Acute Hemolytic Reaction & TRALI Quiz
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Questions and Answers

What is the most likely cause of the patient's sudden onset shortness of breath during the blood transfusion?

  • Endotoxin release from infused bacteria
  • Preformed antibodies to transfused red blood cells (correct)
  • Immune response to transfused plasma proteins
  • Intra-abdominal hemorrhage

    • In a patient with type A blood, which blood types can they safely receive?

  • Type A blood and type B blood
  • Type A blood and type AB blood
  • Type O blood and type AB blood
  • Type A blood and type O blood (correct)

    • What is a life-threatening condition that can arise from ABO incompatibility during a blood transfusion?

  • Acute hemolytic transfusion reaction (correct)
  • Transfusion-associated immunomodulation
  • Delayed hemolytic transfusion reaction
  • Transfusion-related acute lung injury

    • Which clinical manifestation is NOT typically associated with acute hemolytic transfusion reaction?

    <p>Diarrhea</p> Signup and view all the answers

    What is the first action to take when an acute hemolytic transfusion reaction is suspected?

    <p>Immediately stop the transfusion</p> Signup and view all the answers

    What is the most common reason for acute hemolytic transfusion reactions?

    <p>Clerical error in blood type matching</p> Signup and view all the answers

    What treatment step should follow the cessation of transfusion in case of an acute hemolytic reaction?

    <p>Notify the blood bank and laboratory</p> Signup and view all the answers

    Which of the following symptoms is characteristic of an acute hemolytic transfusion reaction?

    <p>Hypotension</p> Signup and view all the answers

    What condition could result from a spinal cord injury in this patient?

    <p>Neurogenic shock</p> Signup and view all the answers

    What is the most appropriate next step in managing this patient's injuries?

    <p>Exploratory laparotomy</p> Signup and view all the answers

    Which imaging technique is primarily used to assess the presence of free fluid in trauma patients?

    <p>Ultrasonography</p> Signup and view all the answers

    Which of the following injuries is commonly associated with blunt abdominal trauma?

    <p>Laceration of the spleen</p> Signup and view all the answers

    What is a common symptom of splenic injury as evidenced in this patient's case?

    <p>Left upper quadrant tenderness</p> Signup and view all the answers

    What mechanism explains the hypotension seen in the patient with a spinal cord injury?

    <p>Disruption of sympathetic innervation</p> Signup and view all the answers

    What finding on imaging is indicative of significant splenic injury?

    <p>Extravasation of contrast</p> Signup and view all the answers

    Which statement correctly describes the role of angiography in the context of this trauma?

    <p>It helps locate active bleeding areas in solid organs.</p> Signup and view all the answers

    Which of the following is NOT a typical presentation for a splenic injury?

    <p>Severe headaches</p> Signup and view all the answers

    What type of approach is generally required for managing a severe splenic injury in unstable patients?

    <p>Exploratory laparotomy</p> Signup and view all the answers

    What is a potential result of delayed or insufficient management of a splenic laceration?

    <p>Hemodynamic instability</p> Signup and view all the answers

    Why might the use of FAST be limited in this patient after a CT scan shows free fluid?

    <p>The patient has already had a detailed CT scan.</p> Signup and view all the answers

    What is the significance of tachycardia in the context of traumatic injuries?

    <p>It may reflect hemodynamic instability.</p> Signup and view all the answers

    What is the primary characteristic of TRALI?

    <p>Respiratory distress due to neutrophil activation</p> Signup and view all the answers

    Which symptom is NOT commonly associated with TRALI?

    <p>Dark urine</p> Signup and view all the answers

    What immediate action is required for a patient exhibiting symptoms of TRALI?

    <p>Provide supportive care</p> Signup and view all the answers

    In the case of splenic injury due to blunt abdominal trauma, when is exploratory laparotomy indicated?

    <p>In hemodynamically unstable patients</p> Signup and view all the answers

    Which of the following findings on imaging would most likely indicate a ruptured spleen?

    <p>Free fluid around the spleen</p> Signup and view all the answers

    What distinguishes TRALI from other pulmonary complications following transfusion?

    <p>Timing of symptom onset</p> Signup and view all the answers

    What clinical findings might suggest a diagnosis of pulmonary embolism instead of TRALI?

    <p>Hypotension and altered mental status</p> Signup and view all the answers

    How should a mild splenic injury generally be managed in a stable patient?

    <p>Observe and reassess</p> Signup and view all the answers

    Why is it critical not to use blood from the same donor after a TRALI episode?

    <p>To prevent recurrence of TRALI symptoms</p> Signup and view all the answers

    Which aspect of splenic injury assessment is critical for determining the management approach?

    <p>The presence of hemodynamic stability</p> Signup and view all the answers

    Which finding on clinical examination would indicate possible kidney involvement in trauma?

    <p>Flank pain and dark urine</p> Signup and view all the answers

    What treatment is often included in the supportive care of patients with TRALI?

    <p>Vasopressors if hypotensive</p> Signup and view all the answers

    What is a defining feature of an acute hemolytic transfusion reaction?

