[MCQ] Deep Venous Thrombosis and Pulmonary Thromboembolism- Part 2

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Deep Venous Thrombosis and Pulmonary Thromboembolism- Part 2

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Congratulations - you have completed Deep Venous Thrombosis and Pulmonary Thromboembolism- Part 2. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Definitive diagnostic test for pulmonary embolism is ?

A	V/Q scan
B	MR Angiography
C	CT Chest
D	Selective pulmonary angiography

Question 1 Explanation:

Selective pulmonary angiography demonstrating intraluminal filling defect in more than one projection is the most specific examination available for establishing the definitive diagnosis of PE and can detect emboli as small as 1 to 2 mm. Although, chest CT with contrast has replaced invasive pulmonary angiography as a diagnostic test, invasive catheter-based diagnostic testing is reserved for patients with technically unsatisfactory chest CTs and those in whom an interventional procedure such as catheter-directed thrombolysis or embolectomy is planned.

Question 2

Primary therapy of PE is ?

A	Anticoagulation with heparin
B	Anticoagulation with warfarin
C	Thrombolysis
D	Placement of inferior vena caval filter

Question 2 Explanation:

Primary therapy consists of clot dissolution with thrombolysis or removal of PE by embolectomy. Anticoagulation with heparin and warfarin or placement of an inferior vena caval filter constitutes secondary prevention of recurrent PE

Question 3

In pulmonary embolism, which of the following identify high risk patients ?

A	Hemodynamic instability
B	Right ventricular dysfunction
C	Elevation of troponin level
D	All of the above

Question 3 Explanation:

Hemodynamic instability, right ventricular dysfunction, or elevation of the troponin level due to right ventricular microinfarction identify high-risk PE. RV enlargement on chest CT indicates a 5x increased likelihood of death within next 30 days compared with PE patients with normal RV size on chest CT.

Question 4

In PE, which of the following is the most widely used approach to risk stratification ?

A	Elevation of troponin level
B	S1Q3T3 pattern in ECG
C	Detection of RV hypokinesis by echocardiography
D	Increased levels of D-dimer

Question 4 Explanation:

In PE, detection of RV hypokinesis on echocardiography is most widely used for risk stratification

Question 5

Heparin should be overlapped with oral anticoagulation for at least how many days ?

A	2 to 3 days
B	3 to 4 days
C	4 to 5 days
D	5 to 6 days

Question 5 Explanation:

Warfarin requires 5-7 days to achieve a therapeutic effect. During that period, the parenteral and oral agents are overlapped

Question 6

In massive pulmonary embolism, immediately effective anticoagulation is initiated with ?

A	Unfractionated heparin (UFH)
B	Low molecular weight heparin (LMWH)
C	Fondaparinux
D	Any of the above

Question 6 Explanation:

In massive PE, immediately effective anticoagulation is initiated with a parenteral drug - UFH, LMWH (Enoxaparin, Tinzaparin), or fondaparinux.

Question 7

A typical initial intravenous bolus of unfractionated heparin in PE is ?

A	60 U / kg
B	80 U / kg
C	100 U / kg
D	100 U / kg

Question 7 Explanation:

UFH is dosed to achieve a target activated partial thromboplastin time (aPTT) that is 2 - 3 times the upper limit of laboratory normal. This is usually equivalent to an aPTT of 60 - 80 seconds. For UFH, a typical initial intravenous bolus is 80 U/kg, followed by an initial infusion rate of 18/kg per hour

Question 8

Which of the following is a direct thrombin inhibitor ?

A	Argatroban
B	Lepirudin
C	Bivalirudin
D	All of the above

Question 8 Explanation:

Direct thrombin inhibitors are argatroban, lepirudin, or bivalirudin and should be used in patients with proven or suspected heparin-induced thrombocytopenia. Dabigatran is a direct thrombin inhibitor

Question 9

What is the dose of Fondaparinux in patients weighing between 50 - 100 kg ?

