Does this patient need dvt prophlaxis? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-28-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Vascular Does this patient need dvt prophlaxis?

A 75-year-old woman is admitted to the hospital from her home for treatment of communityacquired
pneumonia because of extreme weakness and nausea. She has a history of
hypertension and compensated heart failure. Medications are metoprolol, lisinopril, and
hydrochlorothiazide.
On physical examination, temperature is 38.9C (102.0F), blood pressure is 110/74 mm Hg,
pulse rate is 100/min, and respiration rate is 20/min. Oxygen saturation by pulse oximetry is
92% on ambient air. Crackles are heard at the left lower lung base. Cardiopulmonary
examination is otherwise normal.
Hemoglobin 15 g/dL (150 g/L)
Leukocyte count 18,500/μL (18.5 109/L)
Platelet count 150,000/μL (150 109/L)
Creatinine 1.2 mg/dL (106.1 mmol/L)
Electrolytes Normal
Which of the following venous thrombosis prophylactic interventions is most
appropriate for this patient?
(A) Aspirin
(B) Knee-high compression stockings
(C) Lepirudin
(D) Unfractionated heparin
(E) Prophylaxis not indicated
Reply With Quote Quick reply to this message
The above post was thanked by:
dryogi (05-28-2012)



  #2  
Old 05-28-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

D may be ?????
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #3  
Old 05-28-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

(D) Unfractionated heparin

She is at a relatively high risk for DVT/PE. Aspirin is inadequate, Stockings will most likely push her towards congestive failure, Lepirudin is mostly used for HIT, and she certainly needs prophylaxis.
Reply With Quote Quick reply to this message
 
  #4  
Old 05-28-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

i agree, elderly with CHF need Hep, but why compressive stoking is contraindicated (just bcuz of HF, ? though it's compensated)
can someone plz clarify this topic, cuz its confusing
are there criteria (easy to memorize; not like the web) mentioned for easy use in the exam about DVT prophylaxis

ifound this http://pulmccm.org/main/2012/review-...commendations/
but is so lengthy
Reply With Quote Quick reply to this message
  #5  
Old 05-28-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Quote:
Originally Posted by bisho View Post
but why compressive stoking is contraindicated (just bcuz of HF, ? though it's compensated)
can someone plz clarify this topic, cuz its confusing
are there criteria
They are not contraindicated. They are just not preferred in a patient who is at a high risk for DVT. Current recommendations are to use Unfractionated heparin.

Quote:
6.0 Medical Conditions
6.0.1. For acutely ill medical patients admitted to hospital with congestive heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors, including active cancer, previous VTE, sepsis, acute neurologic disease, or inflammatory bowel disease, we recommend thromboprophylaxis with LMWH (Grade 1A), LDUH (Grade 1A), or fondaparinux (Grade 1A).

6.0.2. For medical patients with risk factors for VTE, and for whom there is a contraindication to anticoagulant thromboprophylaxis, we recommend the optimal use of mechanical thromboprophylaxis with GCS or IPC (Grade 1A).
Reply With Quote Quick reply to this message
The above post was thanked by:
usmle 99 (05-30-2012)
  #6  
Old 05-28-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by bisho View Post
can someone plz clarify this topic, cuz its confusing
are there criteria (easy to memorize; not like the web)
totally agree with you. what i did was no prophylaxis.lolz. but ans is heparin.
i read harrison and basically its surgery of some sort or medically ill patient.
make sense? please see pic of harrison table mentioning the same.
Attached Thumbnails
Does this patient need dvt prophlaxis?-prevention-dvt-harrison.png  
Reply With Quote Quick reply to this message
The above post was thanked by:
bisho (05-28-2012), dryogi (05-28-2012), usmle 99 (05-30-2012)
  #7  
Old 05-28-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

Quote:
Originally Posted by Novobiocin View Post
(D) Unfractionated heparin

Stockings will most likely push her towards congestive failure.

how stockings lead to CHF ????anyone explain...???
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #8  
Old 05-28-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

What is GCS or IPC ?????
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #9  
Old 05-28-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

Intermittent pneumatic compression : Ideal for immobilized patients, either in hospital, skilled nursing facility, or at home

Graduated compression stockings

the only contraindicated to these are venous insufficiency & Severe PAD
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (05-29-2012), Novobiocin (05-29-2012)
  #10  
Old 05-29-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

Quote:
Originally Posted by bisho View Post
Intermittent pneumatic compression : Ideal for immobilized patients, either in hospital, skilled nursing facility, or at home

Graduated compression stockings

the only contraindicated to these are venous insufficiency & Severe PAD
thnx....
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message



Reply

Tags
Cardiology-, Internal-Medicine-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Vaccination in HIV patient! achistikbenny USMLE Step 2 CK Forum 9 03-16-2012 02:14 PM
INR 4.6 in AF patient! drnrpatel USMLE Step 2 CK Forum 5 10-21-2011 08:02 PM
$40 to be a 'patient' for a day Step2CS USMLE Links & Free Ads 0 07-07-2010 04:01 AM
transplanted patient? sam01 USMLE Step 1 Forum 2 05-07-2010 10:05 AM
Patient is angry! mary USMLE Step 2 CS SP Challenges 3 03-13-2010 11:46 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)