    <p>Direct hemolysis of transfused red blood cells</p> Signup and view all the answers

    Which of the following is a common symptom of both TRALI and pneumonia?

    <p>Dyspnea</p> Signup and view all the answers

    Which condition is ruled out due to the absence of fluid on chest x-ray and FAST exam?

    <p>Aortic disruption</p> Signup and view all the answers

    What is one hallmark of neurogenic shock due to spinal cord injury?

    <p>Bradycardia</p> Signup and view all the answers

    What is the primary concern associated with acute hemolytic transfusion reactions?

    <p>Profound hemolysis due to ABO incompatibility</p> Signup and view all the answers

    Which imaging method is most appropriate to confirm increased intracranial pressure in a case of suspected idiopathic intracranial hypertension?

    <p>Lumbar puncture</p> Signup and view all the answers

    Which patient group is at a higher risk of transfusion-related sepsis?

    <p>Patients receiving platelets</p> Signup and view all the answers

    In a patient with suspected idiopathic intracranial hypertension, which of the following findings is commonly expected?

    <p>Bilateral papilledema</p> Signup and view all the answers

    What is the best initial step to manage a patient with neurogenic shock?

    <p>Fluid resuscitation</p> Signup and view all the answers

    What is a common clinical manifestation of transfusion-related acute lung injury (TRALI)?

    <p>Sudden onset dyspnea</p> Signup and view all the answers

    What typically happens to patients with type A blood who receive type B blood?

    <p>They can develop acute hemolytic transfusion reactions</p> Signup and view all the answers

    Which statement best describes idiopathic intracranial hypertension?

    <p>It can lead to permanent vision loss if untreated.</p> Signup and view all the answers

    What could bradycardia resulting from neurogenic shock also indicate?

    <p>Increased vagal tone</p> Signup and view all the answers

    Which type of transfusion reaction is characterized by renal failure and disseminated intravascular coagulopathy?

    <p>Acute hemolytic transfusion reaction</p> Signup and view all the answers

    What should be done immediately if an acute hemolytic transfusion reaction is suspected?

    <p>Contact the blood bank and cease the transfusion</p> Signup and view all the answers

    In patients with fractures, which type of fracture is associated with more significant hemodynamic hemorrhage?

    <p>Femur fracture</p> Signup and view all the answers

    What is a potential consequence of clerical errors during blood transfusions?

    <p>ABO incompatibility leading to AHTR</p> Signup and view all the answers

    What role do baroreceptors play in blood pressure regulation?

    <p>They provide feedback to the medulla oblongata for vasomotor control.</p> Signup and view all the answers

    What type of antibodies do patients with type O blood possess?

    <p>Antibodies against both A and B antigens</p> Signup and view all the answers

    Which medication may be trialed for managing bradycardia following acute traumatic spinal cord injury?

    <p>Atropine</p> Signup and view all the answers

    What does the focused assessment with sonography for trauma (FAST) primarily evaluate?

    <p>Presence of fluid in the abdomen</p> Signup and view all the answers

    What is a key difference between transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO)?

    <p>TRALI results from neutrophil activation in the lungs</p> Signup and view all the answers

    In patients with IgA deficiency, an immune response to transfused plasma proteins can lead to which type of reaction?

    <p>Anaphylactic reaction</p> Signup and view all the answers

    Which of the following is least likely to be a cause of secondary headaches in young women with increased BMI?

    <p>Migraine episodes</p> Signup and view all the answers

    What condition can potentially occur following traumatic injury to the autonomic centers of the brain?

    <p>Neurogenic shock</p> Signup and view all the answers

    What can be a result of transferring packed red blood cells from a donor whose blood contains inflammatory cytokines?

    <p>Non-cardiogenic pulmonary edema</p> Signup and view all the answers

    What characterizes the onset timing of symptoms in a typical TRALI case?

    <p>Symptoms develop within minutes to hours</p> Signup and view all the answers

    In the setting of an acute hemolytic transfusion reaction, what is a common laboratory finding?

    <p>Positive direct antiglobulin (Coombs) test</p> Signup and view all the answers

    How does preformed antibodies against donor erythrocyte antigens affect transfusions?

    <p>They can lead to life-threatening reactions</p> Signup and view all the answers

    What characterizes idiopathic intracranial hypertension (IIH)?

    <p>Commonly occurs in young women with increased BMI</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing idiopathic intracranial hypertension (IIH)?

    <p>Advanced age</p> Signup and view all the answers

    What symptom often worsens when lying down in patients with increased intracranial pressure?

    <p>Chronic headache</p> Signup and view all the answers

    In the evaluation of suspected idiopathic intracranial hypertension, what is the initial step after a normal CT scan?

    <p>Therapeutic lumbar puncture</p> Signup and view all the answers

    What type of lesion is basal cell carcinoma most commonly associated with?

    <p>Aged skin with excessive sun exposure</p> Signup and view all the answers

    Which technique is typically used in the biopsy of basal cell carcinoma?

