Deep vein thrombosis

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Deep vein thrombosis

Cardiovascular system

Cardiovascular system

Cardiovascular system

Cardiovascular system


Deep vein thrombosis


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USMLE® Step 1 questions

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High Yield Notes

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Deep vein thrombosis

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USMLE® Step 1 style questions USMLE

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A 37-year-old woman presents to the emergency department with acute onset shortness of breath. The patient reports she was on a walk when she suddenly had sharp chest pain worse with inspiration. The patient reports she is otherwise healthy. Her only medication is a combined oral contraceptive pill, which she recently started taking for birth control. She is a current smoker, she drinks 3-4 beers daily and she occasionally uses cocaine. The patient reports she was recently incarcerated. While in the ED, she is noted to have an episode of hemoptysis. Her temperature is 37.5°C (99.5°F), pulse is 107/min, respirations are 22/min, blood pressure is 108/80 mm Hg, and oxygen saturation is 90% on room air. Her chest x-ray and ECG and shown below. Which of the following best describes the pathophysiology of this disease process?  

Reproduced from: Radiopaedia

Reproduced from: Wikipedia

External References

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Deep venous thrombosis (DVT) p. 697

direct factor Xa inhibitors for p. 445

embolic stroke and p. 529

glucagonomas and p. 357

heparin for p. 443

labs/findings p. 721

tamoxifen/raloxifen and p. 449

Enoxaparin p. 443

deep venous thrombosis p. 696

Heparin p. 443

deep venous thrombosis p. 696

Pulmonary embolism p. 697

deep venous thrombosis and p. 697

Rivaroxaban p. 444

deep venous thrombosis p. 696


“Deep vein” refers to the veins that typically run between muscles as they travel back towards the heart, as opposed to superficial veins that you can see on the surface, and “thrombosis” refers to a blood clot. So a deep vein thrombosis or DVT is a blood clot in one of those deep veins.

Normally, blood makes it back to the heart from the tissues and organs via a network of veins that merge over and over. Superficial veins drain blood into deep veins, which rely on the skeletal muscle pump to move blood forward. The way it works is that the surrounding skeletal muscles compress the vein and propel blood forward, and the veins prevent blood from moving backwards by using one-way valves.

Ultimately, all of the blood ends up in the superior or inferior vena cava and then dumps into the right atrium. From there, the blood goes into the right ventricle and before being pumped into the pulmonary artery and eventually into the lungs. Deep vein thrombosis most commonly develops in the lower legs, below the knee, although blood clots can form in both superficial and deep veins and in other parts of the body as well.

Normally, the process starts with damage to the endothelium or inner lining of blood vessel walls, after which there’s an immediate vasoconstriction or narrowing of the blood vessel, limiting the amount of blood flow. After that, some platelets adhere to the damaged vessel wall, and become activated by collagen and tissue factor, proteins that are normally kept separate from the blood by the intact endothelium. These platelets then recruit additional platelets, forming a plug. The formation of the platelet plug is called primary hemostasis.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Deep vein thrombosis and pulmonary embolism" The Lancet (2016)
  5. "Deep vein thrombosis" Hematology (2014)
  6. "Diagnosis of deep-vein thrombosis" Thrombosis Research (2018)

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