Thrombosis: Definition, Risk Factors, Pathophysiology, Diagnosis, and Management

Question 1

Where do deep vein thromboses (DVTs) most commonly occur?

Accepted Answer

Lower extremities

Answer

Upper extremities

Answer

Abdomen

Answer

Thorax

Question 2

For a patient suspected of having deep vein thrombosis (DVT), which diagnostic test should be performed first?

Accepted Answer

Doppler ultrasonography

Answer

Venography

Answer

D-dimer testing

Answer

Magnetic resonance imaging (MRI)

Question 3

Which coagulation factor is **primarily** involved in the intrinsic coagulation pathway?

Accepted Answer

Factor IX

Answer

Factor VII

Answer

Factor X

Answer

Factor XIII

Question 4

What is the **most common** clinical presentation of deep vein thrombosis (DVT) in the lower extremities?

Accepted Answer

Pain and swelling

Answer

Skin discoloration

Answer

Fever

Answer

Shortness of breath

Question 5

Which imaging modality is considered the **gold standard** for diagnosing pulmonary embolism (PE)?

Accepted Answer

Computed tomography (CT) angiography

Answer

Chest X-ray

Answer

Ultrasound

Answer

Magnetic resonance imaging (MRI)

Question 6

What is the **first-line** anticoagulant medication used to treat VTE?

Accepted Answer

Heparin

Answer

Warfarin

Answer

Dabigatran

Answer

Rivaroxaban

Question 7

Which of the following conditions is an **absolute** contraindication to the use of thrombolytic therapy for PE?

Accepted Answer

Active bleeding

Answer

Recent surgery

Answer

Hypertension

Answer

Pregnancy

Question 8

What is the **primary** goal of anticoagulation therapy in patients with VTE?

Accepted Answer

Prevent clot extension and embolization

Answer

Dissolve existing clots

Answer

Improve blood flow

Answer

Reduce inflammation

Question 9

Which of the following laboratory tests is used to **specifically** monitor the effectiveness of warfarin therapy?

Accepted Answer

Prothrombin time (PT)

Answer

Activated partial thromboplastin time (aPTT)

Answer

Platelet count

Answer

Fibrinogen level

Question 10

What is the **most common** long-term complication of DVT?

Accepted Answer

Post-thrombotic syndrome

Answer

Pulmonary hypertension

Answer

Heart failure

Answer

Stroke

Question 11

Which three factors are included in Virchow's triad, which explains the development of thrombosis?

Accepted Answer

Altered blood flow, hypercoagulability, and endothelial damage

Answer

Inflammation, oxidative stress, and impaired fibrinolysis

Answer

Stasis, hyperlipidemia, and atherosclerosis

Answer

Hypotension, anemia, and thrombocytopenia

Question 12

Which of the following is a long-term complication of untreated or inadequately treated deep vein thrombosis (DVT)?

Accepted Answer

Post-thrombotic syndrome

Answer

Pulmonary embolism

Answer

Stroke

Answer

Myocardial infarction

Question 13

Thrombosis development is influenced by various factors. Which of the following accurately reflects this complexity?

Accepted Answer

Thrombosis risk is comprehensively influenced by inherited thrombophilias, acquired risk factors, and lifestyle factors.

Answer

Only inherited thrombophilias significantly impact thrombosis risk.

Answer

Modifiable lifestyle factors solely determine thrombosis risk.

Answer

Acquired risk factors, such as surgery or trauma, do not contribute to thrombosis development.

Question 14

Which of the following clinical presentations is most commonly associated with deep vein thrombosis (DVT)?

Accepted Answer

Swelling and pain in the affected extremity

Answer

Sudden onset of chest pain

Answer

Shortness of breath and cough

Answer

Neurological symptoms

Question 15

The gold standard diagnostic test for pulmonary embolism (PE) is:

Accepted Answer

Computed tomography pulmonary angiography (CTPA)

Answer

Chest X-ray

Answer

Echocardiography

Answer

Ventilation-perfusion (V/Q) scan

Question 16

The recommended duration of anticoagulation therapy for a first episode of unprovoked DVT is:

Accepted Answer

6 months

Answer

3 months

Answer

12 months

Answer

Indefinitely

Question 17

The most common complication associated with the use of thrombolytics in the treatment of PE is:

Accepted Answer

Major bleeding

Answer

Thrombocytopenia

Answer

Anaphylaxis

Answer

Neurological damage

Question 18

In patients with severe renal impairment, which modification is recommended for anticoagulation management?

Accepted Answer

Reduce LMWH dose and monitor anti-Xa levels

Answer

Switch from LMWH to DOACs

Answer

Use vitamin K antagonists instead of LMWH

Answer

Withhold anticoagulation

Question 19

Identify the risk factor for thrombosis:

Accepted Answer

Advanced age

Accepted Answer

Immobility

Accepted Answer

Smoking

Answer

Regular exercise

Question 20

Which of the following is NOT a recognized risk factor for venous thromboembolism (VTE)?

