Diagnosis of DVT and PE
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Questions and Answers

Which test is not supported for a stand-alone diagnosis of DVT?

  • Chest x-ray
  • D-dimer test (correct)
  • Venous ultrasound
  • Ventilation perfusion scan

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

  • Chest pain
  • Cough
  • Dyspnea (correct)
  • Hemoptysis

    • In patients where CTPA is contraindicated or inconclusive, which test is typically reserved for further evaluation?

  • Ventilation perfusion scan (correct)
  • Chest x-ray
  • D-dimer test
  • Venous ultrasound

    • What is the traditional normal level of D-dimer considered to be?

    <p>Exactly 500µg/l</p> Signup and view all the answers

    What is the radioactive material used in a V/Q scan to examine airflow and blood flow in the lungs?

    <p>Technetium-99m</p> Signup and view all the answers

    What is the stance on routine chemical prophylaxis in foot/ankle surgery or injuries requiring immobilization?

    <p>It is never warranted.</p> Signup and view all the answers

    What is the preferred exam for suspected DVT?

    <p>Venous duplex ultrasound</p> Signup and view all the answers

    Which of the following should be ordered in any case of suspected DVT?

    <p>D-dimer test</p> Signup and view all the answers

    When should anticoagulants be initiated in patients with suspected DVT?

    <p>After confirming DVT with imaging</p> Signup and view all the answers

    Which of the following is NOT a common choice for anticoagulation in DVT?

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

    Which laboratory value is recommended to assist in the diagnosis of DVT?

    <p>D-dimer</p> Signup and view all the answers

    What is the utility of a positive Homan sign in diagnosing DVT?

    <p>Neither particularly sensitive nor specific</p> Signup and view all the answers

    Which of the following conditions could present with calf pain similar to that seen in a positive Homan sign?

    <p>Gastrocnemius muscle tear</p> Signup and view all the answers

    When should noninvasive duplex ultrasound be ordered for suspected DVT?

    <p>ASAP in all patients postoperatively</p> Signup and view all the answers

    What is the reported sensitivity and specificity of noninvasive duplex ultrasound in diagnosing DVT?

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

    When should D-dimer be ordered in the work-up for DVT?

    <p>Always as the first step</p> Signup and view all the answers

    What does a positive D-dimer test indicate?

    <p>Unlikely presence of DVT</p> Signup and view all the answers

    Which of the following is not a recommended treatment for DVT according to the text?

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

    What is the most appropriate initial anticoagulant to initiate in a patient with suspected DVT?

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

    What is the recommended anticoagulant therapy in DVT for patients with high risk of bleeding?

    <p>Coumadin with heparin bridge</p> Signup and view all the answers

    In the context of suspected DVT, which medication should be considered based on renal status and bleeding risk?

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

    Which medication is suggested by the American College of Chest Physicians (ACCP) 2012 guidelines for acute isolated distal DVT without severe symptoms or risk factors?

    <p>LMWH or heparin</p> Signup and view all the answers

    Which laboratory value is commonly used to assist in diagnosing DVT, but should not be solely relied upon for diagnosis?

    <p>D-dimer</p> Signup and view all the answers

    Which type of DVT treatment does not seem to decrease the incidence of pulmonary embolism (PE) according to the text?

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

    When considering anticoagulation for DVT, which medication is often prescribed as a subcutaneous injection once daily?

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

    In what situation are thrombolytics rarely indicated for DVT management?

    <p>Patients with comorbid conditions</p> Signup and view all the answers

    Which of the following is a key consideration in determining the duration of anticoagulation treatment for a patient with DVT?

    <p>Renal status</p> Signup and view all the answers

    Which of the following is not mentioned as a form of DVT treatment in the text?

    <p>$\text{Thrombectomy}$</p> Signup and view all the answers

    In patients with suspected DVT, what factor besides risk assessment may influence the decision to initiate anticoagulants postoperatively?

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

    What is the mechanism of action (MOA) of aspirin?

    <p>Inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes</p> Signup and view all the answers

    Which of the following blood thinners is not supported by current evidence after foot and ankle surgery?