A	2.5 mg
B	5 mg
C	7.5 mg
D	10 mg

Question 9 Explanation:

Fondaparinux is an anti-Xa pentasaccharide. It is administered by once-daily subcutaneous injection. Patients weighing <50 kg receive 5 mg, 50-100 kg patients receive 7.5 mg, and patients weighing >100 kg receive 10 mg. 2.5 mg of Fondaparinux is ised to prevent VTE.

Question 10

Warfarin acts by preventing carboxylation activation of which coagulation factor ?

A	II
B	VII
C	X
D	All of the above

Question 10 Explanation:

Warfarin is a vitamin K antagonist that prevents carboxylation activation of coagulation factors II, VII, IX, and X.

Question 11

Which of the following affect warfarin metabolism ?

A	Drug-drug and drug-food interactions
B	Age, sex, weight
C	Concomitant drugs
D	All of the above

Question 12

“Bridging” with a parenteral anticoagulant is required when which of the following is used ?

A	Dabigatran
B	Warfarin
C	Rivaroxaban
D	All of the above

Question 12 Explanation:

Rivaroxaban is a factor Xa inhibitor, and dabigatran is a direct thrombin inhibitor. Because of these drugs’ rapid onset of action & relatively short half-life compared with warfarin, “bridging” with a parenteral anticoagulant is not required.

Question 13

Antidote for bleeding from fondaparinux is ?

A	Protamine sulfate
B	Vitamin K
C	Recombinant factor VIIa
D	None of the above

Question 13 Explanation:

There is no specific antidote for bleeding from fondaparinux or direct thrombin inhibitors

Question 14

Catastrophic bleeding associated with warfarin administration is best treated by ?

A	Fresh-frozen plasma
B	Recombinant factor VIIa therapy (rFVIIa)
C	Vitamin K
D	All of the above

Question 14 Explanation:

For life-threatening or intracranial hemorrhage due to heparin or LMWH, protamine sulfate can be administered. Major bleeding from warfarin is best managed with prothrombin complex concentrate. With non-life threatening bleeding, fresh-frozen plasma can be used. Recombinant human coagulation factor VIIa (rFVIIa) is used to manage catastrophic bleeding from warfarin. For minor bleeding or to manage an excessively high INR in the absence of bleeding, oral vitamin K may be administered

Question 15

Most common nonbleeding side effect of warfarin is ?

A	Alopecia
B	Skin necrosis
C	Seizure
D	Osteoporosis

Question 15 Explanation:

Most common nonbleeding side effect of warfarin is alopecia. Warfarin-induced skin necrosis is rare

Question 16

Warfarin embryopathy occurs with warfarin exposure during ?

A	Second to sixth weeks of gestation
B	Sixth to twelfth weeks of gestation
C	Twelfth to sixteen weeks of gestation
D	Twenty to twenty four weeks of gestation

Question 16 Explanation:

Warfarin embryopathy is most common with exposure during 6th to 12th weeks of gestation. Warfarin therapy is contraindicated in first trimester due to its association with fetal chondrodysplasia punctata. In the second and third trimesters, warfarin may cause fetal optic atrophy and mental retardation

Question 17

Warfarin can be administered safely during ?

A	Second trimester of pregnancy
B	Postpartum period
C	Breast feeding
D	All of the above

Question 17 Explanation:

Warfarin is safe during second trimester, postpartum and breast feeding period.

Question 18

Duration of anticoagulation for PE following surgery or trauma is ?

A	3 - 6 months
B	6 - 12 months
C	12 - 18 months
D	Indefinite

Question 18 Explanation:

Duration of anticoagulation for PE following surgery or trauma is 3 - 6 months.

Question 19

Duration of anticoagulation for PE with moderate or high levels of anticardiolipin antibodies is ?

