Transfusion Reactions and Splenic Injury Overview
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Questions and Answers

What is the most likely cause of the patient's acute onset of shortness of breath and back pain following a blood transfusion?

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

    • Which type of blood can a patient with type A blood safely receive?

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

    • What is the primary mechanism responsible for acute hemolytic transfusion reaction in patients with incompatible blood types?

  • Transfusion of expired blood
  • Infection from contaminated blood
  • Complement activation (correct)
  • Electrolyte imbalance caused by the transfusion

    • What clinical feature is NOT typically associated with acute hemolytic transfusion reactions?

    <p>Significant abdominal tenderness</p> Signup and view all the answers

    In the context of blood transfusions, what is the function of preformed antibodies?

    <p>To initiate an immune response against non-self antigens</p> Signup and view all the answers

    How do type O blood individuals differ from those with type A or B blood in terms of antibody presence?

    <p>Type O individuals have antibodies against A and B antigens</p> Signup and view all the answers

    What is the essential step to prevent an acute hemolytic transfusion reaction during blood transfusion?

    <p>Ensuring the blood type compatibility of the donor and recipient</p> Signup and view all the answers

    Which symptom is commonly seen in a patient experiencing an acute hemolytic transfusion reaction?

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

    What is the most common initial symptom of acute hemolytic transfusion reaction (AHTR)?

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

    Which blood type has antibodies against both A and B antigens?

    <p>Type O</p> Signup and view all the answers

    What is a critical immediate treatment for a suspected AHTR?

    <p>Cessation of transfusion</p> Signup and view all the answers

    Which symptom is least likely to be associated with transfusion-related acute lung injury (TRALI)?

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

    What is a significant risk factor for the development of transfusion-related sepsis?

    <p>Transfusion of platelets</p> Signup and view all the answers

    Which response best describes the pathogenesis of TRALI?

    <p>Endothelial dysfunction from activated neutrophils</p> Signup and view all the answers

    What characterizes the onset of TRALI symptoms post-transfusion?

    <p>Within 6 hours</p> Signup and view all the answers

    Which of the following is NOT a classic symptom of acute hemolytic transfusion reaction?

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

    What is the main purpose of contacting the blood bank immediately during a suspected AHTR?

    <p>To alert them of the error</p> Signup and view all the answers

    Which type of transfusion reaction is associated with the presence of preformed antibodies against donor antigens?

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

    In which situation is the likelihood of AHTR highest?

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

    Which of the following conditions is characterized by sudden onset dyspnea and hypoxemia after blood product transfusion?

    <p>Transfusion-related acute lung injury</p> Signup and view all the answers

    What factor increases the incidence of transfusion-related acute lung injury (TRALI)?

    <p>Female donors with a history of pregnancy</p> Signup and view all the answers

    Which condition is a serious risk following an AHTR if not treated promptly?

    <p>Shock and death</p> Signup and view all the answers

    What is the most appropriate treatment for a patient recovering from TRALI?

    <p>Implement supportive care with non-invasive or invasive ventilation</p> Signup and view all the answers

    Which symptoms are characteristic of TRALI?

    <p>Hypoxemia, cyanosis, fever</p> Signup and view all the answers

    Which of the following is NOT true about acute hemolytic transfusion reactions?

    <p>They are associated with a gradual onset of symptoms</p> Signup and view all the answers

    What is the likely diagnosis in a patient presenting with acute dyspnea and hypoxemia immediately after a blood transfusion?

    <p>Transfusion-related acute lung injury (TRALI)</p> Signup and view all the answers

    In the case of a splenic laceration due to trauma, what is the best next step in management?

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

    What imaging finding is suggestive of a splenic injury after blunt abdominal trauma?

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

    What is the expected relationship between transfusions and TRALI in patients?

    <p>TRALI can develop within minutes to hours after transfusion</p> Signup and view all the answers

    What is NOT a typical symptom of a pulmonary embolism (PE)?

    <p>Diffuse crackles on examination</p> Signup and view all the answers

    What is the appropriate immediate management for a patient with unstable splenic injury?

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

    How does the treatment of TRALI differ from the treatment of transfusion-associated cardiac overload (TACO)?

    <p>TRALI is treated with supportive care while TACO requires fluid restriction</p> Signup and view all the answers

    Which symptom is indicative of splenic injury due to diaphragmatic irritation?

    <p>Referred pain to the left shoulder</p> Signup and view all the answers

    Which injury pattern is NOT typically associated with splenic trauma?

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

    Which of the following is characteristic of pneumonia diagnosis?

    <p>Presence of fever, cough, and imaging consolidation</p> Signup and view all the answers

    What is the purpose of using vasopressors in the treatment of TRALI?