    <p>Shave biopsy</p> Signup and view all the answers

    Which of the following medications is NOT associated with idiopathic intracranial hypertension (IIH)?

    <p>Acetazolamide</p> Signup and view all the answers

    What is the characteristic appearance of basal cell carcinoma (BCC)?

    <p>Pink, pearly papules with rolled borders</p> Signup and view all the answers

    Which of the following treatments is recommended for noncritical area BCC?

    <p>Complete surgical excision with 1-cm margins</p> Signup and view all the answers

    What is a typical presentation of optic neuritis?

    <p>Decreased vision and relative afferent pupillary defect</p> Signup and view all the answers

    What is the risk of metastasis in basal cell carcinoma?

    <p>Low, with most cases remaining localized</p> Signup and view all the answers

    What clinical finding is most indicative of papilledema?

    <p>Increased opening pressure on lumbar puncture</p> Signup and view all the answers

    Which lesion is characterized by a hyperkeratotic crust rather than a smooth surface?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which of the following describes the typical appearance of a basal cell carcinoma?

    <p>Pearly nodules with rolled borders</p> Signup and view all the answers

    What should be the margin of excision for a BCC located in a non-critical area?

    <p>1 cm</p> Signup and view all the answers

    Which of the following interventions is NOT part of the management for idiopathic intracranial hypertension?

    <p>Routine use of systemic steroids</p> Signup and view all the answers

    Which of the following statements about visual evoked potentials (VEP) is true?

    <p>VEP can help assess optic nerve conduction delay.</p> Signup and view all the answers

    Which of the following is NOT typically recommended for basal cell carcinoma management?

    <p>Sentinel lymph node biopsy</p> Signup and view all the answers

    What is a common clinical feature of a melanoma?

    <p>Irregular borders and variable coloration</p> Signup and view all the answers

    What should be performed as part of the initial evaluation in a patient with papilledema?

    <p>CT scan of the brain</p> Signup and view all the answers

    What characterizes the lesions of squamous cell carcinoma compared to basal cell carcinoma?

    <p>Higher risk of metastasis</p> Signup and view all the answers

    In which regions of the body is basal cell carcinoma most commonly found?

    <p>Sun-exposed areas of the head and neck</p> Signup and view all the answers

    What is the recommended margin for complete surgical excision of basal cell carcinoma located in noncritical areas?

    <p>1 cm</p> Signup and view all the answers

    What demographic factors increase the risk of developing basal cell carcinoma?

    <p>Fair skin, UV light exposure, and family history</p> Signup and view all the answers

    What is the risk of recurrence for basal cell carcinoma when a margin of 1 cm is used?

    <p>Less than 1%</p> Signup and view all the answers

    What distinguishes hemangioma from other skin lesions?

    <p>They present as highly vascular, firm lesions</p> Signup and view all the answers

    What subtype of melanoma is known to lack pigment?

    <p>Amelanotic melanoma</p> Signup and view all the answers

    Which statement about sentinel lymph node biopsy in basal cell carcinoma is true?

    <p>It is not usually recommended due to low yield</p> Signup and view all the answers

    What is the most appropriate next step in managing a patient with frostbite after rewarming the affected area?

    <p>Administer analgesics and observe</p> Signup and view all the answers

    What characteristic is associated with the evolved nature of melanoma lesions?

    <p>They rapidly evolve in characteristics</p> Signup and view all the answers

    Which of the following is NOT a method for managing frostbite?

    <p>Administering intravenous heparin alone</p> Signup and view all the answers

    What is the role of Mohs micrographic surgery?

    <p>It allows for excision while sparing normal tissues</p> Signup and view all the answers

    Which of the following features would NOT suggest a basal cell carcinoma?

    <p>Firm, raised, vascular lesions</p> Signup and view all the answers

    What is the primary cause of tissue destruction in frostbite?

    <p>Cold-induced cell death</p> Signup and view all the answers

    What symptoms are typically associated with the onset of frostbite?

    <p>Cyanosis and numbness</p> Signup and view all the answers

    When is amputation typically indicated for frostbite patients?

    <p>After 24 hours of observation for tissue viability</p> Signup and view all the answers

    In which patient population is frostbite commonly seen?

    <p>Those exposed to extreme cold environments</p> Signup and view all the answers

    What is the best initial treatment method upon diagnosing frostbite?

    <p>Warm water immersion</p> Signup and view all the answers

    What does a pedal pulse of 0.85 indicate regarding limb circulation?

    <p>Mild impairment in blood flow</p> Signup and view all the answers

    What kind of lesions may require more extensive surgical margins than 1 cm?

    <p>Cutaneous melanoma</p> Signup and view all the answers

    Why is immediate arteriography not appropriate in the patient with frostbite in this scenario?

    <p>The patient has palpable pedal pulses</p> Signup and view all the answers

    What is the most appropriate next step in managing a patient with gangrene in a non-communicative, immobile state?

    <p>Amputation</p> Signup and view all the answers

    Which risk factors are commonly associated with peripheral arterial disease (PAD)?

    <p>Diabetes mellitus and hypertension</p> Signup and view all the answers

    What symptom is typically associated with intermittent claudication due to PAD?

