This question sparked a discussion among the expert group.

A thoracic surgeon slapped the table indignantly, "This kind of question is a joke, how can people answer it!"

"That is, the interventional surgery gave heparin, the contrast agent was pushed, and then there was a sudden respiratory and circulatory arrest during the operation. However, heparin has been used in the previous medication, the enhanced CTA has also been done, and the contrast agent has also been given, so I don't think it is a drug."

"Who can tell for sure other than interventional vascular surgeons? If I guess, it may have been a coma caused by touching the carotid sinus. But it is also said that the patient's lungs are full of crackles, and there may also be heart problems."

Everyone had different opinions, and the finger was pointed at this question, and they didn't even see the answer on the answer sheet to be reviewed.

In the opinion of experts, it should be impossible for this kind of bullshit question to be answered by a regular doctor.

Not to mention a doctor who has not yet practiced a license, this question is put into the promotion examination of the chief physician, and it is estimated that few people can give the correct answer.

Zhou Tianbo sat in the corner, listening to the discussion of the expert group review experts, as if it was a whole-hospital consultation without a clue, and he felt interesting and a little confused.

On the Internet, Zhou Tianbo saw that the exercises of primary school students were so difficult that he couldn't solve them, but he never expected that the current medical practitioner exam would be so difficult.

It's more difficult than imagined, but the little guy Ji Xiang gave a perfect answer.

"Since someone can answer the perfect score, the question stem should be fine."

Suddenly, someone said.

The noise in the classroom suddenly fell silent.

"Who knows what's wrong with the computer system."

"That is, this question must be related to intervention and stenting, so I don't believe that Dr. Guipei can touch level 4 surgery."

"Yes! Generally, there is no vascular department in the city-level tertiary hospitals, and even if there is, carotid artery stents are not daring to be used."

Other experts objected after a brief period of silence.

"Wait a minute, I'll consult with the vascular interventionists at our hospital." One said.

After he finished speaking, he stood up and was about to go out and make a call.

Zhou Tianbo felt that it was not so much like a problem with the system, but because Ji Xiang was good at interventional surgery.

A long time has passed, and what happened between Ji Xiang and Boss Qin Chu Qin and Ling Tian in the Demon Capital has gradually spread, and Zhou Tianbo has heard about it.

Although I don't believe it, Ke Jixiang is now doing scientific research on interventional + partial nephrectomy in the Second Affiliated Hospital, and the amount of surgery is quite considerable.

There must be something wrong with the operation, Zhou Tianbo thought to himself.

"Director Lu, just fight here, so you don't have to tell it back and forth."

"Don't toss, you go out and let's listen together."

The man thought about it, felt that it made sense, and took out his mobile phone to make a call.

"Director Zhongliang, I, Lao Lu." The man said, "Busy, I'll consult a vascular specialist for something."

Then Director Lu told Director Lu about this question.

"We think there's something wrong with this question."

"Who's asking this?" The person on the other side of the phone asked directly.

"What's wrong?"

"This is a medical practitioner exam? In clinical practice, 99% of doctors can't answer, is the occupational medical exam so difficult now?" The experts on the other side were somewhat incomprehensible.

Director Lu said, "That's why I'm going to ask you, you know more about interventional surgery, what went wrong?" Did it hit the carotid sinus when the stent was lowered, causing respiratory and circulatory arrest?"

"It has nothing to do with surgery." The man on the other side said.

"Director Zhongliang, you say it again, it has nothing to do with surgery? It can't be."

"I guess the answer to this question ...... Let's put it this way, I've had two similar cases in my clinical practice."

「！！！」

「！！！」

Everyone pricked up their ears, including Zhou Tianbo.

No

Maybe, absolutely impossible, there must be something wrong with the surgical process, Zhou Tianbo's intuition told him.

"Director Zhongliang, what's going on?" Director Lu asked suspiciously.

"Before the operation, the patient was allergic to heparin, resulting in anaphylactic shock. The question stem says that there are a lot of crackles in both lungs, etc., all prove this from the side."

"It's impossible, the patient was given low molecular weight heparin in the neurology department, and there was no allergic reaction."

"Low-molecular-weight heparin is low-molecular-weight heparin, it's not heparin."

「……」

「……」

「……」

The vast majority of people are stunned.

A small number of people who know about this matter also feel that the intention of the person who wrote the question is sinister.

"Is there a difference?" Director Lu was puzzled.

He is not engaged in vascular surgery or intervention, so he only has a slight understanding of the pharmacology of heparin, not a deep understanding.

"It sounds like one medicine, but when you look closely, it's completely two kinds of medicine." The man on the other side said.

"First, the molecular weights of the two drugs are different.

Unfractionated heparin is a type of glucosamine sulfate extracted from the intestinal mucosa of pigs or bovine lungs. IT IS A MIXTURE WITH A MOLECULAR WEIGHT RANGING FROM 3000 TO 30000KD AND AN AVERAGE MOLECULAR WEIGHT OF ABOUT 15000KD.

Low molecular weight heparin includes low molecular weight heparin sodium, heparin calcium, enoxaparin sodium, droheparin, dalteparin, etc. IT IS A GLUCOSAMINE SULFATE FRAGMENT AFTER CLEAVAGE OF COMMON STEM, WITH AN AVERAGE MOLECULAR WEIGHT RANGING FROM 3000 TO 8000KD."

"Second, the mechanism of action of drugs is different.

Heparin binds to platelets mainly through antithrombin III, inhibits the formation of thrombin on the surface of platelets, and inhibits the aggregation and release of platelets.

Anticoagulation by inhibiting activated coagulation factors such as II, IX, X, XI, and XII. Low molecular weight heparin mainly affects the activity of coagulation factor Xa, but has little effect on thrombin and other coagulation factors."

"Therefore, not being allergic to low molecular weight heparin does not mean that you are not allergic to heparin."

"Although heparin rarely causes allergic reactions, and there is no need for skin testing before surgery, once it appears, it needs to be rescued and it is a headache. If there is an allergy to the internal medicine medication, the drug should be stopped immediately, and they don't see much. We do a lot of surgery, and I've seen two similar patients in the last 10 years or so."

"Uh......" Director Lu was stunned.

"And it's rare to find even a skin test. The amount of heparin used for our intervention in anticoagulation is large, and it is injected directly into a tube to avoid thrombus agglutination. Forget it, don't talk too much, that's about it."

"This question is embarrassing. Not to mention Director Lu, you rarely come into contact with heparin and low molecular weight heparin, and there are not many people in our department who can figure it out."

"Is it so difficult to get questions out of the occupational medical exam now? Give me a copy of the exam paper, and I'll have it under my hand...... Ahem, ahem, I'll make it for them. I don't even know the questions of the occupational medical exam, and I blow my beard and stare all day long, Lao Tzu is the first in the world, give them a lesson! Hahaha."

On the other side of the phone, Director Zhongliang laughed.

There was silence in the classroom, except for the echoing of awkward laughter.

This question seems to be a clinical case analysis, but in the end it turns out to be a pharmacological problem.

It's not just embarrassing, it's just embarrassing!

(End of chapter)

Source: /txt/45149/30733751 341 in the previous chapter 343 full marks in the next chapter of the review paper!