Venous Thromboembolic Disease

Question 1

What are IVC filters used for?

Answer 1

patients who have frequent reoccurrence despite optimum pharmacological treatment or can’t be anti-coagulated

Question 2

What is the D-Dimer?

Answer 2

test of exclusion - high negative predictive value - low positive predictive value

Question 3

What is Virchow’s Triad?

Answer 3

sites of endothelial injury, turbulent blood flow and hypercoagulable blood

Question 4

What are the consequences of VTE?

Answer 4

post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension

Question 5

What are low risk causes of thrombosis?

Answer 5

smoking, contraceptive pill, renal disease, cardiomyopathy

Question 6

What is a V/Q scan?

Answer 6

ventilation/perfusion imaging - shows mismatched perfusion defects

Question 7

What is used to treat cancer associated PEs and DVTs?

Answer 7

weight adjusted fragmin

Question 8

What is the risk of an IVC filter?

Answer 8

clot can form on the filter

Question 9

What is the risk with graduated compression stockings?

Answer 9

arterial compromise

Question 10

What is an embolism?

Answer 10

thrombus detached - travels through vasculature - gets stuck

Question 11

What are the Wells score and the Geneva score?

Answer 11

probability scores

Question 12

What is chronic thromboembolic pulmonary hypertension?

Answer 12

original embolic material is replaced overtime with fibrous tissue - may occlude pulmonary artery - pulmonary artery resistance - right heart failure

Question 13

What are graduated compression stockings used for?

Answer 13

prevent post thrombotic syndrome, worn for at least two years after diagnosis

Question 14

Where is thrombosis formation favoured?

Answer 14

locations with Virchow’s Triad

Question 15

When is a V/Q scan useful?

Answer 15

small peripheral PEs, pregnancy

Question 16

What DVTs are scanned for and treated?

Answer 16

proximal DVTs - popliteal and femoral vein

Question 17

What is a thrombosis?

Answer 17

excess intravascular coagulation, static

Question 18

What characterises post-thrombotic syndrome?

Answer 18

pain, oedema, hyperpigmentation, eczema, varicose collateral veins, venous ulceration, venous hypertension

Question 19

What are the secondary causes of thrombosis?

Answer 19

prolonged immobility, significant tissue injuries, MI, atrial fibrillation, cancer, chemotherapy

Question 20

What are the predisposing risk factors for DVT and PE?

Answer 20

history of VTE, chronic heart failure, advanced age, varicose veins, obesity, immobility, paresis, pregnancy, thrombophilia, hormone therapies, renal insufficiency, cancer, inflammatory disease

Question 21

What is a pulmonary embolism?

Answer 21

thrombus that has travelled to lungs and blocked a vessel there

Question 22

What are the symptoms of chronic thromboembolic pulmonary hypertension?

Answer 22

initially asymptomatic, progressive dyspnoea and hypoxaemia

Question 23

What are the exposing risk factors for DVT and PE?

Answer 23

acute medical illness, acute heart failure, acute respiratory failure, surgery, trauma, central venous catheterisation, cancer, inflammatory diseases

Question 24

What is deep vein thrombosis?

Answer 24

formation of thrombi n the lumen of vessels that make up the deep venous system, form mainly in venous valves pockets

Question 25

What is the pharmacological treatment of PEs and DVTs?

Answer 25

anticoagulation, thrombolysis, analgesia

Question 26

What is used to treat drug use associated PEs and DVTs?

Answer 26

rivaroxaban or fragmin - risk of haemorrhage

Question 27

What does a CXR show in PE?

Answer 27

usually normal, may show some pleural effusions or infarct

Question 28

What is the meaning of hypoxaemia?

Answer 28

low blood oxygen concentration

Question 29

What are the signs of a PE?

Answer 29

tachypnea, crackles, tachycardia, fever