DVT PTE Flashcards
The two most common autosomal dominant genetic mutations are:
Factor V Leiden:
Resistance to activated protein C, leading to impaired inactivation of clotting factors V and VIII
Prothrombin gene mutation:
Increases plasma prothrombin concentration.
The most common gas exchange abnormalities are
Arterial hypoxemia
Increased alveolar-arterial O₂ tension gradien
Virchow’s Triad
Venous stasis
Hypercoagulability
Endothelial Injury
Hallmarks of Massive PE
Dyspnea.
Syncope.
Hypotension.
Cyanosis.
Characterized by right ventricular (RV) dysfunction, despite normal systemic arterial pressure.
Submassive (intermediate Risk) PE
The Great Masquerader
PE
The most common symptom of PE is
unexplained breathlessness
The most common symptom in DVT is
cramp or charley horse
Most frequent abnormality in ECG
Sinus tachycardia
S1Q3T3 sign
Well established abnormalities
Westermark’s Sign
Hampton’s hump
Palla’s sign
Focal oligemia
Westermark’s sign
A peripheral wedge-shaped density located at pleural base
Hampton’s Hump
Enlarged right descending pulmonary artery
Palla’s sign
The principal imaging test for diagnosis of PE
Chest CT with IV contrast
Second line diagnostic test for PE
Lung Scanning
The best known indirect sign of PE on TTE
McConnell’s sign
Hypokinesis of the RV free wall with normal or hyperkinetic motion of the RV apex
McConnell’s sign
A definitive diagnosis of PE requires visualization of
intraluminal filling defect in more than one projection
Secondary Signs of PE:
Abrupt vessel occlusion (“cut-off”).
Segmental oligemia or avascularity.
Prolonged arterial phase with slow filling.
Tortuous, tapering peripheral vessels.
Open Vein Hypothesis
Patients who receive primary therapy reduces long-term venous valve damage, lowering rates of postthrombotic syndrome.
APEX Trial Findings
Asymptomatic DVT patients had a threefold higher mortality rate
Rate of Upper Extremity DVT has increased with increased use of
PICC
IVC filters are indicated in patients with an absolute contraindication to _____ and for those who suffered recurrent VTE while receiving therapeutic doses of anticoagulation
anticoagulation
To reduce discomfort in patients with leg swelling from acute DVT.
Compression stockings
How often should compression stockings be replaces
3 months due to loss of elasticity
T/F
Vascular compression stockings in asymptomatic newly diagnosed acute DVT patients does not prevent development of postthrombotic syndrome
T
DVT more commonly associated with surgery or leg trauma.
Isolated calf DVT
Target INR for PTE
2-3
For patients with massive PE and hypotension, replete volume with ______
500ml of normal saline
First line vasopressor and inotropic agents for treatment of PE related shock
NE
Dobu
Last resort for patients requiring heroic measures.
ECMO
tPA can be used for at least _____ after PE has occurred
14 days
FDA approved regimen of tPA
100mg over 2 hrs via continuous peipheral IV infusion
Most common in-hospital prophylactic method.
Low dose UFH or LMWH
Which is the most common genetic mutation associated with venous thromboembolism (VTE)?
Prothrombin gene mutation
Factor V Leiden
In patients with venous thromboembolism (VTE), how does carotid artery plaque influence the risk of future events?
A) It decreases the risk of pulmonary embolism.
B) It doubles the risk of future VTE.
C) It has no significant association with VTE.
D) It protects against arterial thrombosis.
B
What is the primary gas exchange abnormality observed in pulmonary embolism (PE)?
A) Decreased alveolar dead space
B) Increased alveolar-arterial O₂ tension gradient
C) Increased pulmonary compliance
D) Decreased airway resistance
B Increased alveolar-arterial tension gradient and arterial hypoxemia
What is the hallmark ECG finding associated with right ventricular (RV) strain in pulmonary embolism (PE)?
A) Sinus bradycardia
B) T-wave inversion in leads V₁ to V₄
C) Prolonged PR interval
D) Left axis deviation
B
What is the most common symptom of pulmonary embolism (PE)?
A) Chest pain
B) Unexplained breathlessness
C) Syncope
D) Cough
B
In a patient with suspected PE who is hemodynamically stable and has a low clinical probability, which test should be performed first?
A) CT pulmonary angiography
B) Chest X-ray
C) d-Dimer assay
D) Venous ultrasound
C
The age-adjusted d-dimer formula is applicable for patients:
A) Younger than 50 years with suspected PE.
B) Older than 50 years with low to intermediate clinical probability of PE.
C) With suspected acute DVT.
D) Hospitalized with systemic illness.
B
A 55-year-old male with suspected PE has a normal d-dimer level. What is the next step in management?
A) Perform CT pulmonary angiography.
B) Discharge the patient with no further testing.
C) Initiate anticoagulation empirically.
D) Obtain a lung scan.
B
Which finding on an electrocardiogram (ECG) is specific but insensitive for PE?
A) Sinus tachycardia
B) T-wave inversion in leads V₁–V₄
C) S1Q3T3 pattern
D) Prolonged QT interval
C
Which diagnostic test is recommended for patients with a high likelihood of DVT?
A) d-Dimer assay
B) Venous ultrasound
C) Chest X-ray
D) Ventilation-perfusion lung scan
B
What clinical feature most commonly suggests DVT in the lower extremities?
A) Fever and chills
B) Persistent calf cramp (“charley horse”) that worsens over days
C) Sudden, severe calf pain
D) Diffuse leg edema
B
In a patient with PE, what does a peripheral wedge-shaped density on chest X-ray (Hampton’s hump) indicate?
