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Clin Med2: Pulmonology > VTD - fiore > Flashcards

VTD - fiore Flashcards

1
Q

what is venous thromboembolic disease

A

“blood clots” involving the venous system
aka venous thromboembolism (VTE)

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2
Q

what is included in VTE

A

DVT
PE
thrombus or embolism involving any other vein

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3
Q

what is virchows triad

A

venous stasis
endothelial injury
hyper-coagulability

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4
Q

what is venous stasis

A

venous return is passive and requires skeletal muscle, gravity, intrathoracic pressure etc. to promote flow
pressure on vein opens proximal valve pushing blood back towards heart

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5
Q

what are hypercoagulability disorders

A

CALM APES
protein C, Antiphrospholipid Ab syndrome, Factor V lediden, Malignancy
Antithrombin III deficiency, prothrombin gene mutation, factor VII (eight) elevated, Protein S deficiency

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6
Q

what are the types of venous thromboemobilisms

A

provoked (identifiable trigger (reversible)
unprovoked (no identifiable trigger)

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7
Q

what are proving factors for VTE

A

surgery
trauma
prolonged immobility
pregnancy
hormone therapy (estrogen)
medications
infection (COVID)

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8
Q

what is the presentation of DVT

A

may be asymptomatic
ipsilateral LE edema
LE erythema
LE pain
LE warmth to touch

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9
Q

what is Homans sign

A

passive dorsiflexion of the ankle with knee at 30 degrees - calf pain
possible positive DVT

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10
Q

what is the workup for DVT

A

D-dimer
Duplex venous ultrasound (test of choice)
contrast venography (gold standard but not routinely utilized)

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11
Q

a wells criteria score of 3+ means what?

A

Duplex US needed
if + d-dimer and negative US -> recheck 1 week

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12
Q

what is a pulmonary embolism

A

blood clot in the pulmonary artery system
most likely cause is embolus from DVT

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13
Q

what are the locations for PE

A

saddle (worst)
lobar
segmental
sub-segmental - more likely to cause lung infarct or pleuritis

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14
Q

what is a saddle PE

A

considered most severe PE
staddles the bifurcation of the PA
occlusion of both R and L pulm arteries
may lead to hemodynamic instability, R HF
more likely to be fatal or require surgical management

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15
Q

what are symptoms of PE

A

dyspnea
pain with inspiration
cough
leg pain (DVT as source)
hemoptysis
wheezing
chest pain

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16
Q

what is found on EKG with PE

A

may show patterns of Right heart strain - RBBB, R axis deviation, R atrial enlargement, inverted T waves leads III and V1
tachycardia
S1Q3T3 pattern - deep S wave in lead 1, Q wave in 2, inverted T wave in 3 - not very specific

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17
Q

what is assessed with POCUS for PE

A

assess for right ventricular dilation
“D” sign
potential massive PE (saddle most likely)

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18
Q

what is the preferred diagnostic test for PE

A

CT-pulmonary angiography (CTPA)

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19
Q

what is the definitive diagnostic test for PE

A

pulmonary angiography
not often performed

20
Q

a wells criteria for PE > 4 is indicative of what

A

PE is likely
consider CTPA or V/Q

21
Q

what is PERC rule

A

Pulmonary Embolism Rule-Out Criteria Rules
rules out pulmonary embolism if NO criteria are present and pre-test probability is < 15%

22
Q

what is part of the PERC rules

A

Age > 50
HR >100
o2 sat < 95% on room air
prior hx of DVT/PE
recent trauma/surgery
hemoptysis
exogenous estrogen
unilateral leg swelling

23
Q

What is the PESI

A

Pulmonary Embolism Severity Index Score
predicts 30-day mortality

24
Q

what is the mainstay of PE

A

anticoagulation

25
Q

what kind of PE get thrombolytics

A

massive PE (hemodynamic instability)

26
Q

when is embolectomy indicated

A

massive PE
If thrombolytics unsuccessful or contraindicated

27
Q

what is the recommended VTE treatment during pregnancy

A

LMWH is most preferred
Coumadin is HIGHLY CONTRAINDICATED
DOACs are contraindicated as well

28
Q

what is fleischner sign

A

enlarged PA

29
Q

what is westermark sign

A

lack of distal pulmonary vasculature

30
Q

what is hamptons hump

A

wedge shaped pulmonary infarct

31
Q

what do we look for hypercoaguable states

A

patients under 50
significant family hx of VTE
clot in unusual location
recurrent clots
women of childbearing age
other clinical suspicion

32
Q

how long is VTE treatment for major provoked PE

A

3 months + prophylaxis for subsequent exposures

33
Q

how long is treatment for cancer-related VTE

A

3-6 months or as long as cancer is active

34
Q

how long is treatment for unprovoked VTE

A

minimum of 3 months, possible indefinite if no bleeding risk

35
Q

how long is treatment for recurrent unprovoked VTE

A

indefinite

36
Q

how long is treatment for underlying hypercoaguable state

A

indefinite

37
Q

what are mechanical prophylaxis options for VTE

A

compression stockings
intermittent pneumatic compression devices (A-v boots, sequential compression devices SCDs)
encourage early mobilization

38
Q

what is pharmacologic therapy for VTE prophylaxis

A

LMWH (enoxaparin/lovenox) and low-dose UFH preferred for medical patients

ultimately determined by teams preference and patients risk profile

39
Q

what is a thrombophlebitis

A

inflammation of a vein
clotting leading to inflammation of a deep vein - DVT
superficial - superficial thrombophlebitis

40
Q

what is the presentation of superficial thrombophelbitis

A

pain
induration (‘hardened’ skin)
erythema (linear)
tenderness
palpable cord
symptoms consistent with course of a vein
fever and chills - septic phlebitis

41
Q

what is the treatment for thrombophlebitis

A

remove any offending lines
inflammation is self-limited in 1-2 weeks
heat and NSAIDs for symptomatic treatment
anticoag not usually indicated

42
Q

what is the treatment for septic embolism

A

vancomycin + ceftriaxone 7-10 days +/- surgery

43
Q

what is a ventilation-perfusion scan (VQ scan)

A

requires a NORMAL chest x-ray
patient breathes radioactive gas and distribution measured (ventilation)
radioactive tracer injected into venous system and allowed to diffuse (perfusion)
positive = VQ mismatch

44
Q

what patients cannot receive lovenox for PE treatment

A

chronic kidney disease patients

45
Q

what anticoagulation medication needs to be avoided during preganancy

A

coumadin

Clin Med2: Pulmonology (13 decks)

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