Thrombotic Disorders

Question 1

name the elements of haemostasis

Answer 1

primary haemostasis
blood coagulation
fibrinolysis

Question 2

name the components of primary haemostasis

Answer 2

vasoconstriction
platelet adhesion
platelet aggregation

Question 3

name the components of blood coagulation

Answer 3

insoluble fibrin formation

fibrin crosslinking

Question 4

what converts plasminogen to plasmin?

Answer 4

XII
urokinase
tissue plasminogen activator

Question 5

name the components of Virchow’s triad and what its for

Answer 5

thrombosis:

stasis, vessel damage, hypercoagulability

Question 6

when would you be in a hypercoaguable state?

Answer 6

pregnancy

trauma

Question 7

what makes blood stasis more likely to occur?

Answer 7

best rest

travel

Question 8

what forms a clot in the arterial system?

Answer 8

platelets and fibrin

Question 9

what does an arterial thrombus result in?

Answer 9

ischaemia and infarction

Question 10

arterial thrombi are principally secondary to?

Answer 10

atherosclarosis

Question 11

name the results of a coronary thrombus

Answer 11

MI

unstable angina

Question 12

name the results of a cerebrovascular thromboembolism

Answer 12

stroke

transient ischaemia

Question 13

name the results of peripheral embolism

Answer 13

limb ischaemia

Question 14

risk factors for arterial thrombi

Answer 14

age
smoking
sedentary lifestyle
hypertension
DM
obesity
hypercholesterolaemia

Question 15

management of arterial thrombi

Answer 15

o	Primary prevention
	Lifestyle modification
	Treatment of vascular risk factors
o	Acute presentation
	Thrombolysis
	Antiplatelet/anticoagulant drugs
o	Secondary prevention

Question 16

name the components of a venous thrombus

Answer 16

fibrin and red cells

Question 17

what does venous thrombus result in?

Answer 17

back pressure

Question 18

what is venous thrombus principally due to?

Answer 18

stasis and hypercoagulability

Question 19

effects of a VTE

Answer 19

limb deep vein thrombosis
PE
visceral venous thrombosis
intracranial venous thrombosis
superficial thrombophlebitis

Question 20

risk factors for venous thrombus

Answer 20

age
pregnancy
hormonal therapy - COCP/HRT
tissue trauma
immobility
surgery
obesity
systemic disease
family history

Question 21

systemic disease and venous thrombosis

Answer 21

cancer
myeloproliferative neoplasm (MPN)
autoimmune disease - IBD, connective tissue disease (SLE), antiphospholipid syndrome - arterial and venous thrombosis

Question 22

diagnosis of venous thrombus: pretest probability scoring

Answer 22

Wells score

Geneva score

Question 23

diagnosis of venous thrombus: lab testing if pretest probability low

Answer 23

D-dimer

Question 24

diagnosis of venous thrombus: imaging

Answer 24

Doppler US
V/Q scan
CT pulmonary angiogram

Question 25

aim of management in venous thrombosis

Answer 25

prevent clot extension prevent clot embolisation prevent clot recurrent in long term treatment

Question 26

drugs for treatment of venous thrombosis

Answer 26

anticoagulants - LMWH, coumarins (warfarin), DOACs | thrombolysis

Question 27

when would you consider thrombolysis in venous thrombosis?

Answer 27

massive PE

Question 28

heritable thrombophilia is/

Answer 28

an inherited predisposition to venous thrombosis

Question 29

what problems may cause heritable thrombophilia?

Answer 29

``` o Common  Factor V Leiden  Prothrombin G20210A o Rare  Antithrombin deficiency  Protein C deficiency  Protein S deficiency ```

Question 30

screening and heritable thrombophilia

Answer 30

* Majority are not predictive of recurrent events * Screening of asymptomatic family members not recommended * Limited thrombophilia screening: restricted to high risk heritable thrombophilia (antithrombin deficiency)

Question 31

microvascular thrombus is a result of?

Answer 31

platelets and/or fibrin

Question 32

what does microvascular thrombus result in?

Answer 32

diffuse ischaemia

Question 33

main cause of microvascular thrombus?

Answer 33

disseminated intravascular coagulation

Question 34

what is DIC?

Answer 34

diffuse systemic coagulation activation

Question 35

when does DIC occur?

Answer 35

septicaemia malignancy eclampsia

Question 36

what does DIC result in?

Answer 36

gangrene organ failure consumption of platelets and clotting factors leading to bleeding