A 65 year old woman presents with a swollen, red, tender left lower limb-UKMLA PLAB AMC USMLE Prometric MCQ

A 65 year old woman presents with a swollen, red, tender left lower limb

on Monday, March 26, 2012

Question Number 0011

Question:
A 65 year old woman presents with a swollen, red, tender left lower limb. She has had surgery for a hip replacement 10 days ago. Ultrasound demonstrated a non-compressible left superficial femoral vein. What is the most appropriate management?

a) Course of vancomycin
b) stripping of varicose veins
c) Percutaneous thrombolysis
d) Pulmonary Ventilation/Perfusion scintigraphy
e) Administer low-molecular-weight-heparin

Correct Answer: E

Explanation:
The finding of a a non-compressible superficial superficial femoral vein is indicative of thrombosis of this vein which is the major vein draining the lower limb. Once a diagnosis of Deep vein thrombosis has been made by venography or ultrasonography , baseline CBC, PTT, and INR levels should be obtained.

Heparin should be administered Warfarin should be started on the evening of Day 1, and the dose adjusted to obtain an INR level of 2.0 - 3.0

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