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Tax > Week 6 > Flashcards

Week 6 Flashcards

1
Q

Where do lower extremity DVT’s most commonly originate?

A

calf veins at the valve leaflets

may extend proximally into calf and thigh

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2
Q

What are the signs and symptoms of lower extremity DVT?

A

lower extremity swelling and pain (unilateral)

swelling more likely cardiovascular in origin and secondary to heart failure

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3
Q

What’s the pathophysiology of Virchow’s triad?

A

Venous stasis- more time for clotting, small clots not washed away, inc blood viscosity
Vessel wall damage- accidental/surgical trauma
Blood coagulability increase- inc in tissue factor, presence of activated factors, dec in coag inhibitors

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4
Q

What are 3 hyper-viscosity syndromes?

A

heparin induced thrombocytopenia (platelet deficiency)
myelodysplasia (cancer of immature bone marrow blood cells)
polycythemia (too many RBC in bone marrow)

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5
Q

The Homan’s sign is a reliable diagnostic tool for DVT. True or false

A

False

can be positive w/ other conditions such as gastrocnemius tears

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6
Q

Palpable cords are an unreliable sign of DVT. True or false

A

True

often found in patients with SVT instead of DVT

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7
Q

Accuracy of clinical diagnosis of DVT is

A

50%

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8
Q

Wells score:

A

estimation of probability of DVT prior to ordering an ultrasound
based on clinical risk factors

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9
Q

What are the positive criteria of the Wells score

A 
\+1 point for each
active malignancy (within 6wks)
paralysis, paresis or recent plaster immobilization of lower limb
bedridden >3days
major surgery/trauma within past 4 wks
localized tenderness along lower extremity veins 
swelling of entire lower limb
pitting edema
swelling greater than 3cm
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10
Q

In the wells score, calf swelling greater than ____ as compared to asymptomatic leg yields a point.

A

3cm

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11
Q

Peripheral edema:

A

seen in both legs

can be due to aging of the veins, or other conditions that put pressure on the leg veins

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12
Q

Wells score negative criteria:

A

-2 points for DDx as likely as DVT

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13
Q

Wells score final totals:

A

probability of DVT:
high >3 points
intermediate 1-2 points
low <0

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14
Q

What are the most common means of measuring pretest probability for DVT?

A

d-dimer

Wells score

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15
Q

If there is a low pretest probability and a negative d-dimer test, what treatment is necessary?

A

none

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16
Q

In patients with a high pretest probability for PE or DVT, the D-dimer assay should not be obtained since the negative predictive value of the assay is low. True or false

A

true

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17
Q

Patients can be treated on the basis of a + d-dimer test test alone. True or false

A

false

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18
Q

What increases the pulsatility of the Doppler waveform in the EIV and CFV?

A

tricuspid valve regurgitation or rt. sided heart failure

19
Q

Thrombus in the _____ _____ or ____ will flatten the Doppler signal and eliminate respiratory variation and cardiac pulsations in the CFV and below.

A

EIV and IVC

20
Q

What can also eliminate/reduce the respiratory variation in veins below the inguinal ligament?

A

compression by pelvic or inguinal masses

ascites

21
Q

What is the gold standard for US evaluation of DVT?

A

compression

22
Q

What is primary diagnostic criterion for DVT?

A 
lack of venous compression or complete coaptation of walls
intraluminal echoes
color void-complete or partial
lack of spontaneous flow
absence of respiratory variation
high sensitivity for thigh DVT
low sensitivity for calf thrombus
23
Q

What is the best way to treat DVT? (not really a great question but it was a bullet point lol)

A

prevention!

24
Q

The part of Virchow’s triad with the greatest impact is venous stasis. What do we use to keep blood flowing?

A

calf venomotor pump

can also elevate the lower extremity to aid gravity

25
Q

What do compression stockings do?

A

keep the vein at a smaller diameter, pushing blood upward and not allowing it to pool into stasis dermatitis
precursor to venous ulcers

26
Q

What is the medical treatment for DVT?

A

anticoagulants - initially heparin injection, then oral drug started within 24-48h

27
Q

Inadequate anticoagulation in the first _________ may increase risk of recurrence or PE.

A

24 to 48hrs

28
Q

Acute DVT can be treated on an outpatient basis unless:

A 
severe symptoms require parental analgesic
other disorders preclude safe outpatient discharge
other factors (functional, socioeconomic) that prevent the patient from adhering to prescribe treatments
29
Q

What’s the goal for DVT treatment? (primary and secondary)

A

primary- PE prevention

secondary- symptom relief, prevention of DVT recurrence, chronic venous insufficiency and postphlebitic syndrome

30
Q

Are treatment of upper and lower DVT the same?

A

yes, generally

31
Q

Which anticoagulant is taken orally? Which one is injected?

A

oral- warfarin, factor Xa or direct thrombin inhibitor

injected- heparin

32
Q

Warfarin is also known as?

A

coumadin

33
Q

What anticoagulants are most often used?

A 
low molecular weight heparins (LMWHs)
unfractionated heparin (UFH)
fondaparinuv
warfarin
non-warfarin oral anticoagulants (factor Xa inhibitors, apixaban. Direct thrombin inhibitors- dabigatran)
34
Q

An IVC filter may help prevent PE in patients with:

A 
LEDVT who have contraindications to anticoagulant therapy
recurrent DVT (despite adequate anticoagulation)
35
Q

Where is an IVCF placed?

A

in IVC just below renal veins, via catheterization of IJV or FV

36
Q

What are some complications of the IVCF?

A

migration
tilts/shifts
fractures
perforation

37
Q

Thrombectomy:

A

includes percutaneous mechanical thrombectomy and pharamalogical thrombolysis
most invasive and used prior to new methods

38
Q

With percutaneous mechanical thrombectomy, the thrombus can be mechanically removed via

A

a catheter inserted into the CFV

it macerates the thrombus and suctions it away. Uses medicines that prevent clot formation

39
Q

Streptokinase, urokinase and alteplase lyse clots, and may be more effective to prevent postphlebitic syndrome than heparin alone, but

A

the risk of bleeding is higher than with heparin

40
Q

Thrombolytic therapy alone may be indicated for

A

large proximal thrombi

those in iliofemoral veins, and for phlegmasia alba or cerulea dolens

41
Q

Historically, if DVT’s persisted a patient would have to do surgical bypass reconstruction. What do they do now instead? Why?

A

Balloon dilations and stents

less invasive

42
Q

Where do they feed the venous balloon dilation catheter

A

vein near the groin

43
Q

Duration of treatment is typically

A

3-6mo
depending on presence and nature of risk factors
some people may need lifelong treatment

44
Q

What are some early preventative measures for DVT?

A

early mobilization, leg elevation, compression stockings/devices/both and anticoagulants

(required for bedbound patients w/ major illness or those undergoing certain surgical procedures)

Tax (16 decks)

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