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NBME 24 Answers

nbme24/Block 1/Question#6 (40.2 difficulty score)
A 57-year-old woman requires intubation in ...
Acute lung injuryπŸ”
tags: respiratory transfusion 

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submitted by brethren_md(88),
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drschmoctor  Neutrophils sequestered in recipient lung are triggered by donor antigen (e.g., anti leukocyte IgG), which causes release of cytokines, inflammation party in the lungs. +4  

submitted by mousie(211),
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Is 54 emituns oto lgno to eb cayanipctlha adn oudlw hte nsabcee fo rhsa ictari(a,ur trris)upu RO aplnt?yaacchi

hayayah  Yes! Allergic/anaphylactic blood transfusion reaction is within minutes to 2-3 hours. (pg 114 of the 2019 FA has a list of them ordered by time) +7  
hayayah  (also allergy / anaphylactic presents with more skin findings (urticaria, pruritus) +6  
seagull  The time through me off too. I though ABO mismatch since it occured around an hour. I thought TRALI would take a little longer. +7  
charcot_bouchard  Guys anaphylactic reaction to whole blood doesnt occur much except for selective IgA defi. so look out for prev history of mucosal infection. And it can have all feature of type 1 HS inclding bronchospasm. +5  
soph  I saw hypotension and though anaphylaxis........ -.- +  
usmile1  Chest Xray showed "bilateral diffuse airspace disease". This is much more indicative of TRALI than anaphylaxis which would have wheezing and possibly respiratory arrest but no actual damage to the lungs. Additionally there was no urticaria or pruritus one would expect to see with anaphylaxis. +5