DVT/PE

Question 1

Name the three components of Virchow’s triad.

Answer 1

• Venous stasis
• Endothelial damage
• Hypercoagulable state

These components are critical in understanding the pathophysiology of venous thromboembolism.

Question 2

Name three high-risk factors for DVT.

Answer 2

• Hip or knee replacement
• Lower limb fracture
• Major trauma
• Previous VTE
• MI within 3 months
• Spinal cord injury
• Admission for HF or AFib

Identifying high-risk factors is essential for prevention and management of DVT.

Question 3

Name three moderate risk factors for DVT.

Answer 3

• Heart failure
• Oral contraceptive use
• Postpartum state
• Infection
• Cancer
• Thrombophilia

Moderate risk factors also contribute to the likelihood of developing DVT.

Question 4

Name four clinical features of DVT.

Answer 4

• Unilateral leg edema
• Erythema
• Warmth
• Tenderness
• Palpable cord
• Pain with dorsiflexion (Homan sign)

Recognizing these features is important for diagnosis.

Question 5

Name three differential diagnoses for unilateral leg swelling suspicious for DVT.

Answer 5

• Ruptured Baker’s cyst
• Venous valvular insufficiency
• Cellulitis

Differentiating DVT from other conditions is crucial for appropriate management.

Question 6

In suspected DVT with **Wells score <2 **, what is the next diagnostic step?

Answer 6

• D-dimer

A negative D-dimer can help rule out DVT.

Question 7

In suspected DVT with Wells score ≥2, what investigation should be ordered first?

Answer 7

• Venous compression ultrasound

This is the preferred initial imaging modality for suspected DVT.

Question 8

A patient has high Wells score but negative initial ultrasound. Name the next step.

Answer 8

• D-dimer
• Repeat ultrasound in 3–7 days

This approach helps confirm or rule out DVT.

Question 9

What should be done if imaging for suspected DVT will be delayed?

Answer 9

• Start anticoagulation

Early anticoagulation can prevent complications.

Question 10

Name two anticoagulant options for treatment of DVT.

Answer 10

• LMWH (enoxaparin)
• Apixaban
• Rivaroxaban

These medications are commonly used for DVT treatment.

Question 11

What is the minimum duration of anticoagulation for provoked DVT?

Answer 11

• 3 months

This duration is recommended to prevent recurrence.

Question 12

In unprovoked DVT, what medication can be considered after stopping anticoagulation?

Answer 12

• Aspirin

Aspirin may help reduce the risk of recurrence.

Question 13

Name three criteria favoring anticoagulation in isolated distal DVT.

Answer 13

• Positive D-dimer
• Thrombosis >5 cm length
• Diameter >7 mm
• Close to proximal vein
• Active cancer
• Prior VTE
• Severe symptoms
• No reversible provoking cause

These criteria help guide treatment decisions.

Question 14

What is the preferred management for isolated distal DVT with low risk of extension?

Answer 14

• Serial imaging for 2 weeks

This approach monitors for potential progression.

Question 15

Name three non-pharmacologic DVT prophylaxis strategies.

Answer 15

• Early ambulation
• Graduated compression stockings
• Intermittent pneumatic compression

These strategies are important for preventing DVT in at-risk patients.

Question 16

Name two preventive strategies for patients with prior VTE taking long flights (>6h).

Answer 16

• Compression stockings
• Single dose LMWH

These measures help reduce the risk of DVT during long travel.

Question 17

Name four symptoms of pulmonary embolism.

Answer 17

• Sudden dyspnea
• Pleuritic chest pain
• Syncope
• Hemoptysis

Recognizing these symptoms is critical for timely diagnosis.

Question 18

Name three physical signs of pulmonary embolism.

Answer 18

• Tachypnea
• Tachycardia
• Hypoxemia
• Hypotension

These signs can indicate the severity of the condition.

Question 19

Name three ECG findings suggestive of pulmonary embolism.

