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Chapter 10. Venous Thromboembolism

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A 42-year-old Asian woman just returned from vacation in Ethiopia. She presents to the emergency department (ED) with shortness of breath and is subsequently diagnosed with pulmonary embolism (PE). She weighs 45 kg (100 lb; body mass index [BMI] 19 kg/m2). Medications on admission include: estrogen-containing oral contraceptives, ibuprofen (prn), and ginseng tablets. She smokes one pack of cigarettes per day and drinks alcoholic beverages three to four times per week. Her sister died (age 41) of PE 4 years ago. The factors that most likely predisposed this patient for venous thromboembolism (VTE) include:

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A. Age, ibuprofen use, smoking

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B. Female sex, foreign travel, weight

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C. Asian ancestry, ginseng use, regular alcohol consumption

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D. Recent immobility, estrogen use, inherited disorder of hypercoagulability

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The following is a recommended risk assessment model for estimating VTE risk specific to hospitalized medical patients:

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A. The CAPRINI Risk Prediction Score

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B. The WELLS Risk Prediction Score

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C. The PADUA Risk Prediction Score

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D. The PESCI Risk Prediction Score

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Which VTE prevention strategy is the most appropriate for a 61-year-old patient who is undergoing a knee replacement surgery tomorrow, weighs 94 kg (207 lb), has an estimated creatinine clearance of 58 mL/min (0.97 mL/s), and has no known contraindications to anticoagulant drugs?

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A. Rivaroxaban 15 mg given orally every 12 hours

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B. Fondaparinux 2.5 mg given SC every 24 hours

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C. Aspirin 81 mg given orally every 24 hours

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D. Early ambulation combined with graduated compression stockings (GCS)

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Which of the following prophylactic strategies is most appropriate for a 62-year-old patient who is admitted to hospital with left-sided paralysis following an acute hemorrhagic stroke?

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A. GCS

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B. Early ambulation

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C. Inferior vena cava (IVC) filter

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D. Intermittent pneumatic compression (IPC)

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Which of the following anticoagulants would be an appropriate option as single therapy for the initial acute-phase treatment of patients diagnosed with acute lower extremity DVT?

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A. Apixaban

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B. Dabigatran

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C. Desirudin

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