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31 Cards in this Set
- Front
- Back
A negative D-dimer in a suspected PE case suggests that:
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PE or thrombotic event is a less likely diagnosis.
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Risk factors for PE include:
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Malignancy, surgery, immobile, COC, past history, thrombophilia.
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During a PE, perfusion to lung parenchyma can be maintained in otherwise healthy patients by:
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Bronchial arteries providing collateral perfusion.
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Is a PE more likely, on average, to cause infarction or haemorrhage?
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Only around 10% of PE cases have infarction.
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What predisposes a patient's PE to infarction rather than haemorrhage?
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Positive history, pre-existing heart lung problem, indicative risk factors.
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Why are peripheral pulses usually palpable in a suspected DVT?
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Pulses - arterial, DVT - venous.
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Does a PE more often have effect on upper or lower lung lobes?
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~75% of PEs occur in lower lobes.
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List four (4) substances (not blood) that can embolise, suggest a likely cause for each.
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Fat - bone marrow in extensive fracture.
Amniotic fluid - in birth involving uterine tearing or rupture. Septic - IV drug users. Air - Deep sea diving. |
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Which bone fracture is most often implicated in fat embolism?
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Femur.
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Pulmonary hypertension is said to occur when the pulmonary vasculature reaches what fraction of the systemic circulation?
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1/4 (normally around 1/8).
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List the four steps in haemostasis.
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1. Vasoconstriction.
2. Platelet adherence, activation, aggregation. 3. Coagulation cascade. 4. Resolution (fibrinolysis). |
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How can orthopnoea be differentiated from paroxysmal nocturnal dypnoea?
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Orthopnoea is likely to happen immediately while PND requires fluid redistribution which typically takes 3-4 hours.
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T/F: Platelets contain alpha bodies and dense bodies.
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F: Alpha granules and dense bodies.
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Wrt platelets, list at least two things dense bodies secrete.
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ADP, ATP, histamine, 5-HT (serotonin), adrenaline
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Within Virchow's triad, which component is implicated is nearly all instances of thrombosis?
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Endothelial injury.
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What is the most common cause of primary hypercoagulability?
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Factor V Leidin.
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What is Factor V Leidin?
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Hereditary activated protein C resistance.
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T/F: Venous thrombi develop in a retrograde direction.
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F: They develop with blood flow (toward heart).
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Axilla-subclavian vein thrombosis common presents in which patient demographic?
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Young athletes with overworked arms.
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Does superficial thrombophlebitis carry a risk of DVT?
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Yes, around 5-10%.
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What is the physiologic rationale for graduated compression stockings?
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1. Increase velocity of blood flow
2. Decrease venous dilation, decrease endothelial tears. 3. Increase fibrinolysis. |
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A patient with idiopathic VTE should be 'warfarinised' for how long?
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3-6 months.
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Do peripheral pulses aid the clinician with regards to diagnosing peripheral vascular disease?
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Good peripheral pulses decrease the likelihood of PVD. No peripheral pulses is a poor predictor of PVD.
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Describe the signs and symptoms of acute ischaemia.
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Pain, pulselessness, pallor, parasthesias, paralysis, 'perishing cold'.
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T/F: APTT is a measure of the intrinsic clotting cascade.
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T
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Haemophilia B has an effect on which clotting factor?
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IX.
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Do lines of Zahn on a thrombus suggest it was in a high or low flow area?
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High flow, eg. arterial.
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Why can CABG not be performed as prophylaxis?
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If a native vessel is still patent then blood will ALWAYS flow through it. The graft then creates a very high thrombosis risk.
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What patient factor might suggest using unfractionated heparin over LMWH?
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Renal failure.
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DVT Tx
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heparin
superficial does not need tx but DVT need prompt tx during few months first time of DVT- with a clearly reversible inciting incident ( SURGERY) heparin should be started as the P transition to >3 months of walfarin therapy with INR goal2-3 if P is hemodynamically stable- it is safe to start anticoagulation after surgery as soon as 48-72 hours w/o signifiant risk for bleeding goal of therapy- to prevent extension of the clot and develop of future clots |
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DVT in th setting ofincreased homocystein level what tx
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add pyrodoxin or ( an
d ffolate |