VTE

Question 1

What is the process of thrombus formation

Answer 1

virchows triad

Question 2

What is virchows triad

Answer 2

Stasis
endothelial injury
hypercoagulability

Question 3

What allows for blood to flow in the venous system

Answer 3

skeletal muscle
gravity
intrathoracic pressure

Question 4

What factors can cause a prothrombotic state

Answer 4

trauma
surgery
pregnancy
hormone therapy
medications
infection
prolonged immobility

Question 5

What are some hyper coagulable states

Answer 5

Protein C&S deficiency
Factor V Leiden
Malignancy
Prothrombin mutations
Antithrombin 3 deficiency

Question 6

Presentation of DVT

Answer 6

Ipsilateral LE edema
LE erythema
LE pain
LE warmth to touch

Question 7

What may be seen on physical exam with a DVT

Answer 7

Calf tenderness
palpable cord
superficial vein dilation
Homans sign

Question 8

What is Homans sign

Answer 8

Calf pain with passive dorsiflexion of the ankle with the knee at 30 degrees

Question 9

What is the test of choice with a DVT

Answer 9

DUplex venous ultrasound

Question 10

What is the gold standard for DVT workup

Answer 10

Venogram (not routinely used)

Question 11

How do you work up a DVT

Answer 11

D-Dimer
duplex venous ultrasound
venogram

Question 12

When is DVT criteria beneficial

Answer 12

for risk stratification only

Question 13

Which criteria is used for DVT

Answer 13

wells criteria

Question 14

What embolism is the worst PE

Answer 14

saddle

Question 15

What are the locations for PEs

Answer 15

Saddle
Lobar
Segmental
Sub-segmental

Question 16

What location of a PE is most likely to cause infarct or pleuritis

Answer 16

sub-segmental

Question 17

What is a saddle pulmonary embolism

Answer 17

PE that straddles the bifurcation of the PA

occludes both right and left pulm arteries

Question 18

What are common symptoms of a PE

Answer 18

Dyspnea
Pain with inspiration
cough
Leg pain

Question 19

How may a patient present with a PE

Answer 19

tachypenic
tachycardia

Question 20

What may be seen on a CXR with PEs

Answer 20

Fleischners sign
westermark sign
hamptoms hump

Question 21

What is Fleischners sign

Answer 21

Enlarged PA

Question 22

What is westermark sign

Answer 22

lack of distal pulmonary vasculature

Question 23

What is hamptoms hump

Answer 23

Wedge shaped pulmonary infarct

Question 24

What pattern will be seen on an EKG with PE

Answer 24

S1,Q3, T3

Question 25

What is the preferred diagnostic test for a PE

Answer 25

CTA

Question 26

If a patient is pregnant, would you still get a CTA if there is suspicion for a PE

Answer 26

Still preferred if there is HIGH suspicion for a PE or elevated D-dimer

Question 27

When can a ventilation perfusion scan (VQ) be done for a PE

Answer 27

there must be a normal chest xray first

Question 28

What is a definitive diagnostic test for PE

Answer 28

Pulmonary angio

Question 29

When is a PERC score used with PE

Answer 29

when the well's score <2 to r/o PE instead of D-dimer

Question 30

When can you NOT rule out PE with PERC rule

Answer 30

if any one of the criteria are present

Question 31

When is inpatient treatment considered with PEs

Answer 31

Proximal DVT Significant co-morbidities Neuro conditions GI bleed/ liver dysfunction Active bleeding HIT / TTP

Question 32

What is the mainstay treatment for PEs

Answer 32

Anticoagulation for most *If massive = TPA -possible embolectomy -Unfractionated heparin vs LMWH

Question 33

What form of heparin is preferred in PE treatment

Answer 33

LMWH (Lovenox) **If CKD need UFH

Question 34

What are oral anticoagulants that a patient can be put on with PE

Answer 34

Warfarin DOACs

Question 35

If a pregnant patient has a PE, how are they treated

Answer 35

LMWH **NO Coumadin or DOACs

Question 36

If treating a patient with a PE with warfarin, how long are they on it for

Answer 36

until their INR >2 then D/C **Called bridging

Question 37

How often is an INR required if a patient is on Warfarin

Answer 37

2x a week until INR is stable again

Question 38

If a patients INR on warfarin is 5-9, what do you do

Answer 38

Omit 1-2 doses on Warfarin and administer vitamin K if at a high risk for bleeding

Question 39

Why are DOACs preferred over warfarin

Answer 39

Less drug interaction, no lab monitoring, quicker onset, lower bleeding risk

Question 40

Which patients do we look for hypercoagulable states in

Answer 40

<50y/o significant family hx of VTE Clot in unusual location Recurrent clots Women of child bearing age

Question 41

What is the preferred PE treatment for cancer patients

Answer 41

DOACs

Question 42

What is thrombophlebitis

Answer 42

Inflammation of a vein clot leading to inflammation of deep vein = DVT

Question 43

What are some causes of thrombophlebitis

Answer 43

**Secondary to PICC lines and IVs Trauma, pregnancy, varicose veins

Question 44

What is the most common cause of infection for thrombophlebitis

Answer 44

staph aureus

Question 45

If a patient gets spontaneous thrombophlebitis, where do they generally occur

Answer 45

GSV

Question 46

What are some presentations of thrombophlebitis

Answer 46

Pain Induration tenderness palpable cord linear erythema `

Question 47

How long do you treat someone with major risk factor fro PE

Answer 47

3months + prophylaxis for subsequent exposures

Question 48

How long do you treat cancer related PEs

Answer 48

3-6 months or as long as cancer is active

Question 49

How long do you treat unprovoked VTE

Answer 49

minimum of 3 months

Question 50

How long do you treat recurrent unprovoked VTE

Answer 50

indefinitely

Question 51

If a patient is septic with thrombophlebitis, how do you treat them

Answer 51

Vanco + ceftriaxone

Question 52

How do you symptomatically treat thrombophlebitis

Answer 52

Heat and NSAIDS