Thromboembolism Flashcards
Which coagulation disorders are a/w hypercoagulability predisposing to DVT and PE?
-protein C&S deficiency
-Factor V Leiden mutation
Other than coagulation system disorders, which conditions or states cause a hypercoagulable state predisposing to DVT and PE?
-cigarette smoking
-Pregnancy, Postpartum
-OCP use
-Malignancy
-Severe burns
Venous stasis can be induced by ___ (list all).
-immobility (bedbound, long plane ride)
-CHF
-obesity
-increased CVP (in renal failure etc.)
List the indicators in the Wells scoring system for evaluation of PE risk.
MN: SHIT PMH
-Symptoms of DVT : 3 points
-H/o DVT or PE. : 1.5 points
-Immobilization ≥ 3 days : 1 point
-Tachycardia > 100/min : 1.5 points
-Post-op : 1.5 points
(surgery within
previous 4 weeks)
-Malignancy : 1 point
-Hemoptysis : 1 point
Total possible score 11.
What are the pathophysiological consequences of PE?
-Pulmonary infarction
-Right heart failure
-Hypoxemia
A cardiac exam in PE may reveal ___ findings.
-loud P2
-s/o RHF (prominent a-waves in JVP)
An acute massive PE (eg. saddle embolus) may p/w ___ (list all).
-hypotension
-JVD
-new-onset RBBB
in a pt. who p/w sudden-onset dyspnea, pleuritic chest pain, tachypnea, tachycardia +/- LG fever, cough, hemoptysis (rare).
What is the best initial step in m/m of a patient suspected of PE?
calculation of modified Wells score.
MN: SHIT PMH
-Symptoms of DVT : 3 points
-H/o DVT or PE. : 1.5 points
-Immobilization ≥ 3 days : 1 point
-Tachycardia > 100/min : 1.5 points
-Post-op : 1.5 points
(surgery within
previous 4 weeks)
-Malignancy : 1 point
-Hemoptysis : 1 point
Total possible score 11.
PE is unlikely with a modified Wells score of ___.
≤ 4.
PE is likely with a modified Wells score of ___.
5 or more.
What is the best initial test in a patient suspected of PE with a modified Wells score of ≤ 4 (PE unlikely/less likely)?
D-Dimer test
(less SP but high SN and NPV)
