PE/DVT

Question 1

patients with lower extremity DVT often present with what three things?

Answer 1

Redness, swelling and tenderness

Question 2

What is the initial and most important step in evaluating a possible DVT?

Answer 2

Estimating the clinical likelihood of disease

Question 3

Let’s say the patient has a low clinical likelihood, what should be done next? What is the patient has a high clinical likelihood, what should be next?

Answer 3

Do d dimer test, and if its negative, rule out DVT. If its positive, go to duplex US
If clinical likelihood is high, go straight to duplex US

Question 4

What is the most effective preventable treatment in patients with VTE risk factors in the hospital?

Answer 4

Pharmacological prophylaxis

Question 5

What is the most common therapy for an established DVT?

Answer 5

Most of the time overlap heparin and warfarin for 5 days or until INR is normal between 2 and 3 for two measurements taken 24 hours apart.
Most patients should be treated with anticoagulation for at least 3 months.

Question 6

If there are strong contraindications to anticoagulation, what should be done?

Answer 6

IVC filter

Question 7

What is the best treatment for prevention of PE and what not to use?

Answer 7

Pharmacological prophylaxis and don’t use IVC filter

Question 8

What are the 4 most common symptoms of a PE?

Answer 8

Dyspnea, chest pain, cough and coughing up blood

Question 9

4 most common physical exam findings for PE?

Answer 9

Tachycardia, tachypnea, lung crackles, and p2 on steroids

Question 10

What test do we do for clinically stable, low probability of PE?

Answer 10

Check a d dimer, and if negative, then you can rule out PE

Question 11

What two tests are good for initial imaging testing for PE for high risk probability patients?

Answer 11

CT and V/Q

Question 12

What to consider if doing a V/Q scan for a PE?

Answer 12

It doesn’t visualize the clot, just measures pulmonary blood flow, and there are many cardiopulmonary or cardiac diseases that can affect pulmonary blood flow.

Question 13

3 extreme clinical manifestations of PE?

Answer 13

Right heart dysfunction, infarction and cardiac arrest

Question 14

Therapy for current PE?

Answer 14

Heparin and warfarin for 5 days or until INR is normal at 2-3 on two separate measurements within 24 hours.

Question 15

What is an alternative for a massive PE?

Answer 15

If patient has massive PE and unstable, go in and surgically take that thing out.

Question 16

Everything under the wells criteria gets how many points and what is the only thing that drops the score and how many points does it drop?

Answer 16

Everything gets a point.

If there is an alternative diagnosis to DVT patient score gets negative 2 points.

Question 17

A score of 0 or lower is associated what what, what do we do next and how should the approach/treatment proceed?

Answer 17

Unlikely for DVT
Do a d dimer test, if negative rule out DVT. If positive, do US.
If negative on US, rule out DVT. If positive, anti-coagulate

Question 18

What about a score of 1-2?

Answer 18

Moderate risk.

Everything is the same as a score of 0 or lower just do a high sensitivity d dimer test.

Question 19

What does a score of 3 or higher suggest?

Answer 19

Likely DVT

Question 20

What is the point value for the following 7 variables for the wells criteria for PE?
Signs of DVT, alternative diagnosis of DVT not likely, Cancer, previous PE or DVT, coughing up blood, HR over 100, immobilization or recent surgery?

Answer 20

3
3
1
1.5
1
1.5
1.5

Question 21

What is the three tiered clinical probably assessment for wells criteria for PE? What is the modified wells criteria for PE?

Answer 21

Score over 6 is high
2-6 is medium
Less than 2 is low

Over 4 is PE likely, 4 and under unlikely

Question 22

What is the one pro and con to using d dimer test?

Answer 22

Negative test makes DVT unlikely but a positive test is not diagnostic of DVT

Question 23

2 pros of CT angiography and 3 cons?

Answer 23

High sensitivity and specificity
Gold standard for intermediate risk

Allergies because contrast
Expensive
Radiation

Question 24

1 pro and 1 con to using v/Q scanning?

Answer 24

High sensitivity but low specificity

Question 25

3 pros of doppler venography?

Answer 25

Cheap, easy and no radiation

Question 26

1 pro and 3 cons to contrast venography?

Answer 26

See anatomy and lumen very good

Contrast, so allergies
Painful
Invasive

Question 27

What diseases are we thinking of hyper coagulable states?

Answer 27

Deficiencies in factors that are anti clot, so like antithrombin, protein c, protein s, Leiden v, prothrombin mutation

Question 28

5 acquired causes of hyper coagulable?

Answer 28

Cancer, smoking, oral contraceptives, pregnancy, PCV