Clin Med: Venous Thromboembolic Disease

Question 1

Three key components to thrombus formation (virchow’s triad)

Answer 1

stasis
hypercoagulability
vessel wall injury

Question 2

Presentation of DVT

Answer 2

may be asymptomatic
Ipsilateral LE edema (usually not pitting)
LE erythema
LE pain
LE warmth to touch
palpable cord

Question 3

Homans sign

Answer 3

passive dorsiflexion of the ankle with knee at 30 degrees – calf pain

Question 4

DVT work up

Answer 4

d-dimer
duplex venous ultrasound (dx)
contrast venography (gold standard)

Question 5

Interpretation of Well’s criteria for DVT:
0 or less
1-2
3 or higher

Answer 5

DVT unlikely
moderate risk
DVT likely

Question 6

Most likely cause of pulmonary embolism

Answer 6

DVT

Question 7

Location of PE

Answer 7

saddle
lobar
segmental
sub-segmental (more likely to cause lung infarct or pleuritis)

Question 8

Saddle Pulmonary embolism is

Answer 8

large PE that straddles the bifurcation of the PA
Occlusion of both the L and R pulm arteries

Question 9

Presentation of PE

Answer 9

largely based on size and location
dyspnea
pain with inspiration
cough
leg pain
hemoptysis
wheezing
chest pain

Question 10

Physcial exam: PE

Answer 10

tachycardia
tachypnea
crackles
S4
Pleural friction rub
cyanosis
hypoxia

Question 11

Work up PE

Answer 11

labs (preg testing)
ECG
Duplex US
POCUS ECHO
CXR
CTPA (requires contrast may be contraindicated in CKD patients) is the preferred dx test!

Question 12

Fleischner’s sign

Answer 12

enlarged PA

Question 13

Westermark sign

Answer 13

last of distal pulmonary vasculature

Question 14

Hampton’s hump

Answer 14

wedge shaped pulmonary infarct

Question 15

PE ECG findings

Answer 15

may show patterns of R heart strain
tachycardia

Question 16

POCUS PE showings

Answer 16

assessing for R ventricular dilation
D sign
potential massive PE (saddle most likely)

Question 17

Well’s criteria treatment:
0 or less
1-2
3 or more

Answer 17

DVT ruled out
D-dimer
Ultrasound

if positive d-dimer and negative US then recheck in a week

Question 18

PERC score to ______ PE

Answer 18

r/o

Question 19

PERC is used when well’s score is ______ than ____

Answer 19

greater
2

Question 20

VTE treatment: PE

Answer 20

mainstay of tx is anticoagulation (heparin/ LWMH)
massive PE (hemodynamic instability) – thrombolytics
embolectomy

Question 21

IVC filter is to treat
IVC filter treat DVT treatment to
used when there are contraindications to

Answer 21

treat VTE
prevent clot from going into the pulmonary system
contraindication to anticoags

Question 22

two types of IVC filter

Answer 22

Retrievable or permanent

Question 23

Duration of treatment for VTE:
Major transient risk factor (provoked) =
Cancer - related =
Unprovoked =
Recurrent unprovoked =
Underlying hypercoagulable state =

Answer 23

3 months + prophylaxis for subsequent exposures
3-6 months or as long as cancer is active
min of 3 months, possible indefinite if no bleeding risk
indefinite
indefinite

Question 24

Mechanical prophylaxis

Answer 24

compression socks
intermittent pneumatic compression devices
encourage early mobilization

Question 25

Pharmacologic prophylaxis

Answer 25

LMWH and low dose UFH preferred for medical pts
Therapy for surgical pts as well

Question 26

Thrombophlebitis is

Answer 26

inflammation of the vein

Question 27

Thrombophlebitis is most commonly secondary to

Answer 27

PICC lines
IVs

Question 28

Thrombophlebitis can lead to

Answer 28

thrombosis or infection (septic phlebitis)

Question 29

______ is the most common cause of infection

Answer 29

Staph aureus

Question 30

Presentation of superficial thrombophlebitis

Answer 30

pain
induration (hardened skin)
erythema (linear)
tenderness
palpable cord

sx consistent with course of vein

Question 31

Presentation of septic phlebitis

Answer 31

fever
chills

other sx from superficial thrombophlebitis as well

Question 32

Treatment of Thrombophlebitis

Answer 32

remove any offending lines
inflammation is usually self-limiting in 1-2 weeks
heat and NSAIDs for sx treatment
anticoag not usually indicated
if extensive – ?surgery

Question 33

treatment of septic Thrombophlebitis

Answer 33

vancomycin + ceftriaxone 7-10 days +/- surgery

Question 34

What has to occur to consider it a “massive” PE (not just size)

Answer 34

hemodynamically unstable

Question 35

Treatment for PE in CKD pts

Answer 35

heparin
NOT LOVENOX

Question 36

Treatment for massive PE

Answer 36

tPA