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NBME p2ck_form6 Answers

step2ck_form6/Block 1/Question#13 (6.7 difficulty score)
Four hours after undergoing a cesarean ...
Postoperative intra-abdominal hemorrhage๐Ÿ”,๐Ÿ“บ
tags: postop surgery 

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 +2 
submitted by sugaplum(413),

This patient has signs of internal bleeding Decreased breath sounds--> abdomen filling with fluid, so the diaphragm has to push against increased pressure to get a breath in. Abdominal distension, tachycardic, hypotensive.

hematocrit drop by 12%. think about this. 1% change in hematocrit is 3 units of blood. 1 unit is 500mL. So based on her calculated blood loss, she should have only dropped hct by (1%-2). So I mean it could be underestimated blood loss, but her PE signs point to hemorrage

ronabobonafofona  Correct. Could be a retroperitoneal hematoma. See Uworld QID: 16318 +2  
jlbae  Yes to this and also - underestimated blood loss would not wait 4 hours to suddenly become symptomatic. +1