Wound complications (dehiscence, evisceration) US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Wound complications (dehiscence, evisceration). These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Wound complications (dehiscence, evisceration) US Medical PG Question 1: The surgical equipment used during a craniectomy is sterilized using pressurized steam at 121°C for 15 minutes. Reuse of these instruments can cause transmission of which of the following pathogens?
- A. Non-enveloped viruses
- B. Sporulating bacteria
- C. Prions (Correct Answer)
- D. Enveloped viruses
- E. Yeasts
Wound complications (dehiscence, evisceration) Explanation: ***Prions***
- Prions are **abnormally folded proteins** that are highly resistant to standard sterilization methods like steam autoclaving at 121°C, making them a risk for transmission through reused surgical instruments.
- They cause transmissible spongiform encephalopathies (TSEs) like **Creutzfeldt-Jakob disease**, where even trace amounts can be highly infectious.
*Non-enveloped viruses*
- Non-enveloped viruses are generally **more resistant to heat and disinfectants** than enveloped viruses but are typically inactivated by recommended steam sterilization protocols.
- Standard autoclaving conditions are effective in destroying most non-enveloped viruses.
*Sporulating bacteria*
- **Bacterial spores**, such as those from *Clostridium* or *Bacillus*, are known for their high resistance to heat and chemicals, but are usually **inactivated by steam sterilization at 121°C** for 15 minutes.
- This method is specifically designed to kill bacterial spores effectively.
*Enveloped viruses*
- Enveloped viruses are the **least resistant to heat and chemical disinfectants** due to their lipid envelope.
- They are readily **inactivated by standard steam sterilization** at 121°C.
*Yeasts*
- **Yeasts** are eukaryotic microorganisms that are typically **susceptible to heat sterilization**.
- They are effectively killed by typical steam autoclaving conditions used for surgical instruments.
Wound complications (dehiscence, evisceration) US Medical PG Question 2: A 27-year-old man presents to the emergency department after being stabbed. The patient was robbed at a local pizza parlor and was stabbed over 10 times with a large kitchen knife with an estimated 7 inch blade in the ventral abdomen. His temperature is 97.6°F (36.4°C), blood pressure is 74/54 mmHg, pulse is 180/min, respirations are 19/min, and oxygen saturation is 98% on room air. The patient is intubated and given blood products and vasopressors. Physical exam is notable for multiple stab wounds over the patient's abdomen inferior to the nipple line. Which of the following is the best next step in management?
- A. Exploratory laparotomy (Correct Answer)
- B. Diagnostic peritoneal lavage
- C. CT scan of the abdomen and pelvis
- D. Exploratory laparoscopy
- E. FAST exam
Wound complications (dehiscence, evisceration) Explanation: ***Exploratory laparotomy***
- The patient presents with **multiple stab wounds** to the abdomen and signs of **hemorrhagic shock** (BP 74/54 mmHg, HR 180/min), which are clear indications for immediate surgical intervention.
- An exploratory laparotomy allows for direct visualization and repair of internal injuries, which is critical in this life-threatening situation.
*Diagnostic peritoneal lavage*
- While DPL can detect intra-abdominal bleeding, it is an **invasive procedure** and may delay definitive treatment in a hemodynamically unstable patient with obvious penetrating trauma.
- It is **less specific** than a laparotomy for identifying the exact location and nature of injuries, and it has largely been replaced by imaging studies or direct surgical exploration in unstable patients.
*CT scan of the abdomen and pelvis*
- A CT scan requires a **hemodynamically stable** patient and time for scanning and interpretation, which this patient does not have.
- Delaying definitive treatment for imaging in a patient with severe shock could lead to worse outcomes.
*Exploratory laparoscopy*
- Although less invasive, laparoscopy can be time-consuming and may not be feasible or safe in a patient with **profound hemorrhagic shock** and extensive injuries, especially if major vascular or visceral damage is suspected.
- Conversion to a **laparotomy** is often necessary in cases of significant injury, making immediate open exploration more efficient.
*FAST exam*
- A FAST exam can rapidly detect free fluid in the abdomen, suggesting internal bleeding, but it does **not provide specific information** about the source or extent of the injuries.
- While useful in the initial assessment, a positive FAST exam in a hemodynamically unstable patient with penetrating trauma directly points to the need for immediate surgical intervention, not further diagnostic delay.