    <p>Muscle cramping during physical activity</p> Signup and view all the answers

    What does the presence of dry gangrene typically imply in the context of PAD?

    <p>Tissue perfusion is severely compromised</p> Signup and view all the answers

    Which of the following treatments is ineffective for severe PAD with gangrene?

    <p>Cilostazol therapy</p> Signup and view all the answers

    The inability to extend hips beyond 110 degrees and knees beyond 70 degrees in a patient indicates what clinical condition?

    <p>Contractures</p> Signup and view all the answers

    In the management of PAD, when is surgical revascularization generally indicated?

    <p>When ischemic ulcers are present</p> Signup and view all the answers

    What effect does clopidogrel have in patients with peripheral arterial disease?

    <p>Prevents blood clot formation</p> Signup and view all the answers

    What aspect makes amputation a suitable option for an immobile patient with contractures?

    <p>It aligns better with goals of care</p> Signup and view all the answers

    Which statement about peripheral arterial disease is incorrect?

    <p>It directly causes respiratory issues.</p> Signup and view all the answers

    What presentation is characteristic of wet gangrene as opposed to dry gangrene?

    <p>Presence of pus and foul odor</p> Signup and view all the answers

    Which statement accurately describes the physiological effect of decreased blood flow due to atherosclerosis?

    <p>It may lead to pain at rest.</p> Signup and view all the answers

    What indicates a severe form of PAD that often necessitates drastic management options?

    <p>Tissue necrosis or gangrene</p> Signup and view all the answers

    Why might surgical revascularization not be suitable for a patient with lower extremity gangrene?

    <p>Gangrene suggests irreversibility of damage.</p> Signup and view all the answers

    What characteristic of the lump makes it potentially concerning for malignancy?

    <p>Firmness and adherence to the bone</p> Signup and view all the answers

    Which imaging technique is preferred for characterizing primary bone lesions?

    <p>MRI</p> Signup and view all the answers

    What is the rationale for performing a biopsy of the lesion?

    <p>To definitively diagnose tumor type</p> Signup and view all the answers

    What immediate management step is necessary after confirming the patient's symptoms post-surgery?

    <p>Perform a 12-lead ECG</p> Signup and view all the answers

    What does the presence of tachycardia and diaphoresis indicate in the postoperative patient?

    <p>Potential cardiac complications</p> Signup and view all the answers

    Which characteristic is NOT typically associated with malignancies of bone?

    <p>Skin changes around the lesion</p> Signup and view all the answers

    Why is a second x-ray in 2 months considered inappropriate management for this patient?

    <p>It could postpone necessary treatment.</p> Signup and view all the answers

    What should be prioritized before any additional radiographic testing in case of a concerning bone lesion?

    <p>Performing a biopsy</p> Signup and view all the answers

    In the context of cardiovascular risks, what is the importance of monitoring the patient's troponin levels?

    <p>To evaluate potential myocardial damage</p> Signup and view all the answers

    Which of the following would be an inappropriate response to the patient's symptoms post-surgery?

    <p>Immediately conducting a CT scan of the abdomen</p> Signup and view all the answers

    What is the potential significance of a periosteal reaction found in the x-ray results?

    <p>Could suggest possible malignancy</p> Signup and view all the answers

    Which other diagnostic tool is typically used alongside a biopsy to assess for malignancies?

    <p>MRI</p> Signup and view all the answers

    What could be the consequence of performing nonweight-bearing exercises for this patient?

    <p>Delayed diagnosis</p> Signup and view all the answers

    What factor increases the risk of major adverse cardiovascular events in this postoperative patient?

    <p>Hypertension and diagnosed CAD</p> Signup and view all the answers

    Which blood gas analysis finding is indicative of hypoventilation in this patient?

    <p>Decreased Po2</p> Signup and view all the answers

    What does a pH of 7.31 suggest about the acid-base status of this patient?

    <p>Respiratory acidosis</p> Signup and view all the answers

    Which of the following best explains the patient's decreased breath sounds observed during the examination?

    <p>Decreased lung volumes</p> Signup and view all the answers

    What is the likely relationship between this patient's obesity and his respiratory failure?

    <p>Obesity leads to hypoventilation</p> Signup and view all the answers

    Which mechanism is primarily responsible for the presence of hypercapnia in this patient?

    <p>Decreased ventilation</p> Signup and view all the answers

    What is the most appropriate tool for assessing the risk of major adverse cardiovascular and cerebrovascular events (MACCE) in a patient prior to surgery?

    <p>Revised cardiac risk index (RCRI)</p> Signup and view all the answers

    Which symptom in a patient with aortic stenosis indicates the need for aortic valve replacement?

    <p>Angina and syncope</p> Signup and view all the answers

    What indicates that a 12-lead ECG should be performed before other imaging in a patient presenting with abdominal pain?

    <p>Symptoms indicative of acute coronary syndrome</p> Signup and view all the answers

    What is the best initial step if pulmonary embolism is considered in a patient with abdominal pain?

