Question of the Week # 94

Q94) A 62 year old man presents with right leg pain and swelling.   The pain and swelling started 2 days ago and has been increasing. He denies any fever, chest pain or shortness of breath. He has no significant past medical history. There is no family history of clots. His last visit to a doctor’s office was 30 years ago. He denies any weightloss or dyspepsia or melena or rectal bleeding. Physical examination reveals ankle tenderness and mild swelling of the right lower extremity up until his mid thigh. Laboratory investigations reveal normal complete blood count with prothrombin time and partial thromboplastin time with in normal limits. A venos doppler reveals a common femoral to popliteal DVT in his right lower extremity. The patient is started on Low Molecular Weight heparin. The next important step in evaluating the hypercoaguilabilty in this patient?

A) Protein C level

B) Protein S level

C) Anti thrombin III level

D) Screening Colonoscopy

E) CT scan of the abdomen and Pelvis.

F) Heparin Induced Platelet Antibodies

 

12 Responses

  1. A

  2. C on second thought – will determine efficacy of heparin

  3. D
    cause GI cancer induce DVT. This patient did not get a screening colonoscopy as it was supposed to have at 60 yo

  4. D.Screening Colonscopy

    ****Hypercoagulable State
    1.Inherited
    CLUE-a.FH(+)
    b.<50 yrs
    c..Recurrent
    2.Acquired

    • He denies any weightloss or dyspepsia or melena or rectal bleeding

  5. D

  6. why not protein c deficency?

  7. F

  8. whats the right answer ?

  9. D

  10. D, no family history of clots precludes A-C.

  11. D. Cancer history = unexplained DVT. This patient does not have family history of acquired or inherited thrombophilias ( Protein C, S, AT III deficiency ).
    Colonoscopy screening at age 50.

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