Wound complications (dehiscence, evisceration) US Medical PG Question 3: A 35-year-old man is brought to the emergency department from a kitchen fire. The patient was cooking when boiling oil splashed on his exposed skin. His temperature is 99.7°F (37.6°C), blood pressure is 127/82 mmHg, pulse is 120/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has dry, nontender, and circumferential burns over his arms bilaterally, burns over the anterior portion of his chest and abdomen, and tender spot burns with blisters on his shins. A 1L bolus of normal saline is administered and the patient is given morphine and his pulse is subsequently 80/min. A Foley catheter is placed which drains 10 mL of urine. What is the best next step in management?
- A. Additional fluids and escharotomy (Correct Answer)
- B. Escharotomy
- C. Continuous observation
- D. Moist dressings and discharge
- E. Additional fluids and admission to the ICU
Wound complications (dehiscence, evisceration) Explanation: ***Additional fluids and escharotomy***
- The patient has **circumferential full-thickness burns** on both arms (dry, nontender), which require **escharotomy** to prevent compartment syndrome and vascular compromise to the limbs.
- The **oliguria** (10 mL urine output) despite a 1L fluid bolus indicates **inadequate fluid resuscitation** from burn shock. With approximately 40% TBSA burns, the patient requires aggressive fluid resuscitation per the Parkland formula (4 mL/kg/% TBSA), which would be approximately 11 liters in the first 24 hours. Adequate resuscitation targets urine output of 0.5-1 mL/kg/hr (35-70 mL/hr for this patient).
- Both interventions are immediately necessary: fluids for burn shock and escharotomy for circumferential burns.
*Escharotomy*
- While **escharotomy** is essential for the circumferential full-thickness burns to prevent compartment syndrome, it alone will not address the **severe fluid deficit** causing oliguria and hypoperfusion.
- The low urine output reflects systemic hypovolemia from burn shock, not just local compartment issues, requiring aggressive fluid resuscitation.
*Continuous observation*
- **Continuous observation** is inappropriate given the patient's critical findings: circumferential full-thickness burns requiring urgent escharotomy and oliguria indicating inadequate resuscitation.
- Delaying escharotomy can lead to irreversible ischemic damage to the limbs, and inadequate fluid resuscitation can progress to multiorgan failure.
*Moist dressings and discharge*
- This option is completely inappropriate for a patient with **extensive deep burns** (approximately 40% TBSA) including full-thickness injuries requiring hospitalization and specialized burn care.
- Discharge would lead to severe complications including infection, inadequate fluid resuscitation, compartment syndrome, and potential limb loss.
*Additional fluids and admission to the ICU*
- While ICU admission and additional fluids are necessary components of care, this option is **incomplete** because it omits **escharotomy**, which is urgently needed for the circumferential full-thickness burns.
- Escharotomy is a time-sensitive procedure that must be performed promptly to prevent ischemic injury to the limbs from vascular compromise.
Wound complications (dehiscence, evisceration) US Medical PG Question 4: A 4-year-old girl is brought to the emergency department by her father for the evaluation of abdominal pain for 1 hour after drinking a bottle of rust remover. The father reports that she vomited once on the way to the hospital and that her vomit was not bloody. The patient has pain with swallowing. She appears uncomfortable. Oral examination shows mild erythema of the epiglottis and heavy salivation. Which of the following is the most likely long-term complication in this patient?
- A. Esophageal strictures (Correct Answer)
- B. Esophageal webs
- C. Mallory-Weiss tears
- D. Thyroglossal fistula
- E. Oral cavity cancer
Wound complications (dehiscence, evisceration) Explanation: ***Esophageal strictures***
- Ingestion of corrosive substances like **rust remover** (typically acidic) causes **severe chemical burns** to the esophagus, leading to inflammation and tissue damage.
- Over time, as the damaged esophageal tissue heals, it can form **fibrotic scar tissue**, resulting in the narrowing of the esophageal lumen, known as strictures, which can lead to dysphagia.
*Esophageal webs*
- Esophageal webs are **thin, eccentric mucosal folds** that protrude into the esophageal lumen, often congenital or associated with iron deficiency anemia (Plummer-Vinson syndrome).
