Deep Venous Thrombosis and Pulmonary Embolism: Pathogenesis and Evaluation
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Questions and Answers

What is the main difference between superficial venous thrombosis and deep venous thrombosis?

  • Location within the body
  • Presence or absence of inflammation
  • Risk factors associated
  • Potential for migration (correct)

    • Which condition is described as 'presence of thrombus within a vein accompanied by inflammation'?

  • Thrombus
  • Thrombophlebitis (correct)
  • Deep Venous Thrombosis
  • Pulmonary Embolism

    • What is the annual incidence of DVT/PE in the United States according to the text?

  • 700,000
  • 1,000,000
  • 900,000 (correct)
  • 500,000

    • Which condition following foot and ankle surgery has an incidence rate of 0.15% based on the text?

    <p>Pulmonary Embolism</p> Signup and view all the answers

    In Virchow’s Triad, what does 'alterations in the constituents of the blood' refer to?

    <p>Changes in blood clotting factors</p> Signup and view all the answers

    Which characteristic makes pulmonary embolism potentially fatal according to the text?

    <p>Presence in pulmonary artery</p> Signup and view all the answers

    What is the main reason behind the formation of thrombus in deep veins according to the text?

    <p>Endothelial injury</p> Signup and view all the answers

    In the context of deep vein thrombosis (DVT), what is a common symptom that should raise a high index of suspicion?

    <p>Warmth along the affected extremity</p> Signup and view all the answers

    What is the typical location of distal DVT as mentioned in the text?

    <p>Veins confined to the calf (peroneal, posterior tibial)</p> Signup and view all the answers

    What percentage of thigh DVT cases are likely to propagate to pulmonary embolism if left untreated, based on the text?

    <p>50%</p> Signup and view all the answers

    What is one of the key functions of valves in deep veins?

    <p>Preventing blood from flowing backward</p> Signup and view all the answers

    How does blood from superficial veins typically pass into deep veins according to the text?

    <p>Through perforators</p> Signup and view all the answers

    What is the recommended treatment for acute isolated distal DVT without severe symptoms or risk factors?

    <p>Serial imaging of deep veins for 2 weeks</p> Signup and view all the answers

    Which anticoagulant is NOT typically recommended for DVT management based on the information provided?

    <p>Thrombolytics</p> Signup and view all the answers

    What does LMWH stand for in the context of DVT management?

    <p>Low Molecular Weight Heparin</p> Signup and view all the answers

    In which scenario is thrombectomy seldom performed according to the text?

    <p>In all cases of DVT</p> Signup and view all the answers

    Why do most providers continue to prescribe prophylaxis despite recommendations against it?

    <p>Lack of awareness about the recommendations</p> Signup and view all the answers

    What is the main purpose of oral chemoprophylaxis in DVT management?

    <p>To decrease the incidence of PE</p> Signup and view all the answers

    What is the potential impact of thorough risk assessment on venous thromboembolism prophylaxis implementation in foot and ankle surgery?

    <p>Improving patient outcomes</p> Signup and view all the answers

    What is a potential consequence of not implementing proper deep venous thrombosis prophylaxis in orthopedic surgery?

    <p>Increased risk of postoperative complications</p> Signup and view all the answers

    In the context of the cohort study by Sweetland et al., what demographic group was specifically studied regarding the postoperative risk of venous thromboembolism?

    <p>Middle-aged women</p> Signup and view all the answers

    How does superficial venous thrombosis differ from deep venous thrombosis according to the information provided in the text?

    <p>Affecting superficial veins close to the skin</p> Signup and view all the answers

    What key factor contributes to the potential fatality of pulmonary embolism as highlighted in the mentioned information?

    <p>Obstruction of blood flow to the lungs</p> Signup and view all the answers

    What is the most common presenting symptom for pulmonary embolism (PE)?

    <p>Dyspnea</p> Signup and view all the answers

    Which test uses radioactive material to examine airflow and blood flow in the lungs?

    <p>Ventilation perfusion scan</p> Signup and view all the answers

    What is the reported sensitivity and specificity of noninvasive duplex ultrasound in diagnosing deep vein thrombosis (DVT)?

    <p>More than 90%</p> Signup and view all the answers

    When should a ventilation perfusion scan (V/Q scanning) be mostly reserved for patients?

    <p>When CTPA is contraindicated or inconclusive</p> Signup and view all the answers

    What was the average timing to the diagnosis of venous thromboembolism (VTE) according to Saragas et al?

