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31 Cards in this Set

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