Answer 19

• S1Q3T3 pattern
• Right bundle branch block
• T wave inversions
• RV strain pattern

These findings can assist in the diagnosis of PE.

Question 20

In suspected PE, what should be assessed first before diagnostic testing?

Answer 20

• Hemodynamic stability (SBP)

Assessing stability is crucial for determining the urgency of intervention.

Question 21

A patient with suspected PE has SBP <90 mmHg. What is the next investigation?

Answer 21

• CT pulmonary angiography (CTPA)

This imaging is critical for confirming PE in unstable patients.

Question 22

In hemodynamically stable PE with Wells <4.5, what rule should be applied next?

Answer 22

• PERC rule

The PERC rule helps to further stratify risk.

Question 23

If Wells <4.5 and PERC is negative, what is the probability of PE?

Answer 23

• <2%

This low probability suggests that PE is unlikely.

Question 24

If Wells <4.5 but PERC is positive, what test should be ordered next?

Answer 24

• D-dimer

A positive D-dimer may indicate the need for further imaging.

Question 25

A positive D-dimer in suspected PE should be followed by what **investigation**?

Answer 25

* CT pulmonary angiography ## Footnote This is the next step to confirm or rule out PE.

Question 26

Name two situations where **V/Q scan** should be considered instead of CTPA.

Answer 26

* Young patients (especially women) * Patients who cannot tolerate radiation ## Footnote V/Q scans are useful alternatives in specific populations.

Question 27

What scoring system is used to assess **severity and prognosis** of pulmonary embolism?

Answer 27

* PE Severity Index (PESI) ## Footnote PESI helps in determining the management approach.

Question 28

Name three features of **high-risk (massive)** pulmonary embolism.

Answer 28

* Cardiac arrest * SBP <90 mmHg * Persistent hypotension (>15 minutes) * Need for vasopressors ## Footnote These features indicate a critical condition requiring immediate intervention.

Question 29

Name three components of **supportive management** for pulmonary embolism.

Answer 29

* Oxygen therapy * Anticoagulation * Treat RV failure ## Footnote Supportive care is essential in managing PE.

Question 30

What anticoagulant should be used when there is **high suspicion for PE** and imaging is delayed?

Answer 30

* Unfractionated heparin ## Footnote This anticoagulant is preferred in urgent situations.

Question 31

What is the treatment for **hemodynamically unstable** pulmonary embolism?

Answer 31

* Systemic thrombolytics * Embolectomy ## Footnote These interventions are critical for unstable patients.

Question 32

How should **right ventricular failure** in PE be treated hemodynamically?

Answer 32

* Vasopressors rather than IV fluids ## Footnote This approach helps manage hemodynamic instability.

Question 33

A patient remains dyspneic 3–6 months after PE treatment. Name two **investigations** to assess complications.

Answer 33

* Transthoracic echocardiogram * NT-proBNP * V/Q scan ## Footnote These tests can help evaluate long-term complications of PE.

Question 34

Name four components of the **Wells criteria for DVT**.

Answer 34

* Active cancer * Paralysis, paresis, or recent immobilization of the lower extremities * Bedridden for more than 3 days or recent major surgery * Localized tenderness along the deep venous system * Entire leg swelling * Calf swelling >3 cm compared to the other leg * Pitting edema confined to the symptomatic leg * Collateral superficial veins * Previous DVT * Alternative diagnosis at least as likely as DVT (subtracts points) ## Footnote The Wells criteria are used to assess the probability of deep vein thrombosis.

Question 35

Name four components of the **Wells criteria for pulmonary embolism (PE)**.

Answer 35

* Clinical signs of DVT * PE more likely than alternative diagnosis * Heart rate >100 bpm * Immobilization ≥3 days or surgery within previous 4 weeks * Previous DVT or PE * Hemoptysis * Active cancer ## Footnote The Wells criteria help determine the likelihood of pulmonary embolism.