08.25 - Venous Thromboembolism (Muthiah) - Questions Flashcards Preview

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Flashcards in 08.25 - Venous Thromboembolism (Muthiah) - Questions Deck (53):
1

S1Q3T3

Right Ventricular Strain - Pathognomonic for PE

2

2 classic tumors that grow into venous system

Renal Cell Carcinoma, Lung Primary

3

3 important congenital hypercoagulabilities that predispose to PE

Factor V Leiden, Prothrombin Mutation, Proteins C and S deficiency

4

Most common cause of thrombocytopenia in the ICU

DIC

5

Commonest cause of DIC

Sepsis

6

What is our concern in Heparin Induced Thrombocytopenia

Even though platelet count low, can still clot

7

2 Actions of Warfarin

Blocks vit-K-dependent factors; Decreases production of Proteins C and S

8

2 important acquired hypercoagulabilities

HIT, Nephrotic

9

Pulmonary Vascular resistance after PE

Increased - serotonin, endothelin

10

Gas Exchange after PE

Increased dead space (v/q mismatch), low DLCO, shunting in massive PE

11

PaCO2 after PE

Hypocapnea, trying to maintain oxygenation, and CO2 diffuses more readily than O2

12

Alveolar ventilation after PE

Alveolar Hyperventilation - reflex stimulation of irritant receptors

13

Airway resistance after PE

Increased - Bronchoconstriction - Serotonin

14

Pumonary Compliance after PE

Decreased - Edema, Hemorrhage, Loss of Surfactant

15

Circulatory Compensation after PE

Vasodilation of uninvolved vasculature helps decr the incr in PVR, also improves V/Q relationship

16

Gas Exchange abnormalities after PE

Hypocapnia, Hypoxemia, Wide A-a

17

Blood pressure after PE

Pulmonary HTN, Systemic Hypotension

18

When might patients get bradycardia after PE

Beta Blocker

19

What causes BNP release

Ventricular Stretch (higher BNP associated with adverse outcomes)

20

Commonest arrhythmias after PE

A Fib, A Flutter

21

Sign of RV strain

S1Q3T3

22

Most common complaint from patient with acute PE

SOB

23

2 most common complaints after PE other than Dyspnea, Tachypnea, and Tachycardia

Pleuritic Pain, Loud P2

24

Heparin Antidote

Protamine Sulfate

25

A-a gradient after PE

Usually wide, but normal does not rule out

26

Widened Mediastinum on CXR indicates

Ascending Aortic Aneurysm

27

Most common CXR abnormality with PE

Atelectasis or decrease in lung volume

28

New atrial arrhythmias with new onset dyspnea, think

PE

29

EKG Findings in PE

S1Q3T3 (minority), Atrial Arrhythmias

30

Atelectasis in PE is due to

decreased surfactant production

31

Hampton's Hump is buzzword for

PE

32

Westermark's Sign is seen in

PE

33

Discoid Atelectasis is seen in

PE

34

No pulmonary vasculature in right lung could be

PE, Pneumothorax

35

If lack of pulmonary vasculature on CXR, if it was pneumothorax, we:

wouldn't hear breath sounds; Tympanic on percussion; Likely see collapsed lung

36

Majority of V/Q Lungs scans are

intermediate probability

37

Gold standard for PE

Pulmonary Angiography - Invasive, Contrast Dye

38

If perfusion scan is normal and d-dimer is ___, the possibility of PE or DVT is extremely low

<500

39

Sensitivity and specificity of D-Dimer

Very Sensivitive, but not specific

40

Negative D-Dimer means that PE

is highly unlikely

41

Primary diagnostic modality for PE

Helical CT

42

Homan's Sign

Passive dorsiflexion of ankle will cause pain in calf

43

Best diagnostic modality for lower extremity DVT:

Bilateral lower extremity B-Mode US to demonstrate non-compressability

44

Gold stand, but not practical test for DVT

Bilateral LE contrast venography

45

What are you looking for in DVT with B-Mode US

Non-compressability

46

Best pharmacologic prophylaxis to prevent DVT in patient admitted to ICU

Heparin

47

Test for Heparin

aPTT

48

Test for Warfarin

PTT

49

Assay to measure adequacy of anticoagulation with LMW Heparin (Enoxaparin)

Factor Xa Activity

50

Most accepted situation for thrombolysis (t-PA)

Large PE w/ Shock

51

If treated, mortality from PE is

uncommon

52

What fraction of treated PE patients develop pulmonary hypertension

Very few

53

Triad for Fat Embolism

Mental Status, Thrombocytopenia, Petechiae