Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CARDIO > CHAPETER 56 VTE/PE > Flashcards

CHAPETER 56 VTE/PE Flashcards

1
Q

Umbrella term for PE and DVT

A

Venous thromboembolism (VTE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A consequence of a triggering risk factor for clots, such as recent surgery, trauma, or any condition associated with limb or body immobility

A

Provoked VTEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

postthrombotic syndrome

A

Blood clots in the femoral and iliofemoral veins usually form on the valves, leading to scarring and poor function of the venous valves. This causes venous reflux and pooling of venous blood in the legs, leading to varicose veins, pain, swelling, skin hyperpigmentation, and ulcers,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Increase risk of first-time VTE

A

Inherited thrombophilias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Joint immobility involvement (least to most)

A

Elbow
Shoulder
Ankle
Knee
Hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk of VTE increases with whole-body immobility or neurologic immobility and with travel _____________

A

> 8 hours

In general, risk becomes significant after 6 h of continuous travel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Average time of post-operative PE

A

> 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The highest-risk surgical p cedures

A

abdominal surgery to remove cancer
joint replacement surgery
surgery on the brain or spinal cord in the setting of neurologic deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Malignancies with high-risk VTE

A

Adenocarcinoma (pancreatic, ovarian, and colon)
glioblastoma
metastatic melanoma
lymphoma,
multiple myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Malignancies with low-risk VTE

A

localized breast, cervical, prostate, and non-melanomatous localized skin cancers such as squamous cell carcinoma and basal cell carcinoma not treated with chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: Risk becomes significant at 50 y and increases with each year of life until age 80 y

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

VTE risk starts at BMI ___________ and increases with increasing BMI

A

> 35 kg/m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T/F: PEs can occur in any trimester and postpartum

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F: Highest risk of recurrence is for unprovoked VTE in men, particularly if d-dimer remains elevated

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F: Risk greatest with adenocarcinomas and metastatic disease.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute leukemias and myeloma confer the greatest risk, particularly when treated with ____________ and _____________ derivatives

A

L-asparaginase and the thalidomide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

T/F: In thrombophilias, Non-O blood type, lupus anticoagulant, shortened aPTT, factor V Leiden, and familial protein C and S and antithrombin deficiency have the strongest risk

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

T/F: Acute limb immobility of two contiguous joints confers the highest risk

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bed rest becomes a risk factor at approximately ________

A

72 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

T/F: In stroke, risk greatest in first month after deficit.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F: All contraceptives containing estrogen increase risk of VTE including transdermal and transvaginal preparations

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hallmark of PE

A

DYSPNEA unexplained by auscultatory findings, ECG changes, and without a clear alternative diagnosis on chest radiograph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Second most common symptom of PE

A

Chest pain with pleuritic features

-The classic PE pain is in the thorax between the clavicles and the costal margin that increases with cough or breathing; it is not substernal and emanating from the skin or muscle.

23
Q

T/F: PE does not predictably alter any vital sign

A

T

24
Q

PE findings:

A
  1. Unilateral limb swelling (with or without an indwelling catheter), which increases probability of PE diagnosis by three-fold
  2. Wheezing, which reduces probability of PE by one half
25
Q

wedge-shaped area of lung oligemia usually from complete lobar artery obstruction

A

Westermark’s sign

26
Q

peripheral dome-shaped dense opacification —indicative of pulmonary infarction

A

Hampton’s hump

27
Q

T/F: The presence of hypoxemia or dyspnea with clear lungs on physical exam and chest radiography suggests the need to test for PE.

A

T

28
Q

ECG patterns of PE

A

heart rate >100 beats/min
T-wave inversion in leads V 1 to V4
incomplete or complete right bundle branch block
S1-Q3-T3 pattern

29
Q

Doubles the likelihood of DVT

A

A difference of ≥2 cm between right and left leg diameter at 10 cm below the tibial tubercle doubles the likelihood of DVT.

