AG-ACNP 1 Final Exam with Complete
Solutions
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
Solutions
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
