American Board of Internal Medicine (ABIM) Certification Practice Exam

When is an IVC filter indicated?

1. For patients with stage I DVT

2. In cases of acute pelvic or proximal leg DVT with active bleeding

3. For patients needing outpatient anticoagulation

4. In chronic venous insufficiency

The correct answer is: In cases of acute pelvic or proximal leg DVT with active bleeding

An IVC (inferior vena cava) filter is indicated primarily in situations where there is a high risk of pulmonary embolism but anticoagulation therapy is contraindicated or the patient has active bleeding. In the context of acute pelvic or proximal leg DVT, the presence of active bleeding presents a significant concern; anticoagulation may expose the patient to a heightened risk of bleeding complications. Therefore, to mitigate the risk of a thrombus dislodging and causing a pulmonary embolism, an IVC filter can be employed to catch any clots before they can reach the lungs. This situation is particularly critical because the proximal venous systems are strongly associated with the formation of clots that can lead to severe embolic events. The IVC filter serves as a preventative measure, providing a mechanical barrier against these potentially life-threatening occurrences. In contrast, the other scenarios presented do not warrant the immediate use of an IVC filter. Stage I DVT may not present a significant risk of embolism, outpatient anticoagulation typically involves monitoring and managing the use of anticoagulants rather than requiring an invasive intervention like an IVC filter, and chronic venous insufficiency focuses on managing varicosities and inadequate venous return rather than preventing embolism in the