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🎯🪬🪬🪬🪬 Flashcards

1
Q

Metabolic acidosis with a normal anion gap (AG) occurs with
A. Diabetic acidosis
B. Renal failure
C. Severe diarrhea
D. Starvation

A

Severe diarrhea

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2
Q

All are possible causes of postoperative hyponatremia EXCEPT
A. Excess infusion of normal saline intraoperatively.
B. Administration of antipsychotic medication.
C. Transient decrease in antidiuretic hormone (ADH) secretion.
D. Excess oral water intake.

A

Transient decrease in antidiuretic hormone (ADH) secretion.

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3
Q

Which of the following is an early sign of hyperkalemia?
A. Peaked T waves
B. Peaked P waves
C. Peaked (shortened) QRS complex D. Peaked U waves

A

Peaked T waves

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4
Q

Hypocalcemia may cause which of the following?
A. Congestive heart failure
B. Atrial fibrillation
C. Pancreatitis
D. Hypoparathyroidism

A

Congestive heart failure

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5
Q

The next most appropriate test to order in a patient with a pH of7.1, Pco2 of 40, sodium ofl32, potassium of4.2, and chloride of 105 is
A. Serum bicarbonate
B. Serum magnesium
C. Serum ethanol
D. Serum salicylate

A

Serum bicarbonate

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6
Q

Which of the following is FALSE regarding hypertonic saline?
A. Is an arteriolar vasodilator and may increase bleeding
B. Should be avoided in closed head injury
C. Should not be used for initial resuscitation
D. Increases cerebral perfusion

A

Should be avoided in closed head injury

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7
Q

Normal saline is
A. 135 mEq NaCl!L
B. 145 mEq NaCl!L
C. 148 mEq NaCl!L
D. 154mEqNaCl!L

A

154mEqNaCl!L

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8
Q

Fluid resuscitation using albumin
A. Is associated with coagulopathy
B. Is available as 1% or 5% solutions
C. Can lead to pulmonary edema
D. Decreased factor XIII

A

Can lead to pulmonary edema

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9
Q

Water constitutes what percentage of total body weight?
A. 30-40%
B. 40-50%
c. 50-60%
D. 60-70%

A

50-60%

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10
Q

If a patient›s serum glucose increases by 180 mg/dL, what is the increase in serum osmolality, assuming all other laboratory values remain constant?
A. Does not change
c. 10
B. 8
D. 12

A

10

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11
Q

What is the actual potassium of a patient with pH of7.8 and serum potassium of2.2?
A. 2.2 B. 2.8 c. 3.2 D. 3.4

A

3.4

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12
Q

The free water deficit of a 70 kg man with serum sodium of 154 is
A. 0.1 L
B. 0.7 L
C. lL
D. 7L

A

7L

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13
Q

All the following treatments for hyperkalemia reduce serum potassium EXCEPT
A. Bicarbonate
B. Kayexalate
C. Glucose infusion with insulin
D. Calcium

A

D. Calcium

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14
Q

An alcoholic patient with serum albumin of 3.9, K
of 3.1, Mg of 2.4, Ca of 7.8, and P04 of 3.2 receives three boluses ofiV potassium and has serum potassium of 3.3. You should
A. Continue to bolus potassium until the serum level is >3.6.
B. Give MgSO 4 IV
C. Check the ionized calcium.
D. Check the BUN and creatinine.

A

B. Give MgSO 4 IV

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15
Q

Calculate the daily maintenance fluids needed for a 60-kg female
A. 2060
B. 2100
c. 2160
D. 2400

A

B. 2100

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16
Q

A patient who has spasms in the hand when a blood pressure cuff is blown up most likely has
A. Hypercalcemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypomagnesemia

A

B. Hypocalcemia

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17
Q

The actual AG of a chronic alcoholic with Na 133, K 4, CI-101, HC03-22, albumin of2.5 mg/dL is
A. 6
B. 10
c. 14
D. 15

A

D. 15

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18
Q

The effective osmotic pressure between the plasma and interstitial fluid compartments is primarily controlled by
A. Bicarbonate
B. Chloride ion
C. Potassium ion
D. Protein

A

D. Protein

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19
Q

The metabolic derangement most commonly seen in patients with profuse vomiting
A. Hypochloremic, hypokalemic metabolic alkalosis
B. Hypochloremic, hypokalemic metabolic acidosis
C. Hypochloremic, hyperkalemic metabolic alkalosis
D. Hypochloremic, hyperkalemic metabolic acidosis

A

B. Hypochloremic, hypokalemic metabolic acidosis

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20
Q

Symptoms and signs of extracellular fluid volume deficit include all of the following EXCEPT
A. Anorexia
B. Apathy
C. Decreased body temperature
D. High pulse pressure