A) Enlarged right descending pulmonary artery
B) Pulmonary infarction
C) Normal finding
D) Air embolism
B
Which of the following scenarios most likely suggests May-Thurner syndrome?
A) Right thigh edema in an elderly male
B) Recurrent left thigh edema in a young woman
C) Bilateral leg edema in a patient with venous insufficiency
D) Sudden onset calf pain with fever
B
What is the primary goal of catheter-directed thrombolysis in the treatment of DVT?
A) Prevent pulmonary embolism (PE)
B) Reduce long-term venous valve damage and postthrombotic syndrome
C) Reduce anticoagulation duration
D) Eliminate the need for secondary prevention
B
What was the primary finding of the ATTRACT trial regarding catheter-directed thrombolysis for femoral or iliofemoral DVT?
A) No overall reduction in postthrombotic syndrome after 2 years.
B) A significant reduction in mortality among patients treated with thrombolysis.
C) Higher bleeding risk in patients receiving thrombolysis.
D) No benefit of thrombolysis in any patient subgroup.
A
In asymptomatic DVT, findings from the APEX trial substudy showed that patients with asymptomatic DVT had:
A) No difference in outcomes compared to patients without DVT.
B) A threefold higher mortality rate than patients without DVT.
C) A reduced risk of recurrent VTE.
D) Increased likelihood of postthrombotic syndrome.
B
Which of the following interventions can reduce the rate of upper extremity DVT in patients with peripherally inserted central catheters (PICC)?
A) Use of double-lumen catheters
B) Use of the largest possible catheter size
C) Judicious selection of patients requiring PICCs
D) Routine anticoagulation for all PICC patients
C
Which of the following statements about isolated calf DVT is correct based on the GARFIELD-VTE Registry findings?
A) Cancer-associated isolated calf DVT has a lower recurrence rate than proximal DVT.
B) Surgery or leg trauma is a common trigger for isolated calf DVT.
C) Anticoagulation is rarely used for isolated calf DVT.
D) Isolated calf DVT is associated with significantly higher mortality compared to proximal DVT.
B
In cancer-associated isolated calf DVT, the risk of recurrence is:
A) Lower than non-cancer-associated DVT.
B) Equal to cancer-associated proximal DVT.
C) Significantly lower than proximal DVT in non-cancer patients.
D) Eliminated with anticoagulation.
B
Which patients with DVT are candidates for an inferior vena cava (IVC) filter?
A) Patients with an absolute contraindication to anticoagulation
B) Patients with asymptomatic DVT
C) Patients with isolated calf DVT
A
What is the primary benefit of below-knee graduated compression stockings in patients with acute DVT?
A) Prevent postthrombotic syndrome in asymptomatic patients
B) Lessen discomfort from leg swelling
C) Improve anticoagulation efficacy
D) Reduce risk of recurrent DVT
B
Which of the following is NOT an indication for anticoagulation in DVT management?
A) Asymptomatic DVT with significant clot burden
B) Recurrent DVT in a patient receiving therapeutic anticoagulation
C) Proximal DVT in patients with cancer
D) Isolated calf DVT
B Indication for IVC filter
Which of the following is the primary treatment for hemodynamically stable PE with normal right ventricular (RV) function?
A) Systemic fibrinolysis
B) Surgical embolectomy
C) Anticoagulation alone
D) Catheter-directed thrombolysis
C
Which anticoagulant therapy is appropriate as a monotherapy for PE without bridging?
A) Warfarin
B) Unfractionated heparin (UFH)
C) Rivaroxaban
D) Low-molecular-weight heparin (LMWH)
C
What is the target activated partial thromboplastin time (aPTT) for unfractionated heparin (UFH) when treating PE?
A) 40–60 seconds
B) 60–80 seconds
C) 90–120 seconds
D) 30–50 seconds
B
What is a key advantage of low-molecular-weight heparins (LMWH) over unfractionated heparin (UFH) in treating PE?
A) Shorter half-life allowing rapid discontinuation
B) No need for routine laboratory monitoring
C) Higher risk of bleeding complications
D) Direct inhibition of thrombin
B
Which of the following anticoagulants is associated with no risk of heparin-induced thrombocytopenia (HIT)?
A) Low-molecular-weight heparin (LMWH)
B) Fondaparinux
C) Unfractionated heparin (UFH)
D) Warfarin
B
Which clinical condition is a contraindication to fibrinolytic therapy in the treatment of massive PE?
A) Moderate RV dysfunction
B) Recent intracranial surgery
C) Hemodynamically stable PE
D) Hypoxia
B
For which subset of patients with PE is catheter-directed thrombolysis most appropriate?
A) Hemodynamically stable PE with low bleeding risk
B) Hemodynamically unstable PE with contraindications to systemic fibrinolysis
C) Small, asymptomatic PE
D) Chronic thromboembolic pulmonary hypertension
B
What is the recommended management for a patient with cancer-associated PE?
A) Warfarin monotherapy
B) Low-molecular-weight heparin (LMWH) as monotherapy or a NOAC (if no gastrointestinal cancer)
C) Immediate surgical embolectomy
D) Short-term anticoagulation (≤3 months)
B
Which intervention is appropriate for a patient with massive PE and hypotension who is unresponsive to anticoagulation and vasopressors?
A) Continue IV fluids
B) Start veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridge to thrombolysis or embolectomy
C) Place an inferior vena cava (IVC) filter
D) Increase anticoagulation dose
B
