Family Medicine EOR questions with correct answers

A 32-year-old woman is hospitalized for bilateral pulmonary embolisms following a period of immobilization after suffering a femur fracture. She has a family history of blood clots. Her medical team makes the decision to start her on warfarin while first bridging her with heparin. Several days into her admission, the heparin is discontinued. The patient develops large, demarcated violet areas of necrotic skin tissue on her breasts. What hypercoagulable disorder should be considered given the course of the patient's illness? A. Antiphospholipid syndrome B. Antithrombin III deficiency C. Factor V Leiden D. Protein C deficiency CORRECT ANSWER D. Protein C deficiency While antiphospholipid syndrome (A) is a hypercoagulable disorder, it is not inherited but rather an autoimmune syndrome. Patients may also have other autoimmune conditions, such as systemic lupus erythematosus. Antithrombin III deficiency (B) is also a hypercoagulable disorder, but it is not as frequently associated with warfarin-induced skin necrosis as protein C deficiency. Additionally, antithrombin III deficiency is sometimes associated with heparin resistance. While factor V Leiden (C) is the most common hypercoagulable disorder, it is not as commonly associated with warfarin-induced skin necrosis as protein C deficiency. Warfarin-induced skin necrosis is a complication of warfarin therapy that can be observed in patients with protein C deficiency. Protein C deficiency is a hypercoagulable disorder that can be inherited or acquired. Patients with protein C deficiency have an increased risk of venous thromboembolism (VTE), particularly deep vein thrombosis in the leg, pulmonary embolism, and thrombosis within the mesenteric veins. The risk of VTE increases with prolonged immobilization, surgery, smoking, pregnancy, and use of oral contraceptives or exogenous estrogen. In addition to VTE, adverse pregnancy outcomes, such as fetal loss and miscarriage, can be observed. Patients with