A	3 - 6 months
B	6 - 12 months
C	12 - 18 months
D	12 - 18 months

Question 19 Explanation:

Duration of anticoagulation for PE with moderate or high levels of anticardiolipin antibodies is indefinite, even if initial VTE was provoked by trauma or surgery

Question 20

Indefinite-duration anticoagulation is recommended for ?

A	Patients with high levels of anticardiolipin antibodies
B	Patients with idiopathic VTE
C	Patients with cancer and VTE
D	All of the above

Question 21

First-line inotropic agent for treatment of PE-related shock is ?

A	Dopamine / dobutamine
B	Phenylephrine
C	Vasopressin
D	Norepinephrine

Question 21 Explanation:

Dopamine and dobutamine are first-line inotropic agents for treatment of PE-related shock.

Question 22

Successful fibrinolytic therapy in PE leads to ?

A	Rapidly reversal of right heart failure
B	Lowers rate of death
C	Prevention of recurrent PE
D	All of the above

Question 22 Explanation:

Successful fibrinolytic therapy in PE rapidly reverses right heart failure and leads to a lower rate of death and recurrent PE

Question 23

The preferred fibrinolytic regimen in PE is ?

A	Recombinant tissue plasminogen activator (tPA)
B	Streptokinase
C	Urokinase
D	Urokinase

Question 23 Explanation:

Preferred fibrinolytic regimen is 100 mg of tPA administered as a continuous peripheral intravenous infusion over 2 hours

Question 24

PE patients respond to fibrinolysis for up to how many days after the PE has occurred ?

A	1 day
B	3 days
C	7 days
D	14 days

Question 24 Explanation:

PE patients respond to fibrinolysis for up to 14 days after the PE has occurred.

Question 25

Which of the following prevents postphlebitic syndrome ?

A	Vascular compression stockings
B	Aspirin
C	Warfarin
D	Clopidogrel

Question 25 Explanation:

Only therapy to prevent postphlebitic syndrome is daily use of below-knee 30 - 40 mmHg vascular compression stockings.

Question 26

All are true for pulmonary embolism except ?

A	Plasma D-dimer ELISA assay has high (-) predictive value
B	ABG lacks diagnostic utility
C	Westermark’s sign in chest X-Ray is focal oligemia
D	Palla’s sign is enlarged (L) descending pulmonary artery

Question 26 Explanation:

Quantitative ELISA plasma D-dimer level is elevated (>500 ng/mL) in more than 90% of patients with PE, reflecting plasmin’s breakdown of fibrin and indicating endogenous thrombolysis. D-dimer assay is not specific and levels increase in patients with MI, sepsis etc. Plasma D-dimer ELISA has a high negative predictive value (99.6%) and can be used to help exclude PE. It has a sensitivity of 96.4%. Arterial blood gases lack diagnostic utility for PE.

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Deep Venous Thrombosis and Pulmonary Thromboembolism- Part 1 |Deep Venous Thrombosis and Pulmonary

1.Definitive diagnostic test for pulmonary embolism is ?
A. V/Q scan
B. MR Angiography
C. CT Chest
D. Selective pulmonary angiography

2. Primary therapy of PE is ?
A. Anticoagulation with heparin
B. Anticoagulation with warfarin
C. Thrombolysis

D. Placement of inferior vena caval filter

3. In pulmonary embolism, which of the following identify high risk patients ?
A. Hemodynamic instability
B. Right ventricular dysfunction
C. Elevation of troponin level
D. All of the above

4. In PE, which of the following is the most widely used approach to risk stratification ?
A. Elevation of troponin level
B. S1Q3T3 pattern in ECG
C. Detection of RV hypokinesis by echocardiography
D. Increased levels of D-dimer

5. Heparin should be overlapped with oral anticoagulation for at least how many days ?
A. 2 to 3 days
B. 3 to 4 days
C. 4 to 5 days
D. 5 to 6 days

6. In massive pulmonary embolism, immediately effective anti coagulation is initiated with ?
A. Unfractionated heparin (UFH)
B. Low molecular weight heparin (LMWH)
C. Fondaparinux
D. Any of the above

