Venous Thrombo

Question 1

Test of choice for DVT dx

Answer 1

Compression ultrasonography-

Doppler technique assesses blood flow

Question 2

Gold Standard for DVT Dx

Answer 2

Contrast Venography

Question 3

Virchow’s Triad

Answer 3

Stasis
Vascular Injury
Hypercoagulability

Question 4

SBP /=40 from baseline for a period longer than 15 min that is not d/t hypovolemia, sepsis, acute MI, tension pneumothorax or new arrhythmia

Answer 4

Massive PE

Question 5

Most common symptom of PE

Answer 5

Dyspnea

Question 6

Most common sign of PE

Answer 6

Tachypnea

Question 7

Tx of UNstable PE

Answer 7

O2, IVF, BP support, ICU, consider thrombolytics

Question 8

Tx of stable PE

Answer 8

Proceed with further dx workup

Question 9

Gold standard for PE Dx

Answer 9

Pulmonary Angiography

Question 10

Disadvantages of pulm angiograph

Answer 10

• invasive
• high contrast load, contraindicated in renal pts
• technically demanding
• costly

Question 11

Not reliable as a diagnostic tool
Useful for PE DDx
More useful for prognosis

Answer 11

Echocardiogram

Question 12

Med indicated for initial tx of VTE

• inhibits clotting cascade by inactivating thrombin; potentiates antithrombin
• Requires continuous inpatient IV infusion

Answer 12

Unfractioned Heparin

Question 13

Med approved for outpt tx of DVT and stable PE

• inhibits clotting cascade similar to heparin, Factor Xa
• Subq injection
• expensive
• Don’t use in elderly, obese or pts with Cr clearance

Answer 13

Low molecular wt heparin/ Lovenox

Question 14

Med for long term tx of VTE

• acts on liver to block vit K dependent coagulant proteins
• PO, dose varies with INR

Answer 14

Warfarin/coumadin

Question 15

Duration of anticoagulation tx for major transient risk factor

Answer 15

3 mo

VTE prophylaxis w/ future exposure

Question 16

Duration of anticoagulation tx for minor transient risk factor

Answer 16

3 mo

VTE prophylaxis with future exposure

Question 17

Duration of anticoagulation tx for cancer

Answer 17

3-6 mo or as long as cancer is active

Question 18

Duration of anticoagulation tx for unprovoked thrombosis

Answer 18

3 mo, consider indefinite

Question 19

Duration of anticoagulation tx for underlying thrombophilia

Answer 19

Indefinite

Test 3 mo after event

Question 20

Activate plasminogen to form plasmin, resulting in the accelerated lysis of thrombi

Answer 20

Thrombolytics

Question 21

Thrombolytics are indicated for unstable pts with PE which are pts with:

Answer 21

• Massive PE and cardiogenic shock
• Severe hypoxemia
• Substantial perfusion deficit on V/Q scan
• RV dysfunction
• Extensive DVT

Question 22

Mechanical device designed to remove clots from the veins quickly in order to aid restoration of normal blood flow, reduce sx, and prevent post-thrombophlebitic syndrome

Answer 22

Thrombectomy/Embolectomy

Question 23

Indications for IVC filter

filter placed in inferior vena cava

Answer 23

• Pt with absolute contraindication to anticoagulation (active bleeding)
• Recurrent PE despite adequate coag
• Complication of anticoag (severe bleeding)
• Hemodynamic or resp compromise that is severe enough that another PE may be life threatening

Question 24

Prophylactic measures

Answer 24

SCDs (sequential compression devices)
TED hose (thromboembolic deterrent)
Low-dose SQ Heparin
and Lovenox