    <p>To increase peripheral vascular resistance</p> Signup and view all the answers

    What could be the cause of persistent hypotension in a patient with a spinal cord injury?

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

    What is the role of a focused assessment with sonography for trauma (FAST) in unstable trauma patients?

    <p>Identify free fluid in the abdomen</p> Signup and view all the answers

    What best describes the cause of endothelial dysfunction in TRALI?

    <p>Widespread activation of neutrophils in the lung</p> Signup and view all the answers

    What complication can arise from a splenic laceration if left untreated?

    <p>Hemorrhage into the peritoneal cavity</p> Signup and view all the answers

    Why is a repeat CT scan usually inappropriate for a patient with hemodynamic instability?

    <p>It doesn't provide any additional information</p> Signup and view all the answers

    What diagnostic tool is most useful for analyzing blunt abdominal trauma when free fluid is detected?

    <p>Diagnostic peritoneal lavage</p> Signup and view all the answers

    What condition might cause a patient to present with bradycardia following a spinal cord injury?

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

    In young adults with splenic injuries, which non-operative management is applicable?

    <p>Observation and reassessment</p> Signup and view all the answers

    What indicates a need for exploratory laparotomy in a patient with hemoperitoneum?

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

    What does tachycardia typically suggest in the context of trauma?

    <p>Hypovolemia and possible hemorrhage</p> Signup and view all the answers

    Which imaging technique is most appropriate for detecting solid organ injuries in unstable patients?

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

    What is one complication of splenic laceration that must be monitored for?

    <p>Hemorrhage into the peritoneal cavity</p> Signup and view all the answers

    Which treatment may be considered for managing bradycardia after acute traumatic spinal cord injury?

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

    What is a critical factor to consider when diagnosing neurogenic shock after spinal cord injury?

    <p>Presence of bradycardia</p> Signup and view all the answers

    Which condition is less likely to cause hemodynamically significant hemorrhage due to a fracture?

    <p>Fractures of the tibia and fibula</p> Signup and view all the answers

    What is the underlying issue in idiopathic intracranial hypertension (IIH)?

    <p>Inadequate resorption of cerebrospinal fluid</p> Signup and view all the answers

    What is the primary demographic at risk for developing idiopathic intracranial hypertension?

    <p>Young women with high BMI</p> Signup and view all the answers

    Which initial imaging study is most important in a patient suspected of having increased intracranial pressure?

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

    What clinical sign is commonly associated with increased intracranial pressure?

    <p>Blurry vision</p> Signup and view all the answers

    What is a hallmark symptom that differentiates headaches secondary to increased intracranial pressure?

    <p>Progressive intensity over weeks</p> Signup and view all the answers

    Which medication is typically NOT used for managing idiopathic intracranial hypertension?

    <p>Systemic corticosteroids</p> Signup and view all the answers

    What finding on a lumbar puncture would support a diagnosis of increased intracranial pressure?

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

    Which of the following is a potential complication of untreated idiopathic intracranial hypertension?

    <p>Optic nerve damage</p> Signup and view all the answers

    In the assessment of trauma, which of the following can lead to a rapid loss of intravascular volume?

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

    What alternative diagnosis would need to be excluded when assessing a patient with bradycardia following spinal cord injury?

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

    Which diagnostic test is LEAST useful in the case of suspected traumatic brain injury leading to neurogenic shock?

    <p>Visual evoked potentials</p> Signup and view all the answers

    What is the primary risk factor for developing basal cell carcinoma (BCC)?

    <p>Ultraviolet light exposure</p> Signup and view all the answers

    Which symptom is commonly associated with optic neuritis?

    <p>Visual acuity and color vision loss</p> Signup and view all the answers

    What is the most appropriate initial step in evaluating a patient with suspected idiopathic intracranial hypertension (IIH)?

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

    What is a characteristic feature of basal cell carcinoma?

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

    Which of the following medications is associated with the development of idiopathic intracranial hypertension?

    <p>Growth hormone</p> Signup and view all the answers

    What does optical coherence tomography primarily measure?

    <p>Optic nerve swelling</p> Signup and view all the answers

    What condition is characterized by inadequate resorption of cerebrospinal fluid (CSF)?

    <p>Idiopathic intracranial hypertension (IIH)</p> Signup and view all the answers

    Which type of tumor typically presents with a pink, pearly nodule on sun-exposed areas?

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

    What indicates an increased intracranial pressure during lumbar puncture?

    <p>Elevated opening pressure</p> Signup and view all the answers

    What type of headache is often associated with increased intracranial pressure?

    <p>Headaches that worsen when lying down</p> Signup and view all the answers

    Which visual assessment technique measures the electrical response of the visual cortex?

