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PDX 1 > DVTs > Flashcards

DVTs Flashcards

1
Q

What is a DVT?

A

Blood clot in the deep veins

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2
Q

What is the most common area for DVTs to occur?

A

Legs
10x more common than upper extremity
Usually starts in calf & spreads proximally

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3
Q

Do distal DVTs have more or less risk of clot embolizing to lungs?

A

Less risk

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4
Q

Do proximal DVTs (popliteal or femoral veins) have high or low incidence of pulmonary embolism?

A

Higher

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5
Q

Are varicose veins a significant risk for DVT?

A

No

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6
Q

Does venous stasis promote or decrease thrombus formation?

A

Promote

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7
Q

What makes up Virchow’s triad?

A

Venous stasis
Hypercoagulability
Inflammation

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8
Q

Does thrombosis happen before or after an event of Virchow’s triad has occurred?

A

After

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9
Q

What increases the risk of DVT? (7)

A 
Family history of DVT
Immobilization
Recent major surgery/trauma
Active cancer/ chemotherapy
Age over 60
Systemic diseases
Pregnancy, estrogen
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10
Q

Are individual DVT risk findings reliable?

A

No- you will need to use clinical prediction guidelines to predict likelihood of DVT

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11
Q

What are some findings when a patient has a DVT?

A

asymmetric calf swelling
(also includes Baker’s cyst in or near popliteus)
asymmetric warmth & redness
acute cellulitis which signifies subcutaneous CT infection
exquisitely tender to touch
asymmetric edema (most likely acute onset)

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12
Q

If a patient has chronic edema & skin changes that include thickening and a dusky color, what is a possible diagnosis?

A

Chronic Venous Insufficiency

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13
Q

What is chronic venous insufficiency caused by?

A

incompetent valves in the deep veins

can also be a DVT complication

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14
Q

What could be a helpful treatment for chronic venous insufficiency?

A

venous compresion

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15
Q

Is chronic venous insufficiency unilateral or bilateral usually?

A

Can be either

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16
Q

What are some typical findings of chronic venous insufficiency?

A

medial lower leg skin changes above the ankle
there may or may not be an ulcer
calf muscle cords/ tenderness
Homan’s sign (no longer considered reliable)
medial calf size greater than 3cm larger than other leg (could be from swelling for something other than a DVT as well)

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17
Q

What is used to predict DVT probability?

A

Clinical prediction guide such as Wells DVT Clinical Prediction Rules

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18
Q

If a patient has bilateral lower extremity pitting edema do they get a point on Wells DVT Clinical Rules?

A

NO- because it should be unilateral, not bilateral

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19
Q

How long would a patient have restricted mobility (such as bedridden for more than 3 days or major surgery) in order to give them a point on Wells DVT Clinical Rules?

A

4 weeks

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20
Q

How recent would an active malignancy have to be in order to give a patient a point on Wells DVT Clinical Rules?

A

Within the last 6 months

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21
Q

If the circumference of one calf over the other is 2cm how many points does the patient receive on Wells DVT Clinical Rules?

A

0 points- because it has to be greater than 3cm difference

- measure this 10cm below tibial tuberosity

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22
Q

How many points does a patient receive on Wells DVT Clinical Rules if they have varicose veins?

A

0 points

- 1 point is given for NON-varicose collateral superficial veins

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23
Q

On Wells DVT Clinical Rules what do you deduct 2 points for?

A

strong alternative to DVT, if there is another diagnosis that is at least as likely as DVT

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24
Q

On Wells DVT Clinical Rules, your patient gets 0 points, what this indicate?

A

Low probability (3% DVT frequency)

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25
Q

On Wells DVT Clinical Rules, your patient gets 1-2 points, what this indicate?

A

Medium probability (17% DVT frequency)

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26
Q

On Wells DVT Clinical Rules, your patient gets >2 points, what this indicate?

A

High probability (75% DVT frequency)

27
Q

What do you do if you suspect a DVT?

A

Get an urgent ultrasound done

28
Q

What do you use a D-dimer blood test for? How do you interpret it?

A

To test for DVT
Negative= NO DVT
Positive does NOT rule IN a DVT (imaging is required for this)

29
Q

What is a potentially fatal complication of DVT?

A

Pulmonary Embolus

30
Q

What is the classic triad of a pulmonary embolus?

A

Hemoptysis
Dyspnea
Chest pain
(all 3 occur in less than 20% of cases)

31
Q

What is the treatment for a suspected DVT?

