Venous thrombosis

Question 1

where can thrombotic events occur

Answer 1

arteries in coronary, cerebrak or peripheral

Question 2

venous thrombosis

Answer 2

blood clot which forms ina. vein

Question 3

atherosclerosis

Answer 3

build up of cholesterol plaque in wall of artery

Question 4

what does atheroscleoris present with in legs

Answer 4

claudication pain

Question 5

prevention of arterial thrombosis

Answer 5

aspirin or other antiplatelet drugs

Question 6

what is a venous thrombosis usually due to

Answer 6

lack of movement

Question 7

risk factors for venous thrombosis

Answer 7

virchows triad
stasis
vessel wall ; damage to valves
hypercoagulability

Question 8

what main things damage valves

Answer 8

previous dvt
age

Question 9

treatment of venous thrombosis

Answer 9

heparin/ warfarin

Question 10

DVT features

Answer 10

limb feels hot swollen and tender
pitting oedema

Question 11

PE features

Answer 11

Pulmonary infarction
Pleuritic chest pain
Cardiovascular collapse/death
Hypoxia
Right heart strain

Question 12

what is right heartvstrain detected on

Answer 12

echo or elctrocardiogram

Question 13

characterisitc of right heart strain

Answer 13

S1Q1T3

Question 14

Risk factors for venous thromboembolism

Answer 14

Age
Marked obesity
Pregnancy
Puerperium
Oestrogen therapy
Previous DVT/PE
Trauma/Surgery
Malignancy
Paralysis
Infection
Thrombophilia

Question 15

what do protein s and c switch off

Answer 15

factor 5 and factor 8

Question 16

thrombophilia

Answer 16

Familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis

Question 17

pathophysiology of venous thrombosis

Answer 17

low pressure system meaning platelets arent activated > coagulation cascade activated due to virchows triad > clot rich in fibrin

Question 18

dvts of which veins are more likely to embolise

Answer 18

femoral / popliteal

Question 19

clinical features of a pulmonary embolism

Answer 19

sob
chest pain
dvt symptoms
collapse
fever
haemopytsis
tachycardic
hypoxia
cyanosis
low bp

Question 20

what test is doen to rule out DVT, if wells score indicates pe unlekly

Answer 20

d dimer if considered unlikely based on wells score

Question 21

which scan is diagnostic for DVT

Answer 21

us doppler if patient has raised d dimers / high wells score in which case US would be first

Question 22

what test to perform if wells score indicates pe is liekly

Answer 22

CTPA

Question 23

what alternative test is used in pregnancy, renal impairment or at risk of radiation

Answer 23

V/Q scan

Question 24

what ABG pattern willbe shown

Answer 24

type 1 resp failure

Question 25

initial management for a suspected or confirmed DVT or PE

Answer 25

anticoag; apixaban or rivaroxaban if not suitable then LMWH followed by dabigatran or edoxaban

Question 26

first line treatment for massive PE

Answer 26

thrombolysis

Question 27

secondary prevention in pregnancy

Answer 27

LMWH

Question 28

second line prevention in antiphos syndrome

Answer 28

warfarin

Question 29

treatment timeline

Answer 29

○ Provoked DVT with reversible factors - 3 months Provoked DVT with irreversible factors, or unprovoked DVT - 3-6 months, potentially life-long depending on patient factors (e.g. genetic clotting disorder)