arlete
Intern in 2009!!!!!
Topics: 39
Posts: 2,795
|
1 - You are taking care of a 42 year-old man who came to the hospital with a pulmonary embolism suspicion, after an airplane trip from China to USA. He's a smoker (2 packs per day for 20 years), has hypercholesterolemia and his father died on an MI at 62 years old. The V/Q test defined the diagnosis as PE. You started him on heparin, added warfarin after 24 h and reached the ideal level of anticoagulation. Upon discharge, you are going to keep him anticoagulated for:
a - 1 week
b - between 3 and 6 months
c - at least 6 months
d - at least 12 months
e - indefinely
f - he's going to receive Aspirin daily only
2 - You are taking care of a 32 year-old woman for pulmonary embolism. After two miscarriages, about 10 years ago, she was diagnosed with lupus anticoagulant syndrome. She's adequately anticoagulated, asymptomatic and you think it's time to discharge her home. She asks you for how long she's going to take the warfarin and your answer is:
a - 1 week
b - between 3 and 6 months
c - at least 6 months
d - at least 12 months
e - indefinely
f - she's going to receive Aspirin daily only
3 - You are the doctor at a nursing home and you are called by one of the patient's son. The patient is a 78 year old male with severe orteoarthritis, hypertension, Alzheimer's disease and GERD. He's bedridden because of his orthopedic problems and taking coumadin because of a PE that caused him to be hospitalized 4 months ago. The son is extremely upset because he was shaving his father and he "bled too much from a little cut". You check the last lab values and he's adequately anticoagulated. The son wants to know when the coumadin will be suspended. Your answer is:
a - "It should have been already, I'll do it right away."
b - "He's going to receive this drug for 2 more months."
c - "He needs at least 1 year of anticoagulation."
d - "He needs to receive this drug indefinetely."
e - "He may not take the coumadin anymore, but he's going to receive Aspirin instead, and that's going to keep him bleeding more than normal when he's cut."
4 - You are about to discharge a 68 year-old female patient you have been treating for pulmonary embolism. She's receiveing coumadin, you already suspended the heparin and she's adequately anticoagulated. You ordered a venous USG, had a detailed history taken, did some lab work and yet could not identify any risk factor or any obvious reason for her PE episode. She's very concerned about taking the coumadin, because according to her, her nephew took this medicine after a cardiac surgery and ended up having a "bleeding inside the brain". You tell her it's very important that she take the medication and have regular blood work for:
a - 1 week
b - between 3 and 6 months
c - at least 6 months
d - at least 12 months
e - indefinely
f - she's going to receive Aspirin daily only
___________________
84/99/99, grad. 92, GC, 14 public., 2 y USCE
|
| truedoc
Forum Senior
Topics: 44
Posts: 156
|
1.c
2.e
3.b
4.c
|
| nyimalay
Forum Elite
Topics: 10
Posts: 285
|
c
e
d
c
waiting your answers
|
| peter90036
Forum Elite
Topics: 28
Posts: 315
|
ok i had to look it up i only knew 6months...
http://www.chestjournal.org/cgi/content/full/119/...
1.3. Long-term Anticoagulation
1.3.1. We recommend that oral anticoagulant therapy should be continued for at least 3 months to prolong the prothrombin time to a target INR of 2.5 (range, 2.0 to 3.0). When oral anticoagulation is either contraindicated or inconvenient, a treatment dose of LMW heparin or unfractionated adjusted-dose heparin to prolong the APTT to a time that corresponds to a therapeutic plasma heparin level for most of the dosing interval should be used (grade 1A).
1.3.2. We recommend that patients with reversible or time-limited risk factors should be treated for at least 3 months (grade 1A).
1.3.3. We recommend that patients with a first episode of idiopathic VTE should be treated for at least 6 months (grade 1A).
1.3.4. For patients with recurrent idiopathic VTE or a continuing risk factor such as cancer, antithrombin deficiency, or anticardiolipin antibody syndrome, we recommend treatment for 12 months or longer (grade 1C).
|
| arlete
Intern in 2009!!!!!
Topics: 39
Posts: 2,795
|
Therefore:
1 - b
2 - d
3 - d
4 - c
___________________
84/99/99, grad. 92, GC, 14 public., 2 y USCE
|
| paheli
It'sAllAboutGoodKarma
Topics: 192
Posts: 2,567
|
Excellent qns, arlete. Thanks.
Could you please put up the answers, for more comprehensive explanation regarding the incorrect options. Thanks again.
___________________
Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows.
|
| arlete
Intern in 2009!!!!!
Topics: 39
Posts: 2,795
|
1 - PE with identifiable transient cause = anticoagulation for 3 - 6 months
2 - PE with lupus anticoagulante syndrome, malignancy, antithrombin deficiency = anticoagulation for at least 12 months
3 - PE with permanent condition (immobilization) as a risk factor = anticoagulation forever
4 - Idiopathic PE = anticoagulation for at least 6 months.
Peter's information was exactly the same I had when I created the questions.
Edited by arlete on 05/20/08 - 07:13 AM
___________________
84/99/99, grad. 92, GC, 14 public., 2 y USCE
|
| paheli
It'sAllAboutGoodKarma
Topics: 192
Posts: 2,567
|
Thanks a lot.
You created them? Geez, go pay a visit to the UW guys! 
___________________
Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows.
|
| arlete
Intern in 2009!!!!!
Topics: 39
Posts: 2,795
|
 Maybe if I don't get to be an intern in 2009...
___________________
84/99/99, grad. 92, GC, 14 public., 2 y USCE
|
| liliaeliz
Forum Elite
Topics: 41
Posts: 373
|
thanks
|
| arlete
Intern in 2009!!!!!
Topics: 39
Posts: 2,795
|
___________________
84/99/99, grad. 92, GC, 14 public., 2 y USCE
|
| peter90036
Forum Elite
Topics: 28
Posts: 315
|
good Qs Arlete step3 or im boards !
|
| arlete
Intern in 2009!!!!!
Topics: 39
Posts: 2,795
|
Thanks. I didn't know that before studying for step 3...
___________________
84/99/99, grad. 92, GC, 14 public., 2 y USCE
|
| mildus
Forum Guru
Topics: 19
Posts: 614
|
thanks arlete
|
|
| |
| | | | | | | | | | | | | | |
