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General Medicine & Family Medicine > Haematology\ Venous Thromboembolism > Flashcards

Haematology\ Venous Thromboembolism Flashcards

1
Q

What are the three factors typically involved in thrombosis formation (and also make up Virchow triad)?

A
  1. Stasis of blood flow
  2. Vascular endothelial injury
  3. Hypercoagulable state
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2
Q

What is Homans sign?

A

Calf pain with passive ankle dorsiflexion associated with the presence of a deep venous thrombosis (DVT) (a frequently pimped but unreliable examination finding)

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3
Q

What physical examination findings suggest a DVT?

A
  • Local edema (>3-cm diameter increase compared to the unaffected side)
  • pain
  • warmth
  • a palpable cord (indicating a thrombosed vein)
  • presence of newly developed varicose veins
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4
Q

What is the imaging study of choice to rule out DVT?

A

Compression ultrasonography

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5
Q

What is the role of D-dimers in the workup of suspected DVT?

A

D-dimer levels <500 ng/mL are helpful in excluding DVTs.

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6
Q

What are the risk factors for thrombsis?

A
  • Inherited
    • Protein C deficiency
    • Factor V Leiden mutation
    • Prothrombin gene mutation
    • Antithrombin deficiency
    • Protein S deficiency
  • Acquired
    • Malignancy
    • Trauma
    • Recent Surgery
    • Pregnancy
    • Drugs
    • Immobilisation
    • Heart failure
    • Antiphospholipid syndrome
    • Myeloproliferative disorders
    • Hyperviscosity syndromes
    • Hyperhomocysteinemia
    • Nephrotic syndrome
    • Obesity
    • Past VTE
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7
Q

Do all DVT patients need a workup for an inherited thrombophilia?

A

No

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8
Q

What is the management of a DVT?

A

Unfractionated or low-molecular-weight heparin (LMWH) and warfarin

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9
Q

For how many days should treatment with heparin and warfarin overlap?

A
  • At least 4-5 days
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10
Q

If heparin and warfarin have overlapped sufficiently and international normalized ratio (INR) has been therapeutic for two consecutive days, what should you do?

A

Discontinue heparin and continue warfarin alone.

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11
Q

How long should you continue oral anticoagulation with warfarin if the cause of the venous thromboembolism (VTE) is reversible?

A

3 months

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12
Q

How long should you continue oral anticoagulation with warfarin if its patient’s first idiopathic VTE?

A

6-12 months

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13
Q

How long should you continue oral anticoagulation with warfarin if the cause of the venous thromboembolism is irreversible?

A

indefinitely

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14
Q

What does INR stand for?

A

International normalized ratio

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15
Q

By whom and why was INR developed?

A

By the World Health Organization (WHO) in order to standardize prothrombin times

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16
Q

What INR is considered therapeutic for warfarin treatment of DVTs?

A

2-3

17
Q

What should be done if anticoagulation is contraindicated (eg, active bleeding) or if anticoagulation has failed?

A

Place an inferior vena cava (IVC) filter

18
Q

Is LMWH at least as effective as unfractionated heparin?

A

Yes

19
Q

What are the advantages of using LMWH versus unfractionated heparin?

A
  • Longer half-life allows for once or twice daily dosing
  • doses are fixed
  • monitoring of the activated partial thromboplastin time (aPTT) is not required
  • thrombocytopenia is less likely
20
Q

What percentage of symptomatic, untreated, proximal DVT patients will develop pulmonary embolism?

A

50%

21
Q

What are the symptoms associated with pulmonary embolism (PE)?

A
  • Dyspnea
  • pleuritic pain
  • cough
  • hemoptysis
22
Q

What are the signs associated with PE?

A
  • Tachypnea
  • rales
  • diaphoresis
  • tachycardia
  • heart gallop
  • a loud second heart sound
23
Q

What chest x-ray (CXR) findings suggest a PE?

A
  • Atelectasis
  • Hampton hump
  • Westermark sign
24
Q

What is Hampton hump on CXR?

A

A triangular pleural-based density with an apex that points toward the hilum

25
Q

What is Westermark sign?

A

Oligemia distal to the infarction

26
Q

Although the ECG is often normal, a PE may cause what ECG changes?

A
  • Sinus tachycardia
  • right bundle branch block
  • S I Q III T III
27
Q

What is S I Q III T III ?

A
  • Prominent S wave in lead
  • Q wave in III
  • T-wave inversion in III
28
Q

What arterial blood gas findings suggest PE?

A
  • Hypoxemia
  • hypocapnia
  • respiratory alkalosis
29
Q

What other diagnostic studies are used in suspected PE?

A
  • D-dimer
  • ventilation/perfusion (V/Q) scan
  • spiral CT pulmonary angiography
30
Q
A

General Medicine & Family Medicine (150 decks)

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