    <p>Visual evoked potentials (VEP)</p> Signup and view all the answers

    What type of medical intervention is primarily included in the management strategy for IIH?

    <p>Weight reduction</p> Signup and view all the answers

    Which demographic is primarily affected by idiopathic intracranial hypertension?

    <p>Young women with increased BMI</p> Signup and view all the answers

    What is a typical management approach for optic disc edema caused by hypertension?

    <p>Intravenous administration of nifedipine</p> Signup and view all the answers

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

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

    Which surgical technique is preferred for excising BCC in critical areas of the face?

    <p>Mohs micrographic surgery</p> Signup and view all the answers

    What is the risk of recurrence with a 1 cm margin for treating basal cell carcinoma?

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

    In cases of basal cell carcinoma, which of the following interventions is not routinely recommended?

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

    What is the immediate management step for a patient with frostbite?

    <p>Rewarming by immersion in warm water</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with frostbite?

    <p>Numbness and blisters</p> Signup and view all the answers

    Which adjunct therapy is often used in the management of frostbite to limit tissue damage?

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

    What is the most appropriate next step in management after rapid rewarming of frostbitten feet?

    <p>Hospital admission for observation</p> Signup and view all the answers

    Why is nitroglycerin ointment not recommended as the first step in managing frostbite?

    <p>It cannot provide adequate vasodilation</p> Signup and view all the answers

    Which of the following is true regarding the management of severe frostbite?

    <p>Observational admission may be required for recovery</p> Signup and view all the answers

    What physical finding is typically noted on a patient with frostbite?

    <p>Pallor and loss of sensation</p> Signup and view all the answers

    What is the importance of a warm water rewarming protocol for patients with frostbite?

    <p>It helps in dilation of blood vessels and tissue recovery</p> Signup and view all the answers

    Which of the following complications is associated with severe frostbite?

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

    Which subtype of basal cell carcinoma (BCC) is considered more invasive?

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

    What is the primary characteristic that differentiates BCC from squamous cell carcinoma?

    <p>Smooth, pearly surface</p> Signup and view all the answers

    Which treatment is considered first-line for basal cell carcinoma located in noncritical areas?

    <p>Complete surgical excision</p> Signup and view all the answers

    What margin is typically recommended during excision for noncritical areas of BCC?

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

    What is the common presentation of a basal cell carcinoma on the skin?

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

    Why is sentinel lymph node biopsy not usually recommended for most patients with BCC?

    <p>BCC does not typically require such extensive procedures.</p> Signup and view all the answers

    What finding in a lesion might suggest it is basal cell carcinoma rather than actinic keratosis?

    <p>Central ulceration</p> Signup and view all the answers

    In which demographic is basal cell carcinoma most commonly seen?

    <p>Elderly with fair skin</p> Signup and view all the answers

    What is the main risk factor for developing basal cell carcinoma?

    <p>Ultraviolet light exposure</p> Signup and view all the answers

    Which of the following describes the appearance of melanoma?

    <p>Pigmented lesion with asymmetry and irregular borders</p> Signup and view all the answers

    What is a common characteristic of a nodular basal cell carcinoma?

    <p>It appears as a pink, pearly nodule.</p> Signup and view all the answers

    If a BCC is located in a critical area of the face, what surgical technique may be utilized?

    <p>Mohs micrographic surgery</p> Signup and view all the answers

    Which of the following is NOT true regarding the risk of basal cell carcinoma?

    <p>BCC is highly aggressive and spreads quickly.</p> Signup and view all the answers

    In the case of superficial basal cell carcinoma, how does it typically present?

    <p>As a light pink, ill-defined macule</p> Signup and view all the answers

    What is the most common type of gangrene associated with peripheral arterial disease?

    <p>Dry gangrene</p> Signup and view all the answers

    What immediate action is generally required when gangrene is present?

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

    What does the presence of medullary and cortical bone destruction on an x-ray suggest in a patient with a raised lesion?

    <p>Possible malignancy</p> Signup and view all the answers

    In evaluating a painful lump on the ankle with potential malignancy, what should be the initial step in management?

    <p>Conducting a biopsy of the lesion</p> Signup and view all the answers

    Why would a second x-ray after 2 months be considered unnecessary in this clinical scenario?

    <p>It delays diagnosis and treatment.</p> Signup and view all the answers

    What is the most appropriate imaging study to consider first if a patient exhibits bone pain with a firm lump?

    <p>X-ray of the affected area</p> Signup and view all the answers

    What complication is likely in a patient with peripheral arterial disease who develops significant ischemia?

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

    For a patient with suspected malignancy indicated by an x-ray, what role does an MRI serve?

