MEQ Session CLA A
A 46-year-old female is evaluated in the emergency department for diffuse, mild, left calf pain without swelling of 10 days' duration, which has worsened in the past 2 days. The patient reports no provoking injury or incident no recent flights. She feels well otherwise. Medical and family histories are unremarkable. He takes no medications.On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 132/82 mm Hg, pulse rate is 75/min, and respiration rate is 16/min. BMI is 32. She is in no acute distress, but she scores his leg pain as 3/10 in intensity. Mild to moderately deep palpation of the calf muscles provokes diffuse discomfort. The left leg is not discolored, and no edema is present, but it feels slightly fuller than the right and is 3 cm in circumference larger than the right at the midcalf level. What investigation should be done?
Anticoagulant therapy for 3 months
Blood D Dimer test
Duplex ultrasonography of the leg
MRI Venography of the leg
While awaiting further evaluation, your patient developed acute chest pain associated with breathlessness. CT Pulmonary Angiogram was performed as below. All following factors are associated with a higher mortality except...
Respiratory rate 33
Following diagnosis of Pulmonary embolism based on CT-PA. BP 120/65 HR 95 SPo2 94% on room air. Hemoglobin is 13.5 Coagulation profile is normal. Which of the following would be considered appropriate therapies in acute management of her pulmonary embolism.
Insertion of IVC filter
Warfarin 5mg >5mg >3mg and titrate to INR goal of 2-3
Aspirin 300mg, Clopidogrel 300mg stat
Enoxaparin 1mg/kg Subcutaneous q12h
IV UFH 80u/kg bolos then infusion titrated to goal ptt 60-80s
rTPA 100mg over 2h
Rivaroxaban 15mg BD
Patient was started on Low-molecular-weight heparin (LMWH) and decision was made for warfarin are initiation. When should LMWH be discontinued
IN 3 days if INR is therapeutic
In 3 days if INR is therapeutic for 24H
In 5 days if INR is therapeutic
In 5 days if INR is therapeutic for 24H
Your patient is initiated on warfarin and is being managed in anticoagulation clinic. She is tolerating anticoagulation well for the past 3 month. She has no signs of bleeding Hb stable INR 2.5. Her calves are supple and she has no symptoms of breathlessness. Which of the following would be appropriate measures
Stop Warfarin now
Discontinue warfarin in 3 months
Discontinue warfarin and perform thrombophilia testing
Continue anticoagulation indefinitely
Pt's 26 year old sister now consults you in clinic for concerns about a possible hypercoagulable state. She is concerned with her own risk of thrombosis. Medical history is unremarkable, with no venous thromboembolism or abnormal bleeding. She takes no medications. Which of the following is the most appropriate
Acticated protein C resistance assay
factor V activity level
Factor V leiden genetic test
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