Venous Thromboembolism Quiz
Created by Chris Galbraith and Connor Bohlken
Edited by Dr. Paris Ingledew
Today you are working with Dr. Verdachow, a vascular surgeon. Dr. Verdachow treats a lot of venous thromboembolism (VTE), an occurrence that cancer patients are at a 4-7X increased risk for. Dr. Verdachow wants to make sure that you understand why a particular patient may be at increased risk for a VTE. He asks you: What 3 factors can lead to blood clotting?
Hypothermia, Acidosis, and Coagulopathy
Abdominal pain, Ascites, and Hepatomegaly
Aminoaciduria, Proteinuria, and Phosphaturia
Ptosis, Miosis, and Anhydrosis
Venous Stasis, Endothelial Dysfunction, and a Hypercoagulable State
You are working an emergency shift, and you next patient is Mrs. Wells. She is a lovely 78 year old female with known lymphoma for which she is receiving chemotherapy. Today she is presenting with pleuritic chest pain and new onset dyspnea. Her ECG shows sinus tachycardia but is otherwise unremarkable. You ask a few more questions and determine that she had a DVT 4 years ago. Her past medical history is remarkable for diabetes, hypertension, and von willebrand's disease. Which of the following is NOT a risk factor for a VTE?
Age > 50
History of DVT
Von Willebrand's Disease
You are a R2 family practice resident considering doing a plus one year in oncology. Today you are working in the Oncology clinic. Your next patient is Mr. Thinme, a 67 year old male with pancreatic cancer, this patient is new to you. You quickly glance at his routine lab work which was done yesterday. The CBC demonstrates a Platelet count of 417, Leukocyte count of 13, and a Hemoglobin of 99. Otherwise the labwork is normal. You enter the room and meet Mr. Thinme, a tall, thin caucasian male, you approximate his BMI to be 21.0. You discuss the patient’s current status, conduct a physical exam, and review his current treatment plan/ medications. You notice that Mr. Thinme is not on prophylactic VTE therapy. Should he be?
No, his Khorana score is 0 thus he is low risk for VTE.
Maybe, his Khorana score is 2 thus he is at moderate risk for VTE.
Yes, his Khorana score is 5 thus he is at high risk for VTE.
No, his Khorana score is 5 thus he is at low risk for VTE.
Yes, his Khorana score is 0 thus he is at high risk for VTE.
You are spending the day with Dr. Gestalt, a tired old physician on the brink of retirement. Once hallowed for their clinical acumen, they have become disgruntled with all these modern physicians who just open up MD Calc and arrive at the same answer. Which of the following would NOT make Dr. Gestalt suspicious of a pulmonary embolism (PE)?
Red, Painful, Swollen Calf
Surgery 1 Week Ago
You are a R1 family practice resident. You are just starting the first rotation of your residency, Emergency medicine. You glance at a chart and see the following reason for admission: “Unilateral leg swelling”. You immediately order a D-dimer. Then go see the patient. You enter the room and are met by a 51 year old male, with a swollen right calf. His admission vitals are: HR 106, Temp: 38.1, RR:22, O2 sats: 97% ORA, BP: 110/75. He appears nervous but responsive, his breathing is somewhat strained but he can speak in full sentences. His past medical history is significant for a bee allergy, but is otherwise non-contributory, he takes no medications but does carry an EpiPen, he has had no recent long extended travel or periods of immobility. Your D-dimer comes back positive. What do you do next?
CT-PE for possible pulmonary embolism
Watch and Wait
Give a fluid bolus, 1000 mL NS IV over 30 mins
Discharge home with a recommendation to pick up some over the counter antihistamine.
Mr. Coag Ulopath is a 78 year old male with metastatic prostate cancer. He is known to have recurrent cancer-associated thromboembolism (CAT) and presented today with new onset dyspnea, which was worked up and found to be a pulmonary embolism. He is hemodynamically stable, and there are no signs of right ventricular dysfunction or myocardial necrosis. What is the mainstay of VTE treatment for this patient?
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