Deep Venous Thrombosis and Pulmonary Thromboembolism

Chapter 27 Deep Venous Thrombosis and Pulmonary Thromboembolism




Clinical Case Problem 1 A 65-Year-Old Woman with Cyanosis, Shortness of Breath, and Substernal Chest Pain


A 65-year-old woman is admitted to the emergency department with a 3-hour history of cyanosis, shortness of breath, and substernal chest pain. She had been discharged 5   days earlier after having a total hip replacement for severe osteoarthritis. The hip surgery was uneventful.


On physical examination, the patient is in obvious acute respiratory distress. Her respiratory rate is 40 breaths/minute and her breathing is labored. Her blood pressure is 100/70   mm Hg. Cyanosis is present. There appear to be decreased breath sounds in the lower lobe of the right lung as well as adventitious breath sounds in all lobes.



Select the best answer to the following questions




1. Based on the information provided, what is the most likely diagnosis in this patient?


a. fat embolus

b. acute myocardial infarction

c. dissecting aortic aneurysm

d. acute pulmonary embolism (PE)

e. cholesterol emboli syndrome

2. Which of the following findings, if present in the history and physical examination, increases the likelihood of a patient’s having a PE?


a. heart rate    >    100 beats/minute

b. hemoptysis

c. surgery within the previous 4   weeks

d. previous deep venous thrombosis (DVT)

e. all of the above

3. Which of the following statements concerning examination of a patient with suspected DVT is true?


a. clinical examination is diagnostic in every case

b. clinical examination is, in most cases, diagnostic

c. clinical examination is of some value but has low sensitivity and low specificity

d. clinical examination is of no value

e. nobody really knows for sure

4. Which of the following blood gas combinations occur most commonly in the condition described in this clinical case?


a. decreased PO2 and decreased PCO2

b. decreased PO2 and increased PCO2

c. increased PO2 and increased PCO2

d. increased PO2 and decreased PCO2

e. none of the above

5. What is the most common cause of morbidity and mortality among hospitalized immobile patients?


a. myocardial infarction

b. cerebrovascular accident

c. DVT/PE

d. nosocomial infection

e. none of the above

6. Which of the following best describes D-dimer screening for suspected venous thromboembolism (VTE)?


a. high sensitivity, low specificity

b. low sensitivity, high specificity

c. high sensitivity, high specificity

d. low sensitivity, low specificity

e. none of the above

7. Which of the following is correct regarding treatment of patients with VTE?


a. low-molecular-weight heparin (LMWH) is as effective as unfractionated heparin (UFH)

b. warfarin therapy should be started after a minimum of 2   days of heparin

c. LMWH is safe to use in patients with a history of heparin-induced thrombocytopenia

d. early ambulation and use of graded compression stockings increase risk of PE in DVT

e. none of the above


Clinical Case Problem 2: A 35-Year-Old Woman Who Has Recently Returned from a Trip Overseas


A 35-year-old recently pregnant woman, now taking oral contraceptives, presents to the office with 1   week of unilateral painful right leg swelling. There is no history of trauma, but 12   days ago the patient returned from overseas via a 12-hour airplane ride. On physical examination, her right calf is 5   cm greater in circumference than her left, and there is tenderness when you squeeze the gastrocnemius muscle.



8. Which of the following is (are) a risk factor(s) for the condition described here?


a. prolonged immobilization

b. long leg fractures

c. pregnancy

d. malignant neoplasm

e. all of the above

9. Which of the following statements about treatment modalities for VTE is correct?


a. LMWH increases the partial thromboplastin time (PTT) to the same degree as UFH does

b. protamine reverses the anticoagulant activity of UFH but not LMWH

c. in hemodynamically stable patients, thrombolytic therapy has been shown to reduce mortality and the risk of recurrent PE

d. leafy green vegetables can potentiate the anticoagulant effect of warfarin

e. inferior vena cava (IVC) filters are indicated in patients with VTE and a contraindication to anticoagulation

10. Which of the following statements regarding DVT prophylaxis is correct?


a. patients undergoing hip replacement surgery should receive either LMWH or warfarin

b. low-dose subcutaneous heparin has been shown to be as effective as LMWH in patients undergoing knee replacement surgery

c. intermittent pneumatic compression of the legs should not be used in combination with LMWH or coumadin

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Deep Venous Thrombosis and Pulmonary Thromboembolism

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