- While they can cause dysphagia, they are **not typically a direct complication of acute caustic ingestion**.
*Mallory-Weiss tears*
- These are **longitudinal mucosal tears** at the gastroesophageal junction, usually caused by forceful vomiting, which can lead to **upper gastrointestinal bleeding**.
- Although the patient vomited, it was not bloody, and Mallory-Weiss tears are an **acute complication** rather than a long-term structural sequela of corrosive ingestion.
*Thyroglossal fistula*
- A thyroglossal fistula is a **persistently open tract** that results from the incomplete obliteration of the thyroglossal duct during embryonic development.
- This is a **congenital anomaly** unrelated to caustic ingestion and typically presents as a neck mass or drainage from the anterior neck.
*Oral cavity cancer*
- While long-term exposure to certain carcinogens can increase the risk of oral cancers, a single acute ingestion of a caustic substance is **not typically a direct cause** of oral cavity cancer.
- The immediate and most common long-term complication from such an event is esophageal damage.
Wound complications (dehiscence, evisceration) US Medical PG Question 5: Five days after undergoing right knee arthroplasty for osteoarthritis, a 68-year-old man has severe pain in his right knee preventing him from participating in physical therapy. On the third postoperative day when the dressing was changed, the surgical wound appeared to be intact, slightly swollen, and had a clear secretion. He has a history of diabetes, hyperlipidemia, and hypertension. Current medications include metformin, enalapril, and simvastatin. His temperature is 37.3°C (99.1°F), pulse is 94/min, and blood pressure is 130/88 mm Hg. His right knee is swollen, erythematous, and tender to palpation. There is pain on movement of the joint. The medial parapatellar skin incision appears superficially opened in its proximal and distal part with yellow-green discharge. There is blackening of the skin on both sides of the incision. Which of the following is the next best step in the management of this patient?
- A. Vacuum dressing
- B. Antiseptic dressing
- C. Nafcillin therapy
- D. Removal of prostheses
- E. Surgical debridement (Correct Answer)
Wound complications (dehiscence, evisceration) Explanation: ***Surgical debridement***
- The patient presents with classic signs of **necrotizing fasciitis** or a severe wound infection: rapidly worsening pain, erythema, swelling, **yellow-green discharge**, and crucially, **blackening of the skin** (indicating tissue necrosis).
- Immediate **surgical debridement** is critical for source control, removal of necrotic tissue, and preventing further spread of infection, which can be life-threatening.
*Vacuum dressing*
- A vacuum-assisted closure (VAC) dressing is used for wound management after adequate debridement or for wounds without signs of aggressive infection to promote healing.
- Applying a VAC dressing to a wound with widespread necrosis and active infection, especially necrotizing fasciitis, without prior debridement would be ineffective and potentially harmful.
*Antiseptic dressing*
- While antiseptic dressings can help reduce bacterial load in some superficial wounds, they are entirely insufficient for deep-seated, rapidly spreading infections with tissue necrosis.
- This approach fails to address the underlying necrotic tissue and the extent of the infection, leading to rapid deterioration.
*Nafcillin therapy*
- **Antibiotic therapy** is essential for treating severe infections; however, it must be combined with source control, especially when necrosis is present.
- Giving antibiotics alone without **surgical debridement** in cases of necrotizing fasciitis is inadequate and will not prevent progression of the infection or improve patient outcomes.
*Removal of prostheses*
- While **prosthesis removal** may be necessary in some cases of established periprosthetic joint infection, it is a definitive and often late measure.
- The immediate priority in a rapidly progressing, necrotic wound infection is **surgical debridement** to remove devitalized tissue and control the local infection, prior to considering implant removal unless the infection is directly on the implant.
Wound complications (dehiscence, evisceration) US Medical PG Question 6: Three hours after undergoing left hip arthroplasty for chronic hip pain, a 62-year-old man complains of a prickling sensation in his left anteromedial thigh and lower leg. He has never had these symptoms before. He has hyperlipidemia and coronary artery disease. He has had recent right-sided gluteal and thigh pain with ambulation. Vital signs are within normal limits. Sensation to pinprick and light touch are decreased on the anteromedial left thigh as well as medial lower leg. Neurologic exam shows left leg strength 3/5 on hip flexion and 2/5 on knee extension. Patellar reflex is decreased on the left. The remainder of neurologic exam is normal. Dorsalis pedis, popliteal, and femoral pulses are 2+ bilaterally. The surgical incision is without erythema or drainage. Which of the following is the most likely underlying cause of this patient's symptoms?
