Venous Thromboembolism

Question 1

What is a thrombus?

Answer 1

Clot arising in the wrong place

Question 2

What is a thromboembolism?

Answer 2

Movement of a clot along a vessel

Question 3

What is stasis?

Answer 3

Changes in the dynamics of blood flow

Question 4

What is Virchow’s Triad?

Answer 4

It is a way of describing the three broad categories of factors that are thought to contribute to thrombosis

Question 5

What events cause hypercoagulability?

Answer 5

Pregnancy

Trauma

Question 6

What events cause stasis?

Answer 6

Bed rest

Travel

Question 7

What event causes vessel damage?

Answer 7

Atherosclerosis

Question 8

Give examples of venous thromboembolism.

Answer 8

Limb deep vein thrombosis 
Pulmonary embolism 
Visceral venous thrombosis 
Inter cranial venous thrombosis 
Superficial thrombophlebitis

Question 9

What is superficial thrombophlebitis?

Answer 9

Thrombosis and inflammation of the superficial veins

Question 10

What is a venous thrombus formed of?

Answer 10

Fibrin and red cells

Question 11

What are venous thrombi due to?

Answer 11

Stasis and hypercoagulability

Question 12

What type of pain can a venous thrombus cause?

Answer 12

Back pressure

Question 13

How is an arterial thrombus described?

Answer 13

White clot

Question 14

What is a white clot made of?

Answer 14

Platelets and fibrin

Question 15

What does an arterial thrombus result in?

Answer 15

Ischaemia and infarction

Question 16

What is an arterial thrombus usually secondary to?

Answer 16

Atherosclerosis

Question 17

What are the signs and symptoms of DVT?

Answer 17

Unilateral limb swelling
Persisting discomfort
Calf tenderness
Warmth Erythema

Question 18

What are the signs and symptoms of pulmonary embolism?

Answer 18

Pleuritic chest pain 
Dyspnoea 
Haemoptysis
Tachycardia 
Pleural rub on auscultation

Question 19

What are the signs and symptoms of a massive pulmonary embolism?

Answer 19

Severe dyspnoea of sudden onset 
Collapse 
Central cyanosis 
Tachycardia 
Low blood pressure 
Raised JVP 
Altered heart sounds

Question 20

What can a massive pulmonary embolism cause?

Answer 20

Sudden death

Question 21

What are the potential long-term consequences of DVT?

Answer 21

Post-phlebitic syndrome

Question 22

What are the signs of post-phlebitic syndrome?

Answer 22

Swelling
Discomfort
Pigmentation
Ulceration

Question 23

What is the potential long-term consequence of pulmonary embolism?

Answer 23

Pulmonary hypertension

Question 24

What are the risk factors of venous thrombosis?

Answer 24

Increased age 
Tissue trauma 
Immobility 
Obesity 
Smoking 
Some systemic diseases 
Inheritance 
Pregnancy 
Exogenous oestrogen

Question 25

What is heritable thrombophilia?

Answer 25

An inherited predisposition to venous thrombosis

Question 26

What is the most prevalent heritable type of thrombophilia?

Answer 26

Fator V Leiden

Question 27

What increases the risk of venous thromboembolism by 40 folds?

Answer 27

Taking the oral contraceptive with Factor V Leiden

Question 28

What increases the risk of VTE during travel?

Answer 28

``` The short The tall The overweight Women on the contraceptive pill Window seats ```

Question 29

How is DVT diagnosed?

Answer 29

Clinical assessment D-dimer blood test Compression ultrasound

Question 30

How is pulmonary embolism diagnosed?

Answer 30

Clinical assessment D-dimer test Isotope ventilation/perfusion scan CT pulmonary angiogram

Question 31

What methods can be used to prevent VTE in hospital?

Answer 31

Early mobilisation Anti-embolism stockings Daily injection of low molecular weight heparin

Question 32

When should compression stockings be used?

Answer 32

``` Prevention of DVT Chronic venous insufficiency Varicose veins Oedema Lymphedema Prevention of post-phlebitic syndrome ```

Question 33

What is the treatment of VTE?

Answer 33

LMW heparin for 5 or more days Oral anticoagulant for at least 3 months after Thrombolysis for massive pulmonary embolism