DVT PE

Question 0

VTE can lead to: (can cause deaths, and affect survivors)

Answer 0

PE - cause of death
Chronic thromboembolic pulmonary hypertension
Postphlebitic syndrome - among survivors

Question 1

Three major CV causes of death?

Answer 1

1. VTE 2. MI 3. Stroke

Question 2

Most preventable cause of death?

Answer 2

Pulmo embo

Question 3

High risk for VTE include:

Answer 3

Major surgery
Heart failure
Cancer
Stroke

Question 4

Chronic thromboembolic pulmo HPN causes:

Answer 4

Breathlessness

Question 5

Late effect of DVT is post phlebitic syndrome, AKA:

Answer 5

Post thrombotic syndrome

Chronic venous insufficiency

Question 6

PPS causes ___ to the valves of the leg

Answer 6

Causes venous valves of the leg to become incompetent and exude interstitial fluid

Question 7

PPS CVI causes what after prolonged standing?

Answer 7

Chronic ankle or calf swelling

Leg aching

Question 8

Severe PPS causes skin ulceration in the:

Answer 8

Medial malleolus

Question 9

What state (platelet) contributes to VTE?

Answer 9

Prothrombotic state

Thrombophilia

Question 10

Two most common autosomal dominant genetic mutations that lead to prothrombotic states

Answer 10

Factor V Leiden

Prothrombin gene mutation

Question 11

Factor V Leiden causes resistance to:

Answer 11

Activated protein C – which inactivates clotting factors V and VIII
(Resistance to the inactivators – promotes activation – prothrombotic)

Question 12

Prothrombin gene mutation ___ plasma prothrombin concentration

Answer 12

Increases

Question 13

3 Coagulation inhibitors

Answer 13

Antithrombin
Protein C
Protein S

Question 14

Hyperhomocysteinemia can increase the risk of VTE. What can lower homocysteine levels?

Answer 14

Folate
Vitamin B6
Vitamin B12
(but does not lower incidence of VTE)

Question 15

Most common acquired cause of thrombophilia?

Answer 15

Antiphospholipid antibody syndrome

Question 16

Predisposing factors to VTE:

Answer 16

1. Cancer 2. Systemic arterial HPN 3. COPD 4. Long haul air travel 5. Air pollution 6. Obesity 7. Cigarette smoking 8. Eating red meat 9. OCPs 10. Pregnancy 11. Postmenopausal HRT 12. Surgery, trauma

Question 17

Paradoxical PE passes through:

Answer 17

Patent foramen ovale or Atrial septal defect

Question 18

Most common source of paradoxical embolism

Answer 18

Isolated calf vein thrombi

Question 19

Increases risk for upper extremity venous thrombosis:

Answer 19

1. Chronic indwelling central venous catheter (chemo, feeding)
2. Frequent insertion of permanent pacemakers and internal cardiac defibrillators

Question 20

Two most common gas exchange abnormalities

Answer 20

Hypoxemia (decreased atrial pO2)

Increased alveolar-arterial O2 tension gradient – inefficient O2 transfer across the lungs

Question 21

Breathed gas does not enter gas exchange causing increase in:

Answer 21

Anatomic dead space

Question 22

Ventilation to gas exchange units > venous blood flow through pulmo capillaries increases:

Answer 22

Physiologic dead space

Question 23

In PE, there is INCREASED vascular resistance, caused by:

Answer 23

1. Vascular obstruction

2. Release of serotonin by platelet

Question 24

Why is there potential discordance between small PE and large AaO2 gradient?

Answer 24

Due to release of vasoactive mediators -- produce VQ mismatch distal to the embolus

Question 25

There is impairment of gas exchange due to:

Answer 25

1. Increased alveolar dead space from vasc obstruction 2. Alveolar hypoventilation -- hypoxemia 3. Right to left shunting 4. Impaired carbon MONOxide transfer

Question 26

Constriction of airways distal to the bronchi causes

Answer 26

Increased airway resistance

Question 27

Reflex stimulation of irritant receptors cause

Answer 27

Alveolar hypoventilation

Question 28

Decrease in pulmo compliance is due to:

Answer 28

Lung edema, lung hemorrhage, loss of surfactant

Question 29

Usual cause of death from PE:

Answer 29

Progressive right heart failure

Question 30

Pathophysio of RV failure in PE

Answer 30

Inc PVR -- Inc RV wall tension -- RV dilation, dysfunction -- prolonged RV contraction even at end-systole -- IV septum bulges to LV -- impaired LV diastole Inc RV wall tension -- compress RCA -- dec perfusion -- dec myocardial O2 supply -- ischemia, infarction

Question 31

Harrison's labels VTE as the great:

Answer 31

Masquerader

Question 32

Failure to improve despite standard medical treatment can be a clue. Common concomitant illnesses:

Answer 32

Heart failure | Pneumonia

Question 33

Common history in DVT

Answer 33

Cramp in the lower calf that persists for days and becomes more uncomfortable over time

Question 34

Most common history in PE

Answer 34

Unexplained breathlessness

Question 35

Initial test for low to moderate likelihood of DVT

Answer 35

D dimer

Question 36

If D dimer is abnormally elevated, next step is

Answer 36

Imaging

Question 37

Differential diagnosis of DVT

Answer 37

PCR Post phlebitic syndrome, CVI Cellulitis Ruptured Baker's Cyst

Question 38

DDx of PE

Answer 38

``` PPAARC Pneumonia, asthma, COPD Pleurisy: costochon, muscle discomfort ACS Anxiety; Arte Rib fracture -- pneumothorax CHF ```

Question 39

DDx: sudden severe calf discomfort

Answer 39

Ruptured Baker's cyst

Question 40

Calf discomfort + Fever and chills

Answer 40

Cellulitis

Question 41

PE finding in DVT

Answer 41

Mild palpation discomfort on the lower calf -- mild DVT | Marked swelling of thigh and tenderness on palpation of common femoral vein -- severe DVT

Question 42

If leg is diffusely edematous, DVT unlikely. Most probably:

Answer 42

Acute exacerbation of CVI, PPS

Question 43

Presentation of UE VTE:

Answer 43

Asymmetry of supraclavicular fossa | Circumference of upper arms

Question 44

Massive PE presents as

Answer 44

Systemic arterial hypotension

Question 45

Moderate PE presents as __ in 2d echo

Answer 45

RV hypokinesis, but have normal systemic arterial pressure

Question 46

Small PE presents as:

Answer 46

Normal right heart function and normal systemic arterial pressure

Question 47

Small PE can cause __ when it is lodged peripherally

Answer 47

Pulmonary infarction | Usually painful, near the innervation of pleural nerves

Question 48

Pleuritic chest pain more common in

Answer 48

Small peripheral emboli

Question 49

Examples of nonthrombotic emboli

Answer 49

1. Fat emboli - after pelvic or long bone fracture 2. Tumor emboli 3. Bone marrow emboli 4. Air emboli 5. Cement and bony fragment emboli - after total knee and hip replacement 6. Hair talc cotton emboli - in IV drug users 7. Amniotic fluid emboli - leaky fetal membranes, tear in placental margins

Question 50

Most common symptom of PE

Answer 50

Dyspnea

Question 51

Most common sign of PE

Answer 51

Tachypnea - SITA - sign tachypnea