- A. Surgical site infection
- B. Obturator nerve injury
- C. Sural nerve injury
- D. Femoral nerve injury (Correct Answer)
- E. Femoral artery occlusion
Wound complications (dehiscence, evisceration) Explanation: ***Femoral nerve injury***
- The patient's symptoms of **prickling sensation (paresthesia)** in the anterior-medial thigh and medial lower leg, **decreased sensation to pinprick and light touch** in these areas, and **weakness in hip flexion (iliopsoas)** and **knee extension (quadriceps)**, along with a **decreased patellar reflex**, are all classic signs of **femoral nerve dysfunction**.
- The femoral nerve can be susceptible to injury during **hip arthroplasty** due to retraction, direct trauma, or hematoma formation, especially if the patient is slim or has anatomical variations.
*Surgical site infection*
- This typically presents with signs of **inflammation** such as erythema, warmth, severe pain, and sometimes drainage from the incision site, which are absent here.
- Neurological deficits like specific motor weakness and sensory loss in a nerve distribution are *not* primary features of a surgical site infection.
*Obturator nerve injury*
- An obturator nerve injury would primarily affect **adduction of the thigh** and might cause sensory changes in the medial thigh, but would *not* cause weakness in hip flexion or knee extension, nor would it affect the patellar reflex.
- The sensory distribution described (anteromedial thigh and medial lower leg) is more consistent with femoral nerve involvement than obturator nerve.
*Sural nerve injury*
- **Sural nerve injury** primarily causes sensory deficits along the **posterolateral aspect of the lower leg and ankle**, and the lateral aspect of the foot.
- It would *not* cause motor weakness in hip flexion or knee extension, nor would it affect the patellar reflex.
*Femoral artery occlusion*
- **Femoral artery occlusion** would cause symptoms of **acute limb ischemia**, including severe pain, pallor, pulselessness, poikilothermia (coldness), paresthesias, and paralysis (the "6 Ps").
- While paresthesias are present, the patient has **intact distal pulses (2+ bilaterally)** and no signs of pallor or coldness, ruling out significant arterial occlusion.
Wound complications (dehiscence, evisceration) US Medical PG Question 7: A 15-year-old boy is brought to the emergency department by ambulance after his mother found him having muscle spasms and stiffness in his room. His mother stated he scraped his foot on a rusty razor on the bathroom floor 2 days prior. On presentation, his temperature is 102.0°F (38.9°C), blood pressure is 108/73 mmHg, pulse is 122/min, and respirations are 18/min. On physical exam, he is found to have severe muscle spasms and rigid abdominal muscles. In addition, he has a dirty appearing wound on his right foot. The patient's mother does not recall any further vaccinations since age 12. Finally, he is found to have difficulty opening his mouth so he is intubated. Which of the following treatment(s) should be provided to this patient?
- A. Wound debridement and antitoxin
- B. Antitoxin
- C. Wound debridement
- D. Wound debridement and booster vaccine
- E. Wound debridement, antitoxin, and booster vaccine (Correct Answer)
Wound complications (dehiscence, evisceration) Explanation: ***Wound debridement, antitoxin, and booster vaccine***
- The patient presents with classic symptoms of **tetanus** (muscle spasms, stiffness, trismus, fever) following a contaminated wound, and an uncertain vaccination history.
- **Wound debridement** removes the source of toxin production, **antitoxin** (tetanus immune globulin) neutralizes circulating toxin, and a **booster vaccine** provides active immunity against future infections.
*Wound debridement and antitoxin*
- While **wound debridement** and **antitoxin** are critical for acute management, omitting the booster vaccine leaves the patient vulnerable to future tetanus infections.
- A booster dose is essential to stimulate the patient's own immune system and provide **long-term immunity**, especially with a history of unknown vaccination status.
*Antitoxin*
- Administering only **antitoxin** would neutralize circulating toxins but would not address the ongoing production of toxins from the contaminated wound.
- It also wouldn't provide **active immunization** to protect against future exposures.
