thromboembolic disease

Question 1

what is virchows triad

Answer 1

vessel wall damage, venous stasis, and hyper coagulability

Question 2

what falls under venous stasis

Answer 2

COPD - advanced

Question 3

hypercoagulability

Answer 3

protein C and S deficiency
antithrombin III deficiency
factor V leiden mutation

Question 4

CF

Answer 4

pleuritic pain 
haemoptysis 
SOB 
low BP
cyanosis 
sudden death

Question 5

onset

Answer 5

sudden

Question 6

what is it scored with

Answer 6

geneva and well score

Question 7

what are some rare causes

Answer 7

fat, air or amniotic fluid embolism
parasites
foreign material - IV drug user

Question 8

D-dimer

Answer 8

excludes if low

Question 9

investigations

Answer 9

FBC, U&E, baseline clotting, D-dimer
ABG
imaging: CTPA or CXR
ECG

Question 10

what is the first line of imaging

Answer 10

CTPA

Question 11

who should D dimers be performed on

Answer 11

those without a high risk of PE

Question 12

ABG

Answer 12

low PaO2 and low or normal PaCO2

Question 13

what type of resp failure develops

Answer 13

1

Question 14

what hypersensitivity disease can cause PE

Answer 14

SLE

Question 15

ECG

Answer 15

S1Q3T3

sinus tachycardia

Question 16

what is V/Q scan sensitive for

Answer 16

small emboli

Question 17

what is seen on VQ scan

Answer 17

Perfusion defect is seen before infarction, and perfusion and ventilation mismatch after infarction

Question 18

acute treatment for PE

Answer 18

O2
IV fluid
thrombolysis
LMWH - dalteparin

Question 19

PE long term treatment

Answer 19

anticoagulation (warfarin) and IVC filter

Question 20

DVT treatment

Answer 20

Heparin or LMWH (e.g. dalteparin) and vit K antagonist (e.g. warfarin)

Question 21

how would you treat a major PR with normal RV function or minor PE

Answer 21

anticoagulate

Question 22

how would you treat a major PE without normal RV function

Answer 22

anticoagulate and/or thrombolysis

Question 23

how would you treat a major PE with shock or syncope

Answer 23

thrombolysis or surgery

Question 24

what are the benefits of graduated compression stockings

Answer 24

reduce incidence of post thrombotic syndrome

Question 25

what are the benefits of IVC filters

Answer 25

temporarily offered to patients with proximal DVT or PE who cant have anticoagulation treatment
prevent recurrent PE in short term but have complications in long term - used in patients with recurrent

Question 26

PE complication

Answer 26

sudden death
arrhythmias
pulmonary infarct
pulmonary hypertension

Question 27

distal DVT

Answer 27

DVT of the calves

Question 28

proximal DVT

Answer 28

popliteal vein or femoral vein

Question 29

CF DVT

Answer 29

hot swollen and tender leg

Question 30

differential of DVT

Answer 30

Popliteal synovial rupture (Baker’s cyst)
Superficial thrombophlebitis
Calf cellulitis

Question 31

DVT investigation

Answer 31

US - 1st line

CT scan

Question 32

name 3 complications

Answer 32

Post Thrombotic Syndrome
phlegmasia dolens
CTPH

Question 33

Post Thrombotic Syndrome

Answer 33

chronic venous insufficiency due to valves in legs destroyed - vein becomes large and flaccid

Question 34

Post Thrombotic Syndrome CF

Answer 34

pain
oedema
hyperpigmentation
venous ulceration

Question 35

Phlegmasia dolens

Answer 35

medical emergency where DVT causes obstruction of the arterial flow

Question 36

Phlegmasia dolens treatmetn

Answer 36

IVC filter

Question 37

CTPH

Answer 37

blood vessels are blocker/narrowed with recurrent blood clots and constrict. fibrous tissue forms. leads to RHF