Anticoagulation: ABFM practice questions

19 board-style questions on anticoagulation in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 69-year-old woman with newly diagnosed nonvalvular atrial fibrillation presents for management. Her medical history includes hypertension, type 2 diabetes, and stable angina. She has no history of stroke, TIA, thromboembolism, or vascular disease. Her CHA2DS2-VASc score is calculated as 4 (age 65-74 = 1, female sex = 1, hypertension = 1, diabetes = 1). Renal and hepatic function are normal. What is the most appropriate stroke prevention strategy?

  1. No anticoagulation or antiplatelet therapy needed
  2. Dual antiplatelet therapy with aspirin and clopidogrel
  3. Aspirin 81 mg daily
  4. Direct oral anticoagulant such as apixaban

Sample question 2

A 58-year-old man presents to the emergency department with new-onset palpitations and is found to be in atrial fibrillation. The onset of symptoms is unclear; he first noticed palpitations 4 days ago but cannot confirm when the arrhythmia started. He is hemodynamically stable with BP 128/76 mmHg and heart rate 132 bpm. He has not been on anticoagulation therapy. Elective cardioversion is planned. What anticoagulation strategy is required before and after cardioversion?

  1. Cardiovert immediately; anticoagulation is unnecessary if AF duration is less than 7 days
  2. Anticoagulate for at least 3 weeks before cardioversion and at least 4 weeks after, or perform TEE to exclude thrombus before proceeding
  3. Start anticoagulation on the day of cardioversion and continue for 2 weeks afterward
  4. Administer aspirin 325 mg and proceed with cardioversion without additional anticoagulation

Create a free PulseMD account to answer these, see the explanations, and practice five minutes a day.

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