*Wound debridement*
- **Wound debridement** alone removes the bacterial source but does not neutralize the already circulating **tetanus toxin**, which is responsible for the severe neurological symptoms.
- It also fails to provide immediate passive immunity with antitoxin or active immunization with a booster.
*Wound debridement and booster vaccine*
- This option correctly addresses removing the source and providing active immunity but critically misses the immediate need for **antitoxin** to neutralize existing toxins and alleviate the life-threatening symptoms.
- The **tetanus toxin** acts rapidly, and prompt neutralization is crucial to prevent further neurological damage and improve prognosis.
Wound complications (dehiscence, evisceration) US Medical PG Question 8: A 60-year-old male presents with fatigue, dyspnea on exertion, and lower extremity edema. Physical examination reveals an elevated jugular venous pressure and an S3 heart sound. Which of the following medications is most likely to improve this patient's symptoms?
- A. Metoprolol
- B. Furosemide (Correct Answer)
- C. Losartan
- D. Lisinopril
- E. Spironolactone
Wound complications (dehiscence, evisceration) Explanation: ***Correct: Furosemide***
- The patient presents with classic signs of **heart failure with fluid overload**: dyspnea on exertion, lower extremity edema, elevated jugular venous pressure, and an S3 heart sound (indicating volume overload).
- **Furosemide**, a **loop diuretic**, is the most effective medication for **rapid symptomatic relief** in heart failure with congestion. It works by blocking sodium and water reabsorption in the loop of Henle, promoting diuresis and reducing **pulmonary congestion** and **peripheral edema**.
- While other medications like ACE inhibitors, beta-blockers, and aldosterone antagonists are crucial for **long-term mortality reduction** and disease modification, loop diuretics provide the **fastest and most direct symptomatic improvement** for fluid overload.
*Incorrect: Metoprolol*
- **Metoprolol** is a **beta-blocker** that is essential for chronic HFrEF management, providing **mortality reduction** and **reverse cardiac remodeling**.
- However, beta-blockers take **weeks to months** to show symptomatic benefit and can initially **worsen symptoms** due to negative inotropic effects, especially in acute decompensation.
- While important for long-term management, metoprolol does not provide immediate symptomatic relief from fluid overload.
*Incorrect: Losartan*
- **Losartan** is an **angiotensin receptor blocker (ARB)** used as an alternative to ACE inhibitors in HFrEF, particularly in patients who develop cough with ACE inhibitors.
- ARBs reduce **afterload** and prevent **cardiac remodeling**, contributing to improved long-term outcomes and mortality reduction.
- However, they do not directly address fluid overload and do not provide rapid symptomatic relief compared to diuretics.
*Incorrect: Spironolactone*
- **Spironolactone** is an **aldosterone antagonist** that improves mortality in HFrEF by preventing myocardial fibrosis, reducing cardiac remodeling, and preventing potassium loss.
- While beneficial for long-term management, spironolactone has **weak diuretic effects** and takes weeks to provide symptomatic benefit.
- It is not the first-line choice for **acute symptomatic relief** of volume overload, though it is an important component of chronic HFrEF therapy.
*Incorrect: Lisinopril*
- **Lisinopril** is an **ACE inhibitor** and a cornerstone of HFrEF therapy, reducing **mortality**, **hospitalizations**, and preventing **cardiac remodeling** by reducing afterload and preload.
- While ACE inhibitors improve symptoms over time, they do not provide the **rapid diuretic effect** needed for immediate relief of dyspnea and edema.
- Lisinopril is essential for long-term management but is not the most effective option for acute symptomatic improvement of fluid overload.
Wound complications (dehiscence, evisceration) US Medical PG Question 9: During an autopsy of a decomposed body, the forensic pathologist notes marbling of the skin, bloating, and a green discoloration of the abdomen. Based on these findings, which of the following best estimates the postmortem interval?
- A. 7-10 days
- B. 1-2 months
- C. 2-3 weeks
- D. 3-5 days (Correct Answer)
Wound complications (dehiscence, evisceration) Explanation: ***3-5 days***
- The combination of **marbling of the skin**, **bloating**, and **green discoloration of the abdomen** are classic signs of early to moderate putrefaction. These changes typically become evident within **3 to 5 days** postmortem in temperate environments.
