peripheral wedge-shaped density usually located at the pleural base
* Palla’s sign - an enlarged right descending pulmonary artery
* McConnell’s sign - best-known indirect sign of PE on transthoracic echocardiography
* hypokinesis of the RV free wall with normal or hyperkinetic motion of the RV apex
Which of the following medications requires laboratory monitoring?
A) Fondaparinux
B) Warfarin
C) Rivaroxaban
D) Apixaban
Warfarin
What is the first-line vasopressor for treating PE-related shock?
A) Dobutamine
B) Dopamine
C) Norepinephrine
D) Epinephrine
Norepinephrine
What is the most common symptom of pulmonary embolism?
A) Chest pain
B) Hemoptysis
C) Unexplained breathlessness
D) Fever
Unexplained breathlessness
Which ECG finding is most commonly cited in PE, in addition to sinus tachycardia?
A) S1Q3T3 sign
B) ST-segment elevation in lead II
C) Prolonged QT interval
D) Left bundle branch block
S1Q3T3 sign
What is the target INR for patients treated with warfarin for VTE?
A) 1.0–2.0
B) 2.0–3.0
C) 3.0–4.0
D) 4.0–5.0
2.0–3.0
What antidote is used for dabigatran-associated bleeding?
A) Protamine sulfate
B) Idarucizumab
C) Andexanet
D) Vitamin K
Idarucizumab
What is the standard dose of recombinant tissue plasminogen activator (tPA) for PE thrombolysis?
A) 50 mg over 1 hour
B) 100 mg over 2 hours
C) 25 mg over 4 hours
D) 10 mg bolus followed by infusion
100 mg over 2 hours
A 62-year-old female presents to the hospital with an acute upper gastrointestinal bleed, and anticoagulation therapy is immediately stopped. She has a history of deep vein thrombosis (DVT) but cannot receive anticoagulation due to the active bleeding. What is the most appropriate management step to prevent a pulmonary embolism (PE) in this patient?
A) Administer intravenous heparin
B) Insert an inferior vena cava (IVC) filter
C) Start low molecular weight heparin
D) Perform a thrombectomy
Insert an inferior vena cava (IVC) filter
**Two principal indications for insertion of an IVC filter:
1. active bleeding that precludes anticoagulation
2. recurrent venous thrombosis despite intensive anticoagulation
What is the most common gas exchange abnormality in patients with pulmonary embolism?
A) Decreased alveolar-arterial oxygen gradient
B) Increased alveolar-arterial oxygen gradient
C) Increased arterial oxygen content
D) Hypercapnia
Answer: B) Increased alveolar-arterial oxygen gradient
Rationale: PE disrupts the efficiency of oxygen transfer, causing an increased alveolar-arterial oxygen gradient due to ventilation-perfusion mismatch.
Which of the following best describes how a pulmonary embolism affects pulmonary vascular resistance?
A) Decreases resistance due to increased blood flow
B) Increases resistance due to vascular obstruction and vasoconstriction
C) Has no effect on resistance
D) Decreases resistance due to compensatory vasodilation
Answer: B) Increases resistance due to vascular obstruction and vasoconstriction
Rationale: PE increases pulmonary vascular resistance through both mechanical obstruction and vasoconstriction mediated by serotonin and other neurohumoral factors.
Which of the following explains why small pulmonary emboli can sometimes cause significant hypoxemia?
A) Increased cardiac output
B) Reflex bronchoconstriction
C) Ventilation-perfusion mismatch at sites remote from the embolus
D) Increased lung compliance
Answer: C) Ventilation-perfusion mismatch at sites remote from the embolus
Rationale: Release of vasoactive mediators causes mismatched perfusion even in non-obstructed lung areas, leading to disproportionate hypoxemia.
How does a pulmonary embolism contribute to increased right ventricular (RV) afterload?
A) Decreased pulmonary artery resistance
B) Compression of the left ventricle
C) Increased pulmonary vascular resistance
D) Decreased systemic vascular resistance
Answer: C) Increased pulmonary vascular resistance
Rationale: PE increases pulmonary vascular resistance, raising RV afterload, which can lead to RV dilation, dysfunction, and even failure.
What is the primary cause of circulatory collapse in massive pulmonary embolism?
A) Acute left ventricular failure
B) Right ventricular failure and decreased cardiac output
C) Excessive bradycardia
D) Systemic hypertension
Answer: B) Right ventricular failure and decreased cardiac output
Rationale: PE leads to RV failure due to increased afterload, reducing left ventricular preload and cardiac output, which can result in systemic hypotension and shock.
In patients with pulmonary embolism, what is the role of brain natriuretic peptide (BNP) as a biomarker?
A) It indicates increased left ventricular preload
B) It is a marker of left atrial dilation
C) It suggests right ventricular strain and dysfunction
D) It is used to detect systemic hypertension
Answer: C) It suggests right ventricular strain and dysfunction
Rationale: BNP is released in response to increased ventricular wall tension, commonly elevated in PE due to RV dilation and strain.
