Internal medicine Multiple choice questions for PG entrance examinations FCPS, MRCP, USMLE, PLAB (MCQ of the day: Your daily dose of practice mcqs)
A 74-year-old woman presents to her physician for a postoperative medical visit. Three days ago, she underwent a left total knee replacement for severe osteoarthritis. She has a past medical history significant for type 1 diabetes
mellitus and glaucoma. Her hospital course was uneventful. She
continues to take daily NPH insulin and has good control of her blood
glucose. She also takes oxycodone, which was given to her in the
hospital for pain. She is involved in a physical therapy rehabilitation
program at the local hospital. On review of her medications, which of
the following is most acutely indicated at this time?
a) An ACE inhibitor
b)A nonsteroidal anti-inflammatory agent
c)Oral aspirin
d)Oral Coumadin
e) Subcutaneous unfractionated heparin
Explanation:
The correct answer is D.
This patient is post a total knee replacement and is currently not on any anticoagulation therapy. The risk of deep venous thrombosis (DVT) and subsequent pulmonary embolism is very high in this population, and it is the standard of care to initiate Coumadin or low-molecular-weight heparin postoperatively for a period of 6 weeks to 6 months.
An ACE inhibitor (choice A) is, in the long term, an excellent drug for this patient given her diabetes. In the post-surgical period, however, the greatest consideration should be given to the most pressing issue.
A nonsteroidal anti-inflammatory agent (choice B) does not appear to be indicated at this time, as the patient appears to have reasonable pain control with her opiate.
Oral aspirin (choice C) is an anti-platelet agent that has no role in the prevention of DVT.
Subcutaneous unfractionated heparin (choice E) is used for prevention of DVT in immobile patients or in hospitalized patients unable to ambulate. However, after orthopedic surgery, especially after joint procedures, its efficacy is very poor, given the increased venous stasis.
a) An ACE inhibitor
b)A nonsteroidal anti-inflammatory agent
c)Oral aspirin
d)Oral Coumadin
e) Subcutaneous unfractionated heparin
Explanation:
The correct answer is D.
This patient is post a total knee replacement and is currently not on any anticoagulation therapy. The risk of deep venous thrombosis (DVT) and subsequent pulmonary embolism is very high in this population, and it is the standard of care to initiate Coumadin or low-molecular-weight heparin postoperatively for a period of 6 weeks to 6 months.
An ACE inhibitor (choice A) is, in the long term, an excellent drug for this patient given her diabetes. In the post-surgical period, however, the greatest consideration should be given to the most pressing issue.
A nonsteroidal anti-inflammatory agent (choice B) does not appear to be indicated at this time, as the patient appears to have reasonable pain control with her opiate.
Oral aspirin (choice C) is an anti-platelet agent that has no role in the prevention of DVT.
Subcutaneous unfractionated heparin (choice E) is used for prevention of DVT in immobile patients or in hospitalized patients unable to ambulate. However, after orthopedic surgery, especially after joint procedures, its efficacy is very poor, given the increased venous stasis.
Comments
Post a Comment
Although every comment is appreciated, due to time limitations I might not be able to respond to every one. Comments are moderated and may take some time to appear. All spam comments will be deleted.