    <p>33.1 days postoperatively</p> Signup and view all the answers

    What can a positive Homan sign indicate in patients?

    <p>Ruptured Bakers cyst</p> Signup and view all the answers

    What timing of DVT postoperatively has been described as a bell curve with increased incidence around week 2 and 3 following inpatient shoulder replacement?

    <p>Around week 2 and 3</p> Signup and view all the answers

    Which test is reserved for patients in whom computed tomography pulmonary angiogram (CTPA) is contraindicated or inconclusive?

    <p>Ventilation perfusion scan (V/Q scanning)</p> Signup and view all the answers

    What symptom is NOT mentioned as a common presenting symptom for pulmonary embolism?

    <p>Hemoptysis</p> Signup and view all the answers

    What is the sensitivity and specificity of noninvasive duplex ultrasound in diagnosing deep vein thrombosis (DVT)?

    <p>More than 90%</p> Signup and view all the answers

    For which condition would a chest x-ray typically show normal or near-normal results?

    <p>Pulmonary embolism</p> Signup and view all the answers

    What is the most likely diagnosis associated with a positive Homan sign according to the given text?

    <p>Ruptured Baker’s cyst</p> Signup and view all the answers

    Why is postoperative deep vein thrombosis (DVT) prevention considered fundamental according to the text?

    <p>To reduce the risk of pulmonary embolism</p> Signup and view all the answers

    What does the ACFAS Clinical Consensus Panel recommend regarding chemical prophylaxis in foot and ankle surgery?

    <p>To stratify patients for prophylaxis based on risk</p> Signup and view all the answers

    What is one of the main reasons specialty societies emphasize venous thromboembolism prophylaxis after hip or knee arthroplasty?

    <p>To mitigate the danger of postoperative pulmonary embolism</p> Signup and view all the answers

    Why is it important to identify patients at risk for deep vein thrombosis (DVT) according to the text?

    <p>To select appropriate pre-operative treatment</p> Signup and view all the answers

    What is a key rationale behind not prescribing routine chemical prophylaxis in foot and ankle surgery?

    <p>Lack of evidence supporting routine chemical prophylaxis</p> Signup and view all the answers

    Why does the text suggest that foot and ankle surgeons should develop a prophylaxis plan for high-risk patients?

    <p>To tailor preventive measures to patients at risk of VTED</p> Signup and view all the answers

    In what situation would the American College of Chest Physicians (ACCP) 2012 guidelines recommend performing serial imaging of the deep veins for 2 weeks?

    <p>For acute isolated distal DVT without severe symptoms or risk factors</p> Signup and view all the answers

    Which type of management is NOT recommended for most cases of deep vein thrombosis (DVT) according to the information provided?

    <p>Thrombolytic therapy</p> Signup and view all the answers

    What is the primary purpose of LMWH in venous thromboembolism prophylaxis according to the text?

    <p>To reduce the rate of clinically significant VTED</p> Signup and view all the answers

    Which anticoagulant is commonly used with a heparin bridge for treating deep vein thrombosis (DVT)?

    <p>Coumadin</p> Signup and view all the answers

    When should anticoagulation therapy be initiated in patients with acute isolated distal DVT?

    <p>If patients have concurrent symptomatic pulmonary embolism</p> Signup and view all the answers

    What does the American College of Chest Physicians (ACCP) 2012 guidelines recommend for patients with acute isolated distal DVT without severe symptoms or risk factors?

    <p>Serial imaging for 2 weeks</p> Signup and view all the answers

    What is a common consideration for choosing the type of anticoagulation therapy post-surgery?

    <p>Need for non-weight bearing (NWB) postoperatively</p> Signup and view all the answers

    Based on the text, why is it important to identify risk factors before discussing anticoagulation plans?

    <p>To tailor anticoagulation plans based on individual risk factors</p> Signup and view all the answers

    What is a key factor influencing the duration of anticoagulation treatment post-surgery?

    <p>The presence of non-surgical risk factors and non-weight bearing status</p> Signup and view all the answers

    Why should healthcare providers reach out to Primary Care Physicians (PCP) or Hematology for additional guidance?

    <p>In case of unexpected complications or need for specialized advice</p> Signup and view all the answers

    Which factor plays a significant role in deciding the appropriate anticoagulation therapy?

    <p>The type of surgery performed and the risks involved</p> Signup and view all the answers

    What is a key aspect to consider when discussing plans for anticoagulation after foot and ankle surgery?