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

    What is the dosage for Aspirin after foot and ankle surgery?

    <p>81mg BID</p> Signup and view all the answers

    Which of the following is a potential benefit of Low Molecular Weight Heparin (LMWH) over Unfractionated Heparin (UFH)?

    <p>Administered subQ bid/daily</p> Signup and view all the answers

    What is the main benefit of Low Molecular Weight Heparin (LMWH) over Unfractionated Heparin (UFH)?

    <p>Virtually no thrombocytopenia</p> Signup and view all the answers

    What is one potential complication of using Unfractionated Heparin (UFH)?

    <p>Heparin-induced thrombocytopenia (HIT)</p> Signup and view all the answers

    Which anticoagulant has been almost completely replaced by other agents due to its interactions and requirements?

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

    What is the main benefit of using Low Molecular Weight Heparin (LMWH) over Unfractionated Heparin (UFH) according to the text?

    <p>Administered subcutaneously and with less bleeding risk</p> Signup and view all the answers

    When LMWH therapy is considered following foot or ankle surgery, according to the AOFAS consensus panel, when should therapy typically begin?

    <p>When immobilization is initiated and continued for the duration of immobilization</p> Signup and view all the answers

    In which situation would an IVC filter, specifically a Greenfield filter, be considered for patients undergoing foot and ankle surgery?

    <p>When LMWH therapy is contraindicated</p> Signup and view all the answers

    What chemoprophylaxis option is recommended when LMWH injections are not feasible for outpatient use after foot or ankle surgery?

    <p>Dabigatran without need for INR monitoring</p> Signup and view all the answers

    What distinguishes full anticoagulation from prophylactic anticoagulation in the context of DVT management?

    <p>Intensity of the anticoagulation dosage</p> Signup and view all the answers

    Which anticoagulant agent has almost completely replaced warfarin due to interactions and monitoring requirements?

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

    What is a significant consideration in determining the duration of chemoprophylaxis treatment for a patient diagnosed with DVT?

    <p>The presence of immobility postoperatively</p> Signup and view all the answers

    What is a key consideration for determining the duration of anticoagulation treatment for a patient with DVT?

    <p>Type of surgery being performed</p> Signup and view all the answers

    In the context of DVT treatment, which of the following statements is most accurate regarding prophylaxis?

    <p>Routine chemical prophylaxis is not recommended in foot/ankle surgery or injuries requiring immobilization</p> Signup and view all the answers

    When considering the work-up for a suspected DVT, which exam is NOT mentioned as part of the common choices?

    <p>Lower extremity angiography</p> Signup and view all the answers

    What is a potential drawback of using warfarin for DVT treatment?

    <p>Interactions with various medications and foods</p> Signup and view all the answers

    In the context of suspected DVT, which statement about ultrasound is NOT accurate?

    <p>Lower extremity angiography is the most reliable form of ultrasound for DVT diagnosis</p> Signup and view all the answers

    When should prophylaxis for DVT ideally be initiated in patients undergoing foot and ankle surgery?

    <p>Based on the need to be NWB postoperatively and presence of risk factors</p> Signup and view all the answers

    Which of the following is a significant factor in determining the duration of anticoagulation treatment for a patient with DVT?

    <p>Risk of developing postphlebitic syndrome</p> Signup and view all the answers

    What is a potential benefit of Low Molecular Weight Heparin (LMWH) over Unfractionated Heparin (UFH) in DVT treatment?

    <p>Decreased risk of developing postphlebitic syndrome</p> Signup and view all the answers

    In the context of DVT treatment, which medication is often associated with a heparin bridge?

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

    What is a common misconception regarding the use of thrombolytics in DVT management?

    <p>They significantly reduce the incidence of PE</p> Signup and view all the answers

    Which of the following is NOT a common choice for anticoagulation in DVT according to the text?

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

    What is a key consideration in determining the appropriate prophylaxis for foot and ankle surgery or injuries requiring immobilization?

    <p>Risk of developing PE</p> Signup and view all the answers

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