7. A typical initial intravenous bolus of unfractionated heparin in PE is ?
A. 60 U / kg
B. 80 U / kg
C. 100 U / kg
D. 120 U / kg

8. Which of the following is a direct thrombin inhibitor ?
A. Argatroban
B. Lepirudin
C. Bivalirudin
D. All of the above

9. What is the dose of Fondaparinux in patients weighing between 50 – 100 kg ?
A. 2.5 mg
B. 5 mg
C. 7.5 mg
D. 10 mg.

10. Warfarin acts by preventing carboxylation activation of which coagulation factor ?
A. II
B. VII
C. X
D. All of the above

11. Which of the following affect warfarin metabolism ?
A. Drug-drug and drug-food interactions
B. Age, sex, weight
C. Concomitant drugs
D. All of the above
12. “Bridging” with a parenteral anticoagulant is required when which of the following is used ?
A. Dabigatran
B. Warfarin
C. Rivaroxaban
D. All of the above

13. Antidote for bleeding from fondaparinux is ?
A. Protamine sulfate
B. Vitamin K
C. Recombinant factor VIIa
D. None of the above

14. Catastrophic bleeding associated with warfarin administration is best treated by ?
A. Fresh-frozen plasma
B. Recombinant factor VIIa therapy (rFVIIa)
C. Vitamin K
D. All of the above

15. Most common nonbleeding side effect of warfarin is ?
A. Alopecia
B. Skin necrosis
C. Seizure
D. Osteoporosis

16. Warfarin embryopathy occurs with warfarin exposure during ?
A. Second to sixth weeks of gestation
B. Sixth to twelfth weeks of gestation
C. Twelfth to sixteen weeks of gestation
D. Twenty to twenty four weeks of gestation

17. Warfarin can be administered safely during ?
A. Second trimester of pregnancy
B. Postpartum period
C. Breast feeding
D. All of the above

18. Duration of anticoagulation for PE following surgery or trauma is ?
A. 3 – 6 months
B. 6 – 12 months
C. 12 – 18 months
D. Indefinite

19. Duration of anticoagulation for PE with moderate or high levels of anticardiolipin antibodies is ?
A. 3 – 6 months
B. 6 – 12 months
C. 12 – 18 months
D. Indefinite

20. Indefinite-duration anticoagulation is recommended for ?
A. Patients with high levels of anticardiolipin antibodies
B. Patients with idiopathic VTE
C. Patients with cancer and VTE
D. All of the above
21. First-line inotropic agent for treatment of PE-related shock is ?
A. Dopamine / dobutamine
B. Phenylephrine
C. Vasopressin
D. Norepinephrine

22. Successful fibrinolytic therapy in PE leads to ?
A. Rapidly reversal of right heart failure
B. Lowers rate of death
C. Prevention of recurrent PE
D. All of the above

23. The preferred fibrinolytic regimen in PE is ?
A. Recombinant tissue plasminogen activator (tPA)
B. Streptokinase
C. Urokinase
D. Alteplase

24. PE patients respond to fibrinolysis for up to how many days after the PE has occurred ?
A. 1 day
B. 3 days
C. 7 days
D. 14 days

25. Which of the following prevents postphlebitic syndrome ?
A. Vascular compression stockings
B. Aspirin
C. Warfarin
D. Clopidogrel

26. All are true for pulmonary embolism except ?
A. Plasma D-dimer ELISA assay has high (-) predictive value
B. ABG lacks diagnostic utility

C. Westermark’s sign in chest X-Ray is focal oligemia
D. Palla’s sign is enlarged (L) descending pulmonary artery

Deep Venous Thrombosis and Pulmonary Thromboembolism

[MCQ] Deep Venous Thrombosis and Pulmonary Thromboembolism- Part 2

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Deep Venous Thrombosis and Pulmonary Thromboembolism- Part 2

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