Thromboembolic complicationsDownloads

A 32-year-old woman presents with progressive shortness of breath and a dry cough. She says that her symptoms onset recently after a 12-hour flight. Past medical history is unremarkable. Current medications are oral estrogen/progesterone containing contraceptive pills. Her vital signs include: blood pressure 110/60 mm Hg, pulse 101/min, respiratory rate 22/min, oxygen saturation 88% on room air, and temperature 37.9℃ (100.2℉). Her weight is 94 kg (207.2 lb) and height is 170 cm (5 ft 7 in). On physical examination, she is acrocyanotic. There are significant swelling and warmth over the right calf. There are widespread bilateral rales present. Cardiac auscultation reveals accentuation of the pulmonic component of the second heart sound (P2) and an S3 gallop. Which of the following ventilation/perfusion (V/Q) ratios most likely corresponds to this patient’s condition?

A 61-year-old woman presents to the emergency room with left leg pain and swelling. She recently returned to the United States from a trip to India. Her past medical history is notable for osteoarthritis in both hips, lumbar spinal stenosis, and hypertension. She takes lisinopril. Her temperature is 99°F (37.2°C), blood pressure is 140/85 mmHg, pulse is 110/min, and respirations are 24/min. On examination, her left calf is larger than her right calf. A lower extremity ultrasound demonstrates a deep venous thrombosis in the left femoral vein. Results from a complete blood count are within normal limits. She is admitted and started on unfractionated heparin. Seven days later, she presents with a dark erythematous skin lesion on her left thigh and worsening left leg swelling. A lower extremity ultrasound demonstrates a persistent deep venous thrombosis in the left femoral vein as well as a new deep venous thrombosis in the left popliteal vein. Results of a complete blood count are shown below: Hemoglobin: 13.1 g/dL Hematocrit: 38% Leukocyte count: 9,600/mm^3 with normal differential Platelet count: 74,000/mm^3 A medication with which of the following mechanisms of action is most appropriate to initiate in this patient after stopping the heparin?