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clin med pulmonology > VTE > Flashcards

VTE Flashcards

1
Q

What is the process of thrombus formation

A

virchows triad

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2
Q

What is virchows triad

A

Stasis
endothelial injury
hypercoagulability

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3
Q

What allows for blood to flow in the venous system

A

skeletal muscle
gravity
intrathoracic pressure

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4
Q

What factors can cause a prothrombotic state

A

trauma
surgery
pregnancy
hormone therapy
medications
infection
prolonged immobility

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5
Q

What are some hyper coagulable states

A

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

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6
Q

Presentation of DVT

A

Ipsilateral LE edema
LE erythema
LE pain
LE warmth to touch

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7
Q

What may be seen on physical exam with a DVT

A

Calf tenderness
palpable cord
superficial vein dilation
Homans sign

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8
Q

What is Homans sign

A

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

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9
Q

What is the test of choice with a DVT

A

DUplex venous ultrasound

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10
Q

What is the gold standard for DVT workup

A

Venogram (not routinely used)

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11
Q

How do you work up a DVT

A

D-Dimer
duplex venous ultrasound
venogram

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12
Q

When is DVT criteria beneficial

A

for risk stratification only

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13
Q

Which criteria is used for DVT

A

wells criteria

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14
Q

What embolism is the worst PE

A

saddle

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15
Q

What are the locations for PEs

A

Saddle
Lobar
Segmental
Sub-segmental

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16
Q

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

A

sub-segmental

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17
Q

What is a saddle pulmonary embolism

A

PE that straddles the bifurcation of the PA

occludes both right and left pulm arteries

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18
Q

What are common symptoms of a PE

A

Dyspnea
Pain with inspiration
cough
Leg pain

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19
Q

How may a patient present with a PE

A

tachypenic
tachycardia

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20
Q

What may be seen on a CXR with PEs

A

Fleischners sign
westermark sign
hamptoms hump

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21
Q

What is Fleischners sign

A

Enlarged PA

22
Q

What is westermark sign

A

lack of distal pulmonary vasculature

23
Q

What is hamptoms hump

A

Wedge shaped pulmonary infarct

24
Q

What pattern will be seen on an EKG with PE

A

S1,Q3, T3

25
Q

What is the preferred diagnostic test for a PE

A

CTA

26
Q

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

A

Still preferred if there is HIGH suspicion for a PE

or elevated D-dimer

27
Q

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

A

there must be a normal chest xray first

28
Q

What is a definitive diagnostic test for PE

A

Pulmonary angio

29
Q

When is a PERC score used with PE

A

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

30
Q

When can you NOT rule out PE with PERC rule

A

if any one of the criteria are present

31
Q

When is inpatient treatment considered with PEs

A

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

32
Q

What is the mainstay treatment for PEs

A

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

33
Q

What form of heparin is preferred in PE treatment

A

LMWH (Lovenox)

**If CKD need UFH

34
Q

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

A

Warfarin
DOACs

35
Q

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

A

LMWH
**NO Coumadin or DOACs

36
Q

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

A

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

37
Q

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

A

2x a week until INR is stable again

38
Q

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

A

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

39
Q

Why are DOACs preferred over warfarin

A

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

40
Q

Which patients do we look for hypercoagulable states in

A

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

41
Q

What is the preferred PE treatment for cancer patients

A

DOACs

42
Q

What is thrombophlebitis

A

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

43
Q

What are some causes of thrombophlebitis

A

**Secondary to PICC lines and IVs

Trauma, pregnancy, varicose veins

44
Q

What is the most common cause of infection for thrombophlebitis

A

staph aureus

45
Q

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

A

GSV

46
Q

What are some presentations of thrombophlebitis

A

Pain
Induration
tenderness
palpable cord
linear erythema `

47
Q

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

A

3months + prophylaxis for subsequent exposures

48
Q

How long do you treat cancer related PEs

A

3-6 months or as long as cancer is active

49
Q

How long do you treat unprovoked VTE

A

minimum of 3 months

50
Q

How long do you treat recurrent unprovoked VTE

A

indefinitely

51
Q

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

A

Vanco + ceftriaxone

52
Q

How do you symptomatically treat thrombophlebitis

A

Heat and NSAIDS

clin med pulmonology (12 decks)

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