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Self-Assessment Questions

Internal Medicine

Deep Venous Thrombosis: Review Questions

Homayoun Leon Daneschvar, MD, and Hamed Daw, MD

Dr. Daneschvar is an internal medicine resident, Department of Internal Medicine,
Fairview Hospital, Cleveland Clinic Health System, Westlake, OH. Dr. Daw is an
associate staff physician, Department of Hematology/Oncology, the Cleveland Clinic Foundation, Cleveland, OH.



Choose the single best answer for each question.

1. The pathogenesis of deep venous thrombosis (DVT) involves 3 factors, known as Virchow’s triad. All of the following are part of the triad EXCEPT
  1. Damage to the vessel wall
  2. Hypercoagulopathy
  3. Past history of thrombosis
  4. Venous stasis
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Questions 2 to 4 refer to the following case.

A 65-year-old woman presents to the emergency department with a swollen right calf. She has a history of lung cancer and is receiving chemotherapy. DVT is suspected, and a D-dimer test is ordered, the result of which is highly positive. Records of previous blood tests show that this patient’s D-dimer levels were always higher than normal.


2. What is the next step in the management of this patient?

  1. Order a brain natriuretic peptide test to rule out heart failure caused by chemotherapy
  2. Order compression ultrasonography
  3. Order a venogram
  4. No further evaluation
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  3. The patient is found to have DVT of the calf with extension to the right proximal vein. Anticoagulation therapy should be initiated. Which of the following is a relative contraindication to anticoagulation therapy?
  1. Brain metastasis
  2. Gastrointestinal bleeding in the past 6 months
  3. Platelet count < 60 × 103/µL
  4. Severe hypotension
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4. The patient is prescribed unfractionated heparin. All the following are adverse effects associated with unfractionated heparin EXCEPT

  1. Elevated partial thromboplastin time
  2. Osteoporosis
  3. Thrombocytopenia
  4. Worsening of renal failure
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