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http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism, IFDVT and CTEPH
(p 1815)
in regards to PAH-specific drugs like bosentan,
“Survival benefit for the use of PAH-specific drugs in CTEPH  ______, either as sole therapy or in conjunction with pulmonary endarterectomy”
a) is well established
b) is very likely
c) has not been proven
d) has been disproven

Sept 22
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism, IFDVT and CTEPH
(p 1810)
“The differential diagnosis of patients with possible CTEPH mandates a battery of tests to establish 3 criteria:” these  criteria include
a) right heart cath to establish pulmonary hypertension (ie, SPAP >40 mm Hg)
b) “Angiography or ventilation-perfusion scintigraphy
shows evidence of obstruction in the main, lobar, segmental, or subsegmental arteries . . despite 3 months of therapeutic anticoagulation”
c) “Other causes of pulmonary hypertension, . . . have been excluded.”
d) all of above

Sept 21
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism, IFDVT and CTEPH
(p 1815)
“The treatment of choice for CTEPH is _______ . . .  potentially curative, with nearly normalized pulmonary hemodynamics and substantial clinical improvement seen in many patients”
a) warfarin
b) bosentan
c) pulmonary endarterectomy
d) lung transplantation

Sept 20
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism, IFDVT and CTEPH
(p 1815)
For CTEPH, “standard medical therapy includes ________”
a) warfarin targeted to an INR of 2 to 3
b) warfarin targeted to an INR of 3 to 4
c) LMWH or dabigatran
d) bosentan

Sept 19
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism, IFDVT and CTEPH
(p 1812)
“Patients presenting with unexplained dyspnea, exercise intolerance, or clinical evidence of right-sided
heart failure, _____ prior history of symptomatic VTE, ______ CTEPH (Class I; Level of Evidence C).”
a) with a ; can be assumed to have
b) without ; are unlikely to have
c) with or without ; should be evaluated for
d) with or without; normal systolic pulmonary pressures estimated by echocardiogram can exclude

Sept 16
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1807)
“_____ should be given to patients with
IFDVT associated with limb-threatening circulatory
compromise (ie, phlegmasia cerulea dolens) (Class I;
Level of Evidence C).”
a) “Systemic fibrinolysis”
b) “Surgical venous thrombectomy but not CDT”
c) “Intra-arterial fibrinolysis”
d) “CDT or PCDT” (catheter-directed thrombolyis, pharmacomechanical CDT); surgical thrombectomy is Class IIb for IFDVT

Sept 15
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1804)

“Patients with IFDVT should wear 30 – to 40 –mm Hg
____-high graduated ECS on a daily basis for at least
_____ (Class I; Level of Evidence B).”
a) calf ; 12 months
b) knee ; 6 months
c) knee ; 2 years
d) thigh ; 12 months

Sept 14
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1803)
“Cancer patients with IFDVT should receive ____
monotherapy for at least ____ months, or as long as
the cancer or its treatment (eg, chemotherapy) is
ongoing (Class I; Level of Evidence A)”
a) warfarin ; 3 to 6
b) warfarin ; 6 to 12
c) LMWH ; 3 to 6
d) LMWH ; 6 to 12

Sept 13
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1803)
“Patients with first-episode IFDVT related to a major
reversible risk factor should have anticoagulation
stopped after __ months”
“Patients with recurrent or unprovoked IFDVT should have at least __ months of anticoagulation and be considered for indefinite anticoagulation . . . ”
a) 3 ; 3
b) 3 ; 6
c) 6 ; 6
d) 6 ; 12

Sept 12
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism, (p 1803)
“Adult patients with IFDVT who receive oral warfarin as first-line long-term anticoagulation therapy should have warfarin overlapped with initial anticoagulation therapy for a minimum of _ days and until the INR is >2.0 for at least __ hours, and then targeted to an INR of 2.0 to 3.0 (Class I; Level of Evidence A).”
a) 1 ; 24
b) 3 ; 48
c) 5 ; 24
d) 7 ; 48

Sept 9
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1803)
“Patients with IFDVT who have suspected or proven
heparin-induced thrombocytopenia should receive ________________”
(Class I; Level of Evidence B).
a) immediate warfarin therapy without heparin”
b) a low molecular weight heparin”
c) a direct thrombin inhibitor”(argatroban, lepirudin)
d) fondaparinux” (arixtra brand)

Sept 8, 2011
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1803)
“In the absence of suspected or proven heparin- induced thrombocytopenia, patients with IFDVT should receive therapeutic anticoagulation with” one of the following:
(IFDVT = Iliofemoral Deep Vein Thrombosis)
a) IV UFH (OR) LMWH
b) SQ UFH (OR) fondaparinux
c) any of above
d) any of above except SQ UFH

Sept 7
, 2011
Weekly Quiz for the General Public
September 9 is International Fetal Alcohol Spectrum Disorders Day.
According to the CDC’s Sept 2011Fetal Alcohol Spectrum Disorders page,
pregnant mothers should
a) avoid alcohol during all of pregnancy
b) avoid alcohol during the first 2 trimesters
c) avoid alcohol during the 3rd trimester
d) limit alcohol to one serving per day

http://www.cdc.gov/Features/FASD/

Sept 7, 2011
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1802)
“For patients with massive or submassive PE, screening for PFO with an echocardiogram with agitated saline bubble study or transcranial Doppler study for risk stratification _____ (Class IIb; Level of Evidence C).”
a) should be performed
b) may be considered
c) is not useful
d) is contraindicated

Sept 6, 2011
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1801-02)
“Although the optimal treatment for patients with impending paradoxical embolism remains unclear, _____ may result in the lowest rate of stroke, whereas _____ may be associated with the highest mortality compared with . . . ” (the other 2 options)
a) surgical thrombectomy; thrombolysis
b) surgical thrombectomy; heparin
c) thrombolysis; heparin
d) heparin; thrombolysis

Sept 5, 2011
http://circ.ahajournals.org/content/123/16/1788.full.pdf
According to the 2011 AHA
Management of Massive and Submassive Pulmonary Embolism,
(p 1801)
for “IVC Filters in the Setting of Acute PE”
“Adult patients with any confirmed acute PE (or
proximal DVT) ________  an IVC filter (Class I . . .”
a) the first line treatment is
b) with contraindications to anticoagulation or with active bleeding complication should receive
c) only rarely benefit from
d) should not receive
 

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