Vascular

Question 1

What is the definition of “edema”? How/why does this occur?

Answer 1

Edema is defined as an increase in extracellular volume. it develops if hydrostatic pressure > colloid oncotic pressure, capillary permeability increases, or lymphatic drainage becomes impaired.

Question 2

What is the primary cause of decreased oncotic pressure resulting in edema?

Answer 2

Hypoalbuminemia; occurs secondary to malnutrition, hepatocellular failure or excess renal or GI loss of albumin. (pg. 164 Groll)

Question 3

What are possible causes of increased hydrostatic pressure resulting in edema? (Three of these)

Answer 3

1. Fluid retention: seen in CHF, certain drugs i.e. NSAIDs, corticosteroids
2. Impairment of venous outflow: venous valvular incompetence, DVT, pulmonary HTN
3. Venodilating Drugs: nifedipine, CCBs

Question 4

In a pregnant female, where might the provider most likely see a DVT?

Answer 4

In the veins of the left leg or or iliac vein (80% of DVTs in this population occur in these two places)

Question 5

What are the physical findings most indicative of a DVT?

Answer 5

swelling of the entire leg, asymmetric leg edema (>3 cm difference in calf circumference), pitting edema of the involved leg, tenderness along deep veins, prominent collateral superficial veins

Question 6

What is Trousseau Syndrome? (pg. 165 Groll)

Answer 6

Trousseau syndrome is a DVT associated with an underlying malignancy. These account for 20% of thromboembolic disease and 10% of idiopathic cases a year. In 50% of these cases, the malignancy is already metastatic at the time of the initial DVT presentation.

Question 7

What is a D-dimer test? Does this test have high sensitivity and specificity?

Answer 7

A D-dimer is the final degradation product of thrombosis-induced fibrinolysis, which is why it is useful in assessing for a DVT. This test has a 85% sensitivity and 70% specify. Though these are high, the test interpretation must be taken in conjunction with the Wells score (found in Table 22-2 on page 166).

Question 8

True or false: a doppler venous US has high sensitivity and specificity and is the initial choice of test for ruling out an above the knee DVT for patients?

Answer 8

TRUE

Question 9

True or false: for thrombophlebitis (DVT) below the knee, sensitivity and specificity increases.

Answer 9

FALSE. This decreases because up to 40% of calf-vein studies are technically unsuccessful d/t poor sound penetration. A D-dimer test should follow.

Question 10

What are the components of the Constant clinical decision score? What is its purpose?

Answer 10

Purpose: to help risk stratify patients who are suspected of having an upper extremity DVT

Components include:

• localized pain +1
• unilateral upper extremity edema +1
• venous material present in Catheter or PPM thread +1
• other diagnosis at least as plausible -1

< or equal to 1: low pretest probability; 2=intermediate probability; 3= high probability