Appendix A
1. How long have you been a practicing Gastroenterologist?
(a) less than 5 years
(b) 5 - 10 years
(c) 11 - 20 years
(d) more than 20 years
2. In what type of hospital do you take care of admitted IBD patients?
(a) Community Hospital
(b) Academic Medical Center
3. Approximately what proportion of patients in your practice have IBD?
(a) less than 10%
(b) 10%- 25%
(c) more than 25% but less than 50%
(d) 50% or more
4. You are admitting a 24 year-old man to your in-patient service for a UC flare. His disease was
previously controlled with oral aminosalicylates and an anti-metabolite. For the past three weeks
he has had three to four bowel movements (blood seen 50% of time) daily associated with
abdominal pain despite 40 mg of Prednisone daily and topical therapy. On arrival he is in no
apparent distress with normal vital signs and a completely benign abdominal exam. His
leukocyte count is 12,700, hemoglobin is 10.7 g/dl, and erythrocyte sedimentation rate is 9
mm/hr. He is placed on high-dose IV steroids. What type of VTE prophylaxis, if any, would you
prescribe this patient?
(a) Encourage early ambulation.
(b) Mechanical thromboprophylaxis with intermittent pneumatic compression.
(c) Sub-cutaneous low-dose unfractionated heparin or equivalent medication.
(d) Either B or C is acceptable.
(e) No prophylaxis is necessary.
5. A 37 year-old male with colonic CD is admitted to your service for generalized abdominal pain
and bloody diarrhea that have failed to respond adequately to outpatient prednisone. He is
generally ill-appearing but hemodynamically stable and afebrile. Abdominal exam reveals mild
tenderness without frank peritoneal signs. Initial laboratory evaluation is significant for a
leukocyte count of 13,200, hemoglobin of 8.1 g/dl, and platelet count of 90,000. Plain films of
the abdomen are unremarkable. When considering VTE prophylaxis options for this patient,
what factors in the patient’s history would you consider a contraindication to prescribing
pharmacologic thromboprophylaxis?
(a) His active rectal bleeding.
(b) The patient’s low hemoglobin and platelet counts.
(c) The potential need for surgical intervention.
(d) All of the above are contraindications.
(e) No absolute contraindication exists for this patient.
6. A 20 year-old man with UC presents to the Emergency Department with bloody diarrhea
which has failed to respond to oral prednisone and aminosalicylates. He reports approximately
10 bloody bowel movements daily, tenesmus and abdominal pain. He is found to be illappearing, with a soft, non-distended, yet diffusely tender abdominal exam. Vital signs are
within normal limits. His admission hemoglobin is 8.8 g/dl and his erythrocyte sedimentation rate
is 85 mm/hr. The patient is hospitalized and started on intravenous hydrocortisone (100mg
every 8 hours). If you were admitting this patient, what type of VTE prophylaxis would you
prescribe?
(a) Encouraging early ambulation.
(b) Mechanical thromboprophylaxis with intermittent pneumatic compression.
(c) Sub-cutaneous low-dose unfractionated heparin or equivalent medication.
(d) Either B or C is acceptable.
(e) No prophylaxis is necessary
7. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary
embolism (PE), is highly prevalent in hospitalized patients. What is the relative risk of VTE in
patients hospitalized for an inflammatory bowel disease (IBD) flare compared with other
inpatients?
(a) There are currently insufficient quality data to determine the VTE risk in hospitalized IBD
patients.
(b) Several studies have found no significant difference in VTE risk between hospitalized IBD
patients and other inpatients.
(c) Several studies have demonstrated a lower risk of VTE in hospitalized IBD patients relative
to other inpatients.
(d) Several studies have demonstrated a higher risk of VTE in hospitalized IBD patients relative
to other inpatients.
8. In 2008 the American College of Chest Physicians (ACCP) published updated evidencebased practice guidelines on the prevention of VTE. Based on this document, the recommended
modality for VTE prophylaxis in hospitalized IBD patients confined to bed is:
(a) Mechanical thromboprophylaxis using intermittent pneumatic compression (IPC) or
graduated compression stockings (GCS).
(b) Low molecular weight heparin (LMWH), low-dose unfractionated heparin (LDUH)
or fondaparinux.
(c) No prophylaxis since IBD patients are relatively young, sufficiently ambulatory and lack other
co-morbidities.
(d) Either A or B. They are likely equivalent in this patient population.
9. In the American College of Gastroenterology (ACG) Practice Guidelines, what type of VTE
prophylaxis is recommended in hospitalized UC and CD patients?
(a) The ACG Practice Guidelines do not currently recommend VTE prophylaxis for hospitalized
UC and CD patients.
(b) The ACG Practice Guidelines recommend pharmacologic VTE prophylaxis in hospitalized
CD patients but do not address the issue in UC patients.
(c) The ACG Practice Guidelines recommend consideration of pharmacologic VTE prophylaxis
in hospitalized UC patients but do not address the issue in CD patients.
(d) The ACG Practice Guidelines recommend pharmacologic VTE prophylaxis in both
hospitalized CD and UC patients.
10. In your experience, what proportion of hospitalized IBD patients at your institution receive
pharmacologic VTE prophylaxis?
(a) less than or equal to 25%
(b) More than 25% but less than 50%
(c) 50% or more but less than 75%
(d) 75% or more