wednesDay April 25, 2018
Q: Early operative correction of fractures increases the chance of fat embolism syndrome (FES)?
A) True
B) False
Answer: B (False)
Few measures which decrease the chances of FES after long bone trauma include early immobilization of fracture, early operative correction, intraosseous pressure limitation and arguably steroids.
References:
1. Riska EB, Myllynen P. Fat embolism in patients with multiple injuries. J Trauma 1982; 22:891.
2. Kröpfl A, Davies J, Berger U, et al. Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing. J Orthop Res 1999; 17:261.
3. Sen RK, Tripathy SK, Krishnan V. Role of corticosteroid as a prophylactic measure in fat embolism syndrome: a literature review. Musculoskelet Surg 2012; 96:1.
Q: Patients with previous heart transplant have (select one)
A) Supersensitive response to adenosine
B) No response to adenosine
Answer: A
Contrary to poular belief, adenosine effect is exaggerated in patients who are heart transplant recipients. It reduces calcium influx into cardiac cells by antagonizing adenylate cyclase. It also increases potassium conductance.
Denervated donor heart has increased sensitive to circulating catecholamine and adenosine.
#transplantation
#cardiology
Reference:
Koller-Strametz J, Kratochwill C, Grabenwöger M, et al. PR interval adaptation in the denervated transplanted heart. Pacing Clin Electrophysiol 1997; 20:1247.Q: Which of the following modality is preferred in hemodynamically stable patients with acute brain injury? (select one)
A) Intermittent Hemodialysis (HD)
B) Continuous Renal Replacement Therapy (CRRT)
Answer: Most critically ill patients who are hemodynamically stable can be served with less labor intense HD. But patients with acute brain injury or at high risk of developing increased intracranial pressure (ICP) benefit more from CRRT.
Intermittent HD can harm patients via two mechanisms.
1. Rapid removal of urea causes a rapid shift of water to the intracellular space resulting in worsen cerebral edema.
2. Drop in mean arterial pressure (MAP) during HD results in compensatory cerebral vasodilation resulting in worsening cerebral edema.
#Nephrology
#Surgicalcriticalcare
Reference:
Macedo E, Mehta RL. Continuous Dialysis Therapies: Core Curriculum 2016. Am J Kidney Dis 2016; 68:645.Q: All of the following antimicrobials are used for the treatment of severe babesiosis except?
A) Azithromycin
B) Atovaquone
C) Clindamycin
D) Levofloxacin
E) Quinine
Answer: D
The most commonly used drug regimen for severe babesiosis is intravenous azithromycin plus oral atovaquone. Intravenous clindamycin plus oral quinine can be used as an alternative treatment. Therapy should be guided by the level parasitemia and blood smears.
Red blood cell exchange transfusion should be considered as an immediate life-saving therapy or if antimicrobial therapy fails.
References:
1. Vannier E, Krause PJ. Human babesiosis. N Engl J Med 2012; 366:2397.
2. Sanchez E, Vannier E, Wormser GP, Hu LT. Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review. JAMA 2016; 315:1767.
3. Kletsova EA, Spitzer ED, Fries BC, Marcos LA. Babesiosis in Long Island: review of 62 cases focusing on treatment with azithromycin and atovaquone. Ann Clin Microbiol Antimicrob 2017; 16:26.Q: The half life of protamine is?
A) 5 minutes
B) 15 minutes
C) 30 minutes
D) 60 minutes
E) It correlates with heparin level in the plasma
Answer: A
Protamine has a very short half-life of about five minutes. This information is clinically significant as recurrent anticoagulation may occur after initial reversal of heparin, and may require re-dosing of protamine.
Reference:
Butterworth J, Lin YA, Prielipp RC, Bennett J, Hammon JW, James RL. Rapid disappearance of protamine in adults undergoing cardiac operation with cardiopulmonary bypass. .Ann Thorac Surg. 2002 Nov;74(5):1589-95.Q: Which of the following is the most reliable parameter of grading liver laceration/injury?
A) Aspartate aminotransferase (AST)
B) Alanine aminotransferase (ALT)
C) Level of Anemia
D) Blood Urea Nitrogen (BUN)
E) None of the above
Answer: E
None of the laboratory parameters are found to correlate well with the level of injury. This is a clinical diagnosis put together by history, physical exam and radiological workup such as a computed tomography (CT) with IV contrast, Focused Assessment with Sonography in Trauma (FAST), diagnostic peritoneal lavage (DPL) or diagnostic peritoneal aspiration (DPA) if clinically indicated, magnetic resonance imaging (MRI), and selectively arteriography.
#hepatology
#trauma
Reference:
Koyama T, Hamada H, Nishida M, et al. Defining the optimal cut-off values for liver enzymes in diagnosing blunt liver injury. BMC Res Notes 2016; 9:41.