A

D. High pulse pressure

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21
Q

A low urinary [NH/] with a hyperchloremic acidosis indicates what cause?
A. Excessive vomiting
B. Enterocutaneous fistula
C. Chronic diarrhea
D. Renal tubular acidosis

A

D. Renal tubular acidosis

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22
Q

When lactic acid is produced in response to injury, the body minimizes pH change by
A. Decreasing production of sodium bicarbonate in tissues
B. Excreting carbon dioxide through the lungs
C. Excreting lactic acid through the kidneys
D. Metabolizing the lactic acid in the liver

A

B. Excreting carbon dioxide through the lungs

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23
Q

What is the best determinant of whether a patient has a metabolic acidosis versus alkalosis?
A. Arterial pH
B. Serum bicarbonate
C. Pco2
D. Serum C02 level

A

A. Arterial pH

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24
Q

If a patient›s arterial Pco2 is found to be 25 mm Hg, the arterial pH will be approximately
A. 7.52
B. 7.40
c. 7.32
D. 7.28

A

D. 7.28

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25
Q

Which of the following are NOT characteristic findings of acute renal failure?
A. BUN>lOO mg/dL
B. Hypokalemia
C. Severe acidosis
D. Uremic pericarditis
E. Uremic encephalopathy

A

A. BUN>lOO mg/dL

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26
Q

An elderly diabetic patient who has acute cholecystitis is found to have a serum sodium level of 122 mEq/L and a blood glucose of 600 mg/dL. After correcting the glucose concentration to 100 mg/dL with insulin, the serum sodium concentration would
A. Decrease significantly unless the patient also received 3% saline
B. Decrease transiently but return to approximately 122 mEq/L without specific therapy
c. Remain essentially unchanged
D. Increase to the normal range without specific therapy

A

D. Increase to the normal range without specific therapy

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27
Q

The first step in the management of acute hypercalcemia should be
A. Correction of deficit of extracellular fluid volume
B. Hemodialysis.
C. Administration of furosemide.
D. Administration of mithramycin.

A

A. Correction of deficit of extracellular fluid volume

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28
Q

Excessive administration of normal saline for fluid resuscitation can lead to what metabolic derangement?
A. Metabolic alkalosis
B. Metabolic acidosis
c. Respiratory alkalosis
D. Respiratory acidosis

A

B. Metabolic acidosis

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29
Q

A victim of a motor vehicle accident arrives in hemorrhagic shock. His arterial blood gases are pH, 7.25; Po2, 95 mm Hg; Pco2, 25 mm Hg; HC03-, 15 mEq/L. The patient›s metabolic acidosis would be treated best with
A. Ampule of sodium bicarbonate
B. Sodium bicarbonate infusion
C. Lactated Ringer solution
D. Hyperventilation

A

C. Lactated Ringer solution

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30
Q

Three days after surgery for gastric carcinoma, a 50-yearold alcoholic male exhibits delirium, muscle tremors, and hyperactive tendon reflexes. Magnesium deficiency is suspected. All of the following statements regarding this situation are true EXCEPT
A. A decision to administer magnesium should be based on the serum magnesium level.
B. Adequate cellular replacement of magnesium will require 1 to 3 weeks.
C. A concomitant calcium deficiency should be suspected.
D. Calcium is a specific antagonist of the myocardial effects of magnesium.

A

A. A decision to administer magnesium should be based on the serum magnesium level.

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31
Q

Refeeding syndrome can be associated with all of the following EXCEPT
A. Respiratory failure
B. Hyperkalemia
C. Confusion
D. Cardiac arrhythmias

A

B. Hyperkalemia

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32
Q

Which of the following is NOT one of the four major physiologic events of hemostasis?
A. Fibrinolysis
B. Vasodilatation
C. Platelet plug formation
D. Fibrin production

A

B. Vasodilatation

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33
Q

Which is required for platelet adherence to injured endothelium?
A. Thromboxane A2
B. Glycoprotein (GP) lib/Ilia
C. Adenosine diphosphate (ADP)
D. Von Willebrand factor (vWF)

A

D. Von Willebrand factor (vWF)

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34
Q

Which of the following clotting factors is the first factor common to both intrinsic and extrinsic pathways?
A. Factor I (fibrinogen)
B. Factor IX (Christmas factor)
C. Factor X (Stuart-Prower factor)
D. Factor XI (plasma thromboplasma antecedent)

A

C. Factor X (Stuart-Prower factor)

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35
Q

Which congenital factor deficiency is associated with delayed bleeding after initial hemostasis?
A. Factor VII
B. FactoriX
C. FactorXI
D. Factor XIII

A

D. Factor XIII

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36
Q

In a previously unexposed patient, when does the platelet count fall in heparin-induced thrombocytopenia (HIT)?

