Venous Thromboembolic Disease Quiz
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Questions and Answers

What is the primary source of Pulmonary Embolism?

  • Lower limb deep veins (correct)
  • Pelvic veins
  • Upper limb deep veins
  • Abdominal veins

    • What is the path that an embolus takes to reach the pulmonary artery?

  • Femoral artery → IVC → RA → LA → Pulmonary artery
  • Femoral artery → IVC → RA → RV → Pulmonary artery
  • Femoral vein → IVC → RA → RV → Pulmonary artery (correct)
  • Femoral vein → IVC → LV → LA → Pulmonary artery

    • What is the primary component in the formation of a thrombus?

  • Fibrin (correct)
  • Platelets
  • Red blood cells
  • White blood cells

    • What is the term for a blood clot that forms within a blood vessel?

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

    What is the term for a piece of a thrombus that breaks off and travels to another part of the body?

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

    What is the main symptom of massive pulmonary embolism?

    <p>All of the above</p> Signup and view all the answers

    Why does hypotension occur in massive pulmonary embolism?

    <p>Due to the closure of the RV outlet</p> Signup and view all the answers

    What is the characteristic ECG finding in massive pulmonary embolism?

    <p>Sinus tachycardia</p> Signup and view all the answers

    What is the classical ECG finding in massive pulmonary embolism?

    <p>S1Q3T3 is the classical finding</p> Signup and view all the answers

    What is the most common abnormality seen on chest X-ray in massive pulmonary embolism?

    <p>No abnormality is seen</p> Signup and view all the answers

    What is the initial investigation of choice in massive pulmonary embolism?

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

    What is the approximate incidence of Deep Vein Thrombosis (DVT) per year?

    <p>1 per 1000</p> Signup and view all the answers

    What percentage of Venous Thromboembolism (VTE) present with Pulmonary Embolism (PE) initially?

    <p>40%</p> Signup and view all the answers

    What is a strong risk factor for Deep Vein Thrombosis (DVT)?

    <p>Major surgery</p> Signup and view all the answers

    What is the characteristic of a proximal Deep Vein Thrombosis (DVT)?

    <p>High risk of Pulmonary Embolism (PE)</p> Signup and view all the answers

    What is a characteristic of a distal Deep Vein Thrombosis (DVT)?

    <p>Low risk of Pulmonary Embolism (PE)</p> Signup and view all the answers

    What is a significant percentage of Venous Thromboembolism (VTE) cases?

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

    What is an indication for prophylactic anticoagulants?

    <p>Major surgery</p> Signup and view all the answers

    What is a characteristic of Pulmonary Embolism (PE)?

    <p>Can occur with minimal symptoms</p> Signup and view all the answers

    What is the primary reason for hearing localized crackles on auscultation in an area of pulmonary infarction?

    <p>Inflammation of the pleural cavity</p> Signup and view all the answers

    What is the significance of a pleural rub heard on auscultation in an area of pulmonary infarction?

    <p>It suggests a large area of pulmonary infarction</p> Signup and view all the answers

    What is the most likely cause of localized crackles and a pleural rub over an area of pulmonary infarction?

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

    What is the importance of auscultation in diagnosing pulmonary infarction?

    <p>It is a non-invasive method to diagnose pulmonary infarction</p> Signup and view all the answers

    What is the relationship between localized crackles and a pleural rub in an area of pulmonary infarction?

    <p>They are often seen together</p> Signup and view all the answers

    What is the primary modality of choice for imaging deep venous thrombosis?

    <p>Ultrasonography of the deep venous system</p> Signup and view all the answers

    What is the gold standard for pulmonary embolism imaging?

    <p>Pulmonary artery angiography</p> Signup and view all the answers

    What is the primary indication for thrombolysis in pulmonary embolism?

    <p>Massive PE with hypotension</p> Signup and view all the answers

    What is the primary advantage of direct oral anticoagulants (DOACs) over traditional anticoagulation?

    <p>No need for monitoring</p> Signup and view all the answers

    What is the primary difference between a DVT and a PE?

    <p>Location of the thrombus</p> Signup and view all the answers

    What is the Wells score used for?

    <p>Assessing the risk of DVT</p> Signup and view all the answers

    What is the primary reason for using compression ultrasound in DVT diagnosis?

    <p>To assess compression of the vein</p> Signup and view all the answers

    What is the primary indication for surgical intervention in PE?

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

    Study Notes

    Venous Thromboembolic Disease

    • Venous thromboembolic disease encompasses two diseases: deep vein thrombosis (DVT) and pulmonary embolism (PE)
    • DVT occurs when a blood clot forms in the deep veins, usually in the lower limbs
    • If the clot breaks loose and travels to the lungs, it's called a pulmonary embolism (PE)

    Pathogenesis of Thrombosis

    • Thrombosis is the formation of a blood clot within a blood vessel, mainly due to fibrin formation with contributions from platelets and other cells
    • The more proximal the thrombosis, the higher the risk of PE
    • Distal thromboses are less likely to cause PE and are harder to diagnose on ultrasound

    Epidemiology and Risk Factors

    • Venous thromboembolism is a common disease, affecting 1 in 1000 people per year
    • Incidence increases with age, and 60% of cases present with DVT, while 40% present with PE
    • A significant percentage of VTEs are subclinical
    • Risk factors include major surgery, trauma, and absolute bed rest

    Clinical Features

    • Massive PE can cause central chest pain, syncope, hypotension, shock, and raised JVP and right ventricular heave
    • Localized crackles and a pleural rub may be heard on auscultation

    Diagnosis

    • Initial investigations include ECG and chest X-ray, which may be normal or show unspecific abnormalities
    • DVT imaging modalities include ultrasonography of the deep venous system and venography
    • PE imaging modalities include computed tomographic pulmonary angiography (CTPA) and V/Q isotope scan
    • Pulmonary artery angiography is the gold standard for diagnosing PE

    Wells Score and D-Dimer

    • Wells score is used to determine the likelihood of DVT
    • D-dimer is a fibrin degradation product, and high levels indicate activation of the coagulation system

    Treatment

    • Anticoagulation with traditional anticoagulants or direct oral anticoagulants
    • Thrombolysis may be indicated in selected patients with massive PE
    • Surgical intervention may be necessary in some cases

    Traditional Anticoagulation

    • Low molecular weight heparin (LMWH) is used until sufficient coagulation with warfarin is achieved
    • Warfarin is monitored using the international normalized ratio (INR)

    Direct Oral Anticoagulants

    • Direct factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban) and direct thrombin inhibitor (dabigatran)
    • Advantages: no need for monitoring, no drug/food interactions

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    Description

    This quiz covers Venous Thromboembolic Disease, including Deep Vein Thrombosis, Pulmonary Embolism, and the pathogenesis of thrombosis.

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