Accepted Answer

Low hemoglobin

Answer

Prolonged immobilization

Answer

Obesity

Answer

Estrogen use

Question 21

Which of the following is NOT a risk factor for deep vein thrombosis (DVT)?

Accepted Answer

Thrombophilia

Answer

Prolonged immobilization

Answer

Advanced age

Answer

Obesity

Question 22

Which pathophysiological process is central to the formation of arterial thrombi?

Accepted Answer

Atherothrombosis

Answer

Coagulation cascade activation

Answer

Platelet aggregation

Answer

Endothelial damage

Question 23

In the acute setting of a confirmed pulmonary embolism (PE), which therapeutic approach is generally considered first-line?

Accepted Answer

Anticoagulation

Answer

Surgery

Answer

Thrombolysis

Question 24

Among the following, which is an absolute contraindication to anticoagulation therapy for the prevention of VTE?

Accepted Answer

Active bleeding

Answer

Pregnancy

Answer

Renal failure

Answer

Heparin allergy

Question 25

Which of the following hypercoagulable states is most frequently encountered in clinical practice?

Accepted Answer

Factor V Leiden mutation

Answer

Dysfibrinogenemia

Answer

Protein C deficiency

Answer

Antithrombin deficiency

Question 26

Which of the following is a typical symptom associated with deep vein thrombosis (DVT)?

Accepted Answer

Leg pain and swelling

Answer

Skin discoloration

Answer

Chest pain and shortness of breath

Answer

Neurological deficits

Question 27

In which arterial territory do thrombotic events most commonly occur?

Accepted Answer

Coronary arteries

Answer

Renal arteries

Answer

Femoral arteries

Answer

Carotid arteries

Question 28

Which of the following risk factors is specifically associated with arterial thrombosis in younger individuals?

Accepted Answer

Hyperhomocysteinemia

Answer

Diabetes mellitus

Answer

Atrial fibrillation

Answer

History of stroke

Question 29

What is the primary therapeutic objective of anticoagulation in the management of VTE?

Accepted Answer

Prevention of clot propagation and embolization

Answer

Dissolution of existing thrombi

Answer

Improvement of blood flow

Question 30

Identify the most prevalent form of inherited thrombophilia.

Accepted Answer

Factor V Leiden mutation

Answer

Thrombophilia is an inherited disorder that increases an individual's risk of forming blood clots. Factor V Leiden mutation is the most prevalent form of inherited thrombophilia, affecting an estimated 5-15% of the population.

Answer

Protein S deficiency is another inherited thrombophilia that can lead to an increased risk of blood clots.

Answer

While protein C deficiency and antithrombin III deficiency are less common forms of inherited thrombophilia, they can still contribute to an increased risk of blood clots.

Question 31

Consider a 50-year-old female presenting with sudden onset chest pain and shortness of breath. She has tachycardia, tachypnea, and decreased breath sounds on the left side of her chest. What is the most likely diagnosis?

Accepted Answer

Pulmonary embolism

Answer

Pneumonia is an infection of the lungs, which can also cause chest pain and shortness of breath. However, it is usually accompanied by other symptoms such as fever, chills, and cough.

Answer

Pneumothorax is a collapsed lung, which can also cause chest pain and shortness of breath. However, it typically does not present with tachycardia, tachypnea, or decreased breath sounds on one side of the chest.

Answer

Pulmonary embolism is a blockage of an artery in the lungs, often caused by a blood clot that travels from another part of the body, such as the legs. The sudden onset of chest pain and shortness of breath, along with tachycardia, tachypnea, and decreased breath sounds on one side of the chest, are all symptoms suggestive of pulmonary embolism.

Question 32

Which of the following is a well-established risk factor for venous thromboembolism (VTE)?

Accepted Answer

Prolonged immobilization

Answer

Diabetes mellitus controlled with oral medications

Answer

High cholesterol levels

Question 33

Which of the following is the most frequent site of deep vein thrombosis (DVT) in adults?

Accepted Answer

Calf veins

Answer

Popliteal veins

Answer

Iliac veins

Answer

Femoral veins

Question 34

Which of the following laboratory tests is the most commonly used to screen for VTE?

Accepted Answer

D-dimer

Answer

Complete blood count

Answer

Electrolytes

Question 35

Which of the following imaging modalities is considered the gold standard for diagnosing pulmonary embolism (PE)?

Accepted Answer

Computed tomography pulmonary angiography (CTPA)

Answer

Chest X-ray

Answer

Ventilation-perfusion scan

Answer

Ultrasound

Question 36

Which of the following anticoagulants is most commonly used for the initial treatment of VTE, excluding heparin?

Accepted Answer

Enoxaparin

Answer

Rivaroxaban

Answer

Warfarin

Answer

Apixaban

Question 37

Which of the following is a potential complication of anticoagulant therapy with heparin?

