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DVT Flashcards

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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
TRANSIENT PROTHROMBOTIC STATE is seen with
WARFARIN ⭐ Fall in Protein C & Protein S
26
Warfarin Therapy is MONITORED by
INR
27
Target INR for WARFARIN
2-3
28
NORMAL INR 🧠⚡ P-PC⚡
= Prothrombin Time of Patient / Prothrombin Time of Control
29
🤢😳SIDE EFFECTS🥴😵 of WARFARIN 🧠⚡BHAST⚡
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
Maximum permissible value of INR at which SURGERY can be dome WITHOUT ⬆️ HIGH RISK of Bleeding is
1.4
31
To reduce INR quickly
Prothrombin Factor Concentrates > > FFP
32
Pregnancy & ANTICOAGULANTS
33
NOAC Factor Xa inhibitors ➕ Oral Direct Thrombin inhibitors 🧠⚡ BEAR⚡
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
ATTRACT Trial for
Thrombolysis is useful in patient with PROXIMAL (ILIAC/FEMORAL Vein) DVT with MODERATE to Severe Symptoms
35
⚡⚡ MOST COMMON USED IVC FILTER
Greenfield Filter
36
Identify
IVC Filter (Inferior Vena Cava Filter) Prevents Thrombi moving UPWARD
37
INDICATIONS FOR VENA CAVA FILTER 🧠⚡APPP ⚡
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
COMPLICATIONS of IVC FILTERS
1. Migration of filter 2. Bleeding 3. IVC Blockade
39
💊💉 MANAGEMENT of IVC BLACKADE
IV Fluids
40
POST-THROMBOTIC LEG ⭐ VELP
1. Varicose vein 2. Edema 3. Lipodermatosclerosis: CHAMPAGNE BOTTLE Appearance 4. Pigmentation
41
Risk factors for POST-THROMBOTIC LIMB
⭐ EXTENSIVE DVT ⭐ PROXIMAL DVT ⭐ SUB-THERAPEUTIC ANTICOAGULATION
42
HIGH-RISK PATIENT GROUOS FOR VENOUS THROMBOEMBOLISM
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
WHICH PATIENT GROUP recieves DUAL PROPHYLAXIS
Moderate & HIGH RISK patients
44
Dual PROPHYLAXIS
Mechanical ➕ Pharmacological
45
WHICH PATIENT GROUP recieves only MECHANICAL PROPHYLAXIS
Low risk
46
MECHANICAL PROPHYLAXIS
1. Early Ambulation 2. Pneumatic Compression 3. Stockings
47
PHARMACOLOGICAL PROPHYLAXIS
LMWH ✨ Longer T½ ✨ SC ✨ NO MONITORING REQUIRED
48
SITTING FROM LYING DOWN after SURGERY ⬆️ RISK OF
PULMONARY EMBOLISM
49
Identify
PNEUMATIC COMPRESSION STOCKINGS
50
1° UPPER LIMB DVT is known as
PAGET SCHROTTER DISEASE (AXILLARY VEIN THROMBOSIS)
51
PAGET SCHROTTER DISEASE Seen in
AXILLARY VEIN THROMBOSIS ⭐ ATHLETES with REPETITIVE ARM MOVEMENTS ⬇️ Weight Lifters Javelin Throwers
52
2° UPPER EXTREMITY DVT
✨ INDWELLING CATHETER ✨ CANCER
53
🧑🏻‍⚕️ Clinical Features UPPER EXTREMITY DVT
✨ PAIN ✨ SWELLING ✨ EDEMA
54
🩺 IOC of UPPER LIMB DVT
Duplex Scan
55
⚡⚡ MOST COMMON COMPLICATION OF IV Line
SUPERFICIAL THROMBOPHLEBITIS
56
PAINFUL CORD LIKE SWELLING is seen in
SUPERFICIAL THROMBOPHLEBITIS
57
💊💉 MANAGEMENT of SUPERFICIAL THROMBOPHLEBITIS
✨ ANTI-INFLAMMATORY AGENT ✨ THROMBOPHOBE OINTMENT ✨ COMPRESSION GARMENTS
58
ECONOMY CLASS SYNDROME
THROMBOEMBOLISM DUE TO: LONG TIME FLIGHT TRAVEL > 8 hrs
59
PROXIMAL DVT vs DISTAL DVT
✨ More dangerous (because of ⬆️ risk of PULMONARY EMBOLISM & Death) ✨ POPLITEAL VEINS or Above ✨ Femoral or Iliac Veins ⭐ LESS DANGEROUS ⭐ BELOW POPLITEAL VEINS
60
50% RULE in DVT
Only 50% Symptomatic ⬇️ 50% pts have ASYMPTOMATIC PULMONARY EMBOLISM
61
PRATT Sign seen in
⭐ DVT In prone position ⬇️ Squeeze BOTH the calves ⬇️ Give PRESSURE on the POPLITEAL VEIN & PROXIMAL ASPECT @ SAME TIME ⬇️ PAIN
62
Identify the SIGN
⬆️ PRESSURE of Legs by SPHYGMOMANOMETER ⬇️ PAIN
63
NEUHOF'S Sign Seen in
⭐ DVT Squeezing the Calf ⬇️ Pain ✨ Muscles will be THICKENED DUE TO: Edema
64
LINTON'S SIGN seen in ⭐ Procedure
DVT Tourniquet tied at SAPHENO-FEMORAL Junction ⬇️ Patient asked to walk ⬇️ Lift the affected limb up ⬇️ Dilatation of Deep vein
65
MODIFIED VILLALTA SCORE used for
⭐ POST-THROMBOTIC LEG Diagnosis & GRADING
66
LOWENBERG'S SIGN Seen in
DVT ⬇️ Pain is ➕ when a blood pressure cuff is placed around the calf & inflated to 80mm Hg
67
MAY THURNER SYNDROME Synonyms
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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