DVT AND PTE

Question 1

Favorable environment for venous thrombi

Answer 1

1. Stasis
2. Low oxygen Tension
3. Upregulated pro-inflammatory genes

Question 2

is the most common preventable cause of death among hospitalizedpatients

Answer 2

Pulmonary thromboembolism or PE

Question 3

Chronic thromboembolic pulmonary hypertension

Answer 3

causes breathlessness, especially with exertion

Question 4

(also known as chronic venous insufficiency) damages the venous valves Of the leg and worsens the quality of life by causing ankle or calf swelling and leg aching, especially after prolonged standing

Answer 4

Post thrombotic syndrome

Question 5

it’s-most severe form, postthrombotic syndrome causes

Answer 5

skin ulceration

Question 6

Virchow’s triad

Answer 6

venous stasis,
hypercoagulability
endothelial injury

Question 7

Prevention of VTE , most common in-hospital prophylaxis :

Answer 7

Low dose UFH OR LMWH

Question 8

May possibly cure pulmonary hypertension and indicated mgt for chronic thromboembolic pulmonary hypertension

Answer 8

PULMONARY THROMBOENDARTERECTOMY

Question 9

Approve clinical use of Fibrinolysis which is effective up to 14 days post PE

Answer 9

Massive PE

Question 10

Additional indication for fibrinolysis:

Answer 10

Submissive PE
if with preserved BP
WITH MODERATE OR SEVERE RV DYSFUNCTION

Question 11

Preferred fibrinolytic treatment

Answer 11

rtPA 100mg continuous 2 hour IV INFUSION

Question 12

1st line inotropic agents for treatment of PE related shock

Answer 12

Dopamine, dobutamine

Question 13

Principal indications of inferior vena cava IVC filters:

Answer 13

1. Active bleeding precluding anticoagulation

2. Recurrent venous thrombosis despite intensive anticoagulation

Question 14

Duration of anticoagulation: if DVT of upper extremity or calf provoked by surgery, trauma, estrogen exposure, in dwelling device/catheter:

Answer 14

3 months

Question 15

Duration of anticoagulation:

provoked proximal leg DVT or PE

Answer 15

3-6 months

Question 16

Duration of anticoagulation:

Cancer and VTE use

Answer 16

Use LMWH indefinitely until cancer free

Question 17

Duration of anticoagulation:
Idiopathic VTE (unprovoked, ex long haul flight) has high recurrence rate after stopping anticoagulants

Answer 17

Indefinite anticoagulation to INR 2-3

Question 18

Duration of anticoagulation:

Moderate or high levels of antiphospholipids antibodies

Answer 18

Indefinite anticoagulation

Question 19

Duration of anticoagulation:

Heterozygous factor V LEIDEN and prothrombin gene mutation

Answer 19

Not at increased risk of recurrent VTE

Question 20

Most serious adverse effect of anticoagulation:

Answer 20

HEMORRHAGE

Question 21

Treatment for anticoagulation hemorrhage sec to HEPARIN or LMWH

Answer 21

PROTAMINE SULFATE

Question 22

Treatment for anticoagulation hemorrhage sec to dabigatran

Answer 22

IDARUCIZUMAB

Question 23

Treatment for anticoagulation hemorrhage sec to APIXABAN, BETRIXABAN, RIVAROXABAN

Answer 23

Andexanet

Question 24

Treatment for anticoagulation hemorrhage sec to warfarin and major bleeding

Answer 24

Prothrombin complex concentrate

Question 25

Treatment for anticoagulation hemorrhage sec to WARFARIN and less serious bleeding

Answer 25

FFP or IV vitamin k

Question 26

Treatment for anticoagulation hemorrhage sec to WARFARIN and minor bleeding

Answer 26

Oral vitamin k

Question 27

Treatment for heparin induced thrombocytopenia or HIT for patients with renal insufficiency

Answer 27

Argatroban

Question 28

Treatment for heparin induced thrombocytopenia or HIT for patients with hepatic failure

Answer 28

Lepirudin

Question 29

Treatment for heparin induced thrombocytopenia or HIT for patients in the setting of PCI

Answer 29

BIVALIRUDIN

Question 30

Resistance to activated protein c which inactivated factors 5 and 8

Answer 30

Factor 5 Leiden

Question 31

Most common case of acquired thrombophilia

Answer 31

APAS

Question 32

The usual cause of death from PTE

Answer 32

Progressive right Heart failure

Question 33

10x more common than upper extremity DVT

Answer 33

Lower extremity DVT (from calf proximally to popliteal, femoral and iliac veins)

Question 34

Most common symptom of the great masquerader / PE

Answer 34

Breathlessness

Question 35

Presentation: erythema , tenderness and palpable cord

Answer 35

Superficial venous thrombosis

Question 36

Most common symptom of DVT

Answer 36

Cramp or | Charley horse in the lower calf that persists and intensified over several days

Question 37

Often present with marked THIGH swelling, tenderness and erythema

Answer 37

massive DVT

Question 38

True or false If leg is diffusely edematous, unlikely to be DVT

Answer 38

True

Question 39

consists of clot dissolution with pharmacomechanical therapy that usually includes low-dose catheter-directed thrombolysis.

