Chapter 6

Question 1

How many cases of Pulmonary Embolus occurs annually?

Answer 1

600,000

Question 2

How many deaths are a result of PE?

Answer 2

200.000

Question 3

How many new cases of DVT (Deep Vein Thrombosis) occurs annually?

Answer 3

1-10million

Question 4

What is a blood clot?

Answer 4

Applies to a clot anywhere, even in a test tube

Question 5

What is a thrombosis?

Answer 5

The formation of a blood clot in an artery or vein

Question 6

What is a thrombus?

Answer 6

The actual clot within a vessel

Question 7

What is a thromboembolism?

Answer 7

A thrombus that breaks free and travels

Question 8

What occurs with Phlebitis?

Answer 8

Inflammation of a vein wall

Question 9

What is thrombophlebitis?

Answer 9

Thrombus associated with phlebitis

Question 10

What is a thrombus that travels to the heart, through the heart and to the lungs?

Answer 10

Pulmonary Embolism (PE)

Question 11

What is a thrombosis in a superficial vein?

Answer 11

Superficial Thrombophlebitis

Question 12

Who postulated that there were three related factors that caused venous thrombosis?

Answer 12

Dr. Virchow

Question 13

What are the three parts of Virchow’s triangle?

Answer 13

Stasis, Hypercoaguability, Vein Wall Injury

Question 14

What are risk factors for DVT?

Answer 14

Post Operative State
Previous DVT
Cancer
Thrombophilia
Trauma
Pregnancy
High Dose Estrogen Rx
"Economy Class Syndrome"

Question 15

What are the symptoms of DVT?

Answer 15

Persistent leg pain with acute onset
Persistent leg swelling
Calf pain/tenderness
( If pts have above symptoms 50% of DVT)

Question 16

In the clinical diagnosis of DVT, what is associated with low sensitivity and low specificity?

Answer 16

Low Sensitivity- Many Patients are asymptomatic

Low Specificity- Non-thrombotic disorders can cause the same clinical symptoms as DVT.

Question 17

What signs and symptoms are associated with Phlegmasia Cerulea Dolens?

Answer 17

Massive thigh and calf swelling
Limb Cyanosis
Ilio-Femoral outflow obstruction

Question 18

What are the symptoms associated with Superficial Thrombophlebitis?

Answer 18

Erythemia/inflammation
local tenderness
palpable cord or mass
usually more painful than DVT

Question 19

Is Superficial Thrombophlebitis life threatening?

Answer 19

Usually not life threatening, unless the thrombus extends/propagates into the deep system

Question 20

What is looked for in a venous physical exam?

Answer 20

Swelling
Limb discoloration
Stasis dermatitis, ulceration
Varicose Veins
Palpable "cords" (STP)

Question 21

What are the venous duplex techniques?

Answer 21

1. ) compressibility/coaptation of the vein
2. ) Visualization of Thrombus
3. ) Spectral Doppler
4. ) Color Doppler

Question 22

What position is the lower venous exam began in?

Answer 22

With pt in a Semi-Fowler’s or Reverse Trandelenburg postion

Question 23

About how many degrees is the head of the bed elevated in a Reverse Trandelenburg position?

Answer 23

25-45 degrees

Question 24

How many degrees is the torso elevated?

Answer 24

10-20 degrees

Question 25

How is the patient's leg rotated?

Answer 25

Leg rotated externally

Question 26

What vein is located just proximal to inguinal ligament at the groin crease?

Answer 26

Distal external iliac vein

Question 27

Where does the sapheno-femoral junction occur?

Answer 27

At the location of the CFA bifurcation

Question 28

In lower venous scanning when is the image best in accordance to probe position?

Answer 28

The best image is when the ultrasound beam is perpendicular to the vessel.

Question 29

If a thrombus is found in the GSV what should one determine?

Answer 29

If the thrombus extends into the CFV at the sapheno-femoral junction

Question 30

How often should compressions be done to determine coaptation?

Answer 30

Compress every 2-4 cm along the length of the common femoral, femoral, popliteal, and calf veins

Question 31

At the level of the adductor canal, the femoral vein may be difficult to compress due to what factors?

Answer 31

Due to the depth of the vessel and proximity to the adjacent femur

Question 32

What may prevent coaptation of the popliteal vein?

Answer 32

If the transducer is placed directly over the biceps femoris tendon laterally or the semitendinosus tendon medially in the popliteal fossa

Question 33

If the distal popliteal vein is not clearly visualized what can be used to assist in visualization?

Answer 33

Imaged with color doppler in longitudinal plane

Question 34

What is spontaneity?

Answer 34

Flow that is present without augmentation maneuvers

Question 35

What is respiratory phasicity?

Answer 35

Flow should increase and decrease with respiration

Question 36

Augmented flow can easily occur in the presence of DVT via what?

Answer 36

The collateral channels

Question 37

What is augmentation particularly useful for?

Answer 37

Calf vein flow evaluation and for reflux assessment

Question 38

Spectral and Color Doppler Techniques (Longitudinal Evaluation) Look For

Answer 38

Spontaneous flow? phasic with respiration? augments with distal limb compression? reflux?

Question 39

Typically is the flow direction above or below the baseline?

Answer 39

Below baseline

Question 40

Is continuous venous flow in the CFV a normal finding?

Answer 40

No-Abnormal Finding

Question 41

Is venous reflux a normal finding?

Answer 41

Abnormal Finding