Accepted Answer

Bleeding

Answer

Rash

Answer

Constipation

Answer

Nausea

Question 38

Which of the following is a known risk factor for developing post-thrombotic syndrome (PTS) after an episode of DVT?

Accepted Answer

Proximal DVT

Answer

Pulmonary embolism

Answer

Superficial thrombophlebitis

Answer

Atrial fibrillation

Question 39

Which of the following is a non-pharmacological treatment option for chronic venous insufficiency (CVI)?

Accepted Answer

Compression stockings

Answer

Aspirin

Answer

Statins

Question 40

Which of the following is the most common modifiable risk factor for venous thromboembolism (VTE)?

Accepted Answer

Prolonged immobilization

Answer

Aspirin use

Answer

Smoking

Answer

Hypertension

Question 41

Which of the following prophylactic measures is the most effective against VTE in hospitalized patients?

Accepted Answer

Low-molecular-weight heparin

Answer

Mechanical compression stockings

Answer

Aspirin

Answer

Warfarin

Question 42

Which laboratory test is the most useful in the initial evaluation of suspected deep vein thrombosis (DVT)?

Accepted Answer

D-dimer

Answer

Fibrinogen level

Answer

Complete blood count

Answer

Prothrombin time

Question 43

Which of the following imaging modalities is considered the gold standard for diagnosing pulmonary embolism (PE)?

Accepted Answer

Computed tomography pulmonary angiogram (CTPA)

Answer

Ventilation-perfusion scan

Answer

Chest X-ray

Answer

Transthoracic echocardiography

Question 44

Which of the following is a potential complication of long-term anticoagulation therapy for VTE?

Accepted Answer

Gastrointestinal bleeding

Answer

Myocardial infarction

Answer

Hypertension

Answer

Hepatotoxicity

Question 45

Which of the following risk factors is associated with the development of post-thrombotic syndrome after DVT?

Accepted Answer

Proximal DVT

Answer

Thrombophilia

Answer

Distal DVT

Answer

Superficial thrombophlebitis

Question 46

Which of the following conditions is associated with an increased risk of both arterial and venous thrombosis?

Accepted Answer

Antiphospholipid syndrome

Answer

Sickle cell disease

Answer

Diabetes mellitus

Answer

Hypertension

Question 47

A 72-year-old male presents with the sudden onset of severe unilateral right leg pain and swelling, without fever. He has a history of paroxysmal atrial fibrillation. Which of the following is the most likely diagnosis?

Accepted Answer

Deep vein thrombosis (DVT)

Answer

Baker's cyst

Answer

Muscle strain

Answer

Cellulitis

Question 48

Which of the following is NOT a major modifiable risk factor for venous thromboembolism (VTE)?

Accepted Answer

Regular exercise

Answer

Immobilization

Answer

Pregnancy

Answer

Obesity

Question 49

A patient presents with acute shortness of breath, pleuritic chest pain, and hypoxia. Chest X-ray shows Hampton's hump. Which of the following investigations is most likely to confirm the diagnosis of pulmonary embolism?

Accepted Answer

Computed tomography pulmonary angiography (CTPA)

Answer

D-dimer

Answer

Electrocardiogram (ECG)

Question 50

Which of the following anticoagulants is the preferred initial treatment for a patient with a confirmed diagnosis of deep vein thrombosis (DVT) without contraindications?

Accepted Answer

Low molecular weight heparin (LMWH)

Answer

Clopidogrel

Answer

Warfarin

Answer

Aspirin

Question 51

A 45-year-old female presents with recurrent episodes of deep vein thrombosis (DVT) without any identifiable risk factors. Which of the following investigations is most likely to identify a potential underlying cause?

Accepted Answer

Testing for inherited thrombophilia (e.g., Factor V Leiden mutation)

Answer

Liver function tests

Answer

Complete blood count (CBC)

Answer

Electrolytes

Question 52

A patient with a history of atrial fibrillation is on warfarin for stroke prevention. What is the recommended international normalized ratio (INR) range for this patient?

Accepted Answer

2.0-3.0

Answer

1.0-1.5

Answer

0.5-1.0

Answer

3.0-4.0

Question 53

Which of the following is a potential life-threatening complication of untreated deep vein thrombosis (DVT)?

Accepted Answer

Pulmonary embolism

Answer

Diabetes mellitus

Answer

Hypertension

Answer

Gastrointestinal bleeding

Question 54

A patient with a history of DVT is being discharged home on warfarin. Which of the following instructions is most important for the patient to understand?

Accepted Answer

The need for regular INR monitoring to ensure optimal anticoagulation

Answer

Increased fluid intake

Answer

Avoidance of aspirin

Answer

Restriction of physical activity

Question 55

Which of the following medications is a direct oral anticoagulant (DOAC) used for the treatment of DVT and pulmonary embolism, offering advantages of fixed dosing and potentially reduced bleeding risk compared to warfarin?

Accepted Answer

Rivaroxaban

Answer

Warfarin

Answer

Aspirin

Answer

Heparin