MDcooper
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15.A 70-year-old woman with aortic sclerosis is admitted with chest pain. An infarct is ruled out by cardiac enzymes, but the patient has recurrent symptoms when weaned off heparin. On hospitalization day 2, she has right arm pain, absent brachial pulse on the right, and a cold distal right arm. Her hematocrit is 34%, and platelets are 30,000/mm3. Her partial thromboplastin time is 64 sec. Which of the following is the most likely cause of this patient's absent brachial pulse?
A. Embolization from aortic sclerosis
B. Heparin-induced thrombocytopenia
C. Paradoxical embolus
D. Hypercoagulable state from immobilization
E. Vasospasm of the brachial artery
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| hanialkhadher
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(B)HIT.
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| prathapdoctor
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i will go with embolization from aortic sclerosis, but i am not sure, this question is a bit intriguing, i welcome replies to this question.
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| sarika
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C. Paradoxical embolus
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| fox
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yes the q is quite wierd, but A seems to be the answer
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| robin082006
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BBBBBB
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| Guptashutosh
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1.first thing is that wat the hell is AORTIC SCLEROSIS , i never heard of that... i know aortic stenosis but wat is sclerosis
2. we need to differntiate whether it is really a thrmboembolic episode, with such t`cytopenia how can a throbus formed..
3. with hct of 34% and ptt 64 sec ther cant be a hypercoagulable state() ..so option c& D is out.
4. heparin induced t`penia might not cause these symptoms. clinical findings r not corelating.. B is out
5. i `m left with vasospasm but i dont find the reason here
anybody having some clue r invited
GL
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| Guptashutosh
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if it is related to systemic sclerosis (related to aortic SCLEROSIS) then one can explain the spasm... thats all i can do
at last `d say WIERD Q
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| robin082006
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ANSWER IS B. Heparin-induced thrombocytopenia
HEPARIN--> ANTIBODIES--> PLATELETE AGGREGATION--> ABOVE SYMPTOMS.
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| Guptashutosh
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ok good one , thx
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| webjeee
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thanks, robin,
anti-PF4,right.
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| MDcooper
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B IS THE ANSWER
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