Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Cardiovascular Disorders--->Management Strategies (Coagulation, Vasoactive Medications)
Page: 1

Question 1# Print Question

A 67-year-old male patient had a non-ST elevation myocardial infarction and is currently on a heparin drip and requires coronary artery bypass grafting. His baseline activated coagulation time (ACT) is 189 seconds. He is 78 kg and received a total of 28 000 units of heparin (350 Units/kg). Three minutes later, a second ACT is drawn and repeat ACT is 286 seconds. Another 10 000 units of heparin is administered, and targeted ACT is still not achieved. You suspect heparin resistance.

What is NOT a predictor for heparin resistance?

A. Antithrombin activity level
B. Disseminated intravascular coagulation
C. Prior heparin therapy
D. Sepsis
E. Factor IIa level

Question 2# Print Question

A 58-year-old female with diverticulitis developed free air and required intensive care unit admission. In the intensive care unit, she went into persistent atrial fibrillation and the team decided to start her on a heparin drip for stroke prevention. Her preoperative platelet count was 343 000/µL, and on hospital day 5, her platelet count is 86 000/µL. You suspect heparin-induced thrombocytopenia (HIT) but still need to provide anticoagulation.

What is NOT an appropriate drug to administer?

A. Argatroban
B. Bivalirudin
C. Enoxaparin
D. Desirudin
E. Hirudin

Question 3# Print Question

A 29-year-old male is hypotensive in the emergency department after a motor vehicle accident 2 hours ago despite fluid resuscitation. You suspect intra-abdominal hemorrhage and have heard that tranexamic acid may reduce mortality and death from hemorrhage. You decide to administer tranexamic acid knowing the possible complications from it.

How is tranexamic acid metabolized?

A. Renal
B. Liver
C. Lungs
D. Plasma esterases
E. CYP 450

Question 4# Print Question

A 68-year-old female in the intensive care unit on total parenteral nutrition due to ileus from recent abdominal surgery now has an STelevation myocardial infarction and was emergently taken to the cardiac catheterization laboratory. The cardiology team performs percutaneous coronary intervention in one of her coronary arteries and recommends continuation of antiplatelet agents.

Because she cannot tolerate oral aspirin currently, which other medication can be used?

A. Prasugrel
B. Ticagrelor
C. Cangrelor
D. Clopidogrel
E. Argatroban

Question 5# Print Question

You have decided to place a patient with a history of HIT on a bivalirudin infusion for anticoagulation.

Which laboratory value shown below should you be able to monitor?

A. Activated partial thromboplastin time (PTT)
B. Prothrombin time (PT)
C. Fibrinogen
D. Anti-Xa
E. Platelets

Category: Critical Care Medicine-Cardiovascular Disorders--->Management Strategies (Coagulation, Vasoactive Medications)
Page: 1 of 2