A

Go to the ER! for anticoagulation medication to prevent further clotting
May require meds to dissolve the clot as well

32
Q

What are 5 red flags for a cardiac problem?

A 
Chest Pain!!
Palpitations
Pre-syncope/syncope
SOB/DOE
LE Swelling (edema)
33
Q

What are the 2 categories of chest pain?

A

Visceral (vague)

Pleuritic

34
Q

Explain how the patient might present if they are having cardiac visceral pain.

A

Hard for patient to localize/ describe

Not made worse by palpation, changes in body position, or taking deep breaths

35
Q

What is a typical example of cardiac visceral pain?

A

Angina (cardiac ischema)

36
Q

When do you see cardiac pleuritic pain?

A

When the pericardium is inflamed and irritates the parietal pleura= pericarditis

37
Q

Why is parietal pleura so pain sensitive?

A

Because parietal pleura lines the chest wall in close proximity to the intercostal nerves

38
Q

Explain how a patient might present if they are having cardiac pleuritic pain.

A

Easier to localize/describe (usually retrosternal or left chest & sharp pain)
Not made worse by palpation but WORSE with breathing and lying supine

39
Q

What might make pericarditis pain feel better?

A

Sitting & leaning forward

40
Q

When is pleuritic chest pain most often seen?

A

Lung conditions & pericarditis & 14% of MIs

41
Q

Differential Diagnosis for chest pain can also include what other conditions?

A

GI problems
Anxiety
Musculoskeletal conditions

42
Q

Is pre-syncope/syncope specific to heart disease?

A

No

43
Q

What leads to pre-syncope/syncope?

A

Global reduction of cerebral perfusion

44
Q

What do benign forms of pre-syncope/syncope tend to have?

A

Prodrome

45
Q

How long is the prodrome for vasovagal syncope?

A

about 2.5 minutes

46
Q

If your patient has short (3-5secs) or no prodrome what can this indicate?

A

Cardiogenic syncope (usually this is not benign and must be investigated further)

47
Q

Are palpitations alone specific to heart disease?

A

No

48
Q

What does a combo of palpitations and pre-syndope/syncope indicate?

A

Arrhythmia

must investigate further

49
Q

What is a potential indicator for cardiovascular disease?

A

Peripheral arterial disease

50
Q

What is a modifiable cardiovascular risk factor?

A

Stacking (finger stacking)

51
Q

What are the non-modifiable risk factors for CVD?

A

Patient age
Male = 45, Female = 55 results in CVD risk increase
Family history of premature heart disease in a first degree relative (premature male= 55, female = 65)

52
Q

What does Nitric Oxide promote?

A

Vasodilation (and can limit platelet clotting)

53
Q

What are some pathophysiological factors that can contribute to CVD?

A 
arterial "stiffness"
injured endothelium (due to decreased NO)
increased risk of vasoconstriction & clotting
54
Q

CV risk factors can lead to activation of endothelium. What does this refer to and what does it cause the formation of?

A

Activation of endothelium refers to leukocyte recruitment & this leads to the formation of Foam Cells

55
Q

In CVD, what happens after foam cells are formed?

A

An inflammatory cascade is triggered in artery wall which causes plaque formation.

56
Q

What area of an artery is most prone to atherosclerosis?

A

Arterial bifurcations

57
Q

What is the strongest modifiable risk of CVD?

A

Diabetes mellitus

some risk present even when glucose levels are under control

58
Q

What is the second strongest modifiable risk of CVD?

A

Smoking (proportional to number of smoked and depth of inhalation)
Second hand smoke also counts

59
Q

Outside of diabetes and smoking, what are other modifiable risks of CVD?

A 
Sedentary lifestyle
Body weight/ obesity
Hypertension
High LDL levels 
Hypertriglyceridemia
Low HDL
60
Q

What causes most heart attacks?

A

Plaque rupture & subsequent clot formation

61
Q

Do all heart attacks occur in patients with high LDL levels?

A

No

62
Q

Explain how MI often happens due to high LDL.

A

Oxidation of LDLs causes inflammatory cascade, and this inflammation may lead to plaque rupture= CV event

63
Q

Explain the cholesterol treatment controversy

A
  • statin meds for those with normal LDL levels to stabilize plaques

EIP suggests this is what leads to decreased CV deaths

64
Q

What can lead to hypertriglyceridemia?

A

Obesity
Uncontrolled diabetes
Chronic alcoholism

PDX 1 (4 decks)

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