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.