Mehl. Thrombophlebitis Flashcards
DVT. CP?
DVT will be unilateral thigh or lower leg swelling in patient with risk factors
DVT. risk factors?
post-surgery, prolonged sedentation, OCP use, Hx of thrombotic disorders (e.g., Factor V Leiden, prothrombin mutation).
DVT. Virchow triad for incr. DVT risk:
1) venous stasis (e.g., post-surgery sedentation),
2) hypercoagulable state (e.g., estrogen use, underlying malignancy),
3) endothelial damage (i.e., smoking).
DVT. OCPs contraindicated in ???
In smokers over 35 because estrogen causes hypercoagulable state for two reasons:
1) estrogen upregulates fibrinogen;
2) estrogen upregulates factors Va and VIIIa.
DVT. USMLE loves what cause of DVT??????
USMLE loves nephrotic syndrome as cause of DVT (loss of antithrombin III in the urine -> hypercoagulable state).
DVT. Antiphospholipid syndrome -> DVTs despite paradoxical incr. PTT (i.e., if PTT is high, you’d think you have bleeding diathesis, not thromboses); may or may not be due to SLE. Antibodies against phospholipids cause in vivo clumping of platelets + incr. clot initiation, but disruption of in vitro PTT assay means incr. PTT.
.
DVT. Major danger is DVT?
DVT can embolize to lungs causing PE -> acute-onset shortness of breath and tachycardia + death if saddle embolus.
DVT. Homan sign can mean DVT. What is this sign?
Pain in the calf with dorsiflexion of foot.
DVT. Dx?
duplex venous ultrasound of the leg/calf.
DVT. Tx?
Treatment is heparin.
DVT. Harder stuff for 2CK is that they care about prophylactic vs therapeutic doses of heparin.
DVT. Prophylactic heparin doses when?
Prophylactic dose is lower-dose and is used perioperatively in patients with venous disease/stasis or who are high risk.
DVT. Therapeutic heparin doses when?
If a patient has an actual full-blown DVT, however, give therapeutic dose, which is higher-dose.
DVT.There are two 2CK Qs on this stuff. One just mentions a guy going into surgery who has Hx of venous stasis -> answer about heparin = ?
“prophylactic heparin dose”;
“therapeutic heparin dose” is wrong answer.
DVT. The second question gives a guy who’s already on prophylactic heparin but gets a DVT anyway. The answer is then for Tx?
“heparin.”
It’s weird because students are like, “Wait what? He’s already on heparin though.” And I’m like, yeah, but what they mean is, we have to give therapeutic dose now for the active DVT, which is higher dose.
DVT. DVT can rarely cause stroke if an ASD is present (paradoxical embolus). Dumb and low-yield, but it shows up, and students get fanatical over it.
.
Post-op migratory. cause?
Post-surgery, this is usually due to changes in hemostasis and coagulability.
Post-op migratory. CP?
Will present as pink/red painful lesions appearing asymmetrically on the limbs within days of surgery. You just need to be able to diagnose this.
Trousseau sign of malignancy.
Migratory thrombophlebitis classically due to head of pancreas adenocarcinoma. But this can also be seen with adenocarcinomas in general, e.g., pulmonary.
.
Catheter-associated septic thrombophlebitis (CAST).
Shows up on 2CK form as patient who had a catheter in and then develops a 4-cm indurated, painful, fluctuant cord in his arm (refers to vein).
TX??????
Answer = “excision of vein.”
Pelvic septic thrombophlebitis (PST). The answer on USMLE in a woman who has post-partum endometritis (fever + tender lower abdomen) with persistent fever >48 hours despite antibiotics.”
Endometritis can lead to incr. risk of local infective clots in the ovarian veins.
Pelvic septic thrombophlebitis (PST).
If they give you a post-partum woman with sepsis (i.e., SIRS + infection), but the vignette doesn’t fit PST as described above, the answer is “puerperal sepsis” on the 2CK form. The latter is a more general term and can refer to many causes of post-partum sepsis (including PST confusingly enough).
.
Superficial thrombophlebitis. CP?
Painful palpable cord in the ankle that may or may not track up to the knee.
Superficial thrombophlebitis. Seen in patients with venous insufficiency.
.
Superficial thrombophlebitis. Tx?
Answer is “subcutaneous enoxaparin.”
Compression stockings are typically the answer for first step in venous insufficiency, but if you have an active ST or DVT, heparin must be given as first step.
Superficial thrombophlebitis.
There will occasionally be some intentional redundancy on my end with things I write in this doc if I believe they’re HY enough (as with this).
.
