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VASCULAR SYSTEM > DVT > Flashcards

DVT Flashcards

1
Q

Sequelae of DEEP VEIN THROMBOSIS

A

✨ PULMONARY EMBOLISM
✨ POST THROMBOTIC LIMB

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2
Q

Virchow’s TRIAD

🧠⚡SHE ⚡

A

S : Stasis
H : HYPERCOAGULABLE state
E : Endothelial Dysfunction

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3
Q

Virchow in MEDICINE

A

🌟 Virchow: FATHER OF MODERN PATHOLOGY

🌟 Virchow’s TRIAD: Stasis + Hypercoagulability + Endothelial dysfunction

🌟 Virchow’s Node: Left Supraclavicular node

🌟 Virchow’s method of Autopsy: Organs are removed 1 by 1

🌟 Virchow’s CELL: MACROPHAGE IN LEPROSY (HENSEN’S DISEASE)

🌟 Virchow’s disease: LEONTIASIS OSSEA (Symptom)

🌟 Virchow’s Line: Line from ROOT OF NOSE to LAMBDA

🌟 Virchow’s Metamorphosis: Lipomatosis in Heart and Salivary Gland

🌟 Virchow’s LAW: During CRANIOSYNOSTOSIS: Skull growth is restricted to plane perpendicular to the affected, prematurely fused suture and is enhanced in a plane parallel to it

🌟 Virchow Robin SPACE: Enlarged Peri-Vascular Spaces (EPVS) Space surrounding the blood vessels for a short distance as they enter the BRAIN

🌟 Virchow-Seckel syndrome: BIRD HEADED DWARFISM

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4
Q

HYPER-COAGULABLE STATES

🧠⚡CALM³ SH²APES² ⚡

A
  1. C protein deficiency
  2. APLA syndrome
  3. Leiden FACTOR V Mutation
  4. Malignancy
  5. Myocardial INFARCTION
  6. MTHF gene mutation
  7. S Protein deficiency
  8. Hyperhomocystinemia
  9. HEPARIN induced Thrombocytopenia
  10. Antithrombin deficiency
  11. Prothrombin G20210A mutation / PREGNANCY
  12. EIGHT Factor deficiency
  13. Sticky Platelet SYNDROME
  14. Surgery & Trauma
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5
Q

⚡⚡ MOST IMPORTANT RISK FACTOR for DVT

A

Admission into HOSPITAL for Medical (OR) Surgical Treatment

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6
Q

Cause of HYPER-COAGULABLE STATE AFTER SURGERY (OR) TRAUMA

A

Large quantity of Tissue Factors is RELEASED
⬇️
ADHESIVENESS of Platelets ⬆️

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7
Q

⚡⚡ MOST COMMON Congenital PROTHROMBOTIC STATE

A

Factor V Leiden Mutation

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8
Q

MAY THURNER SYNDROME

🧠⚡ MA-LE⚡

A

LEft Iliac Vein Thrombosis
⭐ DUE TO: Right Iliac Artery pressure

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9
Q

DVT is MOSTLY U/L or B/L?

A

U/L

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10
Q

⚡⚡ MOST COMMON VEIN AFFECTED IN DVT

A

Calf or SOLEAL Veins

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11
Q

⚡⚡ MOST COMMON VEINS involved in DVT leading to PULMONARY THROMBOEMBOLISM

A

Iliofemoral veins
(Supra-popliteal veins)

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12
Q

⚡⚡ MOST COMMON SYMPTOM OF DVT

⚡⚡ EARLIEST SYMPTOM OF DVT

A

⭐ PAIN & SWELLING

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13
Q

⚡⚡ MOST CONSTANT SIGN OF DVT

A

Limb Edema

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14
Q

Which DVTs are usually ASYMPTOMATIC

A

Calf DVT

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15
Q

MOSES’S SIGN
(OR)
BANCROFT SIGN

A

Squeezing the CALF ➡️ Pain

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16
Q

HOMAN’S SIGN
🧠⚡Human is DuFuR ⚡

A

Dorsiflexion of Foot ➡️ RESISTANCE (OR) STIFFNESS

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17
Q

Homan’s sign vs Hamman’s sign vs HOMAN’S Procedure

A

Homan Procedure: In LYMPHEDEMA management: Skin & SUBCUTANEOUS tissue is REMOVED

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18
Q

PHLEGMASIA CERULEA DOLENS
(PAINFUL BLUE LIMB)

🧠⚡ C = 3⚡

A

Major AXIAL VEIN(1) ➕ COLLATERALS (2)
Occlusion of both Superficial & Deep Venous System.of Leg
⬇️
Venous Gangrene

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19
Q

PHLEGMESIA ALBA DOLENS
🧠⚡ A = 1⚡

A

Thrombosis of
⭐ MAJOR AXIAL VEINS
⭐ COLLATERALS NOT INVOLVED

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20
Q

MODIFIED WELL’S CRITERIA

⭐️ ABCD(CD)E(CDE) – 4P ⭐️

⭐️Rule of 3 – Note the 3 sets of 3:
1. Bedridden for >3 days in 1 month
2. Major surgery in last 3 months
3. More than 3 cm calf enlargement ⭐️

