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Q3 Clin Med II Test 1 (Heme) > Venous Thromboembolism > Flashcards

Venous Thromboembolism Flashcards

1
Q

DVT presentation?

A

(U) asymp
swelling, pain, warm, red

Palpable cord and/or difference >3 cm b/w legs = bad

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2
Q

DVT physical exam components? (6)

A 
Vascular
Extremities
Lungs
Cardiac
Abdominal
Skin
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3
Q

DVT Wells Score?

A

probability of DVT: High = >=3 aggravators

CA, bedridden, swelling, etc: each get point

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4
Q

DVT labs? (5)

A 
CBC w/ platelets
Coag: PT/INR, aPTT
Metabolic Panels: renal and liver
UA
D-dimer
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5
Q

High D-dimers (from fibrin clots) caused by what conditions?

A

DVT/PE
Post-op
Malignancy
Pregnancy

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6
Q

DVT diagnostic tests?

A

*Compression US = loss of vein compressibility

Contrast Venography

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7
Q

DVT testing algorithm

A

If high risk and US = abn -> positive DVT

If US = normal -> do venography
If veno = normal -> no DVT
If veno = abn -> + DVT

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8
Q

DVT tx

A

Prevent clot propagation and PE

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9
Q

UE DVT etiology?

A

spontaneous: thoracic outlet synd

2º: catheter, prothrombic states

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10
Q

UE DVT tx?

A

anticoag
thrombolysis
surgical decompression

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11
Q

DVT vs Superficial Thrombophlebitis (STP) cause?

A

DVT: Virchow’s Triad (stasis, vascular injury, hypercoag)

STP: venous cath/line, pregnancy, trauma, hypercoag

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12
Q

DVT vs Superficial Thrombophlebitis (STP) presentation?

A

DVT: swelling

STP: swelling uncommon

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13
Q

DVT vs Superficial Thrombophlebitis (STP) tx?

A

DVT: anticoag

STP: Ø anticoag, local heat, NSAIDS

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14
Q

PE definition?

A

pulmonary artery or branch obstruction from material originating elsewhere

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15
Q

PE (U) caused by?

A

DVT (U) proximal, rarely from calf DVT

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16
Q

Massive vs Submassive PE?

A

Massive: a/w SBP < 90 or ↓ >= 40 for > 15min;
NOT explained by hypovolemia, sepsis, MI, pneumothorax, new arrhythmia,
results in RV failure

Submassive: all others

17
Q

PE sxs? (6)

A 
dyspnea
pleuritic pain
calf/thigh pain/swelling
cough
orthopnea
wheezing
18
Q

PE signs?

A 
tachypnea
tachycardia
rales
↓ breath sounds
↑ S2
JVD
LE DVT sxs
19
Q

PIOPED II says most common sign and sx of PE are?

A

dyspnea

tachypnea

20
Q

PE prediction

A

Wells for DVT >4 = PE likely

21
Q

PE physical eval?

A 
Vital signs
general exam (BP, HR, RR, mental status)
22
Q

PE labs?

A

same as DVT

(P) thrombin, BNP

23
Q

PE gold stand test?

A

pulmonary angiography:
highly specific/sensitive

disadv: invasive, contrast, expensive

24
Q

VTE tx strategies? (5)

A

1) Anticoag
2) Thrombolytics
3) Thromectomy
4) IVC filter
5) Prophylactics

25
Q

Anticoag meds? (6)

A

1) IV unfractionated Heparin
2) Low MW Heparin
3) Warfarin
4) Fondaparinux
5) Factor Xa Inhibitors
6) Direct Thrombin Inhibitors

26
Q

IV Unfractionated Heparin:

indication

action

A

Initial tx of VTE

Inactivates thrombin, potentiates antithrombin

27
Q

Low MW Heparin:

indication

action

A

outpt DVT and stable PE tx

Inhibits Factor Xa

28
Q

Warfarin:

indication

action

A

long term VTE tx

blocks vit K-dependent coag proteins in liver

29
Q

Duration of Anticoag for:

major transient risk?

minor transient risk?

A

3 months for either

30
Q

Duration of Anticoag for:

cancer?

unprovoked thrombosis?

underlying thrombophilia?

A

CA = 3-6 mo or while CA active

unprovoked = 3 mo

thrombophilia = indefinite, test 3 mo post event

31
Q

Thrombolytics:

indication

action

A

unstable PE

activates plasminogen to make plasmin ->
accelerates lysis of thrombi

32
Q

IVC Filters are/do?

A

filter placed in IVC,

stops clot from moving to lungs

33
Q

IVC Filter indication?

Contraindication?

A

recurrent PE despite anticoag
complications to anticoag
hemo or respiratory compromise

contraindicated w/ anticoag

34
Q

Prophylactics for DVT in hospital?

A

TED hose,
Sequential compression
Heparin low-dose, Lovenox

35
Q

Outpt tx of DVT if? (6)

A 
ambulatory and stable
normal vitals
low bleeding risk
no renal insuff
LMWH/warfarin w/ monitoring
bleed and VTE monitoring

Q3 Clin Med II Test 1 (Heme) (7 decks)

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