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CCFP 3 > DVT > Flashcards

DVT Flashcards

1
Q

DDx lower extremity edema

A

DVT
Venous Insufficiency
Venous Obstruction (Baker’s Cyst, Mass, Position, Compression)
Lymphatic Obstruction
Compartment Syndrome
Trauma
Cellulitis
Allergic Reaction
Cirrhosis
Hypoalbuminuria (nephrotic, malnutrition, enteropathy)
Medications (CCBs, NSAIDs, Thiazolidinediones)
Pre-Eclampsia/Eclampsia
Myxedema
Lymphatic Filariasis
Eosinophilic Fasciitis
Congestive Heart Failure
Pericardial Effusion
Pericarditis
Valvular Issues (stenosis, regurgitation)
Pulmonary Hypertension
Cor Pulmonale

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2
Q

Most common thrombophilia causing DVT

A

Factor V Leiden

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3
Q

RF

A

Virchow’s triad: endothelial damage, venous stasis, hypercoagulability
Hospitalisation
Immobility
Trauma
Prev VTE
OCP
Postpartum
Pregnancy
Cancer
FDR

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4
Q

Complications

A

PE
Chronic venous insufficiency

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5
Q

Chronic venous insufficiency rx

A

exercise, compression stockings, leg raises

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6
Q

Chronic arterial insufficiency sx

A

Decreased Pulses, Loss of Hair, Hypertrophic Nails, Decreased Cap Refill, Rubor, Cool Skin, Arterial Ulcers

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7
Q

Acute arterial insufficiency sx

A

pale, pulseless, pain, paresthesia, polar, paralysis

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8
Q

DDx bilateral leg pain with activity

A

Arterial claudication
Neurogenic Claudication/Spinal Stenosis
Radiculopathy
Osteoarthritis
Popliteal Mass (Baker’s Cyst, Cancer, Trauma)
Varicose Veins
Deep Venous Thrombosis
Post Thrombotic Syndrome
Neuropathy (Diabetic, Peripheral)

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9
Q

Ix for claudication

A

ABPI
Doppler Ultrasound
CT Angiography
MR Angiography
Angiogram

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10
Q

What ABPI is abnormal, and when do you see rest pain?

A

<0.9
<0.3

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11
Q

Where do you see arterial ulcers on lower limb?

A

Lateral foot

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12
Q

Sx DVT

A

Unilateral edema, erythema, warmth, tenderness
Palpable cord

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13
Q

Ix

A

D dimer - for low risk Well’s score <2
US - for high risk Well’s score

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14
Q

Rx

A

LMWH or IV heparin for 5d + warfarin until INR >2
Apixaban 10mg PO BID x 7/7 then 5mg BID

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15
Q

What are the hypercoagulability syndromes causing DVT

A

Factor V leiden
Prothrombin
Protein C or S deficiency
Antithrombin defiency

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16
Q

Prophylaxis for DVT

A

Risk assess all hospitalised pts
Early ambulation
Compression stockings
Intermittent pneumatic compressions
LMWH for high risk (pregnant woman w/ >2 RF)

17
Q

DDx for unilateral edema

A

Deep vein thrombosis
Venous insufficiency
Lymphedema
pretibial myxedema

18
Q

When do you see brown hemosiderin deposits?

A

venous insufficiency

19
Q

What is the Kaposi-Stemmer sign?

A

inability to pinch a fold of skin at dorsum proximal second toe is a sign of lymphedema

20
Q

Post phlebitic syndrome rx

A

r/o DVT w/ duplex doppler US, compression stockings, elevation, exercise, topical meds for skin changes, refer for vein ablation excision, horse chestnut seed oil

21
Q

What is the best way to investigate ?DVT?

A

Wells <2 = D Dimer, wells >2 = proximal leg compression US. If US negative in high risk person, do D dimer. If negative, do US again in few days time

22
Q

RF for DVT

A

stasis, trauma (recent central line, pacemaker, surgery), hypercoagulable states (cancer, pregnancy, meds (hormonal), IBD, CHF, nephrotic syndrome, thrombophilia)

23
Q

When to test for thrombophilia in DVT?

A

Fam hx of clots, young, multiple/ recurrent

24
Q

Upper arm DVT diagnostic score

A

CONSTANS: central line/ pacemaker, localised pain, unilateral edema, other diagnosis plausible

25
Q

When to Rx while awaiting US for DVT?

A

If US is delayed, mod-high suspicion, no CI

26
Q

How to rx DVT if US delayed

A

1 dose oral Xa inhibitor or 1 dose of LMWH

27
Q

When to give heparin as a bridge in DVT?

A

Direct thrombin inhibitor or warfarin

28
Q

Rivaroxaban class

A

factor 10a

29
Q

Dabigatran class

A

direct thrombin inhibitor

CCFP 3 (67 decks)

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