    <p>It is preferred for assessing soft tissue.</p> Signup and view all the answers

    In the context of a patient's recent surgery, what symptom suggests a potential post-operative complication?

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

    What medical history detail increases the urgency of assessing a potential malignancy in a patient with a soft tissue lump?

    <p>Age above 40</p> Signup and view all the answers

    Which method is inappropriate for managing a suspected bone malignancy?

    <p>Waiting for symptoms to resolve</p> Signup and view all the answers

    What is a common presentation of bone malignancies in the lower extremities?

    <p>Localized bone pain</p> Signup and view all the answers

    What type of exercise is inappropriate for a patient with suspected bone malignancy?

    <p>Nonweight-bearing exercises</p> Signup and view all the answers

    What is the most appropriate next step in management for a patient with absent pulses and lower extremity gangrene?

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

    Which of the following factors is NOT typically associated with peripheral arterial disease (PAD)?

    <p>Type 1 diabetes</p> Signup and view all the answers

    What does the presence of blisters in a frostbite injury potentially indicate?

    <p>Nonviable or viable tissue</p> Signup and view all the answers

    Which clinical presentation would most likely indicate the need for immediate arteriography?

    <p>Absence of pulses in the lower extremities</p> Signup and view all the answers

    When is surgical revascularization typically considered in the context of PAD?

    <p>When there is a non-healing wound without gangrene</p> Signup and view all the answers

    Which treatment option is inappropriate for patients with severe PAD and gangrene?

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

    What is a common presentation of patients with worsening atherosclerosis?

    <p>Pain at rest and potential for ischemia</p> Signup and view all the answers

    Which of the following is NOT a typical risk factor for peripheral arterial disease?

    <p>Regular physical activity</p> Signup and view all the answers

    What does a patient with contractures typically experience after an amputation?

    <p>No significant functional loss</p> Signup and view all the answers

    Why might arteriography with contrast not be appropriate for this patient?

    <p>Patient shows signs of dry gangrene</p> Signup and view all the answers

    What is a potential downfall of using cilostazol therapy alone for severe PAD?

    <p>It does not address tissue viability with gangrene</p> Signup and view all the answers

    In managing a patient with frostbite, what is a critical aspect of initial treatment?

    <p>Rewarming the affected area</p> Signup and view all the answers

    What should be monitored in a patient with peripheral arterial disease who has undergone revascularization?

    <p>Signs of viable tissue post-surgery</p> Signup and view all the answers

    What is a common characteristic of wet gangrene compared to dry gangrene?

    <p>Associated with infection and edema</p> Signup and view all the answers

    What are major adverse cardiovascular and cerebrovascular events (MACCE)?

    <p>Significant causes of morbidity and mortality in surgical cases</p> Signup and view all the answers

    Which immediate test should be performed to evaluate for acute coronary syndrome in the patient?

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

    What is the primary reason for assessing preoperative functional status?

    <p>To predict perioperative cardiovascular risk</p> Signup and view all the answers

    Which risk assessment tool is mentioned as useful in determining the risk for MACCE?

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

    Which symptom is least indicative of aortic stenosis severity?

    <p>Generalized weakness and fatigue</p> Signup and view all the answers

    What is the primary complication associated with untreated severe aortic stenosis?

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

    Which of the following factors is NOT associated with myocardial ischemia during surgery?

    <p>Short-term sedation</p> Signup and view all the answers

    What does a serum d-dimer assay primarily assess?

    <p>Active thromboembolic disease</p> Signup and view all the answers

    What should be the first step taken for a patient with abdominal pain and cardiac risk factors?

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

    Which symptom is typically associated with left ventricular hypertrophy in severe aortic stenosis?

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

    What is the recommended next step if an ECG indicates acute coronary syndrome?

    <p>Obtain serum troponin level</p> Signup and view all the answers

    Which complication can arise due to chronic increased afterload from aortic stenosis?

    <p>Diastolic dysfunction</p> Signup and view all the answers

    What would be the most effective approach for identifying potential surgical complications post-operatively?

    <p>Physical examination and observation</p> Signup and view all the answers

    In a patient with symptoms indicative of acute coronary syndrome, which assessment would be least relevant?

    <p>Upper endoscopy for bleeding</p> Signup and view all the answers

    What is an indication for aortic valve replacement in patients with aortic stenosis?

    <p>Presence of angina or syncope</p> Signup and view all the answers

    Which of the following is NOT a consequence of severe aortic stenosis if left untreated?

    <p>Atrial fibrillation</p> Signup and view all the answers

    What are common symptoms of severe aortic stenosis?

    <p>Fatigue and cough</p> Signup and view all the answers

    Which risk factor is commonly associated with peripheral arterial disease (PAD)?

