What this area covers
Interns and residents in Australian hospitals manage ward calls, fluids, prescribing and deteriorating patients, often overnight. This page is for interns, residents and IMGs starting their first Australian hospital job, and focuses on safe, practical decisions.
High-yield topics
| Topic | What to know |
|---|---|
| Warfarin | INR targets and high INR management |
| DOACs | Dosing by kidney function, perioperative plans |
| Heparin | Infusions and HIT |
| Reversal | Vitamin K, prothrombin complex, idarucizumab |
| Bleeding | Assess, stop, reverse, escalate |
Worked example
Worked question · Warfarin
An INR is 7.5 with no bleeding. What is usually advised?
- A Withhold; consider oral vitamin K
- B Continue warfarin unchanged
- C Give prothrombin complex concentrate now
- D Double the next dose
- E Start aspirin
Show the reasoning
Answer A. For INR above 4.5 to 10 without bleeding, withhold warfarin and consider low-dose oral vitamin K per local protocol.
A short study plan
| Week | Focus |
|---|---|
| 1 | Core principles |
| 2 | Common ward calls |
| 3 | Timed questions and review |
Do a short timed set most days and review every explanation, including the options you ruled out.
Common traps
- Acting without checking local protocols.
- Delaying escalation.
- Poor documentation.
Free sample anticoagulation questions
Questions from our Junior Doctor bank. Choose your answer, then open the explanation.
Mrs Webb, 74, on warfarin for AF, has an INR of 6.2. She has no bleeding and a low bleeding risk. What is the most appropriate management?
- AGive 10 mg of IV vitamin K immediately
- BContinue warfarin at the same daily dose
- CWithhold warfarin, recheck INR in 24 h
- DGive Prothrombinex and IV vitamin K now
- EStop warfarin permanently and start aspirin
Show answer and explanation
Answer C. For an INR between 4.5 and 10 without bleeding, withhold warfarin, find the cause (interacting drugs, illness, diet), and recheck. Low-dose oral vitamin K (1 to 2 mg) is considered if bleeding risk is high. Prothrombinex is for major bleeding. What to do next: Find the cause (interacting drugs such as antibiotics, illness, diet), recheck INR in 24 hours and restart at a lower dose once INR is back in range.
Learning point: INR 4.5 to 10 with no bleeding: withhold warfarin, find the cause and recheck; vitamin K only if high bleeding risk.
You are called about Mrs Kaur, 74, day 2 after a bowel resection. Her heart rate is 138 and irregular; BP 124/78, SpO2 96% on air. She feels mildly palpitant but has no chest pain or breathlessness. ECG confirms atrial fibrillation. What is the most appropriate first step?
- AGive IV amiodarone 300 mg as a rapid bolus over 1 minute
- BGive synchronised DC cardioversion on the ward straight away
- CStart therapeutic enoxaparin before checking anything else
- DFind and treat triggers: fluids, sepsis, potassium
- EPrescribe digoxin and review the response in the morning
Show answer and explanation
Answer D. Post-operative AF in a haemodynamically stable patient is usually driven by a reversible trigger: pain, hypovolaemia, sepsis, electrolyte disturbance (potassium, magnesium) or fluid overload. Correcting these often restores sinus rhythm or slows the rate. What to do next: Check UEC, magnesium, FBC and lactate, assess fluid balance and sources of infection, then consider rate control (for example metoprolol) and discuss anticoagulation with the surgical team.
Learning point: Stable new AF after surgery: find and fix the trigger (fluids, sepsis, potassium, magnesium) before drugs.
Mr Patel, 82, on apixaban for atrial fibrillation, fell out of bed at 2 am and hit his head. He is now GCS 15 with a small forehead bruise and no focal deficit. What is the most appropriate next step?
- ASkull X-ray and review on the morning round
- BArrange a non-contrast CT brain tonight
- CGive idarucizumab to reverse apixaban now
- DHourly neuro observations only, no imaging
- EWithhold apixaban and reassess in a week
Show answer and explanation
Answer B. Head injury in a patient taking an anticoagulant is an indication for CT brain even when GCS is 15, because delayed intracranial bleeding is more likely. Continue neuro observations, check FBC and coagulation, and complete a falls review. What to do next: Start neuro observations, check FBC and coagulation, hold the next anticoagulant dose pending CT and senior review, complete an incident report and a falls risk assessment.
Learning point: Head strike on an anticoagulant means CT brain, even if the patient looks well.
Practise more anticoagulation questions free
Every anticoagulation subtopic in our bank
The bank holds 17 anticoagulation questions across 17 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Apixaban dose1
- Bleeding after a renal biopsy1
- Dabigatran reversal1
- DOAC before surgery1
- Enoxaparin in kidney disease1
- Fall on anticoagulation1
- Fresh frozen plasma1
- Heparin infusion1
- Massive PE1
- Melaena1
- New atrial fibrillation1
- Post-operative bleeding1
- Swollen arm with a PICC1
- Swollen calf1
- Thrombocytopenia on heparin1
- Warfarin and a high INR1
- Warfarin and antibiotics1
Common questions
Is this relevant to IMGs?
Yes. Australian hospital systems, protocols and escalation pathways may differ from your previous experience.
Should I follow local protocols?
Always. This page explains principles; local policies apply.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.