Thromboembolism ,DVT

Question 1

When do you consider an hypercoagulable state

Answer 1

Spontaneous thrombosis with no obisous risk factors
Family history of recurrent venous thrombosis at early age
Thrombosis with risk factors at early age
Thrombosis at unusual site (upper extremities , viscera)
Recurrent thrombosis

Question 2

Why is there balance towards thrombosis in hyper coagulable state

Answer 2

Increase in procoagulant element

Decrease in anticoagulant element

Question 3

What is a thrombus

Answer 3

Solid mass formed in circulation from blood constituents

Question 4

Complications of thrombus

Answer 4

Ischemia

Embolization

Question 5

Can a thrombus be venous or arterial

Answer 5

Yes

Question 6

What’s virchow triad in venous thrombosis

Answer 6

Stasis
Hypercoagulopathy
Vessel wall damage

Question 7

Risk factors for venous thrombosis s

Answer 7

Coagulation abnormality 
Stasis 
Age 
Sex
Obesity

Question 8

What are some coagulation abnormalities

Answer 8

Hereditary hemostatic disroders like factor V Leiden

Hereditary or acquired hemostatic disroders raising levels of factors VII, VIII

Question 9

Condition that can cause blood stasis

Answer 9

Cardiac failure

Question 10

Protein that can’t cleave in factor V mutation (FV leiden )

Answer 10

Protein C complex

Question 11

Most common genetic risk factor for thrombosis

Answer 11

FV Leiden

Question 12

Prevalence in caucasians of FV Leiden

Answer 12

5%

Question 13

Risk for heterozygotes compared to homozygotes in FV Leiden

Answer 13

6-8 fold for heterozygotes

80 folds for homo

Question 14

Can elevated FVIII increase risk of thrombosis

Answer 14

Yes

Question 15

Elevation of this coagulation factor is an indépendant risk factor for MI and stroke

Answer 15

vWF

Question 16

What are the inhibitors of hemostasis

Answer 16

Tissue factor pathway inhibitor ( TFPI)
Protein C
Protein S
Antithrombin

Question 17

If there is decrease in anticoagulants elements , what you should expect

Answer 17

Thombrosis

Question 18

Which medical and supportive management is a risk factor for deep vein thrombosis

Answer 18

Central venous catheter

Question 19

Why is thromboembolism so common inn cancer

Answer 19

Factors interaction complexity 
Malignancy 
Chemotherapy and side effects 
Increased Infections 
Increased dehydration

Question 20

What are some acquired prothrombic conditions

Answer 20

Sepsis 
Congenital heart diseas
Hypovolemia 
Trauma 
Surgery 
Immobilization 
Estrogen in contraceptives 
Steroid
Nephrotic syndrome

Question 21

Screen test for thrombotic condition

Answer 21

FBC - elevated 
PBF - myeloproliferative disorders 
PR / APTT - shorter 
Factor assay 
Activated protein C resistance test in FV Leiden 
Assay for protein C and S

Question 22

What is DVT

Answer 22

Formation of blood clot in deep leg vein

May lead to post thrombotic syndrome or PE

Question 23

Mortality rate of DVT

Answer 23

1/100 person with DVT dies

Question 24

What condition is called economy class syndrome

Answer 24

DVT

Question 25

Main location of DVT

Answer 25

Center of leg

Question 26

DVT risk factors

Answer 26

``` Previous DVT Family hx Immobilization Recent surgery More than 40 yo Hormone therapy Oral contraceptive Pregnancy Postpartum Previous/ current cancer Limb trauma Coagulation abnormalities Obesity ```

Question 27

DVT symptoms

Answer 27

``` Leg discoloration Calf pain Leg pain Swelling of leg Warm skin Visible surface veins Leg fatigu ```

Question 28

Diagnosis technique for DVT

Answer 28

``` Serial compression USG Doppler Contrast venography Plasma D dimer concentration MRI ```

Question 29

Drugs used in DVT

Answer 29

Unfractioned heaprin - continuous IV, or intermittent SC - to monitor with APTT Low molecular weight heparin - no monitoring

Question 30

Parentéral Drug given if there is bleeding with heparin

Answer 30

Protamine 1mg/100 units

Question 31

Oral drugs given in DVT

Answer 31

Warfarin

Question 32

In which clinical state do you give warfarin with INR 2.5

Answer 32

``` DVT Pulm Embolism Atrial fibrillation Cardioversion ```

Question 33

Clinical state in which warfarin should in INR 3.5

Answer 33

Recurrent DVT Mechanical heart valves APS

Question 34

If warfarin INR is 3-6 what should you do

Answer 34

Reduce dose | Or stop

Question 35

If warfarin INR is 6-8 or 4-6 what should you do

Answer 35

Stop and Start when <5

Question 36

If warfarin INR is more than 8 what should you do

Answer 36

Can vit k | Restart when les than 5

Question 37

If warfarin give major bleeding what should you do

Answer 37

FFP Vit k Prothrombin n complex

Question 38

Other than heparin, what are other the parties available

Answer 38

Thrombolytic therapy with streptokinase/urokinase | Surgical embolectomy in extensive thrombosis

Question 39

What is post thrombotic syndrome

Answer 39

Complication of DVT treated with anticoagulation alone where clot remain in vein since anticoagulation do not dissolve clot but just prevent their formation Damage of blood veins by body dissolution of clot

Question 40

Percentage of people that develops post thrombotic syndrome

Answer 40

60-70%

Question 41

Can DVT cause pulmonary embolism

Answer 41

Ywa