    <p>Conduct pulmonary vascular imaging</p> Signup and view all the answers

    Which of the following findings would NOT directly warrant investigation of aortic stenosis severity?

    <p>Peripheral edema</p> Signup and view all the answers

    What generally best indicates a patient’s perioperative cardiovascular risk?

    <p>Functional status prior to surgery</p> Signup and view all the answers

    Which diagnostic intervention should be prioritized for a patient showing symptoms of acute coronary syndrome?

    <p>12-lead ECG</p> Signup and view all the answers

    What complication can arise from untreated severe aortic stenosis?

    <p>Myocardial ischemia</p> Signup and view all the answers

    What is a nonspecific test that would NOT provide useful information for assessing cardiac risk in a surgical patient?

    <p>Serum d-dimer assay</p> Signup and view all the answers

    Which symptom is least likely to indicate the severity of aortic stenosis?

    <p>Fatigue and general weakness</p> Signup and view all the answers

    What is the primary purpose of performing a cardiac risk assessment prior to surgery?

    <p>To inform surgical decision-making</p> Signup and view all the answers

    What finding is NOT typically associated with acute coronary syndrome?

    <p>Peripheral edema</p> Signup and view all the answers

    What is the risk associated with anesthesia and surgery related to cardiovascular health?

    <p>Risk of myocardial ischemia and infarction</p> Signup and view all the answers

    Which of these interventions is least likely to provide valuable information in evaluating a patient with suspected cardiac issues?

    <p>CT scan of the abdomen</p> Signup and view all the answers

    Which symptom in patients with severe aortic stenosis warrants aortic valve replacement?

    <p>Decreased exercise tolerance</p> Signup and view all the answers

    What underlying mechanism leads to calcification of the aortic valve in aortic stenosis?

    <p>Mechanical stresses and chronic inflammation</p> Signup and view all the answers

    Which condition is commonly associated with acute limb ischemia in patients with atrial fibrillation?

    <p>Peripheral vascular disease</p> Signup and view all the answers

    What is a common presentation of acute limb ischemia?

    <p>Pallor and coolness in the extremity</p> Signup and view all the answers

    Which factor contributes to the risk of peripheral arterial disease (PAD) in this patient?

    <p>Age</p> Signup and view all the answers

    Which diagnosis is the most likely for a patient with sudden inability to move their foot and toes after experiencing severe leg pain?

    <p>Left femoral artery embolism</p> Signup and view all the answers

    What complication can arise from untreated severe aortic stenosis?

    <p>Sudden cardiac death</p> Signup and view all the answers

    Which medication may be necessary for a patient with atrial fibrillation to reduce the risk of thromboembolism?

    <p>Anticoagulants</p> Signup and view all the answers

    What clinical feature is NOT typically associated with compartment syndrome?

    <p>Cyanosis of the extremity</p> Signup and view all the answers

    What symptom would NOT be a direct indication for aortic valve replacement in a patient with aortic stenosis?

    <p>Nonspecific generalized weakness</p> Signup and view all the answers

    In which scenario would pulmonary embolism NOT be directly associated with aortic stenosis?

    <p>Due to severe left ventricular hypertrophy</p> Signup and view all the answers

    Which of the following statements best reflects the management of thromboembolism in patients with atrial fibrillation?

    <p>Anticoagulation therapy is often necessary.</p> Signup and view all the answers

    What condition is characterized by right ventricular dysfunction due to chronic pulmonary issues?

    <p>Cor pulmonale</p> Signup and view all the answers

    Which symptom is NOT typically associated with cor pulmonale?

    <p>Chest pain</p> Signup and view all the answers

    What is the primary treatment for moderate to severe obstructive sleep apnea (OSA)?

    <p>Continuous positive airway pressure (CPAP)</p> Signup and view all the answers

    What complication may arise from untreated obstructive sleep apnea (OSA)?

    <p>Cor pulmonale</p> Signup and view all the answers

    Which investigation would help evaluate right ventricular dysfunction secondary to pulmonary hypertension?

    <p>Echocardiogram</p> Signup and view all the answers

    What indicates a need for cardiac monitoring in a patient with newly developed arrhythmias after blunt trauma?

    <p>Blunt chest impact</p> Signup and view all the answers

    What finding on an ECG may suggest cor pulmonale in a patient?

    <p>Right axis deviation</p> Signup and view all the answers

    Which of the following symptoms is common in patients suffering from untreated obstructive sleep apnea?

    <p>Daytime fatigue</p> Signup and view all the answers

    What is the immediate best next step in managing a patient with DVT?

    <p>Administer anticoagulation</p> Signup and view all the answers

    What is a key characteristic of the pulmonary circulation that affects treatment for pulmonary hypertension?

    <p>Low-pressure system</p> Signup and view all the answers

    Which clinical calculator is useful for assessing bleeding risk with anticoagulation?

    <p>HAS-BLED Score</p> Signup and view all the answers

    What physiological response is typically seen in patients with cor pulmonale due to pulmonary hypertension?

