MSN Exam for Anticoagulants

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1. Anticoagulants are indicated for an indefinite period in patients with:

  1. Atrial fibrillation
  2. Venous thromboembolism
  3. High risk of myocardial infarction
  4. All of the above

2. Which of the following sentence is true with regard to warfarin?

  1. Is a vitamin K antagonist
  2. Is a thrombin inhibitor
  3. Activates fibrinolysis
  4. Binds to antithrombin III

3. Which of the following is not an approved indication for warfarin therapy?

  1. Atrial fibrillation
  2. Heart valve replacement
  3. Deep vein thrombosis
  4. Peripheral artery disease

4. Time taken for observable anticoagulant effect of warfarin is:

  1. 6-12 hours
  2. 24-36 hours
  3. 2-7 days
  4. 8-10days

5. Which of the following is the recommended test to monitor the effect of oral anticoagulant therapy?

  1. Thrombin time
  2. International normalized ratio (INR)
  3. Bleeding time
  4. Partial thromboplastin time (PTT)

6. What is the most acceptable frequency of INR monitoring in a patient taking warfarin?

  1. Initially thrice daily, then twice daily, then daily, then weekly, and then monthly
  2. Initially twice daily, then daily, then weekly, and then monthly
  3. Initially daily, then weekly, and then monthly
  4. Initially twice per week, then weekly, then every two or three weeks, and then monthly

7. What is the value of International normalized ratio (INR) above which warfarin does not provide any additional therapeutic benefit in most patients, but is associated with a higher risk of bleeding?

  1. 4.0
  2. 3.5
  3. 3.0
  4. 2.5

8. Which of the following is used for reversal of anticoagulant effect of warfarin in case of life-threatening bleeding?

  1. Platelets
  2. Protamine
  3. Vitamin K or Vitamin K dependant coagulation factors
  4. Any of the above

9. Which of the following statement(s) concerning heparin is/are true?

  1. It binds to antithrombin III leading to anticoagulant effect
  2. It exhibits varying anticoagulant response
  3. Heparin therapy is monitored with activated partial thromboplastin time (APTT)
  4. All of the above

10. Which of the following is an advantage of low molecular weight heparin (LMWH) over unfractionated heparin?

  1. Does not require monitoring of activated partial thromboplastin time
  2. Has a greater bioavailibility
  3. Given subcutaneously therefore can be administered in “out of hospital setting”
  4. All of the above

11. Low molecular weight heparins (LMWHs) do not require monitoring, but when necessary, which of the following is measured?

  1. Anti-factor Xa level
  2. Thrombin time
  3. Prothrombin time
  4. Activated partial thromboplastin time (APTT)

12. The anticoagulant effect of heparin is rapidly reversed with:

  1. Protamine
  2. Infusion of vitamin K dependant coagulation factors
  3. Packed red blood cells
  4. Platelets

13. Which of the following anticoagulant should not be given during pregnancy?

  1. Warfarin
  2. Low molecular weight heparins (LMWHs)
  3. Unfractionated heparin
  4. All of the above

14. Which of the following is correct with regard to patients taking warfarin undergoing surgery with minimal risk of bleeding?

  1. Do not stop warfarin but check INR prior to surgery
  2. Switch over to heparin two days prior to surgery and restart warfarin after surgery
  3. Switch over to heparin five days prior to surgery and restart warfarin after surgery
  4. Switch over to heparin seven days prior to surgery and restart warfarin after surgery

15. Anticoagulation in warfarin users at high risk of thromboembolism, undergoing surgery associated with high risk of bleeding involves:

  1. Stop warfarin 4-5 days prior to surgery
  2. Start with full dose unfractionated heparin or LMWH 2-3 days preoperatively
  3. Restart regular warfarin therapy after surgery once adequate haemostasis is achieved
  4. All of the above
Answers
  1. A. Atrial fibrillation
  2. A. Is a vitamin K antagonist
  3. D. Peripheral artery disease
  4. C. 2-7 days
  5. B. International normalized ratio (INR)
  6. D. Initially twice per week, then weekly, then every two or three weeks, and then monthly
  7. A. 4.0
  8. C. Vitamin K or Vitamin K dependant coagulation factors
  9. D. All of the above
  10. D. All of the above
  11. A. Anti-factor Xa level
  12. A. Protamine
  13. A. Warfarin
  14. A. Do not stop warfarin but check INR prior to surgery
  15. D. All of the above

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