CMS surgery form 1

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10+ Year Member
Mar 8, 2013
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Q. Four days after undergoing coronary artery bypass grafting, a hospitalized 47-year-old man has the sudden onset of severe pain in his left great toe. He was admitted to the hospital 10 data ago for evaluation of chest pain with exertion, and received aspirin and heparin therapy for 3 days. Cardiac catheterization on admission showed coronary artery disease involving three vessels. The operation and initial postoperative course were uncomplicated. Vital signs are within normal limits. Examination shows a tender, cyanotic left great toe. There are new ecchymoses over the trunk and upper and lower extremities. The surgical incision appears clean and intact. The remainder of the examination shows no abnormalities. Laboratory studies show,

Hematocnt 37%
Leukocyte count 12,200/mm3
Platelet count 8000/mm3
Prothrombin time 12 sec (INR=1)
Partial thromboplastin time 18 sec

Which of the following is the most likely diagnosis?

A) Cholesterol embolizaton syndrome
B) Disseminated intravascular coagulopathy
C) Gout
D) Heparin-induced thrombocytopenia(this would be the answer right?)
E) Immune thrombocytopenic purpura

Or we assume blue toe after any vascular surgery/instrumentation --> cholesterol embolization? ....and disregard low platelet count possiblty caused by HIT which can also induce thrombosis

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