Quiz 5 PPT's #2

Question 1

Phlegmasia Alba Dolens (PAD):

Answer 1

in reference to very extreme cases of DVT
causes limb ischemia/limb loss (blanching of extremities, edema and discomfort)
diminished arterial pulse due to vasospasm

Question 2

Phlegmasia AD is also known as

Answer 2

milk leg

Question 3

Signs of phlegmasia AD:

Answer 3

swollen, white leg because of early compromise of arterial flow secondary to extensive DVT

Question 4

Phlegmasia Cerulean Dolens:

Answer 4

more advanced than PAD 
precursor for venous gangrene
significant swelling, pain, and cyanosis
surgical emergency
irreversible ischemia, necrosis and gangrene

Question 5

What affects only the deep venous channels (not collaterals)?

Answer 5

PAD

Question 6

What affects the deep, superficial and collateral veins?

Answer 6

PCD - and extends into capillaries 40-60% of the time

Question 7

Later stages of treatment for PCD?

Answer 7

incision into the vein, pass catheter into the clot, and balloon and clot is retreated with the balloon. Risk of PE but they take heparin first

Question 8

Early stages for PCD?

Answer 8

thrombolysis (i think that’s what she said)

Question 9

Trousseau’s Sign:

Answer 9

concerns hypercoagulability associated with cancer

spontaneous recurring venous thrombosis in ppl who have no known risk factors

Question 10

What’s the difference of having a DVT with malignancy?

Answer 10

more extensive
more aggressive
very swollen and painful leg

Question 11

Malignancies associated with venous thrombosis typcally arise in:

Answer 11

breast
GI tract
GU tract (genitourinary)
lung
brain

Question 12

Patients with DVT related to Trosseau’s syndrome usually clinically manifest within

Answer 12

1-2 years

Question 13

Subclavian Vein Obstruction:

Answer 13

detection can be difficult
diagnosis relies on secondary signs of obstruction (color)
pressure fluctuations are transmitted into veins, producing a pulsatile vein..so if it’s a flat signal u know it ain’t good (indicates a proximal obstruction)

Question 14

In many cases of SCV thrombosis, _____ ________ can be involved

Answer 14

IJV thrombosis

Question 15

Lemierre’s syndrome:

Answer 15

or jugular vein thrombosis in a patient with neck infection of enlarged lymph nodes
bacterial that is usually from throat infections and it spreads into major blood vessels and poisons the bloodstream (sepsis)

Question 16

Behcet’s Disease:

Answer 16

inflammation of blood vessels (veins or arteries)
causes redness, pain and swelling in extremitites
can cause blood clot to form because of inflammation
can
**What’s affected

Question 17

Virchow’s classic description:

Answer 17

hyper coagulability
venous stasis
endothelial damager

Question 18

IVC thrombosis due to tumors:

Answer 18

most familiar is RCC

seminomas/teratomas (if gonadal veins are affected it can be because of genitourinary tumors)

Question 19

What else can cause IVCT?

Answer 19

less common tumors in an anatomical location close to IVC
retroperitoneal leiomyosarcoma, adrenal cortical carcinoma, renal angiomyolipoma, hepatic hemangioma (due to compression)

Question 20

Extrinsic compression:

Answer 20

can result from non-tumor compression
causes stasis and turbulent flow
AAA’s (although uncommon)

Question 21

Don’t mistake a ________ for a thrombus within the IVC

Answer 21

enlarged lymph nose in a patient with chronic lymphatic leukemia

Question 22

There’s a lot of shit on the PPT (collateral flow)

Answer 22

so make sure to read it over too

Question 23

Inability for body to produce coagulants to stop bleeding is a

Answer 23

dysfunctional coagulation system and fibrinolytic system

Question 24

Nephrotic syndrome:

Answer 24

patients have urinary protein losses
diminished levels of antihrombin III (this deficiency of AIII can cause blood to clot more easily than normal)
renal vein thrombosis and IVCT have been described

Question 25

Iatrogenic:

Answer 25

no known cause | hx of medical care including: hepatic transplant, dialysis access, FV catheters, pacemaker wires, and IVC filters

Question 26

Other conditions that are associated with IVC thrombosis:

Answer 26

developmental anomalies of IVC retroperitoneal fibrosis (excess growth of tissue) pregnancy OC use

Question 27

May Thurner Syndrome:

Answer 27

rare condition more often in women compression of common venous outflow tract causes discomfort, pain, swelling and blood clots form (stasis) Lt common iliac vein is compressed by the overlying rt. common iliac artery DVT in iliofemoral vein may be cause

Question 28

May Thurner is more common in what side?

Answer 28

Left - the artery acutely overlaps the left iliac vein

Question 29

What can be some causes of leg swelling that can mimic DVT?

Answer 29

``` Baker's cyst hematoma/muscle injury superficial thrombophlebitis iliac nodes/pelvic masses AVF lymphedema knee joint effusion Rt. heart failure ```

Question 30

Hematoma/muscle tears

Answer 30

anechoic structure b/w medial gastroc and soleus muscle | must examine fluid collection to differentiate from vessel

Question 31

Baker's cyst:

Answer 31

identification of the neck between the tendons is necessary for definitive diagnosis (look for neck into joint space) popliteal medial knee is most common location can contain internal debris

Question 32

If Baker's cyst is seen, what must be assessed also?

Answer 32

deep veins as a coexistent DVT may be overlooked

Question 33

Superficial thrombophlebitis

Answer 33

inflammation of the vein with thrombus

Question 34

SPJ

Answer 34

saphenopopliteal junction

Question 35

Knee joint effusions:

Answer 35

patients with arthritis, recent trauma or knee surgery and infection causes pain and swelling

Question 36

Rt heart failure will show:

Answer 36

bilateral leg swelling | fluid can back up into abdomen

Question 37

Lymphedema:

Answer 37

siginificant swelling in one or more extrmeities that result from impared flow of the lymphatic system can mimic DVT cellulitis is complication

Question 38

IV drug use:

Answer 38

risk factor for *secondary DVT of upper extremitity | repeated trauma can cause S/DVT

Question 39

Cellulitis:

Answer 39

infectious process in soft tissue difficult to see sonographically tenderness, dimpling, and erythema are clues

Question 40

Abscess:

Answer 40

well-circumscribed fluid collection gas bubbles are bright reflectors inc vascularity within the walls

Question 41

Soft tissue tumors

Answer 41

Lipoma is most common incidentalomas benign or malignant ( vascularity depends on this) sarcoma/lymphoma/melanoma are m/c malignant mets

Question 42

Arterial ulcers are located:

Answer 42

toes, feet and lateral aspect of ankle/calf

Question 43

Venous ulcers are located:

Answer 43

medial aspect of calf and ankle (not toes or feet)