    <p>Decreased cardiac output</p> Signup and view all the answers

    What might be indicated by brawny induration and ulcers above the medial malleoli in a patient?

    <p>Poor venous circulation</p> Signup and view all the answers

    In the context of recent surgery, what should be carefully assessed before starting anticoagulation?

    <p>Bleeding risk</p> Signup and view all the answers

    What are the common clinical presentations of acute limb ischemia?

    <p>Pain, pallor, and pulselessness</p> Signup and view all the answers

    Why might heparin be preferred for patients with a history of recent surgery or malignancy?

    <p>Greater ease of reversal</p> Signup and view all the answers

    Which of the following is a common feature of right-sided heart failure due to cor pulmonale?

    <p>Jugular venous distention</p> Signup and view all the answers

    Which condition is a complication of atrial fibrillation that can lead to acute limb ischemia?

    <p>Thromboembolism</p> Signup and view all the answers

    In a patient with obstructive sleep apnea, what would a high apnea-hypopnea index (AHI) indicate?

    <p>Severe OSA</p> Signup and view all the answers

    What is the immediate management step for acute limb ischemia?

    <p>Anticoagulation</p> Signup and view all the answers

    What is the most likely diagnosis in a patient with cardiovascular findings after a motor vehicle accident?

    <p>Blunt cardiac injury</p> Signup and view all the answers

    Which patient demographic is likely to develop deep venous thrombosis (DVT) following surgery?

    <p>Older adults with mobility issues and malignancy</p> Signup and view all the answers

    Which symptom is least likely to be associated with blunt cardiac injury?

    <p>Jaundice</p> Signup and view all the answers

    What condition could complicate a blunt cardiac injury following significant trauma?

    <p>Myocardial infarction due to thrombosis</p> Signup and view all the answers

    What characterizes the pain associated with compartment syndrome?

    <p>Severe, worsening with passive stretching</p> Signup and view all the answers

    Which complication is most severe among those associated with blunt cardiac injury?

    <p>Ventricular rupture</p> Signup and view all the answers

    What is the primary factor contributing to the development of DVT in a postoperative patient with malignancy?

    <p>Hypercoagulability</p> Signup and view all the answers

    Which of the following would most likely indicate a thrombus formation in a patient after surgery?

    <p>Swelling and leg pain</p> Signup and view all the answers

    Which of the following is a contraindication to the use of thrombolytics in DVT?

    <p>High risk of bleeding</p> Signup and view all the answers

    What symptom is characteristic of blunt cardiac injury following a motor vehicle accident?

    <p>Hypotension</p> Signup and view all the answers

    What is the role of anticoagulation in the management of deep venous thrombosis?

    <p>To prevent thrombus propagation or embolization</p> Signup and view all the answers

    Which of these choices is less preferred in managing DVT immediately after surgery?

    <p>Intravenous thrombolytics</p> Signup and view all the answers

    What can indicate arrhythmias in patients after blunt cardiac injury?

    <p>Electrocardiogram findings</p> Signup and view all the answers

    What is the primary treatment focus for patients diagnosed with DVT?

    <p>Prevention of thrombus propagation</p> Signup and view all the answers

    What physiological changes contribute to the development of DVT in patients undergoing surgery?

    <p>Hypercoagulability and venous stasis</p> Signup and view all the answers

    Which symptom is typically NOT associated with deep venous thrombosis?

    <p>Pallor of the affected limb</p> Signup and view all the answers

    In patients with DVT, which treatment should NOT take priority over anticoagulation?

    <p>Use of compression stockings</p> Signup and view all the answers

    In the context of a surgical patient at risk for DVT, what is the recommended management approach?

    <p>Anticoagulation therapy</p> Signup and view all the answers

    The presence of which finding may indicate a poor prognosis following a blunt cardiac injury?

    <p>Ventricular arrhythmias</p> Signup and view all the answers

    What condition closely resembles acute limb ischemia but is specifically related to increased compartment pressure?

    <p>Compartment syndrome</p> Signup and view all the answers

    What aspect is crucial to assess before initiating anticoagulation in a surgical patient at risk for DVT?

    <p>Bleeding risk</p> Signup and view all the answers

    What clinical finding is typically associated with an enlarged right ventricle?

    <p>Precordial heave</p> Signup and view all the answers

    What immediate treatment is recommended for a patient with evidence of right ventricular dysfunction?

    <p>CPAP at night</p> Signup and view all the answers

    Which of the following symptoms is most consistent with acute pulmonary embolism?

    <p>Hypoxemia and shortness of breath</p> Signup and view all the answers

    What is the primary reason for initiating heparin therapy in a patient suspected of having a pulmonary embolism?

    <p>To prevent further clot formation</p> Signup and view all the answers

    Which clinical feature is NOT typically associated with acute aortic dissection?

    <p>Pallor and fatigue</p> Signup and view all the answers

    In the context of the patient’s surgery history, what is a major risk factor for acute pulmonary embolism?

    <p>Recent surgery within the past 4 weeks</p> Signup and view all the answers

    Which diagnosis is least likely based on the patient's presentation of tachycardia and hypoxemia?

