1. EK is a 72-year-old female with pancreatic cancer and hypertension. She is 5'3” and weighs 52 kg. Her medical oncologist plans to start treatment with gemcitabine and albumin-bound paclitaxel administered via a central venous access device. EK's risk factors for development of venous thromboembolism include:
A. Age, pancreatic cancer, obesity
B. Pancreatic cancer, hypertension, central venous access device
C. Age, obesity, chemotherapy regimen
D. Age, pancreatic cancer, central venous access device
E. Unsure
2. KD is an 84-year-old male with glioblastoma, prostate cancer, and type 2 diabetes mellitus. He is scheduled to initiate therapy with bevacizumab for glioblastoma. His other medications include metformin, ramipril, and leuprolide. Which medication increases KD's risk of venous thromboembolism?
A. Bevacizumab
B. Metformin
C. Ramipril
D. Leuprolide
E. Unsure
3. All of the following organizations have developed guidelines for the treatment of venous thromboembolism in patients with cancer except:
A. National Comprehensive Cancer Network
B. American College of Chest Physicians
C. American Society for Blood and Marrow Transplantation
D. American Society of Clinical Oncology
E. Unsure
4. According to the National Comprehensive Cancer Network, what is the recommended minimum duration of anticoagulation therapy for patients with cancer who develop a venous thromboembolism?
A. 1 month
B. 3 months
C. 6 months
D. Indefinitely
E. Unsure
5. AJ is a 67-year-old female with pancreatic cancer who weighs 62 kg. She presents with a lower extremity deep vein thrombosis (DVT) and is started on enoxaparin 60 mg subcutaneously twice daily, since her renal function is within normal limits. At her routine blood work check 7 days later, her platelet count is noted to have fallen from 75,000 to 31,000/?L. Follow-up blood work with a serotonin release assay confirms heparin-induced thrombocytopenia. What medication should be recommended to treat AJ's DVT in the ambulatory setting?
A. Fondaparinux 7.5 mg subcutaneously once daily
B. Warfarin 5 mg by mouth daily adjusted to a goal international normalized ratio (INR) of 2 to 3
C. Enoxaparin 90 mg subcutaneously once daily
D. Dabigatran 150 mg by mouth twice daily
E. Unsure
6. Which direct-acting oral anticoagulant is recommended by the National Comprehensive Cancer Network for first-line treatment of cancer-related venous thromboembolism?
A. Rivaroxaban
B. Edoxaban
C. Apixaban
D. Dabigatran
E. Unsure
7. SH is a 69-year-old male who weighs 83 kg. He has small cell lung cancer and is receiving treatment with cisplatin and etoposide. He has normal renal and hepatic function. He developed a deep vein thrombosis and was subsequently started on enoxaparin 80 mg subcutaneously twice daily. Follow-up lab work shows a platelet count of 40,000/?L. What is the appropriate dose adjustment for SH's enoxaparin?
A. 40 mg subcutaneously twice daily
B. 120 mg subcutaneously once daily
C. Hold enoxaparin until platelet count is greater than 50,000/?L
D. No dose adjustment is needed
E. Unsure
8. Guidelines recommend low molecular weight heparin (LMWH) over warfarin on the basis of all of the following reasons EXCEPT:
A. LMWH has been shown to be more effective than warfarin
B. Maintaining a therapeutic international normalized ratio (INR) in patients with cancer receiving warfarin is challenging
C. LMWH is more tolerable in patients unable to swallow
D. Warfarin may be easily held for procedures
E. Unsure
9. MH is a 70-year-old female who weighs 97 kg. She has metastatic breast cancer and was diagnosed with a venous thromboembolism (VTE) while admitted for intractable nausea/vomiting and dehydration post-chemotherapy. What is the most appropriate treatment for MH's VTE?
A. Warfarin titrated to an international normalized ratio (INR) of 2.5 to 3.5
B. Dabigatran 150 mg by mouth twice daily
C. Dalteparin 18,000 units subcutaneously once daily
D. Enoxaparin 150 mg subcutaneously twice daily
E. Unsure
10. CD is a 62-year-old female with metastatic colon cancer who was admitted to the hospital for a febrile neutropenia episode. Upon discharge, what venous thromboembolism prophylaxis should be recommended?
A. Enoxaparin 40 mg subcutaneously twice daily
B. Rivaroxaban 10 mg by mouth once daily
C. Aspirin 325 mg by mouth once daily
D. No prophylaxis is needed
E. Unsure
Evaluation Questions
11. How confident are you in your decision about treatment for patient AJ in the question above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
12. How confident are you in your decision about treatment for patient SH in the question above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
13. How confident are you in your decision about treatment for patient MH in the question above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
14. How confident are you in your decision about treatment for patient CD in the question above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