A

A: Alternate diagnosis of DVT more likely (-2)

B: Bedridden recently >3 days or Big (major) surgery within 3 months (+1)

C: Cancer – treatment or palliation within 6 months (+1)

D: Deep venous involvement:

Mnemonic – CD
Collateral (non-varicose) superficial veins present (+1)
Deep venous system tenderness (+1)

E: Edema:
Mnemonic – CDE

Calf swelling > 3cm compared to other leg – measured 10 cm below tibial tuberosity (+1)
Denting (pitting) edema of involved leg (+1)
Entire leg swollen (+1)

4 P:
Paralysis, Palsy or Plaster immobilization (+1)
Previous documented DVT (+1)

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21
Q

🩺 IOC for DVT

🩺 IOC for PULMONARY EMBOLISM

A

⭐ Duplex Scan
(Color Doppler ➕ B-mode USG)

⭐ CT ANGIOGRAPHY

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22
Q

INDICATIONS of MRI in DVT

A

DVT in ILIAC or FEMORAL VEIN

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23
Q

GOLD STANDARD INVESTIGATION for DVT

GOLD STANDARD INVESTIGATION for PULMONARY EMBOLISM

A

⭐ VENOGRAPHY

⭐ PULMONARY ANGIOGRAPHY

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24
Q

💊💉 MANAGEMENT of DVT

✨ 1st 5 DAYS
✨ Next 5 DAYS
✨ 1st EPISODE
✨ RECURRENT

A

⭐ ANTICOAGULATION

✨ 1st 5 DAYS
🎯 WARFARIN ➕ HEPARIN (LMWH)

✨ Next 5 DAYS
🎯 WARFARIN

✨ 1st EPISODE
🎯 WARFARIN X 3 months

✨ RECURRENT
🎯 LIFELONG WARFARIN

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25
Q

TRANSIENT PROTHROMBOTIC STATE is seen with

A

WARFARIN

⭐ Fall in Protein C & Protein S

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26
Q

Warfarin Therapy is MONITORED by

A

INR

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27
Q

Target INR for WARFARIN

A

2-3

28
Q

NORMAL INR
🧠⚡ P-PC⚡

A

= Prothrombin Time of Patient / Prothrombin Time of Control

29
Q

🤢😳SIDE EFFECTS🥴😵 of WARFARIN

🧠⚡BHAST⚡

A
  1. Bleeding
  2. Bluish discolouration of Feet
  3. HIT worsens
  4. Alopecia
  5. Skin Necrosis ➡️ Breast, Buttocks, Thigh
  6. Teratogenic
    ➡️ Nasal Hypoplasia
    ➡️ Stippled Epiphyseal CALCIFICATION
30
Q

Maximum permissible value of INR at which SURGERY can be dome WITHOUT ⬆️ HIGH RISK of Bleeding is

A

1.4

31
Q

To reduce INR quickly

A

Prothrombin Factor Concentrates > > FFP

32
Q

Pregnancy & ANTICOAGULANTS

A
33
Q

NOAC
Factor Xa inhibitors ➕ Oral Direct Thrombin inhibitors
🧠⚡ BEAR⚡

A
  1. Betri-xa-ban
  2. Epi-xa-ban
  3. Api-xa-ban
  4. Rivaro-xa-ban

Oral Direct Thrombin inhibitors
1. Dabigetran
2. Ximelagetran

34
Q

ATTRACT Trial for

A

Thrombolysis is useful in patient with PROXIMAL (ILIAC/FEMORAL Vein) DVT with MODERATE to Severe Symptoms

35
Q

⚡⚡ MOST COMMON USED IVC FILTER

A

Greenfield Filter

36
Q

Identify

A

IVC Filter
(Inferior Vena Cava Filter)

Prevents Thrombi moving UPWARD

37
Q

INDICATIONS FOR VENA CAVA FILTER

🧠⚡APPP ⚡

A
  1. ANTICOAGULANTS are 🚫 CONTRAINDICATION
  2. Pulmonary HYPERTENSION
  3. PULMONARY EMBOLISM despite ANTI-COAGULATION
  4. Propagating ILIO-FEMORAL VENOUS THROMBUS in ANTICOAGULATION
  5. Complications of ANTICOAGULANTS ➕
38
Q

COMPLICATIONS of IVC FILTERS

A
  1. Migration of filter
  2. Bleeding
  3. IVC Blockade
39
Q

💊💉 MANAGEMENT of IVC BLACKADE

A

IV Fluids

40
Q

POST-THROMBOTIC LEG

⭐ VELP

A
  1. Varicose vein
  2. Edema
  3. Lipodermatosclerosis: CHAMPAGNE BOTTLE Appearance
  4. Pigmentation
41
Q