    <p>Thrombotic stroke</p> Signup and view all the answers

    What would be an inappropriate immediate management option for a patient with suspected pulmonary embolism?

    <p>Reassurance</p> Signup and view all the answers

    Which of the following is a key component of the Wells’ Criteria for assessing the risk of pulmonary embolism?

    <p>Clinical evidence of deep venous thrombosis</p> Signup and view all the answers

    Which approach is inappropriate when managing a patient suspecting acute pulmonary embolism?

    <p>Initiating aspirin therapy alone</p> Signup and view all the answers

    What complication might arise from untreated obstructive sleep apnea (OSA)?

    <p>Cor pulmonale</p> Signup and view all the answers

    What is an expected finding in patients experiencing tachycardia due to pulmonary embolism?

    <p>Sinus tachycardia</p> Signup and view all the answers

    What is a possible long-term consequence of untreated pulmonary hypertension?

    <p>Right ventricular remodeling</p> Signup and view all the answers

    What is the preferred initial management for patients at risk of acute pulmonary embolism?

    <p>Intravenous unfractionated heparin</p> Signup and view all the answers

    What are the classic clinical presentations of acute pulmonary embolism?

    <p>Pleuritic chest pain, tachypnea, and hypoxemia</p> Signup and view all the answers

    What symptom is commonly associated with iron deficiency anemia severe enough to lead to high output heart failure?

    <p>Fatigue and exertional dyspnea</p> Signup and view all the answers

    Which step is most appropriate when a patient exhibits signs of hypoxemic and hypercapnic respiratory failure?

    <p>Intubation and mechanical ventilation</p> Signup and view all the answers

    Why would administration of a fluid bolus likely be counterproductive in a patient with respiratory distress?

    <p>It may worsen pulmonary edema.</p> Signup and view all the answers

    What could indicate a need for metronidazole therapy in a patient post-surgery?

    <p>Symptoms suggesting an intra-abdominal infection</p> Signup and view all the answers

    In which scenarios is heparin therapy indicated during post-operative management?

    <p>Acute pulmonary embolism or coronary syndrome</p> Signup and view all the answers

    What might agitation and tachypnea indicate in a post-operative patient?

    <p>Respiratory failure requiring immediate intervention</p> Signup and view all the answers

    If a patient is normotensive but tachycardic post-operatively, what is the most likely explanation?

    <p>Compensatory response due to decreased oxygen-carrying capacity</p> Signup and view all the answers

    What pretest probability criteria could suggest a higher risk for pulmonary embolism?

    <p>Evidence of deep vein thrombosis (DVT)</p> Signup and view all the answers

    What does a pH of 7.25 and Pco2 of 60 mm Hg indicate in a respiratory examination?

    <p>Respiratory acidosis leading to respiratory failure</p> Signup and view all the answers

    What additional therapy might be considered if excessive fluid was administered during surgery?

    <p>Diuretic therapy</p> Signup and view all the answers

    What is a key risk factor for perioperative pulmonary complications?

    <p>Obesity</p> Signup and view all the answers

    When might naloxone be administered post-operatively?

    <p>If there are symptoms of opioid overdose</p> Signup and view all the answers

    Why is laryngoscopy not recommended for acute management of a patient experiencing respiratory failure?

    <p>It does not provide immediate treatment.</p> Signup and view all the answers

    Study Notes

    Acute Hemolytic Transfusion Reaction (AHTR)

    • Occurs when ABO incompatible blood is transfused
    • Preformed antibodies attack donor red blood cell antigens causing hemolysis
    • Patient presents with:
      • Dyspnea
      • Flank Pain
      • Fever
      • Hemoglobinuria
      • Positive direct antiglobulin (Coombs) test
    • Can progress to DIC, shock, and death
    • Treatment involves immediate stop of transfusion, supportive care, and blood bank notification
    • Develops within 6 hours of transfusion
    • Manifests with:
      • Respiratory distress
      • Hypoxemia
      • Cyanosis
      • Fever
      • New infiltrates on chest x-ray
    • Caused by inflammatory cytokines in donor blood products priming neutrophils, which cause widespread activation within the lung parenchyma
    • Treatment involves supportive care

    Blunt Abdominal Trauma

    • Common injury is a lacerated spleen
    • If hemodynamically stable:
      • Minor splenic injuries can be observed
      • Reassessment is needed
    • If hemodynamically unstable:
      • Exploratory laparotomy for repair or splenectomy is needed

    Neurogenic Shock

    • Can occur after traumatic brain or spinal cord injury
    • Disruption of autonomic fibers in the vasomotor center in the medulla oblongata
    • Sympathetic innervation loss results in vasodilation and loss of vascular tone
    • May cause bradycardia
    • Treatment involves:
      • Fluid resuscitation
      • Atropine for bradycardia
      • Vasoactive infusions such as norepinephrine to maintain perfusion

    Hypothermia

    • This patient presents with hypothermia
    • Hypothermia can be caused by prolonged exposure to cold temperatures
    • Hypothermia can present with shivering, numbness, and pale toes
    • Hypothermia can lead to blisters and loss of sensation
    • Hypothermia can cause absent pedal pulses
    • Hypothermia can be treated with a 104°F water bath

    Treatment

    • Immersion in warm water can cause pain
    • Acetaminophen should be given for pain
    • Tetanus toxoid should be administered to the patient

    Patient Presentation

    • A 62-year-old woman presented for a routine health maintenance examination.
    • Reports no smoking history and only drinks socially.

