DVT and PTE

Question 1

What does DVT stand for?

Answer 1

Deep vein thrombosis

Question 2

What does PE stand for?

Answer 2

Pulmonary embolism

Question 3

What are the parts of virchows triad?

Answer 3

Stasis
Hypercoagulability
Vessel damage

Question 4

Examples of cause of stasis

Answer 4

Bed rest

Travel

Question 5

Examples of causes of hypercoagulability

Answer 5

Pregnancy

Trauma

Question 6

Example of vessel damage

Answer 6

Atherosclerosis

Question 7

Examples of VTE

Answer 7

Limb DVT
PE
Visceral VT
Intracranial VT
Superficial thrombophlebitis

Question 8

Features of a venous thrombus

Answer 8

Red thrombus

Fibrin and red cells

Question 9

What does a venous thrombus result in?

Answer 9

Back pressure

Question 10

What are venous thrombus principally due to?

Answer 10

Stasis

Hypercoagulability

Question 11

Features of arterial thrombus

Answer 11

White clot

Platelets and fibrin

Question 12

What does arterial thrombus result in?

Answer 12

Ischaemia

Infarction

Question 13

What are arterial thrombus principally secondary to?

Answer 13

Atherosclerosis

Question 14

Presentation of DVT

Answer 14

Unilateral limb swelling
Persisting discomfort 
Calf tenderness
Warmth 
Erythema 
May be clinically silent

Question 15

Presentation of PE

Answer 15

Pleuritic chest pain
Dyspnoea
Haemoptysis
Tachycardia

Question 16

What would you hear on auscultation of a PE?

Answer 16

Pleural rub

Question 17

Features of pleuritic chest pain

Answer 17

Sharp

On inspiration

Question 18

Presentation of massive PE

Answer 18

Severe SOB
Collapse
Cyanosis (blue lips and tongue)
Tachycardia
Low BP
Raised JVP
Altered heart sounds
May cause sudden death

Question 19

Potential long term consequence of PE

Answer 19

Most recover fully

Pulmonary HTN

Question 20

Risk factors for VTE

Answer 20

Increasing age 
Tissue trauma 
Immobility
Obesity 
Pregnancy
Exogenous oestrogen 
Smoking
Cancer
Inheritance
Long haul travel
(ALL CAUSING STASIS/HYPERCOAGULABILITY)

Question 21

Examples of exogenous oestrogen

Answer 21

OCP

HRT

Question 22

What is heritable thrombophilia?

Answer 22

An inherited predisposition to venous thrombosis

Question 23

Most common type of heritable thrombophilia

Answer 23

Factor V Leiden

Question 24

Long haul travel risk with VTE is increased in who?

Answer 24

Short
Tall 
Overweight 
Women on OCP
Window seats

Question 25

Investigations for DVT

Answer 25

Clinical D dimer Compression USS

Question 26

What score is done for clinical probability assessment for DVT and PE?

Answer 26

Wells score

Question 27

What does the wells score look at?

Answer 27

``` Active cancer Paralysis / plaster Bed > 3 days / surgery within 4 weeks Tender veins Entire leg swelling Calf swelling > 3 cm Pitting oedema Collateral veins Alternative diagnosis likely (-2) (All rest 1 each) ```

Question 28

Score of wells score

Answer 28

Low (0 or less) - approx. 3 % risk Moderate (1 or 2) - approx. 17% risk High (3 or more) - approx. 75% risk

Question 29

Investigations for PE

Answer 29

``` Clinical assessment D dimer Isotope ventilation Perfusion scan (V/Q) CT pulmonary angiogram (CTPA) ```

Question 30

Prevention of VTE in hospital

Answer 30

Early mobilisation Anti embolism stockings Daily injections of LWMH

Question 31

Indications of graduated compression stockings

Answer 31

``` Prevention of DVT Chronic venous insufficiency Varicose veins Oedema Lymphoedema Prevention of post phlebitic syndrome ```

Question 32

Treatment of VTE

Answer 32

DOAC (apixaban or rivaroxaban) 1st for 5 or more days Then oral anticoagulant (warfarin) for 3 months Thrombolysis for massive PE (Vena caval filter)

Question 33

Massive PE + what = thrombolyse?

Answer 33

Hypotension

Question 34

Patients taking warfarin should avoid what?

Answer 34

Foods high in vitamin K - sprouts - broccoli - kale - spinach

Question 35

ECG changes with PE

Answer 35

Sinus tachycardia | S1Q3T3 (only 10%)

Question 36

Describe S1Q3T3

Answer 36

Deep S waves in I Pathological Q waves in III Inverted T waves in III

Question 37

What does S1Q3T3 indicate?

Answer 37

Right heart strain

Question 38

What is a CTPA contraindicated in?

Answer 38

Renal impairment | Allergy to the contrast media

Question 39

What would the ABG show in a PE?

Answer 39

Respiratory alkalosis