NR571 MIDTERM COMPLEX DIAGNOSIS AND
MANAGEMENT PRACTICE SOLUTION 2026
VIEW AHEAD TESTED SET
◉ A 56-year-old man presented to the emergency room three hours
ago for acute onset of dyspnea. CT pulmonary angiogram performed
upon admission showed a large, central pulmonary embolism.
Treatment was initiated with subcutaneous low molecular weight
heparin (LMWH) and he was transferred to the ICU for continued
monitoring. The nurse calls to report that the patient now has a
blood pressure of 78/50 mmHg. His pulse is 120, respiratory rate is
28, and oxygen saturation is 92% on 2 L of oxygen via nasal cannula.
His lungs are clear on auscultation but there is a new grade 2/6
systolic murmur above the left lower sternal border noted. A 1000
mL fluid bolus of LR is administered and the patient's BP initially
improves to 100/65. Which of the following is the next step in the
clinical management of this patient?
a. Continue low molecular weight heparin
b. Switch the patient to a vitamin K antagonists (coumadin)
c. Contact t. Answer: c. Contact the interventional radiologist for
catheter delivered thrombolytic therapy
◉ A 54-year-old woman was admitted with COVID-19 pneumonia,
she has no prior medical history or comorbidities. Which of the
,following is recommended for hospitalized VTE non-surgical
patients?
a. Low molecular weight heparin (LMWH)
b. Prophylaxis is not needed because the patient is young and has no
risk-factors
c. Mechanical compression boots
d. Direct oral anticoagulant (DOAC). Answer: a. Low molecular
weight heparin (LMWH)
◉ Clinical features of acute DVT. Answer: hypoechoic
vein wall thin with smooth lumen
large and distended lumen
spongy compressibility
no collateral veins
competent valves
◉ Clinical features of chronic DVT. Answer: echogenic
thin and hyperechoic vein walls
rigid and non-compressible vein walls
collaterals present
incompetent valves
,◉ How long will patients be on AC for after VTE?. Answer: 3-6
months
◉ Thrombolytic therapy for VTE. Answer: Treatment for confirmed
thrombus
Catheter directed admin of thrombolytic drug ( eg. tPA)
Medication dissolves the clot
◉ Treatment for VTE in stable non-comorbid patients. Answer:
DOAC such as dabigatran, rivaroxaban, and apixaban
◉ Contraindications to DOAC for VTE tx. Answer: severe renal
impairment
moderate to severe liver disease
antiphospholipid antibody syndrome
◉ Which AC drugs require pretreatment with heparin until
therapeutic effect reached?. Answer: dabigatran and vitamin K
antagonists (coumadin)
◉ How long is heparin pretreatment required with dabigatran?.
Answer: 5-10 days
, ◉ How long is heparin pretreatment required for Coumadin?.
Answer: at least 5 days
◉ Etiology of dilated cardiomyopathy. Answer: Idiopathic
genetic disease
infectious myocarditis
chronic ETOH
MI
amphetamine or cocaine use
iron overload (hemochromatosis)
pregnancy/postpartum
◉ etiology of restrictive cardiomyopathy. Answer: amyloid, sarcoid
post-radiation
open-heart surgery
endomyocardial fibrosis
diabetes
drug-induced (Serotonin, ergotamines, busulfan, and antineoplastic
drugs)
◉ dilated cardiomyopathy. Answer: Dilated cardiomyopathy is the
most common type and typically begins in the left ventricle. As the
ventricle dilates, the volume of blood increases, and the heart's
MANAGEMENT PRACTICE SOLUTION 2026
VIEW AHEAD TESTED SET
◉ A 56-year-old man presented to the emergency room three hours
ago for acute onset of dyspnea. CT pulmonary angiogram performed
upon admission showed a large, central pulmonary embolism.
Treatment was initiated with subcutaneous low molecular weight
heparin (LMWH) and he was transferred to the ICU for continued
monitoring. The nurse calls to report that the patient now has a
blood pressure of 78/50 mmHg. His pulse is 120, respiratory rate is
28, and oxygen saturation is 92% on 2 L of oxygen via nasal cannula.
His lungs are clear on auscultation but there is a new grade 2/6
systolic murmur above the left lower sternal border noted. A 1000
mL fluid bolus of LR is administered and the patient's BP initially
improves to 100/65. Which of the following is the next step in the
clinical management of this patient?
a. Continue low molecular weight heparin
b. Switch the patient to a vitamin K antagonists (coumadin)
c. Contact t. Answer: c. Contact the interventional radiologist for
catheter delivered thrombolytic therapy
◉ A 54-year-old woman was admitted with COVID-19 pneumonia,
she has no prior medical history or comorbidities. Which of the
,following is recommended for hospitalized VTE non-surgical
patients?
a. Low molecular weight heparin (LMWH)
b. Prophylaxis is not needed because the patient is young and has no
risk-factors
c. Mechanical compression boots
d. Direct oral anticoagulant (DOAC). Answer: a. Low molecular
weight heparin (LMWH)
◉ Clinical features of acute DVT. Answer: hypoechoic
vein wall thin with smooth lumen
large and distended lumen
spongy compressibility
no collateral veins
competent valves
◉ Clinical features of chronic DVT. Answer: echogenic
thin and hyperechoic vein walls
rigid and non-compressible vein walls
collaterals present
incompetent valves
,◉ How long will patients be on AC for after VTE?. Answer: 3-6
months
◉ Thrombolytic therapy for VTE. Answer: Treatment for confirmed
thrombus
Catheter directed admin of thrombolytic drug ( eg. tPA)
Medication dissolves the clot
◉ Treatment for VTE in stable non-comorbid patients. Answer:
DOAC such as dabigatran, rivaroxaban, and apixaban
◉ Contraindications to DOAC for VTE tx. Answer: severe renal
impairment
moderate to severe liver disease
antiphospholipid antibody syndrome
◉ Which AC drugs require pretreatment with heparin until
therapeutic effect reached?. Answer: dabigatran and vitamin K
antagonists (coumadin)
◉ How long is heparin pretreatment required with dabigatran?.
Answer: 5-10 days
, ◉ How long is heparin pretreatment required for Coumadin?.
Answer: at least 5 days
◉ Etiology of dilated cardiomyopathy. Answer: Idiopathic
genetic disease
infectious myocarditis
chronic ETOH
MI
amphetamine or cocaine use
iron overload (hemochromatosis)
pregnancy/postpartum
◉ etiology of restrictive cardiomyopathy. Answer: amyloid, sarcoid
post-radiation
open-heart surgery
endomyocardial fibrosis
diabetes
drug-induced (Serotonin, ergotamines, busulfan, and antineoplastic
drugs)
◉ dilated cardiomyopathy. Answer: Dilated cardiomyopathy is the
most common type and typically begins in the left ventricle. As the
ventricle dilates, the volume of blood increases, and the heart's