A

5-7 days

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37
Q

Which is NOT an acquired platelet hemostatic defect?
A. Massive blood transfusion following trauma
B. Acute renal failure
C. Disseminated intravascular coagulation (DIC) D. Polycythemia vera

A

C. Disseminated intravascular coagulation (DIC)

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38
Q

rue about coagulopathy related to trauma?
A. Acute coagulopathy of trauma is mechanistically similar to DIC.
B. Coagulopathy can develop in trauma patients following acidosis, hypothermia, and dilution of coagulation factors, though coagulation is normal upon admission.
C. Acute coagulopathy of trauma is caused by shock and tissue injury.
D. Acute coagulopathy of trauma is mainly a dilutional coagulopathy.

A

C. Acute coagulopathy of trauma is caused by shock and tissue injury.

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39
Q

What is the best laboratory test for determine degree of anticoagulation with dabigatran and rivaroxaban?
A. Prothrombin time/international normalized ratio (PTIINR)
B. partial thromboplastin time (PTT)
C. Bleeding time
D. None of the above

A

D. None of the above

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40
Q

A fully heparinized patient develops a condition requiring emergency surgery. After stopping the heparin, what else should be done to prepare the patient?
A. Nothing, if the surgery can be delayed for 2 to 3 hours.
B. Immediate administration of protamine 5 mg for every 100 units of heparin most recently administered.
C. Immediate administration ofFFP.
D. Transfusion of 10 units of platelets.

A

A. Nothing, if the surgery can be delayed for 2 to 3 hours.

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41
Q

Primary ITP
A. Occurs more often in children than adults, but has a similar clinical course.
B. Includes HIT as a subtype of drug-induced ITP.
C. Is also known as thrombotic thrombocytopenic purpura (TTP).
D. Is a disease of impaired platelet production, unknown cause.

A

Includes HIT as a subtype of drug-induced ITP.

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42
Q

Which of the following is the most common intrinsic platelet defect?
A. Thrombasthenia
B. Bernard-Soulier syndrome
C. Cyclooxygenase deficiency
D. Storage pool disease

A

D. Storage pool disease

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43
Q

Which finding is not consistent with TTP?
A. Microangiopathic hemolytic anemia
B. Schistocytes on peripheral blood smear
C. Fever
D. Splenomegaly

A

D. Splenomegaly

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44
Q

What is FALSE regarding coagulation during cardiopulmonary bypass (CPB)?
A. Contact with circuit tubing and membranes activates inflammatory cascades, and causes abnormal platelet and clotting factor function.
B. Coagulopathy is compounded by sheer stress.
C. Following bypass, platelets’ morphology and ability to aggregate are irreversibly altered.
D. Coagulopathy is compounded by hypothermia and hemodilution.

A

C. Following bypass, platelets’ morphology and ability to aggregate are irreversibly altered.

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45
Q

Following a recent abdominal surgery, your patient is in the ICU with septic shock. Below what level of hemoglobin would a blood transfusion be indicated?
A. <24hours
B. <10 g/dL
C. <8 g/dL
D. <7 g/dL

A

D. <7 g/dL

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46
Q

Less than 0.5% of transfusions result in a serious transfusion-related complication. What is the leading cause of transfusion-related deaths?
A. Transfusion-related acute lung injury
B. ABO hemolytic transfusion reactions
C. Bacterial contamination of platelets
D. Iatrogenic hepatitis C infection

A

A. Transfusion-related acute lung injury

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47
Q

Allergic reactions do not occur with
A. Packed RBCs
B. FFP
C. Cryoprecipitate
D. None of the above

A

D. None of the above

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48
Q

What is the risk of Hepatitis C and HIV-1 transmission with blood transfusion?
A. 1:10,000,000
B. 1:1,000,000
c. 1:500,000
D. 1:100,000

A

B. 1:1,000,000

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49
Q

The most common cause for a transfusion reaction is
A. Air embolism
B. Contaminated blood
C. Human error
D. Unusual circulating antibodies

A

C. Human error

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50
Q

What is NOT a cause of bleeding due to massive transfusion?
A. Dilutional coagulopathy
B. Hypofibrinogenemia
C. Hypothermia
D. 2,3-DPG toxicity

A

D. 2,3-DPG toxicity

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51
Q

Frozen plasma prepared from freshly donated blood is necessary when a patient requires
A. Fibrinogen
B. Prothrombin
C. Antihemophilic factor D. Christmas factor
E. Hageman factor

