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Pulmo > DVT PE > Flashcards

DVT PE Flashcards

0
Q

VTE can lead to: (can cause deaths, and affect survivors)

A

PE - cause of death
Chronic thromboembolic pulmonary hypertension
Postphlebitic syndrome - among survivors

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1
Q

Three major CV causes of death?

A
  1. VTE 2. MI 3. Stroke
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2
Q

Most preventable cause of death?

A

Pulmo embo

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3
Q

High risk for VTE include:

A

Major surgery
Heart failure
Cancer
Stroke

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4
Q

Chronic thromboembolic pulmo HPN causes:

A

Breathlessness

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5
Q

Late effect of DVT is post phlebitic syndrome, AKA:

A

Post thrombotic syndrome

Chronic venous insufficiency

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6
Q

PPS causes ___ to the valves of the leg

A

Causes venous valves of the leg to become incompetent and exude interstitial fluid

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7
Q

PPS CVI causes what after prolonged standing?

A

Chronic ankle or calf swelling

Leg aching

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8
Q

Severe PPS causes skin ulceration in the:

A

Medial malleolus

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9
Q

What state (platelet) contributes to VTE?

A

Prothrombotic state

Thrombophilia

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10
Q

Two most common autosomal dominant genetic mutations that lead to prothrombotic states

A

Factor V Leiden

Prothrombin gene mutation

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11
Q

Factor V Leiden causes resistance to:

A

Activated protein C – which inactivates clotting factors V and VIII
(Resistance to the inactivators – promotes activation – prothrombotic)

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12
Q

Prothrombin gene mutation ___ plasma prothrombin concentration

A

Increases

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13
Q

3 Coagulation inhibitors

A

Antithrombin
Protein C
Protein S

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14
Q

Hyperhomocysteinemia can increase the risk of VTE. What can lower homocysteine levels?

A

Folate
Vitamin B6
Vitamin B12
(but does not lower incidence of VTE)

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15
Q

Most common acquired cause of thrombophilia?

A

Antiphospholipid antibody syndrome

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16
Q

Predisposing factors to VTE:

A
  1. Cancer 2. Systemic arterial HPN 3. COPD 4. Long haul air travel 5. Air pollution 6. Obesity 7. Cigarette smoking 8. Eating red meat 9. OCPs 10. Pregnancy 11. Postmenopausal HRT 12. Surgery, trauma
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17
Q

Paradoxical PE passes through:

A

Patent foramen ovale or Atrial septal defect

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18
Q

Most common source of paradoxical embolism

A

Isolated calf vein thrombi

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19
Q

Increases risk for upper extremity venous thrombosis:

A
  1. Chronic indwelling central venous catheter (chemo, feeding)
  2. Frequent insertion of permanent pacemakers and internal cardiac defibrillators
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20
Q

Two most common gas exchange abnormalities

A

Hypoxemia (decreased atrial pO2)

Increased alveolar-arterial O2 tension gradient – inefficient O2 transfer across the lungs

21
Q

Breathed gas does not enter gas exchange causing increase in:

A

Anatomic dead space

22
Q

Ventilation to gas exchange units > venous blood flow through pulmo capillaries increases:

A

Physiologic dead space

23
Q

In PE, there is INCREASED vascular resistance, caused by:

A
  1. Vascular obstruction

2. Release of serotonin by platelet

24
Q

Why is there potential discordance between small PE and large AaO2 gradient?

A

Due to release of vasoactive mediators – produce VQ mismatch distal to the embolus

25
Q

There is impairment of gas exchange due to:

A
  1. Increased alveolar dead space from vasc obstruction
  2. Alveolar hypoventilation – hypoxemia
  3. Right to left shunting
  4. Impaired carbon MONOxide transfer
26
Q

Constriction of airways distal to the bronchi causes

A

Increased airway resistance

27
Q

Reflex stimulation of irritant receptors cause

A

Alveolar hypoventilation

28
Q

Decrease in pulmo compliance is due to:

A

Lung edema, lung hemorrhage, loss of surfactant

29
Q

Usual cause of death from PE:

A

Progressive right heart failure

30
Q

Pathophysio of RV failure in PE

A

Inc PVR – Inc RV wall tension – RV dilation, dysfunction – prolonged RV contraction even at end-systole – IV septum bulges to LV – impaired LV diastole
Inc RV wall tension – compress RCA – dec perfusion – dec myocardial O2 supply – ischemia, infarction

31
Q

Harrison’s labels VTE as the great:

A

Masquerader

32
Q

Failure to improve despite standard medical treatment can be a clue. Common concomitant illnesses:

A

Heart failure

Pneumonia

33
Q

Common history in DVT

A

Cramp in the lower calf that persists for days and becomes more uncomfortable over time

34
Q

Most common history in PE

A

Unexplained breathlessness

35
Q

Initial test for low to moderate likelihood of DVT

A

D dimer

36
Q

If D dimer is abnormally elevated, next step is

A

Imaging

37
Q

Differential diagnosis of DVT

A

PCR
Post phlebitic syndrome, CVI
Cellulitis
Ruptured Baker’s Cyst

38
Q

DDx of PE

A 
PPAARC
Pneumonia, asthma, COPD
Pleurisy: costochon, muscle discomfort
ACS
Anxiety; Arte
Rib fracture -- pneumothorax
CHF
39
Q

DDx: sudden severe calf discomfort

A

Ruptured Baker’s cyst

40
Q

Calf discomfort + Fever and chills

A

Cellulitis

41
Q

PE finding in DVT

A

Mild palpation discomfort on the lower calf – mild DVT

Marked swelling of thigh and tenderness on palpation of common femoral vein – severe DVT

42
Q

If leg is diffusely edematous, DVT unlikely. Most probably:

A

Acute exacerbation of CVI, PPS

43
Q

Presentation of UE VTE:

A

Asymmetry of supraclavicular fossa

Circumference of upper arms

44
Q

Massive PE presents as

A

Systemic arterial hypotension

45
Q

Moderate PE presents as __ in 2d echo

A

RV hypokinesis, but have normal systemic arterial pressure

46
Q

Small PE presents as:

A

Normal right heart function and normal systemic arterial pressure

47
Q

Small PE can cause __ when it is lodged peripherally

A

Pulmonary infarction

Usually painful, near the innervation of pleural nerves

48
Q

Pleuritic chest pain more common in

A

Small peripheral emboli

49
Q

Examples of nonthrombotic emboli

A
  1. Fat emboli - after pelvic or long bone fracture
  2. Tumor emboli
  3. Bone marrow emboli
  4. Air emboli
  5. Cement and bony fragment emboli - after total knee and hip replacement
  6. Hair talc cotton emboli - in IV drug users
  7. Amniotic fluid emboli - leaky fetal membranes, tear in placental margins
50
Q

Most common symptom of PE

A

Dyspnea

51
Q

Most common sign of PE

A

Tachypnea - SITA - sign tachypnea

Pulmo (2 decks)

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