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Which of the following is true regarding venous thromboembolism (VTE) following major orthopaedic hip or knee surgery?
Almost all patients receive VTE prophylaxis, though often not in compliance with the American College of Chest Physicians (ACCP) guidelines
Length of hospitalization and associated medical costs are significantly increased by in-hospital VTE but not post-discharge VTE
Most acute perioperative pulmonary events result from dislodged chronic deep venous thrombosis resulting in pulmonary embolism
Most symptomatic VTE occur within two weeks after total joint arthroplasty
Warfarin prophylaxis is more often fully compliant with ACCP guidelines than low-molecular-weight heparin (LMWH) prophylaxis
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A 59-year-old patient undergoing total hip arthroplasty has a genetically inherited thrombophilia disorder. In this disorder, a variant co-factor cannot be inhibited by activated protein C causing overproduction of thrombin. What is this patients clotting disorder?
Factor V Leiden
Antithrombin III deficiency
Protein S deficiency
Congenital deficiency of plasminogen
A 52-year-old male underwent a right total knee arthroplasty 3 days ago and reports new onset dyspnea. His vitals signs include a temperature of 98.8, pulse of 133, blood pressure of 130/77, respiratory rate of 28, and oxygen saturation of 91% on room air. A chest radiograph shows atelectasis. Which of the following findings is most likely also present?
Hyperchloremic metabolic acidosis
Jugular venous distention with tracheal deviation
EKG demonstrating S-wave in lead I Q-wave in lead III T-wave inversion in lead III
Pleural effusion with pleural/serum protein >0.5 and pleural/serum LDH > 0.6
Increased carbon monoxide diffusing capacity (DLCO)
A 30-year-old male with Protein C deficiency sustains a large subarachnoid hemorrhage and bilateral calcaneus fractures after falling off of a roof. The patient has been in the intensive care unit for 5 days for monitoring of his head injury. All of the following factors are appropriate reasons to obtain a helical chest CT scan EXCEPT:
Elevated alveolar-arterial gradient (> 20 mm Hg or 2.7 kPa) on arterial blood gas
Pulse oximetry reading of 99% with respiratory rate of 35 breaths/min
Pulse rate of 125 beats/min with new onset right bundle branch block
Paco2 > 35 mm Hg (or 4.7 kPa) on arterial blood gas
Pao2 < 80 mm Hg (or 10.7 kPa) on arterial blood gas
A 67-year-old man complains of low-grade fevers and calf pain 2 weeks following a total knee arthroplasty. What is the next appropriate step in management of this patient?
Plethysmography of lower extremity
MRI of lower extremity
CT angiography of lower extremity
Knee aspiration to evaluate for septic joint
The 2009 AAOS Clinical Guideline on prevention of pulmonary embolism in patients undergoing total hip or knee arthroplasty recommends classifying patients as having either a "standard" or "elevated" risk of bleeding complications. The presence of all of the following qualify a patient as having an "elevated" risk of major bleeding EXCEPT?
History of hemophilia
History of protein C deficiency
History of a recent gastrointestinal bleed
History of a recent hemorrhagic stroke
History of Von Willebrand's Disease
Which of the following is NOT a component of Virchow's triad?
Neither thrombocytopenia (answer 1) nor platelet dysfunction (answer 2) are components of Virchow's triad
In 2012, the American College of Chest Physicians (ACCP) brought forth changes to their guidelines on postoperative pharmacologic venous thromboembolism prophylaxis (VTEP) after total joint arthroplasty in order to converge with the American Academy of Orthopaedic Surgeons (AAOS). Which of the following describes the change in surgeon practice patterns following the convergence of these guidelines?
An increase in the prescribing of ASA (aspirin) monotherapy
An increase in the prescribing of coumadin at INR goals of 2-3
An increase in the prescribing of low-molecular-weight heparin monotherapy
An increase in the use of elastic compressive stockings as monotherapy
An increase in the prescribing of fish oil as monotherapy
Familial (Leiden) thrombophilia is of importance in joint arthroplasty because of an abnormality in the clotting cascade. Which of the following statements best describes the condition?
It is a disease caused by an abnormality of platelets that leads to increased blood clotting.
It is a disease caused by an abnormality of vascular endothelium that leads to increased blood clotting.
It is a disease caused by an abnormality of hepatic metabolism that leads to decreased production of factor V and decreased blood clotting.
It is a disease caused by an abnormality of factor V that leads to decreased inactivation of factor Va by activated protein C (aPC) and increased blood clotting.
It is a familial, genetic disease that requires placement of a Greenfield filter in all individuals who have the abnormality, prior to surgery.
During total hip arthroplasty, which of the following interventions increases the risk of pulmonary ventilation-perfusion mismatch the greatest?
Cement pressurization of the femoral canal
Use of a modular femoral stem
Intra-operative sequential compressive device on the non-operative leg
A 65-year-old man undergoes total knee replacement and is found to have deep vein thrombosis two days later. What molecule is thought to be involved in this process when it is released during surgical dissection?
A 25-year-old healthy male is scheduled to undergo a a nine-level posterior spinal fusion for scoliosis. Administering preoperative recombinant erythropoietin would place the patient at increased risk of developing which of the following complications?
Acute renal failure
Increased bleeding time
Delayed spinal fusion
A 65-year-old female undergoes a total knee arthroplasty. In addition to chemoprophylaxis for deep vein thrombosis (DVT) prevention she is given pneumatic compression devices. Which of the following is associated with pneumatic compression devices?
Increased endothelial fibrinogenesis
Decreased bleeding times
Increased endothelial injury
Increased venous compliance
Increased venous blood flow