    <p>Type 2 diabetes mellitus</p> Signup and view all the answers

    In the context of acute limb ischemia, which symptom is typically observed?

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

    What most likely led to the patient's left femoral artery embolism in the case presented?

    <p>Atrial fibrillation</p> Signup and view all the answers

    What is the primary initial management step for acute limb ischemia due to embolism?

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

    Which clinical finding is most consistent with compartment syndrome?

    <p>Muscle pain that increases with passive stretching</p> Signup and view all the answers

    What condition describes insufficient perfusion resulting in pain and numbness in the lower extremities?

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

    What can be a consequence of untreated aortic stenosis?

    <p>Diminished systemic perfusion</p> Signup and view all the answers

    Which of the following vascular conditions is characterized by the presence of claudication?

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

    Which symptom may develop as a result of chronic heart failure related to aortic stenosis?

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

    Which finding would NOT typically correlate with acute limb ischemia?

    <p>Irregular pulse</p> Signup and view all the answers

    In patients with aortic stenosis, which of the following is a reason for heart failure development?

    <p>Increased left ventricular afterload</p> Signup and view all the answers

    What condition is characterized by increased pressure within a myofascial compartment leading to impaired blood flow?

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

    What symptom is most indicative of acute limb ischemia?

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

    Which risk factor is NOT associated with the development of deep venous thrombosis (DVT)?

    <p>Increased physical activity</p> Signup and view all the answers

    What is the primary reason for the use of anticoagulant therapy in the case of DVT?

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

    What management option is prioritized immediately following a diagnosis of DVT post-surgery?

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

    Acute limb ischemia can result from which of the following conditions?

    <p>Atherosclerosis and arterial embolism</p> Signup and view all the answers

    Which statement about atrial fibrillation in the context of thromboembolism is TRUE?

    <p>It can lead to distal embolization if not anticoagulated properly.</p> Signup and view all the answers

    Following recent surgery, what assessment may help determine a patient's risk of bleeding before anticoagulation therapy?

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

    What is the typical clinical presentation of deep venous thrombosis (DVT)?

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

    What is the primary indication for using intravenous streptokinase therapy in patients?

    <p>Proximal DVT or venous thromboembolism</p> Signup and view all the answers

    What is the most appropriate first step in managing a patient with suspected DVT?

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

    What mechanism increases the risk of thrombosis in patients post-surgery and with malignancy?

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

    What feature of Virchow's triad is NOT typically associated with DVT?

    <p>Increased mobility</p> Signup and view all the answers

    What is a common symptom of chronic peripheral arterial disease (PAD) as it progresses?

    <p>Rest pain in the lower extremities</p> Signup and view all the answers

    Which factor is NOT likely to contribute to acute limb ischemia?

    <p>Chronic venous insufficiency</p> Signup and view all the answers

    Which factor is a contraindication for administering thrombolytics like streptokinase?

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

    In cases of thromboembolism, what is an important acute management strategy?

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

    In a patient who has developed DVT, which assessment is crucial before initiating anticoagulation?

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

    What condition is most likely responsible for the cardiovascular findings in a patient post-motor vehicle accident?

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

    What condition is least likely to cause acute symptoms of limb ischemia?

    <p>Chronic venous insufficiency</p> Signup and view all the answers

    What arrhythmia might occur in approximately 5% of patients suffering from blunt cardiac injury?

    <p>Premature ventricular contractions</p> Signup and view all the answers

    What is a key characteristic of patients experiencing arrhythmias due to blunt cardiac injury?

    <p>They can vary from mild to life-threatening.</p> Signup and view all the answers

    Which of the following is a common prognosis for patients displaying symptoms after blunt cardiac injury?

    <p>Most patients can be monitored safely.</p> Signup and view all the answers

    What is considered a relative contraindication for anticoagulation therapy in patients with DVT?

    <p>Recent major surgery</p> Signup and view all the answers

    What clinical score can help quantify bleeding risk prior to anticoagulation?

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

    Which method is NOT a primary treatment consideration for managing DVT?

    <p>Elevation of legs</p> Signup and view all the answers

    Which cardiac abnormality can result from blunt cardiac injury and require specific diagnostic methods?

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

    What is the common initial evaluation finding in patients presenting with blunt cardiac injury post-MVA?

    <p>Occasional premature atrial contractions</p> Signup and view all the answers

    What is the primary respiratory issue indicated by the arterial blood gas analysis of the patient?

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

    Which vital sign abnormality might be expected in a patient with hypoventilation?

    <p>Decreased oxygen saturation</p> Signup and view all the answers

    How does obesity affect the respiratory function in patients like the one described?

