Recognition
Which of the following is a risk factor for DVT?
a. Over-exercising
b. Surgery
c. Alcohol use
d. Chronic ASA use
b. surgery
Of the following, which is NOT a risk factor for DVT.
a. Atrial fibrillation
b. Orthopedic procedures
c. History of falls
d. Myocardial infarction
C. history of falls
How long is anticoagulation continued for treatment of an acute provoked DVT generally?
a. 12 months
b. 6 months
c. 3 months
d. 9 months
c. 3 months
Patient on DVT ppx develops sudden, severe red/hot/swollen leg with labs significant for low platelet count. What is the diagnosis?
HITT - Heparin Induced Thrombocytopenia
sx: usually s/sx of DVT and/or PE. Antibodies attack heparin-platelet factor 4 complexes, leading to paradoxical activation of platelets and clotting, usually 5-10 days after starting heparin.
Hallmark = platelet count drop of 50%+.
First line tx is argatroban.
Percentage of people with DVT/PE that die within one month of diagnosis?
10-30%
Of the following, it is the one that is NOT FOUND in Virchow’s Triad.
a. Hypercoagulability
b. Circulatory stasis
c. Peripheral edema
d. Vascular damage
C. peripheral edema
What drug can be given prophylactically to a patient at risk for DVT?
a. Warfarin
b. Heparin
c. LMWH (low molecular weight heparin)
d. Clopidogrel
C. LMWH
Which part of the coagulation cascade do apixaban and rivaroxaban inhibit?
factor Xa
Condition in which damaged vein valves and residual blood clots cause high pressure in the veins, leading to leg swelling, aching, heaviness, and skin discoloration. Affects about 20-50% of DVT patients.
post-thrombotic syndrome
what drug class is most commonly associated with VTE/PE risk?
oral contraceptives
This is a common sign of DVT.
A. Pain when lying supine
B. Diaphoresis
C. Headache
D. Erythema
D. erythema
True or False: Administration of LMWH requires close monitorization of lab values.
false
What lab value must be monitored when giving warfarin.
a. platelet count
b. Prothrombin time (PT)
c. INR
d. activated partial thromboplastin time (aPTT)
c. INR
which of the following is the most likely complication of a DVT in the right leg?
a. stroke
b. myocardial infarction
c. pulmonary embolism
d. GI bleed
c. PE
What is the name of the scoring system used to determine the pretest probability of a patient having a PE?
Wells criteria for PE
1.Clinical signs and symptoms of DVT (+3)
2. PE is #1 diagnosis OR equally likely (+3)
3. Heart rate >100 (+1.5)
4. Immobilization at least 3 days OR surgery in the previous 4 weeks (+1.5)
5. Previous, objectively diagnosed PE or DVT (+1.5)
6. Hemoptysis (+1)
7. Malignancy w/ treatment within 6 months or palliative (+1)
scores <=4: PE unlikely
Which of the following matches the Homan's sign
a. Pain in the calf upon dorsiflexion
b. Severe pain when lying supine and leg is straightened
c. Patients hip and knees flex in response to head being maneuvered towards chest
d. small palpable mass in epigastric region
d. lying prone
A. pain in the calf with dorsiflexion
True or False: Age related changes can lead to false negatives on D-dimer Tests
False; can lead to false positive
What usually constitutes a positive ultrasound finding in a patient with DVT?
inability to fully compress a vein in the deep venous system
Major complication that occurs in about 50% of DVT patients.
PE
What type of medication is used to breakdown clots in patients with serious DVT complications?
a. NSAIDS
b. Thrombolytic drugs
c. Anticoagulants
d. Antibiotics
b. thrombolytics
This is the most common place for DVT to occur.
lower extremity deep veins
What would constitute mechanical DVT prophylaxis?
compression stockings, SCDs.
What is an alternative method of treatment for PE in patients who fail anticoagulation, develop complications from anticoagulation, or have high bleeding risk?
IVC filter
DVT/PE patient develops jugular dissension and peripheral edema. What is the most likely complication?
right heart failure
Therapeutic INR level for warfarin in acute DVT?
a. 1.0-2.0
b. 2.0-3.0
c. 3.0-4.0
d. >5.0
B. 2.0-3.0