- **Green discoloration** of the abdomen is usually the first visible sign of putrefaction, appearing within 24-48 hours, followed by **bloating** due to gas production and then **marbling** as bacterial decomposition spreads through blood vessels.
*7-10 days*
- By **7-10 days**, decomposition would likely be more advanced, with prominent desquamation (**skin slipping**) and potentially the formation of **blisters** filled with putrefactive fluid, which are not explicitly mentioned here.
- While these changes can occur within this timeframe, the observed combination specifically points to an earlier stage than a full week.
*1-2 months*
- At **1-2 months**, the body typically enters the **skeletonization** stage, with significant loss of soft tissues due to insect activity and continued bacteria.
- The findings described (bloating, marbling, green discoloration) represent early putrefactive changes, not the advanced decomposition seen after several weeks or months.
*2-3 weeks*
- By **2-3 weeks**, extensive **bloating** and **tissue liquefaction** would be expected, and the body may begin to show signs of **maggot activity** if exposed to insects.
- The described findings are characteristic of a less advanced stage of decomposition compared to this longer interval.
Wound complications (dehiscence, evisceration) US Medical PG Question 10: Eight hours after undergoing an open right hemicolectomy and a colostomy for colon cancer, a 52-year-old man has wet and bloody surgical dressings. He has had episodes of blood in his stools during the past 6 months, which led to the detection of colon cancer. He has hypertension and ischemic heart disease. His younger brother died of a bleeding disorder at the age of 16. The patient has smoked one pack of cigarettes daily for 36 years and drinks three to four beers daily. Prior to admission, his medications included aspirin, metoprolol, enalapril, and simvastatin. Aspirin was stopped 7 days prior to the scheduled surgery. He appears uncomfortable. His temperature is 36°C (96.8°F), pulse is 98/min, respirations are 14/min, and blood pressure is 118/72 mm Hg. Examination shows a soft abdomen with a 14-cm midline incision that has severe oozing of blood from its margins. The colostomy bag has some blood collected within. Laboratory studies show:
Hemoglobin 12.3 g/dL
Leukocyte count 11,200/mm3
Platelet count 210,000/mm3
Bleeding time 4 minutes
Prothrombin time 15 seconds (INR=1.1)
Activated partial thromboplastin time 36 seconds
Serum
Urea nitrogen 30 mg/dL
Glucose 96 mg/dL
Creatinine 1.1 mg/dL
AST 48 U/L
ALT 34 U/L
γ-Glutamyltransferase 70 U/L (N= 5–50 U/L)
Which of the following is the most likely cause of this patient's bleeding?
- A. Factor VIII deficiency
- B. Liver dysfunction
- C. Erosion of blood vessels
- D. Insufficient mechanical hemostasis (Correct Answer)
- E. Platelet dysfunction
Wound complications (dehiscence, evisceration) Explanation: ***Insufficient mechanical hemostasis***
- The patient's **coagulation studies are within normal limits** (normal PT, aPTT, bleeding time, and platelet count), ruling out most common intrinsic bleeding disorders.
- Given the timing (8 hours post-surgery) and the nature of bleeding (oozing from incision margins and colostomy site), **inadequate surgical closure or ligature** is the most probable cause.
*Factor VIII deficiency*
- This would present with a **prolonged activated partial thromboplastin time (aPTT)**, which is normal in this patient (36 seconds). His brother's death from a bleeding disorder is a red herring.
- Congenital factor deficiencies typically manifest earlier in life and cause more severe, spontaneous bleeding, not just post-operative oozing with normal coagulation factors.
*Liver dysfunction*
- Severe liver dysfunction would typically lead to **prolonged PT and aPTT** due to impaired synthesis of clotting factors.
- While the patient has elevated GGT, indicating some liver stress likely from alcohol, his AST and ALT are only mildly elevated, and his coagulation tests are normal.
*Erosion of blood vessels*
- This is less likely to cause widespread oozing and would typically present as a more significant, **pulsatile hemorrhage** or hematoma.
- While possible in a surgical field, the lack of significant hemodynamic compromise and normal coagulation points away from a major vessel erosion.
*Platelet dysfunction*
- This would typically result in a **prolonged bleeding time**, which is normal in this patient (4 minutes).
- Although the patient was on aspirin, it was stopped 7 days prior to surgery, which is typically sufficient for platelet function to recover.
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