I n t e r n a L medicine questions Bank

All are differential diagnosis of sacroilitis, except:

1. 
   Crohn’s
   
2. 
   Ankylosing spondylitis
   
3. 
   Psoriasis
   

62. 
    Which condition is associated with HLA-B27:
    

A. Ankylosing spondylitis

63. 
    Wrong about heparin:
    
    1. 
       Half life 90 minutes
       
    2. 
       Skin necrosis
       
    3. 
       Thromobcytopenia
       
    4. 
       Only administered SC and IV
       

Heparin reversal with protamine — If urgent reversal of heparin effect is required, protamine sulfate can be administered by slow intravenous infusion (not greater than 20 mg/minute and no more than 50 mg over any 10 minute period). The appropriate dose of protamine sulfate is dependent upon the dose of heparin given and the elapsed time since the last heparin dose. Full neutralization of heparin effect is achieved with a dose of 1 mg protamine sulfate/100 units heparin. Because of the relatively short half life of intravenously administered heparin (approximately 30 to 60 min), the protamine sulfate dose used must be calculated by estimating the amount of heparin remaining in the plasma at the time that reversal is required.

Skin necrosis — Skin necrosis is a well-described complication of treatment with unfractionated or LMW heparin. Affected patients develop heparin-dependent antibodies but most do not experience thrombocytopenia. (See "Heparin-induced thrombocytopenia", section on 'Skin necrosis'.)

Thrombocytopenia — Heparin-induced thrombocytopenia (HIT) is a well-recognized and potentially fatal complication of heparin therapy, usually occurring within 5 to 10 days after the start of heparin therapy. The pathogenesis, clinical manifestations, diagnosis, and treatment of HIT are discussed in detail separately. (See "Heparin-induced thrombocytopenia".)

64.