Risk factors for POST-THROMBOTIC LIMB

A

⭐ EXTENSIVE DVT
⭐ PROXIMAL DVT
⭐ SUB-THERAPEUTIC ANTICOAGULATION

42
Q

HIGH-RISK PATIENT GROUOS FOR VENOUS THROMBOEMBOLISM

A
  1. MAJOR ORTHOPEDIC SURGERY, # of HIP, PELVIS, LOWER LIMB
  2. MAJOR ABDOMINAL (OR) PELVIC SURGERY for CANCER
  3. MAJOR SURGERY, TRAUMA, MEDICAL ILLNESS IN PATIENTS WITH DVT, PULMONARY EMBOLISM (OR) THROMBOPHILIAs
  4. LOWER LIMB PARALYSIS (Stroke, Paraplegia)
  5. Major Lower Limb Patients
43
Q

WHICH PATIENT GROUP recieves DUAL PROPHYLAXIS

A

Moderate & HIGH RISK patients

44
Q

Dual PROPHYLAXIS

A

Mechanical
➕
Pharmacological

45
Q

WHICH PATIENT GROUP recieves only MECHANICAL PROPHYLAXIS

A

Low risk

46
Q

MECHANICAL PROPHYLAXIS

A
  1. Early Ambulation
  2. Pneumatic Compression
  3. Stockings
47
Q

PHARMACOLOGICAL PROPHYLAXIS

A

LMWH
✨ Longer T½
✨ SC
✨ NO MONITORING REQUIRED

48
Q

SITTING FROM LYING DOWN after SURGERY ⬆️ RISK OF

A

PULMONARY EMBOLISM

49
Q

Identify

A

PNEUMATIC COMPRESSION STOCKINGS

50
Q

1° UPPER LIMB DVT is known as

A

PAGET SCHROTTER DISEASE
(AXILLARY VEIN THROMBOSIS)

51
Q

PAGET SCHROTTER DISEASE
Seen in

A

AXILLARY VEIN THROMBOSIS

⭐ ATHLETES with REPETITIVE ARM MOVEMENTS
⬇️
Weight Lifters
Javelin Throwers

52
Q

2° UPPER EXTREMITY DVT

A

✨ INDWELLING CATHETER
✨ CANCER

53
Q

🧑🏻‍⚕️ Clinical Features
UPPER EXTREMITY DVT

A

✨ PAIN
✨ SWELLING
✨ EDEMA

54
Q

🩺 IOC of UPPER LIMB DVT

A

Duplex Scan

55
Q

⚡⚡ MOST COMMON COMPLICATION OF IV Line

A

SUPERFICIAL THROMBOPHLEBITIS

56
Q

PAINFUL CORD LIKE SWELLING is seen in

A

SUPERFICIAL THROMBOPHLEBITIS

57
Q

💊💉 MANAGEMENT of SUPERFICIAL THROMBOPHLEBITIS

A

✨ ANTI-INFLAMMATORY AGENT
✨ THROMBOPHOBE OINTMENT
✨ COMPRESSION GARMENTS

58
Q

ECONOMY CLASS SYNDROME

A

THROMBOEMBOLISM DUE TO: LONG TIME FLIGHT TRAVEL > 8 hrs

59
Q

PROXIMAL DVT
vs
DISTAL DVT

A

✨ More dangerous (because of ⬆️ risk of PULMONARY EMBOLISM & Death)

✨ POPLITEAL VEINS or Above
✨ Femoral or Iliac Veins

⭐ LESS DANGEROUS
⭐ BELOW POPLITEAL VEINS

60
Q

50% RULE in DVT

A

Only 50% Symptomatic
⬇️
50% pts have ASYMPTOMATIC PULMONARY EMBOLISM

61
Q

PRATT Sign seen in

A

⭐ DVT

In prone position
⬇️
Squeeze BOTH the calves
⬇️
Give PRESSURE on the POPLITEAL VEIN & PROXIMAL ASPECT @ SAME TIME
⬇️
PAIN

62
Q

Identify the SIGN

A

⬆️ PRESSURE of Legs by SPHYGMOMANOMETER
⬇️
PAIN

63
Q

NEUHOF’S Sign
Seen in

A

⭐ DVT

Squeezing the Calf
⬇️
Pain

✨ Muscles will be THICKENED DUE TO: Edema

64
Q

LINTON’S SIGN seen in
⭐ Procedure

A

DVT

Tourniquet tied at SAPHENO-FEMORAL Junction
⬇️
Patient asked to walk
⬇️
Lift the affected limb up
⬇️
Dilatation of Deep vein

65
Q

MODIFIED VILLALTA SCORE used for

A

⭐ POST-THROMBOTIC LEG
Diagnosis & GRADING

66
Q

LOWENBERG’S SIGN
Seen in

A

DVT
⬇️
Pain is ➕ when a blood pressure cuff is placed around the calf & inflated to 80mm Hg

67
Q

MAY THURNER SYNDROME
Synonyms

A
  1. Iliocaval Venous Compression Syndrome
  2. Iliac Vein Compression Syndrome
  3. Cockett’s syndrome
  4. Venous spur

VASCULAR SYSTEM (5 decks)

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