Why do patients with massive pulmonary embolism often present with systemic hypotension?
A) Decreased venous return due to increased pulmonary vascular resistance
B) Increased systemic vascular resistance
C) Enhanced left ventricular contractility
D) Increased preload to the right ventricle
Answer: A) Decreased venous return due to increased pulmonary vascular resistance
Rationale: Increased pulmonary vascular resistance reduces left ventricular filling, leading to decreased cardiac output and systemic hypotension.
Which of the following is a major risk factor for upper extremity DVT?
A) Long-distance travel
B) Indwelling central venous catheter
C) Dehydration
D) High platelet count
Answer: B) Indwelling central venous catheter
Rationale: Upper extremity DVT is often associated with the presence of central venous catheters, pacemakers, or defibrillators, which can cause local endothelial injury.
What is the classic clinical finding in superficial venous thrombosis?
A) Pitting edema
B) Erythema, tenderness, and a palpable cord
C) Respiratory distress
D) Severe muscle cramping
Answer: B) Erythema, tenderness, and a palpable cord
Rationale: Superficial venous thrombosis presents with localized redness, tenderness, and a palpable cord along the affected vein, distinguishing it from DVT, which often has more subtle symptoms.
What is the relationship between catheter size and the risk of upper extremity DVT?
A) Smaller catheters increase the risk
B) Risk is independent of catheter size
C) Larger catheters with multiple lumens increase the risk
D) Catheters prevent DVT formation
Answer: C) Larger catheters with multiple lumens increase the risk
Rationale: The likelihood of upper extremity DVT increases with larger catheter diameters and multiple lumens due to greater endothelial trauma and venous stasis.
What is the standard upper limit of a normal d-dimer in a healthy individual?
A) 250 ng/mL
B) 500 ng/mL
C) 1000 ng/mL
D) 1500 ng/mL
Answer: B) 500 ng/mL
Rationale: The standard upper limit of normal for d-dimer is 500 ng/mL, but an age-adjusted formula is now used for older patients.
How is the age-adjusted d-dimer calculated for patients over 50 years old?
A) Age × 10
B) Age ÷ 10
C) Age × 50
D) Age + 500
Answer: A) Age × 10
Rationale: For patients older than 50, the upper limit of d-dimer is calculated by multiplying age by 10 (e.g., a 70-year-old has a limit of 700 ng/mL).
In which of the following conditions is the d-dimer test NOT useful?
A) Outpatient evaluation of suspected PE
B) Low clinical probability of DVT
C) Hospitalized patients with systemic illness
D) Emergency department assessment of a young patient with leg swelling
Answer: C) Hospitalized patients with systemic illness
Rationale: D-dimer is frequently elevated in hospitalized patients due to infection, malignancy, pregnancy, or post-surgical states, limiting its specificity.
A patient with a low probability of PE and a negative d-dimer test should:
A) Undergo immediate CT pulmonary angiography
B) Be started on anticoagulation
C) Be discharged without further testing
D) Undergo a V/Q scan
Answer: C) Be discharged without further testing
Rationale: A negative d-dimer test in a low-risk patient effectively rules out PE, avoiding unnecessary imaging.
A patient presents with pleuritic chest pain and hemoptysis. What does this suggest?
A) Pulmonary infarction due to small PE
B) Myocardial infarction
C) Simple pneumonia
D) Pulmonary hypertension
Answer: A) Pulmonary infarction due to small PE
Rationale: Small PEs that lodge in peripheral arteries near pleural nerves can cause pleuritic chest pain and hemoptysis due to infarction.
Which imaging modality is the first-line test for diagnosing DVT?
A) CT venography
B) Contrast phlebography
C) Venous ultrasonography
D) Magnetic resonance venography
Answer: C) Venous ultrasonography
Rationale: Compression ultrasonography is the primary test for DVT, detecting thrombi based on vein compressibility loss.
Which chest X-ray finding is suggestive of PE?
A) Kerley B lines
B) Hampton’s hump
C) Honeycombing pattern
D) Bilateral hilar adenopathy
Answer: B) Hampton’s hump
Rationale: Hampton’s hump is a wedge-shaped opacity at the lung periphery, suggestive of pulmonary infarction due to PE.
What is Westermark’s sign on chest X-ray?
A) Pleural effusion
B) Focal oligemia
C) Mediastinal widening
D) Reticular nodular opacities
Answer: B) Focal oligemia
Rationale: Westermark’s sign refers to focal lung oligemia (decreased vascular markings) due to pulmonary arterial occlusion in PE.
What is the primary diagnostic criterion for DVT on venous ultrasonography?
A) Loss of vein compressibility
B) Presence of turbulent blood flow
C) High echogenicity of thrombus
D) Presence of collateral circulation
Answer: A) Loss of vein compressibility
Rationale: Acute DVT prevents vein collapse under ultrasound probe pressure, making loss of compressibility the primary diagnostic sign.
