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AG-ACNP 1 Final Exam with Complete Solutions
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AG-ACNP 1 Final Exam with Complete Solutions
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AG-ACNP 1 Final Exam with CompleteSolutions
What is the Wells score for intermediate probability of PE? What should we do to make a
diagnosis? Correct Ans-2-6
Get a D-dimer
Neg=PE unlikely
Positive=get a CTA, VQ if CTA contraindicated
What is the next step if the patients Wells score is >6? Correct Ans-CTA or VQ scan if CTA
contraindicated
IF patient is too unstable for CTA what are 2 other diagnostic test that can be done? Correct
Ans-Echocardiogram- look for RV strain
or
Venous Doppler
Treatment for a hemodynamically stable patient with PE and no contraindications for
anticoagulation? Correct Ans-Based off clinical suspicion of PE:
High: Anticoagulate, then get diagnostics
Moderate: Anticoagulate if diagnostics will be delayed
Low: diagnostics first, then anticoagulate if +PE
,Treatment for a hemodynamically stable patient with PE and WITH contraindications for
anticoagulation? Correct Ans-Diagnostics, then IVC filter if +PE
What are the bleeding risk factors for patients if prescribed anticoagulants? Correct Ans-Age
>65
Age >75
Previous bleeding
Cancer
Metastatic Cancer
Renal failure
Liver failure
Thrombocytopenia
Previous stroke
Diabetes
Anemia
Anti-platelet therapy
Poor anticoagulant control
Reduced functional capacity
Recent surgery
Frequent falls
ETOH abuse
Treatment for a hemodynamically UNstable patient with PE? Correct Ans-Resuscitation
,Anticoagulate with IV heparin
portable perfusion scan or echocardiogram
positive evidence of RV overload
any contraindications to thrombolytics?
No- hold anticoagulation and administer thrombolytics
Yes- catheter based or surgical embolectomy
The follow list are?
Prior ICH
Structural cerebral vascular lesion
Malignant intracranial lesion
Ischemic stroke <3 months
Aortic dissection
Active bleeding
Closed-head or facial trauma <3 months Correct Ans-ABSOLUTE contraindications to
Fibrinolytic Therapy
What are the RELATIVE contraindications to fibrinolytic therapy? Correct Ans-
Uncontrolled, chronic, severe HTN
HTN >180/110
Ischemic Stroke >3 months
Prolonged CPR <3 weeks
Major surgery <3 weeks
, Recent internal bleeding
Recent invasive procedure
Pregnancy
Active peptic ulcer
Pericarditis/effusion
INR >1.7
Age >75
Diabetic retinopathy
What is the preferred anticoagulation medication for a patient with CA or bridge for Coumadin
tx? Correct Ans-Low molecular-weight heparin
Enoxaparin: 1mg/kg SQ q12hrs or 1.5mg/kg daily
CrCl <30: 1mg/kg SQ daily
What anticoagulation is recommended for patients with severe renal failure, massive PE, SQ
absorption issues, or if thrombolytics are being considered? Correct Ans-Unfractionated
Heparin
80units/kg IV, then 18 units/kg per hour infusion
What anticoagulation is preferred for non-CA patients? Correct Ans-DOACs
Dabigatran, rivaroxaban, apixaban, or edoxaban
Use Warfarin for patients with contraindications to DOACs
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