    <p>It can cause hypoventilation</p> Signup and view all the answers

    What is the estimated change in pH for acute respiratory acidosis associated with elevated Pco2 of 56 mm Hg?

    <p>0.048</p> Signup and view all the answers

    What condition can lead to a normal alveolar-arterial gradient in this patient?

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

    Which finding is consistent with the arterial blood gas results observed in this patient?

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

    What is a likely consequence of hypoventilation in this type of patient?

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

    What best explains the bilaterally decreased breath sounds in this patient?

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

    What severe complication can arise from blunt cardiac injury?

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

    Which clinical feature could indicate cardiac tamponade in a trauma patient?

    <p>Muffled heart sounds</p> Signup and view all the answers

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

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

    An untreated obstructive sleep apnea (OSA) patient may develop which of the following conditions?

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

    What pattern of symptoms is typical for obstructive sleep apnea?

    <p>Frequent headaches and daytime fatigue</p> Signup and view all the answers

    What is a common finding on arterial blood gas analysis in a patient with respiratory distress?

    <p>High Pco2 levels</p> Signup and view all the answers

    What type of cardiac abnormality is often assessed using echocardiography?

    <p>Pericardial effusion</p> Signup and view all the answers

    What is a primary complication of untreated obstructive sleep apnea (OSA)?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Which of the following best describes cor pulmonale?

    <p>Isolated right heart failure secondary to chronic pulmonary pathology</p> Signup and view all the answers

    Which sign is associated with cardiac tamponade due to blunt cardiac injury?

    <p>Pulsus paradoxus</p> Signup and view all the answers

    Which clinical finding is typically associated with cor pulmonale?

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

    What is the expected respiratory pattern in a patient with significant obesity and sleep apnea?

    <p>Intermittent obstructive breathing patterns</p> Signup and view all the answers

    What should be the immediate treatment for a patient suspected of having a pulmonary embolism?

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

    Which medication is commonly prescribed to treat obstructive sleep apnea?

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

    What symptom is often associated with acute pulmonary embolism, according to established clinical guidelines?

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

    Which symptom suggests possible cor pulmonale in a patient with obstructive sleep apnea?

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

    What finding is indicative of severe obstructive sleep apnea leading to cardiovascular issues?

    <p>Increased apnea-hypopnea index (AHI)</p> Signup and view all the answers

    Which condition could lead to increased arterial pressure in the pulmonary circulation?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    Which diagnostic tool is vital for assessing pulmonary pressures and ventricular function in potential cor pulmonale?

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

    What heart sound may be pronounced in a patient with cor pulmonale?

    <p>Pronounced S2</p> Signup and view all the answers

    Which of the following findings on chest x-ray would suggest cor pulmonale?

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

    Which sign would be least likely present in a patient showing signs of pericardial tamponade?

    <p>Normal blood pressure</p> Signup and view all the answers

    Which of the following would NOT be an indication for initiating heparin therapy?

    <p>History of chronic cough</p> Signup and view all the answers

    What condition could precipitate symptoms consistent with right-sided heart failure?

    <p>Pulmonary thromboembolism</p> Signup and view all the answers

    Which factor would increase the likelihood of pulmonary embolism in a patient?

    <p>Prolonged immobility post-surgery</p> Signup and view all the answers

    What does the term 'right axis deviation' on an ECG typically indicate?

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

    What is a non-specific symptom that can make diagnosing pulmonary embolism challenging?

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

    What might peripheral edema indicate in a patient suspected of having cor pulmonale?

    <p>Right-sided heart failure</p> Signup and view all the answers

    What clinical criteria in the Wells’ Criteria significantly increases the pretest probability of acute pulmonary embolism (PE)?

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

    Which clinical sign is characteristic of acute pulmonary embolism?

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

    In the management of a patient with acute respiratory failure, what is the most critical initial intervention?

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

    What is the primary reason why aspirin and antiplatelet therapy are inadequate for managing acute PE?

    <p>They do not inhibit the coagulation cascade</p> Signup and view all the answers

    Following surgery, which finding in arterial blood gas analysis most strongly indicates respiratory failure?

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

    What is the role of heparin therapy in perioperative management?

    <p>Treat acute PE or coronary syndrome</p> Signup and view all the answers

    What condition is least likely to cause hypoxemia in a post-operative patient?

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

    Which option is a common complication of thoracic and abdominal surgery related to respiratory function?

    <p>Diaphragm dysfunction</p> Signup and view all the answers

    What symptom most likely indicates a need for intubation in a post-operative patient?

    <p>Severe respiratory distress</p> Signup and view all the answers

    What is the best initial management approach for a patient displaying signs of hypoxemic and hypercapnic respiratory failure?

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

    Why is fluid administration potentially harmful in a patient with respiratory failure post-surgery?

