Healing Doctor

Chapter 344 Reviewing the Exam Paper (Part 2)

This question sparked a discussion among the expert panel.

A thoracic surgeon slammed his fist on the table in frustration. "This question is ridiculous! How are we supposed to answer it?!"

"That's right. Heparin and contrast agent were administered during the interventional procedure, and then respiratory and circulatory arrest suddenly occurred during the procedure. But heparin was in the previous medication, enhanced CTA was performed, and contrast agent was administered, so we don't consider it to be a drug-related issue."

"Besides interventional vascular surgeons, who can accurately diagnose this? If I had to guess, it might be due to touching the carotid sinus causing the coma. But the text below also says that the patient's lungs are filled with moist rales, and there might also be a heart problem."

Opinions varied, with everyone pointing the finger at the question itself, as they hadn't even seen the answers on the answer sheets to be reviewed.

Experts believe that no resident physician could possibly answer such a nonsensical question.

Let alone doctors who haven't yet obtained their licenses, even if this question were placed in the promotion exam for chief physicians, probably very few people would be able to give the correct answer.

Zhou Tianbo sat in the corner, listening to the discussions of the expert review panel. It was like a hospital-wide consultation that was going nowhere. He found it interesting, but his mind was a little confused.

Zhou Tianbo saw online that elementary school students' homework problems were so difficult that he couldn't solve them, but he never expected that the current medical licensing exam would be this difficult.

The difficulty was beyond imagination, but that little guy Ji Xiang gave a perfect answer.

"Since someone can get full marks, the question itself must be fine."

Suddenly, someone spoke.

The noise in the small classroom suddenly fell silent.

"Does anyone know what's wrong with the computer system?"

"Exactly, this question is definitely related to interventional procedures and stent placement. I don't believe that resident physicians can handle level 4 surgeries."

"That's right! Most top-tier hospitals in prefecture-level cities don't have a vascular department, and even if they do, they wouldn't dare to perform carotid artery stenting."

Other experts raised objections after a brief silence.

"Wait a moment, let me consult with our hospital's interventional vascular specialist," one person said.

After he finished speaking, he stood up and went out to make a phone call.

Zhou Tianbo felt it was less likely a system problem and more likely a problem because Ji Xiang was skilled in interventional surgery.

A long time has passed, and the events that happened between Ji Xiang, Qin Chu, Qin the Boss, and Ling Tian in Shanghai have gradually spread, and Zhou Tianbo has heard about them.

Although I don't quite believe it, Ji Xiang is currently conducting research on interventional procedures and partial nephrectomy at the Second Affiliated Hospital, and his surgical volume is quite considerable.

"Something must have gone wrong during the surgery," Zhou Tianbo thought to himself.

"Director Lu, let's do it here, so you don't have to come back and relay the message."

"Stop fiddling with it, just turn it on speaker, we'll listen together."

The man thought about it and agreed that it made sense, so he took out his phone and made a call.

"Director Zhongliang, it's me, Lao Lu," the man said. "Are you busy? I have something to consult with a vascular specialist."

Then Director Lu explained the problem to Director Lu.

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

"Who the hell came up with this question?" the person on the other end of the phone asked directly.

"What's wrong?"

"Is this the medical licensing exam? In clinical practice, 99% of doctors can't answer it. Are medical licensing exams this difficult now?" The expert on the other end of the line seemed puzzled.

Director Lu said, "That's why I was preparing to ask you for advice. You're more familiar with interventional surgery. What exactly went wrong? Did the carotid sinus come into contact with the stent during placement, causing respiratory and circulatory arrest?"

"It has nothing to do with the surgery," the person on the other end said.

"Director Zhongliang, say it again, it has nothing to do with the surgery? That's impossible."

"I estimate the answer to this question... Let me put it this way, I've encountered two similar cases in my clinical practice."

"!!!"

"!!!"

Everyone perked up their ears, including Zhou Tianbo.

"Impossible, absolutely impossible. There must be something wrong with the surgery," Zhou Tianbo's intuition told him.

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

"The patient was given heparin pulse anticoagulation before the operation, but was allergic to heparin, which led to anaphylactic shock. The question mentions a large number of moist rales in both lungs, which indirectly proves this point."

"That's impossible. The patient received low molecular weight heparin in the neurology department and had no allergic reaction."

"Low molecular weight heparin is low molecular weight heparin, it is not heparin."

"..."

"..."

"..."

The vast majority of people were stunned.

A small number of people who knew about this incident also lamented the sinister intentions of the person who set the question.

"Is there a difference?" Director Lu asked, puzzled.

He doesn't specialize in vascular surgery or interventional procedures, so his understanding of heparin's pharmacology is only superficial, not profound.

"It sounds like one kind of medicine, but upon closer examination, it's actually two completely different medicines," the person opposite said.

"First, the two drugs have different molecular weights."

Unfractionated heparin is a sulfated glucosamine refined from the intestinal mucosa of pigs or the lungs of cattle. It is a mixture with a molecular weight ranging from 3000 to 30000 kDa, with an average molecular weight of approximately 15000 kDa.

Low molecular weight heparin includes low molecular weight heparin sodium, heparin calcium, enoxaparin sodium, droneparin, dalteparin, etc. It is a sulfated glucosamine fragment resulting from the cleavage of ordinary heparin, with an average molecular weight ranging from 3000 to 8000 kDa.

"Secondly, the mechanisms of action of the drugs are different."

Heparin mainly inhibits the formation of thrombin on the platelet surface by binding to antithrombin III, thereby inhibiting platelet aggregation and release.

It inhibits the activation of coagulation factors II, IX, X, XI, and XII, thus acting as an anticoagulant. Low molecular weight heparin primarily affects the activity of coagulation factor Xa, with little effect on thrombin and other coagulation factors.

"So not being allergic to low molecular weight heparin does not mean not being allergic to heparin."

"Although heparin rarely causes allergic reactions and no skin test is required before surgery, if it does, it requires intensive care, which is very troublesome. They don't see many cases of allergic reactions to internal medicine medications that require immediate discontinuation. We use large doses when performing surgery, and I've only seen two similar cases in the last ten years or so."

"Uh..." Director Lu was stunned.

"Moreover, even a skin test rarely detects it. We use a large amount of heparin for interventional anticoagulation, injecting it directly into the tube to avoid thrombus formation. Well, I won't go into too much detail, but that's roughly the principle."

"This question is deliberately designed to be difficult. Not to mention that you, Director Lu, rarely deal with heparin and low molecular weight heparin, not many of the professors in our department who lead research groups can understand it."

"Are the professional medical exams this difficult now? Give me a copy of the exam paper, my staff... cough cough cough, I'll let them do it. They can't even answer the professional medical exam questions, yet they're always bragging and glaring at each other, thinking they're the best in the world. I'll teach them a lesson! Hahaha."

On the other end of the phone, Director Zhongliang laughed heartily.

The demonstration room was quiet, with only awkward laughter echoing through the room.

This question appears to be a clinical case analysis, but it ended up turning into a pharmacology question.

This is not just difficult, it's downright difficult!

(End of this chapter)