A 54-Year-Old Woman Comes to the Office Due to 2

question 343

Multiple Choice

A 54-year-old woman comes to the office due to 2 days of dull, aching pain and mild swelling of the left leg.  The symptoms began after a 12-hour nonstop flight.  The patient has had no shortness of breath, chest pain, or fever.  She has been able to ambulate and perform daily activities despite the discomfort.  Medical history includes hypertension and hyperlipidemia.  She has smoked a pack of cigarettes daily for the last 30 years but does not use alcohol or injection drugs.  The patient has no drug allergies.  She works in a law firm.
Vital signs are within normal limits.  BMI is 31 kg/m².  Heart sounds are normal, with no murmurs.  The lungs are clear to auscultation.  The left calf is mildly tender to palpation, with increased circumference compared to the right.  The remainder of the physical examination is normal.
Laboratory results of blood cell counts, serum chemistry, and coagulation studies are within normal limits.  Lower extremity venous Doppler ultrasonography shows an occluding thrombus in the left popliteal vein.  Which of the following is the best next step in management of this patient?

• A)Hospital admission for initial treatment with enoxaparin
• B)Hospital admission for initial treatment with unfractionated heparin
• C)Outpatient dabigatran therapy and repeat ultrasonography in 2 weeks
• D)Outpatient rivaroxaban therapy and clinical follow-up
• E)Supportive care only and clinical follow-up

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Definitions:

Conflict Theory

A perspective in sociology that sees social life as a competition, and focuses on the distribution of resources, power, and inequality.

Self-Fulfilling Prophecy

A belief or expectation that invokes a behavior which makes the originally false belief come true.

Generalized Other

A concept in sociology that represents the expectations, attitudes, and viewpoints of the society as a whole that individuals take into account in their behavior.

Thomas Theorem

The sociological theory that situations defined as real are real in their consequences, emphasizing the importance of perception in social dynamics.