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

    Which factor does NOT typically increase the risk of perioperative pulmonary complications?

    <p>Hormonal imbalances</p> Signup and view all the answers

    Which would NOT be appropriate management for a patient who has recently undergone surgery and is agitated and tachypneic?

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

    What immediate treatment should be considered for a patient showing respiratory acidosis with hypoxemia post-surgery?

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

    Study Notes

    Hemolytic Transfusion Reaction

    • Occurs because of ABO incompatibility
    • Preformed antibodies against donor antigens on the surface of incompatible erythrocytes leads to profound hemolysis.
    • Presents with dyspnea, flank pain, dark urine, disseminated intravascular coagulopathy (DIC), and possible death
    • Occurs within 6 hours of transfusion
    • Can include any blood product including erythrocytes, fresh frozen plasma, or platelets
    • Characterized by respiratory distress, hypoxemia, cyanosis, fever, and new infiltrates on chest x-ray
    • Pathogenesis thought to involve abnormal priming of neutrophils in the lung

    Splenic Injury

    • Commonly injured in blunt abdominal trauma with injuries that include devascularization, contusion, laceration, and rupture.
    • can present with abdominal tenderness and if severe, hemodynamic instability from large volume hemoperitoneum
    • Hemodynamically stable patients with minor splenic injuries may be treated nonoperatively with observation and reassessment
    • Hemodynamically unstable patients require exploratory laparotomy for repair or splenectomy

    Neurogenic Shock

    • May occur following traumatic brain or spinal cord injury
    • The vasomotor center regulates blood pressure via sympathetic fibers
    • Loss of sympathetic innervation results in vasodilation and loss of vascular tone
    • Careful fluid resuscitation is essential for maintaining perfusion

    Hypothermia and Frostbite

    • A 47 year old male was found on a snow-covered mountain
    • He was shivering and unable to walk
    • He reported his toes were numb and examination showed pale toes bilaterally
    • Blisters were noted on the 4th and 5th toes bilaterally
    • Sensation to touch was absent over the toes bilaterally
    • Pedal pulses were faintly palpable in both feet
    • Ankle brachial indices were 0.85 bilaterally (normal is greater than 1)
    • The patient was experiencing both hypothermia and frostbite

    Hypothermia

    • Defined as a core body temperature less than 35 degrees Celsius

    Frostbite

    • Occurs when the skin and underlying tissues freeze
    • Characterized by numbness, tingling, and pain
    • Can lead to tissue damage and necrosis

    Treatment of Hypothermia

    • Re-warming the patient is critical
    • This can be done via passive re-warming in a warm environment or active re-warming with warm water or blankets
    • Monitor vital signs carefully and manage any complications

    Treatment of Frostbite

    • Rewarming the affected area can help prevent further tissue damage
    • This can be done by immersing the affected area in lukewarm water
    • Do not rub the affected area, as this can damage the tissues
    • Prompt medical attention is necessary to prevent further complications

    Patient Information

    • A 62-year-old woman comes to the physician for a routine health maintenance examination.
    • She does not smoke and only drinks socially.

    Aortic Stenosis (AS)

    • Common aortic valve disorder caused by calcification
    • Calcification occurs due to mechanical stresses on valve leaflets, leading to repetitive microtrauma and chronic inflammation.
    • Many patients are asymptomatic.
    • Patients with severe AS may experience symptoms like fatigue, shortness of breath, cough, decreased exercise tolerance, angina, or syncope during exertion.
    • Left ventricular hypertrophy can occur due to the increased afterload from the valve obstruction.
    • Diastolic dysfunction is a potential consequence of AS.
    • Untreated AS can lead to:
      • Heart failure
      • Secondary pulmonary hypertension
      • Sudden cardiac death
    • Angina and syncope are crucial symptoms indicating the need for aortic valve replacement as they signify inadequate perfusion to the myocardium and brain respectively.

    Acute Limb Ischemia

    • Characterized by abnormally diminished blood flow to extremities, usually the lower limbs.
    • Common cause is atherosclerotic plaque.
    • Risk factors:
      • Diabetes mellitus
      • Increased age
      • Tobacco smoking
      • Hypertension
      • Dyslipidemia
    • Patients often present with claudication due to insufficient blood flow to muscles during exercise.
    • Acute limb ischemia can be caused by:
      • Rupture of an existing plaque, leading to acute thrombotic limb ischemia.
      • Embolism from a source like atrial fibrillation, which can abruptly occlude a narrowed vessel.
    • Atrial fibrillation can cause distal embolization of thrombi leading to:
      • Strokes
      • Acute limb ischemia
      • Mesenteric or renal ischemia
      • Acute coronary syndromes
    • Management for acute limb ischemia:
      • Anticoagulation
      • Analgesics
      • Reperfusion procedures:
        • Vascular bypass
        • Endovascular or open thrombectomy

