45-year-old male patient has chronic renal failure on regular dialysis. He is being diagnosed with right lobar pneumonia embolism. He had no prior history of DVT. He had sustained right femur fracture a week earlier. There is no past history of any bleeding. What is the best management?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Start IV unfractionated heparin and follow PTT
Haemodynamically stable PE (no hypotension, so no thrombolysis) in a patient on dialysis: LMWH is renally cleared, so give IV unfractionated heparin and monitor with PTT. Options B and C pair the drugs with the wrong test (warfarin is followed by INR; LMWH needs no INR). IVC filter is only for contraindication to anticoagulation, and there is no bleeding history.
ليش كل خيار صح أو غلط
-
A
ليش غلط
An IVC filter is used when anticoagulation is contraindicated (e.g. active bleeding); this patient has no bleeding history, and a filter is a preventive measure, not a treatment.
✓ Pulmonology 🫁.pdf · p. 27 -
B
ليش غلط
Warfarin is monitored by INR (target 2 to 3), not PTT, and it is hard to keep in range, so it is not the best first choice here.
✓ Step Up To Medicine 6th Edition 2024( PE).pdf · p. 10 -
C
ليش غلط
LMWH is not the choice in renal impairment such as dialysis; UFH is given instead.
✓ Pulmonology 🫁.pdf · p. 27 -
D
ليش صح
Patients with renal impairment (such as this dialysis patient) should be given UFH instead of LMWH.
✓ Pulmonology 🫁.pdf · p. 27 -
E
ليش غلط
Thrombolysis (tPA) is for PE with hypotension (massive PE); this patient is not described as hypotensive.
✓ Pulmonology 🫁.pdf · p. 27
- المصدر
- Pulmonology 🫁.pdf · p. 27
Step Up To Medicine 6th, 2024 (anticoagulation).pdf · p. 1 - المحاضرة
- Venous Thromboembolism · Pulmonology · Module B
- ظهر في
- Respi bank