A) True
B) False
Answer: B (False)
Few measures which decrease the chances of FES after long bone trauma include early immobilization of fracture, early operative correction, intraosseous pressure limitation and arguably steroids.
References:
1. Riska EB, Myllynen P. Fat embolism in patients with multiple injuries. J Trauma 1982; 22:891.
2. Kröpfl A, Davies J, Berger U, et al. Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing. J Orthop Res 1999; 17:261.
3. Sen RK, Tripathy SK, Krishnan V. Role of corticosteroid as a prophylactic measure in fat embolism syndrome: a literature review. Musculoskelet Surg 2012; 96:1.
Q: Patients with previous heart transplant have (select one)
A) Supersensitive response to adenosine
B) No response to adenosine
Answer: A
Contrary to poular belief, adenosine effect is exaggerated in patients who are heart transplant recipients. It reduces calcium influx into cardiac cells by antagonizing adenylate cyclase. It also increases potassium conductance.
Denervated donor heart has increased sensitive to circulating catecholamine and adenosine.
#transplantation
#cardiology
Reference:
Koller-Strametz J, Kratochwill C, Grabenwöger M, et al. PR interval adaptation in the denervated transplanted heart. Pacing Clin Electrophysiol 1997; 20:1247.Q: Which of the following modality is preferred in hemodynamically stable patients with acute brain injury? (select one)
A) Intermittent Hemodialysis (HD)
B) Continuous Renal Replacement Therapy (CRRT)
Answer: Most critically ill patients who are hemodynamically stable can be served with less labor intense HD. But patients with acute brain injury or at high risk of developing increased intracranial pressure (ICP) benefit more from CRRT.
Intermittent HD can harm patients via two mechanisms.
1. Rapid removal of urea causes a rapid shift of water to the intracellular space resulting in worsen cerebral edema.
2. Drop in mean arterial pressure (MAP) during HD results in compensatory cerebral vasodilation resulting in worsening cerebral edema.
#Nephrology
#Surgicalcriticalcare
Reference:
Macedo E, Mehta RL. Continuous Dialysis Therapies: Core Curriculum 2016. Am J Kidney Dis 2016; 68:645.Q: All of the following antimicrobials are used for the treatment of severe babesiosis except?
A) Azithromycin
B) Atovaquone
C) Clindamycin
D) Levofloxacin
E) Quinine
Answer: D
The most commonly used drug regimen for severe babesiosis is intravenous azithromycin plus oral atovaquone. Intravenous clindamycin plus oral quinine can be used as an alternative treatment. Therapy should be guided by the level parasitemia and blood smears.
Red blood cell exchange transfusion should be considered as an immediate life-saving therapy or if antimicrobial therapy fails.
References:
1. Vannier E, Krause PJ. Human babesiosis. N Engl J Med 2012; 366:2397.
2. Sanchez E, Vannier E, Wormser GP, Hu LT. Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review. JAMA 2016; 315:1767.
3. Kletsova EA, Spitzer ED, Fries BC, Marcos LA. Babesiosis in Long Island: review of 62 cases focusing on treatment with azithromycin and atovaquone. Ann Clin Microbiol Antimicrob 2017; 16:26.Q: The half life of protamine is?
A) 5 minutes
B) 15 minutes
C) 30 minutes
D) 60 minutes
E) It correlates with heparin level in the plasma
Answer: A
Protamine has a very short half-life of about five minutes. This information is clinically significant as recurrent anticoagulation may occur after initial reversal of heparin, and may require re-dosing of protamine.
Reference:
Butterworth J, Lin YA, Prielipp RC, Bennett J, Hammon JW, James RL. Rapid disappearance of protamine in adults undergoing cardiac operation with cardiopulmonary bypass. .Ann Thorac Surg. 2002 Nov;74(5):1589-95.Q: Which of the following is the most reliable parameter of grading liver laceration/injury?
A) Aspartate aminotransferase (AST)
B) Alanine aminotransferase (ALT)
C) Level of Anemia
D) Blood Urea Nitrogen (BUN)
E) None of the above
Answer: E
None of the laboratory parameters are found to correlate well with the level of injury. This is a clinical diagnosis put together by history, physical exam and radiological workup such as a computed tomography (CT) with IV contrast, Focused Assessment with Sonography in Trauma (FAST), diagnostic peritoneal lavage (DPL) or diagnostic peritoneal aspiration (DPA) if clinically indicated, magnetic resonance imaging (MRI), and selectively arteriography.
#hepatology
#trauma
Reference:
Koyama T, Hamada H, Nishida M, et al. Defining the optimal cut-off values for liver enzymes in diagnosing blunt liver injury. BMC Res Notes 2016; 9:41.