    Deep Venous Thrombosis (DVT)

    • Thrombus within deep veins, typically in the legs.
    • Caused by Virchow's triad:
      • Venous stasis
      • Endothelial injury
      • Hypercoagulability
    • Risk factors for DVT:
      • Surgery
      • Malignancy
      • Prolonged immobilization
    • Immediate management for DVT:
      • Anticoagulation
      • Heparin preferred for recent surgery or malignancy due to reversibility of anticoagulation.
    • The need for long-term anticoagulation is determined by classifying DVT as provoked or unprovoked.

    Blunt Cardiac Injury (BCI)

    • Most often occurs in motor vehicle accidents, with a higher incidence in those with direct blunt precordial trauma or rapid deceleration.
    • Causes a range of cardiac injuries, from mild to life-threatening.
    • Arrhythmias are a common complication, affecting approximately 5% of patients:
      • Premature ventricular contractions
      • Supraventricular tachycardia
      • Ventricular fibrillation
    • Most arrhythmias are mild.
    • More severe complications:
      • Ventricular rupture
      • Pericardial tamponade
      • Valvular rupture
      • Myocardial infarction due to coronary artery dissection or thrombosis.
    • Catastrophic BCI injuries are usually fatal and do not reach ERs.
    • Diagnosis of specific cardiac abnormalities like pericardial tamponade and valvular pathologies can be made using echocardiography and clinical features like refractory hypotension, pulsus paradoxus, and jugular venous distension.

    BCI

    • BCI (Blunt Cardiac Injury) can occur after MVAs (Motor Vehicle Accidents) due to direct blunt trauma to the precordium or rapid deceleration.
    • Clinical presentations range from mild arrhythmias to life-threatening ventricular or valvular rupture.
    • Patients with new arrhythmias after BCI should be admitted for cardiac monitoring.

    Cor Pulmonale

    • Right ventricular dysfunction caused by chronic pulmonary pathology and associated pulmonary hypertension.
    • Chronic increased pulmonary pressures lead to right ventricular remodeling and failure.
    • Patients often present with exertional dyspnea and hypoxemia.

    Obstructive Sleep Apnea (OSA)

    • Characterized by intermittent obstruction of the upper airway leading to hypoxia and apnea.
    • Common symptoms include snoring, witnessed apnea, daytime somnolence, and morning headaches.
    • Severity is assessed with the apnea-hypopnea index (AHI).
    • Treatment for moderate to severe OSA is Continuous Positive Airway Pressure (CPAP).
    • Severe, untreated OSA can lead to pulmonary hypertension and cor pulmonale.

    Acute Pulmonary Embolism (PE)

    • PE can be difficult to diagnose due to nonspecific symptoms.
    • The Wells' Criteria is a validated tool to assess the probability of PE.
    • Patients with acute dyspnea, tachycardia, history of recent surgery, and lack of alternative diagnosis are at higher risk for PE.
    • Heparin therapy should be initiated immediately.

    Perioperative Pulmonary Complications

    • Major cause of mortality and morbidity in surgical patients.
    • Thoracic and abdominal surgeries reduce vital capacity and functional residual capacity.
    • Risk factors include age, obesity, OSA, asthma, COPD, pulmonary hypertension, and general health status.

    Hypoventilation

    • Characterized by decreased Po2, increased Pco2, and normal A-a gradient on ABG.
    • Can be caused by obesity and decreased breath sounds.
    • Respiratory acidosis can be acute or chronic based on changes in pH and Pco2.

    Aortic Dissection

    • Usually presents with severe chest pain radiating to the back.
    • Examination findings vary depending on the direction of the dissection flap.
    • May lead to acute aortic regurgitation, coronary occlusion, pulse deficits, distal ischemia, and end-organ damage.

    Intracerebral Hemorrhage

    • Presents with various symptoms depending on the location and extent of hemorrhage.
    • Common symptoms include headaches and focal neurologic deficits.

    Iron Deficiency Anemia

    • Can lead to fatigue and exertional dyspnea if severe.
    • Severe anemia may lead to high-output heart failure but is rare.

    Thrombotic Stroke

    • Usually presents with a progression of worsening neurologic symptoms.
    • Symptoms depend on the location and speed of thrombosis development.

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    Description

    This quiz explores critical concepts related to hemolytic transfusion reactions, transfusion-related acute lung injury (TRALI), and splenic injuries. Learn about the causes, symptoms, and implications of these medical conditions to enhance your understanding of transfusion medicine and trauma care.

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