10 quiz fes

8/6/2019 10 quiz FES

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10 quiz FES

8/6/2019 10 quiz FES


� Intravascular fat is commonly found following

skeletal trauma, as well as a wide range of other disorders. More rarely is seen the triad of pulmonary,

cerebral and cutaneous signs that is the FES. What

percentage of people with skeletal trauma would

normally develop fat emboli, and what percentage of these would then develop the Fat Embolism

Syndrome?

(A) 30% and 12%

(B)50% and 10%(C)70% and 1%

(D)90% and 5%

D

8/6/2019 10 quiz FES


� There are 2 theories for the appearance of FES. A

mechanical theory suggests that fat obstructs

pulmonary circulation after being forced intosystemic circulation. This occurs classically after

femoral fracture where high intramedullary pressures

can occur during nailing. Systemic spread is ensured

when increased right sided heart pressures force fat

through a patent foramen ovale. What percentage of

the general population are estimated to have a patent

foramen ovale?

(A)5%

(B)15%

(C)25%

(D)40%

C

8/6/2019 10 quiz FES


�

A biochemical theory suggests that a chemical eventduring trauma, or during the activation of the stressresponse, affects the solubility of circulating lipidscausing them to coalesce and form systemic emboli.These emboli travel to lungs, brain and skin to givethe FES triad of signs. There are some very unusualcauses of FES in the non-trauma patients, includingthe strikingly unusual: liposuction, chemotherapy,renal transplant.

(A)True(B)False

A

8/6/2019 10 quiz FES


� The pulmonary signs are usually noted first and

include tachypnoeia, dyspnoea and cyanosis. Thesesigns result from the embolic fat being hydrolised by

lung lipase with the release of lung-toxic Free Fatty

Acids (FFAs). These FFAs induce an acute lung

injury and subsequent ARDS. This process accountsfor the time period between injury and onset of

clinical signs of Fat Embolism. This time period is

normally:

(A)6 to 12 hours(B)12 to 24 hours

(C )24 to 72 hours

(D)72 to 84 hours

C

8/6/2019 10 quiz FES


� The cutaneous signs are usually seen within 72 hours.

The characteristic rash may not be present at all or may be present for only 4 to 6 hours. On a critically

ill patient they go completely unnoticed thereby

losing the chance for confirmation of diagnosis. The

rash is usually seen:

(A)Thighs / Calves / Ankles

(B)Clustered around the fracture site

(C )Chest / Axilla / Conjunctiva

(D)Back of the head and knees

C

8/6/2019 10 quiz FES


� Cerebral signs are non-specific,very rarely focal:

headache, irritability and delirium. Severe cases mayshow coma and convulsions. These signs are produced

by embolism of fat through a patent foramen ovale and

subsequent microvascular occlusion of the brain

circulation by fat. Embolic fat can produce the necessaryright heart pressures to open a patent foramen ovale but

what is another causative factor?

(A)Increased intrathoracic pressures from ventilation

(B)Pneumothorax or haemothorax(C )Poor positioning on the OR table

(D)Pressure exerted on the chest by OR equipment

A

8/6/2019 10 quiz FES


� Diagnosis is always made on clinical grounds, there is no specific

'test' for FES. Various sets of criteria exist to make the diagnosis more

accurate, such as those of Gurd & Wilson or those of Vedrienne,

Guillaume and Gagnieu. Management is then supportive as there isno specific treatment of the FES. Guidelines for the management of

FES would include:

(A)Prompt immobilisation of the fracture / delayed internal fixation of

the fracture / early use of steroids / early use of Heparin

(B)Prompt immobilisation of the fracture / early internal fixation of

the fracture / prompt treatment of hypoxia / maintenance of cardiac

output

(C )Prompt immobilisation of fracture / intraoperative surgical

embolectomy / early use of IV Ethanol / daily low dose Aspirin(D)Prompt immobilisation of the fracture / avoidance of

intramedullary nails / early use of steroids / mandatory use of calf

compressors

B

8/6/2019 10 quiz FES


� A Pulmonary Artery Catheter is often inserted to

facilitate the use of inotropic agents and fluids in

a critically ill patient with FES. Bearing in mind

that there will be widespread microvascular

occlusion with fat in the pulmonary vasculature

what would be the most typical finding?(A)A high Systemic Vascular Resistance (SVR)

(B)A low Systemic Vascular Resistance (SVR)

(C )A high Pulmonary Vascular Resistance (PVR)

(D)A low Pulmonary Vascular Resistance (PVR)

C

8/6/2019 10 quiz FES


� A patient who does not develop a petechial

rash by day 2 or 3 on his or her chest, anterior

axillary folds or conjunctiva does not have

either Fat Embolism or Fat Embolism

Syndrome.

(A)True

(B)False

B

8/6/2019 10 quiz FES


� There have been many exotic causes of FES,

although fracture of a long bone is still the

most common. However a case has never

involved a child being severely bitten by a

donkey.

(A)True

(B)FalseB

10 quiz fes

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