Chapter 344: Reviewing the Exam Paper (Part II)

This question sparked a discussion among the Expert Group.

A Thoracic Surgery Department expert slapped the table in anger, "Is this kind of question a joke? How is anyone supposed to answer this!"

"Exactly. Heparin was given for the interventional surgery, the contrast agent was pushed, and then respiratory and circulatory arrest suddenly occurred during the procedure. But heparin was used in the prior medication, enhanced CTA was performed, and the contrast agent was also administered; it's hard to consider it a drug issue."

"Besides a vascular surgery interventional doctor, who could accurately judge this? If I had to guess, it might be a coma caused by touching the carotid sinus. But it also says the patient's lungs were full of moist rales, and there might be heart issues too."

Everyone expressed different opinions, pointing their fingers at this question; they hadn't even looked at the answer on the exam paper being reviewed.

In the experts' view, it should be impossible for any Standardized Training Doctor to answer such an absurd question.

Let alone a doctor without a Practicing Certificate, even if this question were put into a Chief Physician promotion exam, probably few people could provide the correct answer.

Zhou Tianbo sat in the corner, listening to the Expert Group's discussion, which felt like a chaotic hospital-wide consultation; while he found it interesting, his mind was a bit muddled.

On the internet, Zhou Tianbo had seen elementary school homework that was already too difficult for him to solve, but he never expected the current Practicing Physician Examination to be this difficult.

Yet, despite the unimaginable difficulty, that little guy Ji Xiang had provided a perfect answer.

"Since someone was able to answer with a full score, the question stem should be fine."

Suddenly, someone said.

The noise in the small Demonstration Room suddenly fell silent.

"Who knows what went wrong with the computer system."

"Exactly, this question must be related to intervention and stent placement; I don't believe a Standardized Training Doctor can handle a Level 4 surgery."

"Right! Most Grade A Tertiary Hospitals at the prefecture level don't even have a vascular department, and even if they do, they wouldn't dare place a carotid stent."

Other experts raised objections after a short silence.

"Wait a moment, I'll consult our hospital's vascular intervention expert," one person said.

After speaking, they stood up to go outside and make a call.

Zhou Tianbo felt it wasn't a system error, but rather that Ji Xiang was skilled at interventional surgery.

A long time had passed, and the events involving Ji Xiang, Qin, and Ling Tian in Shanghai had gradually spread; Zhou Tianbo had heard some rumors.

Although he didn't quite believe it, Ji Xiang was currently doing research on intervention plus partial kidney resection at the Second Affiliated Hospital, and the surgical volume was quite considerable.

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

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

"Don't bother, put it on speakerphone, let's all listen together."

That person thought about it, felt it made sense, took out their phone, and dialed a number.

"Is this Director Zhongliang? It's me, Old Lu," the person said. "Are you busy? I have something to consult a vascular department expert about."

Subsequently, Director Lu explained the question to Director Zhongliang.

"We think there's a problem with this question."

"Who the hell wrote this question?" the person on the other end asked directly.

"What's wrong?"

"This is a Practicing Physician Examination? In a clinical setting, 99% of doctors wouldn't be able to answer it. Is the Professional Medical Examination this hard now?" The expert on the other side was somewhat bewildered.

Director Lu said, "That's why I'm preparing to ask you. You know more about interventional surgery; what exactly went wrong? Was it touching the carotid sinus while placing the stent, causing respiratory and circulatory arrest?"

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

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

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

"!!!"

"!!!"

Everyone pricked up their ears, including Zhou Tianbo.

Impossible, absolutely impossible; there must be a problem with the surgical process, Zhou Tianbo's intuition told him.

"Director Zhongliang, what is going on?" Director Lu asked in confusion.

"Using heparin for anticoagulation before surgery, the patient was allergic to heparin, leading to anaphylactic shock. The question stem mentions moist rales in both lungs and so on, all of which indirectly prove this point."

"That's impossible. The patient used 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.

The few who knew about this also marveled at the malicious intent of the question writer.

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

They weren't in vascular surgery or intervention, so their knowledge of heparin's pharmacology was only superficial, not profound.

"It sounds like the same drug, but if you study it carefully, they are completely different drugs," the person on the other side said.

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

Ordinary heparin is a glucosamine sulfate extracted and refined from porcine intestinal mucosa or bovine lung. It is a mixture with a molecular weight range of 3,000 to 30,000 KD, with an average molecular weight of about 15,000 KD.

Low Molecular Weight Heparin includes Low Molecular Weight Heparin Sodium, Heparin Calcium, Enoxaparin Sodium, Nadroparin, Dalteparin, etc. It is a glucosamine sulfate fragment after ordinary heparin is cleaved, with an average molecular weight range of 3,000 to 8,000 KD."

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

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

It acts as an anticoagulant by inhibiting activated coagulation factors II, IX, X, XI, and XII. Low Molecular Weight Heparin mainly affects the activity of coagulation factor Xa and has little effect on thrombin and other coagulation factors."

"Therefore, not being allergic to Low Molecular Weight Heparin does not mean one is not allergic to heparin."

"Although heparin rarely causes allergic reactions and skin tests aren't done before surgery, once it happens, it requires major emergency rescue, which is a headache. Internal medicine doctors don't see it often because they stop the medication immediately when an allergy occurs. We use large doses during surgery, and I've seen two similar patients in the last ten years or so."

"Uh..." Director Lu froze.

"Besides, even if you did a skin test, it would rarely be detected. The amount of Heparin we use for interventional anticoagulation is large; we inject a whole tube directly to prevent Thrombosis. Forget it, I won't say too much, that's roughly the logic."

"This question is just making things difficult for people. Not to mention that you, Director Lu, rarely come into contact with Heparin and Low Molecular Weight Heparin, even among the Attending Professors in our Shen Ke, there aren't many who can figure it out."

"Are the questions on the Professional Medical Examination this difficult now? Give me a copy of the test paper, I'll have my subordinates... cough, cough, cough, I'll have them do it. If they can't even answer Professional Medical Examination questions, yet spend all day huffing and puffing, acting like 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.

In the Demonstration Room, it was silent, with only awkward laughter echoing.

This question looked like a Clinical case analysis, but in the end, it turned into a pharmacology problem.

This wasn't just making things difficult for people, it was simply making things difficult for people!

(End of chapter)