DVT- PE

Question 1

Causes of DVT

Answer 1

1. Trauma
2. Major surgery (ie THA or TKA)
3. OCP
4. Smoking + OCP
5. Cancer
6. Pregnancy/post natal
7. Hypercoaguability (aCL, genetic, factor V)

Question 2

DVT presentation

Answer 2

1. Skin warm, tender

2. Calf pain

Question 3

DVT most often associated with what

Answer 3

PE

Question 4

What is Homan’s sign

Answer 4

Calf pain with passive dorsiflexion of the foot (positive 8-56% of pt with DVT; also positive in 50% of symptomatic people without DVT)

Question 5

Gold standard for DVT diagnosis

Answer 5

U/S doppler

Question 6

Other options for DVT dx (rarely done)

Answer 6

1. MRI and CT venography

2. D-dimer (lab assessing fibrin degradation products). Neg rules out DVT but if positive must do PE workup

Question 7

Treatment DVT

Answer 7

1. Leg exercises
2. Compression stockings
3. Frequent ambulation
4. anticoagulation with warfarin, lovenox, heparin

Question 8

How is superficial thrombophlebitis treated

Answer 8

1. Aspirin (controversy NSAIDs may also cause clot exception aspirin reduces cox 1 more than cox 2 thus less clotting risk)
2. Heat
3. Elevation of extremity

Question 9

Recommended anticoagulant use after DVT

Answer 9

3 mo on 1st episode
Heparin
Warfarin

Question 10

Surgical treatment for DVT

Answer 10

1. IVC filter (if concern for PE)
2. Thrombolysis
3. Thrombectomy

Question 11

PE risk factors

Answer 11

Virchow’s triad of venous thrombosis

1. altered blood flow
2. Hypercoagulable state (i.e. polycythemia)
3. Endothelial injury

Question 12

PE presentation pt presentation

Answer 12

1. Chest pain
2. dyspnea
3. Shortness of breath
4. Hemoptysis

Question 13

PE physical exam findings

Answer 13

1. Tachypnea
2. Tachycardia
3. EKG- normal, but may also have non-specific ST changes
4. Hypoxemia
5. CXR
   * * Westermark sign= dilation of pulmonary vessels prox to embolism with collapse distal vessels often with sharp cut off sign on cxr.
   * * Hamptom’s Hump= dome-shaped, pleural-based opacification due to lung infarct

Question 14

Gold standard for PE

Answer 14

Pulmonary CT angiography

Question 15

Treatment for PE

Answer 15

1. Anticoagulation 6-12 months
   - Heparin immediately and then bridge to warfarin for long-term treatment
2. Thrombolytics (controversial)
3. IVC filter
4. Embolectomy