Saturday, March 24, 2007

pimp questions during surgery rotation

Hi there this is my first post, I am a third year medical student in the US and although at the end of my third year I thought it would be a great idea to write about pimp questions that you (if you are a medstudent too) will probably be asked too. So how about you learn and memorize the answers in advance? :) Than you'll just look like a star...I wish someone had done this for me :'(

Ok so today I was in surgery doing a formalization of a right BKA on a guy who had a big h/o of PVD, HTN, was anuric and was undergoing dialysis...my chief resident (CR) suddenly asked me:
CR: So have you noticed how much this guy is bleeding? You have any idea why
me: err.....because he has atherosclerosis (what a stupid answer in retrospect)
CR: that would make you think that he shouldn't bleed much right?
me: err....hummm.....yeaaahh......
CR: so why is he bleeding?
me:.....hmmmm because he has venous stasis and blood pools down in his lower extremity and thatis why he is bleeding like this?
CR: ....not what I wanna hear...so why is he bleeding
me: ......(heart pounding faster and faster)....hmmmm
CR:....ok think about his two biggest problems....
me:....PVD and he is anuric
CR:....here we go so PVD is out so how is being anuric linked to his bleeding problem?
me:....(light in my head)....because when you are anuric you do not excrete uric acid out of your system and an increase uric acid in your serum is linked to a decreased platelet count and that is why he is bleeding so much
CR:...so you knew it...too bad it was so laborious I almost lost patience....now keep that leg still....

so yeah if you CR asks you why an anuric guy going through dialysis is bleeding like hell, the answer is that he has an increase in serum uric acid that is associated with low platelet so coagulation is messed up and you bleed excessively

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