thrombosis and embolism

Question 1

atheroma symptoms

Answer 1

atherosclerosis
hardening of arteries
coronary artery disease
ischaemic heart disease

Question 2

atheroma risk factor

Answer 2

smoking 
hypertension 
hyperlipidemia 
diabetes
age 
males
genetics

Question 3

atheroma pathogenesis

Answer 3

primary endothelial injury
accumulation of lipds and macrophages 
migration of smooth muscle cells
increases in size with fibrous cap
rupture 
thrombosis

Question 4

progression of atheromatous plaques

Answer 4

fatty streak
fibrofatty plaque
complicated plaque

Question 5

complications of atheroma

Answer 5

stenosis - cardiac ischaemia, cardiac fibrosis 
thrombosis
aneurysm 
dissection
embolism

Question 6

deep vein thrombosis

Answer 6

a thrombosis formed in the deep venous circulation

Question 7

pulmonary embolism

Answer 7

a thrombus that has embolised and lodged in the pulmonary circulation

Question 8

venous thrombolitic disease

Answer 8

DVT and PE

Question 9

Virchow’s triad

Answer 9

hypercoagulable state
endothelial injury
circulatory stasis

Question 10

exposing risk factors for VTE

Answer 10

surgery 
trauma 
acute medical illness
acute heart failure 
acute respiratory failure 
central venous catherisation

Question 11

predisposing risk factors for VTE

Answer 11

history of VTE
chronic heart failure 
age 
varicose veins 
obesity 
immobility or paresis
myeloproliferative disorders 
pregnancy/peripartum period
inherited or acquired thrombophilia 
hormone therapies 
renal insufficiency

Question 12

exposing/predisposing risk factors for VTE

Answer 12

cancer

inflammatory diseases

Question 13

risk factors VTE

Answer 13

smoking 
travel
prothrombin gene mutation 
combined oral contraceptive 
hormone replacement 
Protien s or c deficiency 
factor V leiden mutation 
pregnancy 
active malignancy 
day surgery 
major surgery

Question 14

DVT presentation

Answer 14

painful and swollen limb with redness and heat
tenderness along vein
sub-acute development

Question 15

PE presentation

Answer 15

sudden SOB with pleuritic pain
possible collapse or haemoptysis
hypoxia and tachycardia
BP may be low

Question 16

D dimer

Answer 16

is breakdown product of cross linked fibrin

Question 17

post thrombotic syndrome

Answer 17

1/3 of patients within 5 years after idiopathic DVT
pain 
oedema 
hyperpigmentation 
eczema 
varicose collateral veins 
venous ulceration

Question 18

DVT management

Answer 18

oral anticoagulation

occasionally thrombolysis

Question 19

PE management

Answer 19

high risk - thrombolysis then oral coagulation

low or intermediate risk - oral coagulation

Question 20

anticoagulants

Answer 20

direct oral anticoagulant - apixaban or rivaroxaban
vitamin K antagonist - warfarin
low molecular weight heparin injections

Question 21

stroke

Answer 21

acute onset of neurological symptoms and sign due to disruption of blood supply

Question 22

haemorrhagic stroke

Answer 22

15-20%
raised BP
weakened blood wall due to structural abnormalities or inflammation

Question 23

ischaemic stroke

Answer 23

80-85%
thrombolytic
embolic
hypoperfusion - due to stenosed artery

Question 24

non modifiable risk factors for stroke

Answer 24

age 
family history
gender 
race 
previous stroke

Question 25

potentially modifiable risk factors for stroke

Answer 25

``` hypertension hyperlipidemia smoking prior history of transient ischaemic attack atrial fibrillation diabetes congestive heart failure alcohol excess obesity physical inactivity poor socioeconomic status ```

Question 26

stroke management

Answer 26

thrombolysis and thrombectomy treat cause multidisciplinary assessment and rehabilitation

Question 27

stroke mimics

Answer 27

``` hypoglycaemia hyponatremia seizure migraine brain tumour functional hemiparesis ```

Question 28

atheroembolism

Answer 28

from a thrombus forming on an atherosclerotic plaque infarcts in same side as affected carotid artery platelet rich

Question 29

cardioembolism

Answer 29

from clot formed in the heart infarcts in more than one arterial territory, bilateral clotting factor rich

Question 30

ischaemic stroke investigations

Answer 30

blood tests - glucose, lipids, thrombophilia screen | assess for hypertension

Question 31

haemorrhagic stroke investigations

Answer 31

imaging to investigate cause hypertensive underlying aneurysm vasculitis

Question 32

surgical management for stroke

Answer 32

haematoma evacuation relief of raised intracranial pressure carotid endartectomy

Question 33

transient ischaemic attacks

Answer 33

temporary neurological symptoms due to occlusion of artery stopping flow of blood