    Physical Examination

    • A systolic ejection murmur was best heard over the second right intercostal space, radiating towards the carotid arteries.

    Diagnostic Findings

    • Electrocardiogram (ECG) showed normal sinus rhythm.
    • ECG pattern of left ventricular hypertrophy with strain was noted.

    Aortic Valve Replacement

    • Aortic stenosis (AS) is a common disorder of the aortic valve that results from calcification.
    • Calcification is caused by repetitive microtrauma from the opening and closing of valve leaflets with associated chronic inflammation.
    • Patients with severe AS may experience fatigue, shortness of breath, cough, diminished exercise tolerance, angina, or syncope with exertion.
    • Angina and syncope are indications for aortic valve replacement.
    • Generalized weakness and fatigue are nonspecific symptoms and do not warrant valve replacement.
    • Peripheral edema and ascites are consequences of chronic heart failure and do not indicate impaired perfusion to essential organs.
    • Pulmonary embolus is not directly associated with aortic stenosis.
    • Ventricular arrhythmia is common in patients with AS, especially when left ventricular systolic or diastolic dysfunction is present; it is not an independent indication for aortic valve replacement.

    Acute Limb Ischemia

    • Peripheral arterial disease (PAD) refers to abnormally diminished blood flow to the extremities secondary to atherosclerotic plaque.
    • Risk factors for PAD include diabetes mellitus, increased age, tobacco smoking, hypertension, and dyslipidemia.
    • Patients with PAD may experience claudication caused by insufficient blood flow to the muscles during exercise.
    • Acute limb ischemia presents with pain, pallor, paresthesia, loss of temperature sensation, paralysis, and pulselessness.
    • Acute limb ischemia can be caused by thrombotic acute limb ischemia or embolic source.
    • Atrial fibrillation, when suboptimally anticoagulated, can result in distal embolization of thrombi, leading to acute limb ischemia.
    • Management of thromboembolism includes anticoagulation, analgesics, and reperfusion procedures.

    Deep Venous Thrombosis

    • Leg swelling following recent surgery and known malignancy may provoke deep venous thrombosis (DVT).
    • Risk factors for DVT include venous stasis, endothelial injury, and hypercoagulability.
    • Anticoagulation is the appropriate best next step for managing a DVT.
    • Recent surgery may be considered a relative contraindication to anticoagulation, and a bleeding risk assessment should be performed.
    • Anticoagulation with heparin may be preferable for select patients due to greater ease of reversal.

    Blunt Cardiac Injury

    • Blunt cardiac injury (BCI) is the most common cause of arrhythmias following a motor vehicle accident.
    • BCI can range from mild to life-threatening.
    • Arrhythmias following BCI are often mild and not life-threatening.
    • More severe complications of BCI include ventricular rupture, valvular rupture, and myocardial infarction.
    • Cardiac tamponade and valvular pathologies are diagnosed using echocardiography.

    Cor Pulmonale

    • Right ventricular dysfunction caused by chronic pulmonary pathology and pulmonary hypertension
    • Leads to right ventricular remodeling and failure over time
    • Common symptom is exertional dyspnea and hypoxemia

    BCI/Blunt Cardiac Injury

    • Can occur after motor vehicle accidents with blunt trauma to the chest
    • Can range from arrhythmias to ventricular/valvular rupture
    • Patients develop irregular heart rhythms following blunt chest trauma

    Obstructive Sleep Apnea

    • Characterized by intermittent upper airway blockage leading to hypoxia and apnea
    • Common symptoms include snoring, witnessed apnea, daytime somnolence, and morning headaches
    • Severe OSA can lead to pulmonary hypertension and cor pulmonale

    Acute Pulmonary Embolism

    • Often presents with nonspecific symptoms
    • Signs and symptoms include dyspnea, tachycardia, recent surgery, hypoxemia, and pleuritic chest pain
    • Treatment includes immediate heparin therapy

    Perioperative Respiratory Failure

    • Major cause of mortality and morbidity in surgical patients
    • Factors that contribute to this include obesity, asthma, and COPD
    • Treatment includes intubation and mechanical ventilation

    Hypoventilation

    • Decreased Po2, increased Pco2, and normal A-a gradient on ABG analysis
    • Can be caused by obesity and neuromuscular disorders
    • Treatment includes oxygen therapy and mechanical ventilation

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    Test your knowledge on Acute Hemolytic Transfusion Reaction (AHTR) and Transfusion-Related Acute Lung Injury (TRALI), focusing on symptoms, causes, and treatments. Additionally, explore key aspects of managing blunt abdominal trauma. Perfect for students in medical fields.

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