Rheumatology: antiphospholipid syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Rheumatology: antiphospholipid syndrome

Sample item

A 34-year-old woman has a first unprovoked proximal deep vein thrombosis. The aPTT is prolonged and does not correct on mixing with normal plasma. Lupus anticoagulant, anticardiolipin and anti-beta-2 glycoprotein I antibodies are all positive twice, 12 weeks apart. What is the best long-term anticoagulation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Lifelong warfarin with a target INR of 2 to 3

Persistent antiphospholipid antibodies with a thrombotic event define thrombotic antiphospholipid syndrome. Recurrence risk is high, so indefinite anticoagulation is recommended, and warfarin is preferred over direct oral anticoagulants, especially in triple-positive patients, in whom DOACs show more arterial events. The prolonged aPTT is an in vitro artefact, and the patient is at risk of thrombosis, not bleeding.

Option by option

  • A. Hydroxychloroquine alone

    Hydroxychloroquine is an adjunct and is not an anticoagulant.

  • B. Lifelong warfarin with a target INR of 2 to 3 (correct)

    Correct. Indefinite vitamin K antagonist therapy is the standard for thrombotic APS.

  • C. Rivaroxaban for 3 months then stop

    A short DOAC course is inadequate, and DOACs are less effective in triple-positive disease.

  • D. Lifelong aspirin alone

    Aspirin alone does not adequately prevent venous or recurrent thrombosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Lifelong warfarin with a target INR of 2 to 3. Persistent antiphospholipid antibodies with a thrombotic event define thrombotic antiphospholipid syndrome.

Why is "Hydroxychloroquine alone" not the answer?

Hydroxychloroquine is an adjunct and is not an anticoagulant.

Why is "Rivaroxaban for 3 months then stop" not the answer?

A short DOAC course is inadequate, and DOACs are less effective in triple-positive disease.

Why is "Lifelong aspirin alone" not the answer?

Aspirin alone does not adequately prevent venous or recurrent thrombosis.

What concept does this question test?

It tests Rheumatology: antiphospholipid syndrome in General Medicine. Recurrence risk is high, so indefinite anticoagulation is recommended, and warfarin is preferred over direct oral anticoagulants, especially in triple-positive patients, in whom DOACs show more arterial events. The prolonged aPTT is an in vitro artefact, and the patient is at risk of thrombosis, not bleeding.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: antiphospholipid syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.