VTE

Question 1

DVT can be excluded if what probability tests are low?

Answer 1

Wells score and D-Dimer.

Question 2

D-dimer test is sensitive but not specific, what does this mean?

Answer 2

Many things raise it, but it will NOT be low if a DVT is present. Cannot diagnose, can rule out.

Question 3

Gold standard diagnostic tool for A) DVT, B) PE?

Answer 3

A) (duplex) Ultrasound

B) CTPA

Question 4

Chronic ThromboEmbolic Pulmonary Hypotension (CTEPH) is a complication of PE, why?

Answer 4

Sympathetic response to RHF cannot override the hypotension caused by the emboli.

Over time the original embolic material lodged in the pulmonary vessel is replaced with fribrotic material that constricts and eventually can occlude larger pulmonary the pulmonary arteries (ones moving from RA to lungs) –> pulmonary artery resistance –> increased right ventricle P and dilation occurs –>RIGHT SIDED HEART FAILURE reduced SV, CO and BP.
RHF –> affects left side and Sympathetic response –> sinus tachycardia and vasoconstriction in attempt to increase BP.
DOES NOT WORK and NET HYPOTENSION as the fibrotic emboli that is occluding pulnonary vessels and causing low BP is still there

Question 5

Route of administration of heparin for anticoagulation?

Answer 5

IV if unfractured heparin

Subcutaneous if LMWH

Question 6

Complication of IVC filters?

Answer 6

Thrombosis

Question 7

What is A) Warfarin and B) Heparin reversed by?

Answer 7

A) Vitamin K

B) protamine

Question 8

Why are hypoxemia and hypocapnia signs of PE?

Answer 8

PE –> V/Q mismatch –> inflammation –> BRONCHOCONSTRICTION in the lungs –> decreased O2 coming in (hypoxaemia) –> HYPERVENTILATION –> exhale more than inhale –> reduced blood CO2 levels (hypocapnia)

Question 9

What would the results of an ABG test be for someone with a PE?

Answer 9

Respiratory alkalosis (LOW CO2 in blood –> rise in blood pH.