30
Q

calf pain that occurs with passive foot dorsiflexion; low sensitivity and specificity that it has no predictive value

A

Homan’s sign

31
Q

Swollen, painful, and pale or white limb with a proximal venous thrombosis

A

Phlegmasia alba dolens

*poses the threat of limb loss, demanding aggressive treatment that can include clot disruption

32
Q

A limb with a dusky or blue color

A

Phlegmasia cerulea dolens

*poses the threat of limb loss, demanding aggressive treatment that can include clot disruption

33
Q

The d-dimer has a half-life of approximately _____________ and can be elevated for at least after symptomatic VTE

A

8 hours; 3 days

34
Q

Formula for D-Dimer

A

age×10 nanograms/mL

35
Q

Most common imaging modality for PE

A

Chest CT angiography

36
Q

Pulmonary Embolism Rule-Out Criteria Rule

A

CAPS in ViolET HUES

Clinical Low Probability
Age <50
Pulse <100
SpO2 >94%

Hemoptysis
VTE prior
Surgery
Estrogen Use
Unilateral swelling

***ALL nine factors must be present to exclude pulmonary embolism

37
Q

WELL’S score for PE

A

> 6 points = high risk
2–6 points = moderate risk
<2 points = low risk

38
Q

WELL’S score for DVT

A

≥3 points = high risk
1 or 2 points = moderate risk
<1 point = low risk

39
Q

Potential False-Negative Levels of D-dimer

A

Symptoms >5 days
Pulmonary infarction small isolated
Clots small

Calf vein thrombosis
Lipemia

40
Q

Potential False-Positive Levels of D-dimer

A

PASIT MRL

Age >70
Pregnancy
Malignancy/Mets active
Surgery in previous week
Liver dse
RA
Infections
Trauma

41
Q

Can identify a perfusionndefect when ventilation is normal

A

Ventilation–perfusion (V/Q) lung scanning

42
Q
A
43
Q

T/F: An age-adjusted quantitative d-dimer assay is the best diagnostic test in patients for whom clinical suspicion is low or moderate based on either gestalt estimation, a Wells’ or simplified revised Geneva score of ≤4, or a “safe” designation according to the PE rule-out criteria rule.

A

T

44
Q

T/F: Favor the use of low-molecular-weight heparins over unfractionated heparin for treatment of both PE and DVT in terms of composite outcomes (bleeding and death) and cost

A

T

45
Q

T/F: (+) severe renal insufficiency and acute DVT or PE, most experts recommend unfractionated heparin over low-molecular-weight heparin.

A

T

46
Q

T/F: Treat upper extremity DVT the same as lower extremity DVT, and consider removing any indwelling catheters associated with clot.

A

T

-Do not delay unfractionated heparin for thrombophilia testing

47
Q

T/F: Most DVT can be treated with anticoagulation, but iliofemoral DVT that causes phlegmasia cerulea dolens requires rapid action to reduce the venous pressure

A

T

48
Q

Treatment for localized superficial thrombophlebitis

A

Oral NSAID or topical diclofenac gel until symptoms resolve

-no need for systemic anticoagulation

49
Q

T/F: There are no universally accepted treatment guidelines for thromboses isolated to the calf veins (soleal or gastrocnemius) or the saphenous vein, although many use 3 months of oral anticoagulation.

A

T

-Alternatives include no acute treatment, with repeat US in 1 week to identify progression of clot, or outpatient treatment with low-molecularweight heparin

50
Q

Patients have a systolic blood pressure of <90 mm Hg for >15 minutes;
a systolic blood pressure of <100 mm Hg with a history of hypertension;
>40% reduction in baseline systolic blood pressure

A

Massive PE

51
Q

Patients have normal or near normal blood pressure, but with other evidence of cardiopulmonary stress

A

Submassive PE

52
Q

Systemic fibrinolysis

A

in patients with no contraindications to fibrinolysis and any of the following: cardiac arrest; hypotension (any systolic blood pressure >90 mm Hg); respiratory failure, evidenced by severe hypoxemia (pulse oximetry reading <90%) despite oxygen administration, together with evidence of increased work of breathing; or evidence of right-sided heart strain on echocardiography or elevated levels of troponin T or I, or both

53
Q

Major contraindications to thrombolytic therapy

A

intracranial disease, uncontrolled hypertension at presentation,
recent major surgery or trauma (past 3 weeks),
metastatic cancer

54
Q

Only currently approved agent for PE

A

Alteplase (tissue plasminogen activator) 100 milligrams IV over 2 hours

55
Q

Treatment of patients with active cancer with low-molecular-weight heparin for at least

A

6 months

CARDIO (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions