Thrombosis And Embolism Flashcards

Question

Aschoff body

Answer 1

Seen in heart in rheumatic fever , a focus of chronic inflammatory cells, necrosis, and activated mq (antischkows cells)

Answer 2

Pancarditis in acute can progress to chronic, manifesting as valvular abnormalities Inflammation of endocardium and left valves results in fibrinoid necrosis of valve cusps/chordae tendinae and vegetations form Deforming fibrotic valvular disease particulatly mitral , CT may thicken and fuse Main cause of MS , can cause MR too.

Answer 3

fibrin and RBC

Answer 4

from rupture of athersclerotic plaque comes from arteries of left heart chambers results in ischaemia and infarction causes ACS, IS, limb claudication/ischaemia composed of platelets and fibrin (white thrombus)

Answer 5

comes from virchows triad especially stasis and hypercoaguability originates in venous vakves and sinusoids of muscles results in back pressire causes DVT and PE composed of RBC and fibrin (red thrombus)

Answer 6

pregnancy sepsis cancer

Answer 7

Hypertension smoking hypercholesterol

Answer 8

indwelling venous catheters trauma surgery

Answer 9

``` Limb deep vein thrombosis (DVT) Pulmonary embolism (PE) ``` Visceral venous thrombosis Intracranial venous thrombosis

Answer 10

``` DVT: 1 in 1000 pa PE: 1 in 3000 – 5000 pa (chances) Leading cause of direct maternal death in UK Case fatality rate: 1 to 5% Untreated PE: 30% PE in 20% of autopsies young women more then old men more ```

Answer 11

``` surgery late pregnancy caesatian Lower limb problems eg fracture and vv malignancy reduced mobility Congestive HD HT OC COPD hormone replacement therapy neurological disability thrombotic disorders long distance travel obesity ```

Answer 12

Unilateral limb swelling Persisting discomfort Calf tenderness [Warmth] [Redness- erythema] [Prominent collateral veins] [Unilateral pitting oedema] May be clinically silent

Answer 13

Post Thrombotic Syndrome Damage to venous valves Incidence of 20-60% within 2 years of DVT Swelling Discomfort Pigmentation Ulceration in severe form

Answer 14

Clinical assessment and pretest probability score (Wells score) Blood test: D-dimer if low pre-test probability score Imaging: Compression ultrasound if positive D-dimer or high pre-test probability score

Answer 15

Active cancer, or cancer that’s been treated within last six months 1 Paralyzed leg 1 Recently bedridden for more than three days or had major surgery within last four weeks 1 Tenderness near a deep vein 1 Swollen leg 1 Swollen calf with diameter that’s more than 3 centimeters larger than the other calf’s 1 Pitting edema in one leg 1 Large veins in your legs that aren’t varicose veins 1 Previously diagnosed with DVT 1 Other diagnosis more likely -2

Answer 16

Breakdown product of cross-linked fibrin Produced during fibrinolysis High sensitivity for VTE Low specificity for VTE Trauma, malignancy, sepsis, bleeding, cancer, recent surgery

Answer 17

``` Pleuritic chest pain Breathlessness- dyspnoea [Blood in sputum- haemoptysis] Rapid heart rate- tachycardia Pleural rub on auscultation usually due to pulmonary infarction ```

Answer 18

``` Severe dyspnoea of sudden onset Collapse Blue lips and tongue - cyanosis Tachycardia Low blood pressure Raised jugular venous pressure May cause sudden death ```

Answer 19

Clinical assessment and pretest probability score (Wells score or Geneva score) Blood test: D-dimer if low pre test probability score Imaging: if D-dimer positive or high pre test probability score Isotope ventilation/perfusion scan CT pulmonary angiogram

Answer 20

clinical signs and symptoms of DVT = 3 an alternative diagnosis is less likely than PE = 3 heart rate more than 100 = 1.5 immobilisation for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5 previous objectively diagnosed PE or DVT = 1.5 haemoptysis = 1 malignancy (on treatment, treatment in last 6 months or palliative) = 1

Answer 21

Was there a clear cause or precipitant? Recent surgery / hospitalisation Any symptoms or signs to suggest underlying malignancy? Consider risk of recurrence Clinical Risk Cancer patients DASH score/ HERDoo2 etc

Answer 22

Anticoagulation is main treatment Provoked – 3/12 Unprovoked and high risk of recurrence- Lifelong Parenteral- low molecular weight heparin, a factor 10a inhibitor eg dalteparin, no monitoring but cant use in sig. renal failure direct oral anticoagulants- 10a inhibitors eg rivaroxaban or direct thrombin inhibitor eg dabigatran, no monitoring but be careful with high BMI and low renal function

Answer 23

Vascular surgical interventions in massive DVTs Thrombolysis reserved for massive PE (Collapse, haemodynamic compromise ie. Shocked Patient) E.g. Alteplase

Answer 24

Prevent clot extension Prevent clot embolisation Prevent recurrent clot

Answer 25

Post Thrombotic Syndrome Damage to venous valves Incidence of 20-60% within 2 years of DVT Swelling Discomfort Pigmentation Ulceration in severe form

Answer 26

Most recover fully Pulmonary arterial hypertension Serious outcome 4% patients (< 1/20)