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A 53 yrs old woman dies 4 days after an automobile accident. She sustained multiple injuries including a femoral fracture. Widespread petechiae are found in the cerebral white matter at autopsy. Which of the following is the most likely cause of these findings?
A Adult resp distress syndrome
B Countercoup injury
C Fat embolization
D Septicemia
E Subdural Hematoma

Copied from the sample Cd from the boards.



Edited by Flying h4x0r on Sep 14, 2005 - 7:26 PM


please can you explain why?


nothing else fits the criteria for petechiae in the white matter!

What happens is that fat globules enters the circulation after bony fracture, gets lodged at the microcirculation level in the cerebral and pulmonary vessels, resulting in mechanical obstruction, further exacerbated by RBC' and platelets clumping, and finally due to the release of fatty acids ,can cause endothelial injury , recruitment of polymorphs and all the inflammatory mediators!

ARDS don't cause petechiae!

Countercoup injuries will result in contusions rather than petechiae

Septicemia will result in DIC

Subdural hematoma takes 2-3 weeks to develop following a trauma!


SSRPK, WOW! 99 percentile for you for sure. Man You made it very simple for me to understand now. I knew the answer, but it was answer due to exclusions. I didn't know the reason why the correct answer is fat embolism. Thanks buddy now I know the reason too.


thanks man! and don't worry, just keep up your hard work!


ya c .....

if its is limited to the lungs, means has come from the venous side ,could be a dvt etc, it involves organs of the body, means an arterial thing, and could be fat embolus or others....

just take care of a paradoxical embolus, which is venous in origin, crosses to the arterial side thro an asd, and then becomes arterial clot, but in that case they will m ention in the stem of q that person had an asd

Edited by sturge_weber on Sep 15, 2005 - 7:33 AM


how about fixed splitting of second heart sound upon auscultation!


pulmonic valve (rt side) open first and close last in INSPIRATION..-splliting of 2 HS

this is normal split in cardiac cycle..

am i right ssrpk??please correct me if its wrong anywhere...


wel fixed splitting of second heart sound can also occur in pulmonary embolus...

think so, not too sure


ofcourse reet, you are correct!

normally upon inspiration, P2 folloiws A2, which becomes one sound upon expiration, however if splits remains upon expiration then its abnormal, and yeah i think i agree with sturge, pulmonary microembolism resulting in pulmonary HTN may result in fixed splitting, although i hv'nt read it, but i'll confirm it!

Thnx for pointing out sturge!


sorry.. i should have explained why...

with septicemia, you'll have microabcesses form in the white matter, in the watershed regions. right?

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