Week 9 - Lesson 2 (Part 2)

Question 1

Chronic thrombus

Answer 1

Complete dissolution of clot over time may occur naturally

Question 2

What are characteristics of older clots? (2)

Answer 2

1. Firmer

2. More echogenic

Question 3

What happens to chronic clots over time?

Answer 3

They become better attached

- this is why acute is more dangerous

Question 4

What will develop with chronic thrombus?

Answer 4

Large collaterals

- indicates chronic problem

Question 5

What do echoic clots do?

Answer 5

Blends into the walls

- hard to determine

Question 6

What are 4 characteristics of chronic clots?

Answer 6

1. Scarring appearance
2. Not moving
3. Well adhered thickened walls
4. Gets brighter over time

Question 7

Recanalized vessel

Answer 7

The process of restoring flow to or reuniting an interrupted channel of a bodily tube

Question 8

What does a bilateral lower extremity swelling more likely to indicate what kind of origin?

Answer 8

Cardiovascular

- secondary to heart failure

Question 9

What is Homan’s sign?

Answer 9

Sign of DVT

- but it is an unreliable diagnostic criterion

Question 10

What is another unreliable DVT sign?

Answer 10

Palpable cord

Question 11

Why is a palpable chord an unreliable DVT sign?

Answer 11

Because its more for superficial venous thrombosis

- rather than deep

Question 12

Collateral flow

Answer 12

When a clot forms, blood return to the heart is blocked and smaller, alternate veins can return blood back to the heart

Question 13

What are potential complications of DVT? (7)

Answer 13

1. Pulmonary embolism
2. Incompetent valves
3. Post thrombotic syndrome
4. Recurrent DVT
5. Varicose veins
6. Chronic venous insufficiency
7. Ulcers

Question 14

What % of untreated DVT’s will sustain a non-fatal pulmonary embolism?

Answer 14

25%

Question 15

What is the mortality rate of untreated cases of DVT?

Answer 15

30%

Question 16

Pulmonary embolism

Answer 16

Emboli break off of thrombus in the leg vein and travels to the lungs

Question 17

Where does pressure increase for a pulmonary embolism?

Answer 17

The right ventricle

- pumping out to the lungs

Question 18

What are symptoms of a pulmonary embolism? (2)

Answer 18

1. Difficulty breathing

2. Chest pain on inspiration and palpitations

Question 19

How does a pulmonary embolism show clinically? (4)

Answer 19

1. Low blood oxygen saturation
2. Cyanosis
   - poor circulation
3. Rapid breathing
4. Increased heart rate

Question 20

What do severe cases of a pulmonary embolism cause? (3)

Answer 20

1. Collapse
2. Abnormally low blood pressure
3. Sudden death

Question 21

What is a pulmonary embolism diagnosed by? (3)

Answer 21

1. D-Dimer
2. CT
3. Pulmonary angiography

Question 22

What is the treatment for a pulmonary embolism? (2)

Answer 22

1. Anticoagulent-heparin

2. Warfarin

Question 23

What is the surgical intervention for pulmonary embolisms?

Answer 23

Pulmonary thrombectomy

Question 24

What is recurrent DVT largely due to?

Answer 24

Damage to the walls and valves

- hereditary factors are unavoidable

Question 25

What are acquired factors that are inevitable with recurrent DVT? (3)

Answer 25

1. Cancer
2. Surgery
3. Age

Question 26

What is a sign of recurrent DVT?

Answer 26

Pigmentation

Question 27

What % of vein wall and valves are permanently damaged in post thrombotic syndrome?

Answer 27

60%

Question 28

What occurs with post thrombotic syndrome? (3)

Answer 28

1. Valve leaflets are immobile
   - fixed to vein wall
2. Venous reflux ensues
3. Venous stasis worse in standing position

Question 29

What does chronic venous obstruction and reflux manifests as? (3)

Answer 29

1. Chronic leg swelling
2. Ankle pigmentation
3. Ultimately ulcers form

Question 30

Where are venous ulcers located?

Answer 30

More medial

- reflux

Question 31

Where are arterial ulcers located?

Answer 31

More lateral