Answer 39

Primary therapy for DVT

Question 40

secondary prevention of VTE

Answer 40

Anticoagulation or placement of an inferior vena caval (IVC) filter

Question 41

For patients with swelling of the legs when acute DVT is diagnosed, below-knee graduated compression stockings may be prescribed, to lessen patient discomfort. Theyshould be replaced every 3 months because they lose their elasticity. What is the pressure needed?

Answer 41

usually 30–40 mmHg (secondary prevention)

Question 42

Effective anticoagulation is the foundation for successful treatment ofDVT and PE. There are three major strategies:

Answer 42

1) the classical but waning strategy of parenteral anticoagulation with unfractionated heparin(UFH), low-molecular-weight heparin (LMWH), or fondaparinux“bridged” to warfarin, (2) parenteral therapy switched after 5 days to a novel oral anticoagulant such as dabigatran (a direct thrombininhibitor) or edoxaban (an anti-Xa agent), or (3) oral anticoagulation monotherapy with rivaroxaban or apixaban (both are anti-Xa agents)with a 3-week or 1-week loading dose, respectively, followed by a maintenance dose without parenteral anticoagulation

Question 43

For patientswith VTE in the setting of suspected or proven heparin-induced thrombocytopenia, one can choose between two parenteral direct-thrombin inhibitors:

Answer 43

argatroban and bivalirudin direct-thrombin inhibitors:

Question 44

UFH anticoagulates by binding to and-accelerating the activity of antithrombin, thus preventing additional thrombus formation. The most popular nomogram uses an initial bolus of____, followed by an initial infusion rate of ____ in patients with normal liver function

Answer 44

80 U/kg 18 U/kg per h

Question 45

UFH is dosed to achieve a target activated partial thromboplastin time (aPTT) of

Answer 45

60–80 seconds

Question 46

These fragments of UFH exhibitless binding to plasma proteins and endothelial cells and consequently have greater bioavailability, a more predictable doseresponse, and a longer half-life than does UFH. No monitoring ordose adjustment is needed unless the patient is markedly obese orhas chronic kidney disease.

Answer 46

LMWH

Question 47

An anti-Xa pentasaccharide, is administered as a weight-based once-daily subcutaneous injection in a prefilled syringe. It does not cause heparin-induced thrombocytopenia.

Answer 47

FONDAPARINUX

Question 48

This vitamin K antagonist prevents carboxylation activation of coagulation factors II, VII, IX, and X.

Answer 48

WARFARIN

Question 49

Increased d-dimER but low specificity

Answer 49

``` Pneumonia Pregnancy 2nd and 3rd trimester AMI Post surgery SEPSIS Cancer ```

Question 50

Most frequently cited ECG abnormality

Answer 50

Sinus tachycardia S1Q3T3 T wave in V1 to V4 (most common due to RV strain and ischemia)

Question 51

True or false: Wells Point Score criteria help estimate the clinical likelihood of DVTand PE. Patients with a low-to-moderate likelihood of DVT or PE should undergo initial diagnostic evaluation with d-dimer testing alone without obligatory imaging tests

Answer 51

True

Question 52

True or false: However, patients with a high clinical likelihood of VTEshould skip d-dimer testing and undergo imaging as the next step inthe diagnostic algorithm.

Answer 52

True

Question 53

Second line diagnostic tests for PE

Answer 53

Lung scanning

Question 54

equantitative plasma d-dimer enzyme-linked immunosorbent assay (ELISA)rises in the presence of DVT or PE because of the breakdown of fibrin by

Answer 54

plasmin

Question 55

Chest X-ray PE abnormalities

Answer 55

focal oligemia (Westermark’s sign), a peripheral wedged-shaped density usually located at the pleural base (Hampton’s hump), and an enlarged Right descending pulmonary artery (Palla’s sign)

Question 56

Primary therapy consists of clot dissolution with pharmacomechanicaltherapy that usually includes low-dose catheter-directed thrombolysis. This approach is reserved for patients with extensive

Answer 56

femoral iliofemoral upper extremity DVT

Question 57

Risk stratification: | portend a high risk of an adverse clinical outcome despite anticoagulation.

Answer 57

Hemodynamic instability RV dysfunction on echocardiography RVenlargement on chest CT or elevation of the troponin level due toRV microinfarction