Best blood product to be given in a patient of multiple clotting factor deficiency with active bleeding:
Q22
Allergic salute is seen in -
Q23
A 45-year-old Caucasian male with a history of chronic myeloid leukemia for which he is receiving chemotherapy presents to the emergency room with oliguria and colicky left flank pain. His serum creatinine is 3.0 mg/dL and his urine pH is 5.0. You diagnose nephrolithiasis. His kidney stones, however, are not visible on abdominal x-ray. His stone is most likely composed of which of the following?
INI-CET 2024 - Internal Medicine INI-CET Practice Questions and MCQs
Question 21: Best blood product to be given in a patient of multiple clotting factor deficiency with active bleeding:
A. Whole blood
B. Packed RBCs
C. Cryoprecipitate
D. Fresh frozen plasma (Correct Answer)
Explanation: ***Fresh frozen plasma***
- **Fresh frozen plasma (FFP)** contains all coagulation factors, including labile factors V and VIII, making it the best choice for patients with multiple clotting factor deficiencies and active bleeding.
- It rapidly replenishes clotting factors, which is critical in scenarios of **acute hemorrhage** due to global coagulopathy.
*Whole blood*
- **Whole blood** contains red blood cells, plasma, and platelets, but its clotting factor concentration is lower than FFP and deteriorates over storage.
- It is preferred for massive hemorrhage with significant blood volume loss, but less effective for isolated clotting factor deficiencies without substantial volume depletion.
*Packed RBCs*
- **Packed red blood cells (PRBCs)** are primarily used to increase oxygen-carrying capacity by raising hemoglobin levels in anemic patients.
- They lack significant amounts of clotting factors and are therefore not effective in treating active bleeding due to coagulation factor deficiencies.
*Cryoprecipitate*
- **Cryoprecipitate** contains specific clotting factors, namely factor VIII, von Willebrand factor, fibrinogen, and factor XIII.
- While useful for deficiencies in these specific factors (e.g., hemophilia A, DIC with low fibrinogen), it does not provide a broad spectrum of all clotting factors needed for general multiple factor deficiencies.
Question 22: Allergic salute is seen in -
A. Nasal Myiasis
B. Allergic rhinitis (Correct Answer)
C. Chronic sinusitis
D. Chronic conjunctivitis
Explanation: ***Allergic rhinitis***
- The **allergic salute** is a characteristic physical finding in allergic rhinitis [1], where individuals repeatedly push their nose upward with their hand to relieve nasal itching and clear obstruction.
- This repetitive gesture can lead to a visible transverse crease on the dorsum of the nose, known as the **nasal crease**.
*Nasal Myiasis*
- **Nasal myiasis** is an infestation of the nasal cavity by fly larvae, causing symptoms like nasal discharge, epistaxis, and local pain.
- It does not involve nasal itching that would provoke the "allergic salute" action.
*Chronic sinusitis*
- **Chronic sinusitis** is a prolonged inflammation of the sinuses, causing facial pain/pressure, nasal obstruction, and discharge.
- While it can cause nasal obstruction, it typically doesn't present with the intense nasal itching that would lead to the "allergic salute."
*Chronic conjunctivitis*
- **Chronic conjunctivitis** is an inflammation of the conjunctiva, primarily affecting the eyes with symptoms like redness, itching, and discharge.
- It does not directly affect the nasal passages or provoke nasal symptoms like itching that would result in an allergic salute.
Question 23: A 45-year-old Caucasian male with a history of chronic myeloid leukemia for which he is receiving chemotherapy presents to the emergency room with oliguria and colicky left flank pain. His serum creatinine is 3.0 mg/dL and his urine pH is 5.0. You diagnose nephrolithiasis. His kidney stones, however, are not visible on abdominal x-ray. His stone is most likely composed of which of the following?
A. Uric acid (Correct Answer)
B. Cystine
C. Calcium phosphate
D. Magnesium ammonium phosphate
E. Calcium oxalate
Explanation: ***Uric acid***
- The patient has **chronic myeloid leukemia (CML)** and is receiving **chemotherapy**, which can cause a rapid turnover of cells, leading to **hyperuricemia** and the formation of uric acid stones.
- Uric acid stones are **radiolucent** (not visible on X-ray) and are associated with a **low urine pH** (5.0 in this case).
*Cystine*
- Cystine stones are caused by a **genetic defect** in amino acid transport, leading to high urinary cystine levels.
- While they are also **radiolucent**, there is no clinical information to suggest a genetic predisposition for cystinuria in this patient.
*Calcium phosphate*
- Calcium phosphate stones are typically **radio-opaque** and usually form in alkaline urine, which contradicts the patient's low urine pH [1].
- They are often associated with conditions like **renal tubular acidosis** or hyperparathyroidism [1].
*Magnesium ammonium phosphate*
- These are also known as **struvite stones** and are highly suggestive of **urinary tract infections** with urea-splitting organisms (e.g., *Proteus*) [1].
- They tend to grow large, form **staghorn calculi**, and are **radio-opaque** [1].
*Calcium oxalate*
- Calcium oxalate stones are the **most common type** of kidney stone and are **radio-opaque**, making them visible on X-ray.
- They are typically associated with conditions causing **hypercalciuria** or hyperoxaluria, which are not explicitly indicated here, and they would be visible on the X-ray.