    <p>The need for non-weight bearing (NWB) and presence of risk factors</p> Signup and view all the answers

    What potential impact can a lack of proper venous thromboembolism prophylaxis implementation have on patients undergoing foot and ankle surgery?

    <p>Higher incidence of postoperative deep vein thrombosis</p> Signup and view all the answers

    In the context of orthopedic surgery, which factor might contribute significantly to the potential fatality of pulmonary embolism?

    <p>Presence of preexisting comorbidities</p> Signup and view all the answers

    What is the main reason behind the recommendation for continued prescription of prophylaxis by most providers despite some guidelines suggesting otherwise?

    <p>Better safe than sorry approach</p> Signup and view all the answers

    In the study by Sweetland et al., what specific demographic group was the focus in assessing the postoperative risk of venous thromboembolism?

    <p>Middle-aged women</p> Signup and view all the answers

    What is the primary purpose of using oral chemoprophylaxis in the management of deep vein thrombosis?

    <p>To decrease the risk of pulmonary embolism</p> Signup and view all the answers

    What differentiates delayed union from nonunion?

    <p>Shows slower progression to healing than anticipated</p> Signup and view all the answers

    What is the key characteristic of an atrophic nonunion?

    <p>Radiographically absent callus</p> Signup and view all the answers

    What distinguishes hypertrophic nonunion from atrophic nonunion?

    <p>Radiographically abundant callus formation</p> Signup and view all the answers

    Which term describes osseous healing that has occurred but in less than an optimal position?

    <p>Malunion</p> Signup and view all the answers

    What type of nonunion is characterized by radiographically abundant callus formation and lack of union between bone ends?

    <p>Oligotrophic Nonunion</p> Signup and view all the answers

    In the context of bone grafting, what type of situation would most likely require grafting?

    <p>Inadequate stability at the fracture site</p> Signup and view all the answers

    What is the basic science rationale behind the use of electrical stimulation for bone healing?

    <p>Upregulates TGF-β and BMP's for osteoinduction</p> Signup and view all the answers

    In the context of Extracorporeal Shock Wave Therapy (ESWT), what is the purpose of inducing microtrauma in the bone?

    <p>Promote neovascularization and cell differentiation</p> Signup and view all the answers

    What is considered the 'gold standard' for bone grafting due to its osteoinductive, osteogenic, and osteoconductive properties?

    <p>Autologous Bone Graft</p> Signup and view all the answers

    Based on the text, what is a contraindication for the use of Electrical Stimulation in bone healing?

    <p>Synovial pseudoarthrosis</p> Signup and view all the answers

    What is the main rationale behind using Autogenous Bone Graft in bone healing procedures?

    <p>Containing viable cells and promoting vascular ingrowth</p> Signup and view all the answers

    What type of wave is utilized in Extracorporeal Shock Wave Therapy (ESWT) to induce microtrauma in the bone?

    <p>High amplitude and short wavelength</p> Signup and view all the answers

    Which scenario is most likely to lead to a Septic Nonunion based on the text?

    <p>Inadequate joint preparation with excessive motion</p> Signup and view all the answers

    What is a key characteristic of Pseudoarthrosis according to the text?

    <p>Atrophic and reactive</p> Signup and view all the answers

    Which statement best describes Secondary (Indirect) Bone Healing?

    <p>Relative stability with fracture hematoma formation and cellular proliferation</p> Signup and view all the answers

    What is a critical factor influencing Osseous Healing according to the text?

    <p>Mechanical stability with tension on fibroblasts</p> Signup and view all the answers

    Which factor plays a significant role in the Diamond Concept Etiology of Nonunion?

    <p>Transforming growth factor beta (TGFβ)</p> Signup and view all the answers

    What is the primary role of Osteogenic Cells in the Diamond Concept according to the text?

    <p>Guiding the proliferation and differentiation process towards callus formation</p> Signup and view all the answers

    What is the main function of Osteoconductive Matrix in the Diamond Concept?

    <p>'Natural' scaffold formation at the fracture site</p> Signup and view all the answers

    'Mechanical Stability' is a key factor in the Diamond Concept for encouraging which cell type in bone healing?

    <p>Fibroblasts</p> Signup and view all the answers

    'Nicotine Use' is associated with an increased risk of what outcome according to the text?

    <p>'Nonunion' risk with decreased peripheral oxygen tension</p> Signup and view all the answers

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