A

C. Antihemophilic factor

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52
Q

The most common clinical manifestation of a hemolytic transfusion reaction is
A. Flank pain
C. Oliguria
B. Jaundice
D. A shaking chill

A

C. Oliguria

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53
Q

What type of bacterial sepsis can lead to thrombocytopenia and hemorrhagic disorder?
A. Gram-negative
B. Gram-positive
C. A&B
D. Encapsulated bacteria

A

A. Gram-negative

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54
Q

After tissue injury, the first step in coagulation is
A. Binding of factor XII to subendothelial collagen
B. Cleavage of factor XI to active factor IX
C. Complexing of factor IX with factor VIII in the presence of ionized calcium conversion of prothrombin to thrombin D. Formation of fibrin from fibrinogen

A

A. Binding of factor XII to subendothelial collagen

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55
Q

What are the uses of thromboelastography (TEG)?
A. Predicting need for lifesaving interventions after arrival for trauma
B. Predicting 24-hour and 30-day mortality following trauma
C. Predicting early transfusion ofRBC, plasma, platelets, and cryoprecipitate
D. All of the above

A

D. All of the above

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56
Q

Bank blood is appropriate for replacing each of the following EXCEPT
A. Factor I (fibrinogen)
B. Factorii (prothrornbin)
C. Factor VII (proconvertin)
D. Factor VIII (antihemophilic factor)

A

D. Factor VIII (antihemophilic factor)

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57
Q

Shock caused by a large tension pneumothorax is categorized as
A. Trauma shock
B. Vasodilatory shock
C. Cardiogenic shock
D. Obstructive shock

A

D. Obstructive shock

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58
Q

What is true about baroreceptors?
A. Volume receptors can be activated in hemorrhage with reduction in left atrial pressure.
B. Receptors in the aortic arch and carotid bodies inhibit the autonomic nervous system (ANS) when stretched.
C. When baroreceptors are stretched, they induced increased ANS output and produce constriction of peripheral vessels.
D. None of the above.

A

B. Receptors in the aortic arch and carotid bodies inhibit the autonomic nervous system (ANS) when stretched.

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59
Q

Chemoreceptors in the aorta and carotid bodies do NOT sense which of the following?
A. Changes in 02 tension
B. H+ ion concentration
C. HC03-concentration
D. Carbon dioxide (CO) levels

A

C. HC03-concentration

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60
Q

Neurogenic shock is characterized by the presence of
A. Cool, moist skin
B. Increased cardiac output
C. Decreased peripheral vascular resistance
D. Decreased blood volume

A

C. Decreased peripheral vascular resistance

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61
Q

When a patient with hemorrhagic shock is resuscitated using an intravenous colloid solution rather than lactated Ringer solution, all of the following statements are true EXCEPT
A. Circulating levels of immunoglobulins are decreased.
B. Colloid solutions may bind to the ionized fraction of serum calcium.
C. Endogenous production of albumin is decreased.
D. Extracellular fluid volume deficit is restored.

A

D. Extracellular fluid volume deficit is restored.

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62
Q

In hemorrhage, larger arterioles vasoconstrict in response to the sympathetic nervous system. Which categories of shock are associated with vasodilation oflarger arterioles?
A. Septic shock
C. Neurogenic shock
B. Cardiogenic shock
D. A&C

A

D. A&C

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63
Q

Which of the following is true about antidiuretic hormone (ADH) production in injured patients?
A. ADH acts as a potent mesenteric vasoconstrictor.
B. ADH levels fall to normal within 2 to 3 days of the initial insult.
C. ADH decreases hepatic gluconeogenesis.
D. ADH secretion is mediated by the renin-angiotensin system.

A

A. ADH acts as a potent mesenteric vasoconstrictor.

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64
Q

Which of following occur as a result of epinephrine and norepinephrine?
A. Hepatic glycogenolysis
C. Insulin sensitivity
B. Hypoglycemia
D. Lipogenesis

A

A. Hepatic glycogenolysis

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65
Q

A patient has a blood pressure of 70/50 mm Hg and a serum lactate level of 30 mg/100 mL (normal: 6-16). His cardiac output is 1.9 L/min, and his central venous pressure is 2 em H2 0. The most likely diagnosis is
A. Congestive heart failure
B. Cardiac tamponade
C. Hypovolemic shock
D. Septic shock

A

C. Hypovolemic shock

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66
Q

Which cytokine is anti-inflammatory and increases after shock and trauma?
A. Interleukin (IL)-1
B. IL-2
C. IL-6
D. IL-10

A

D. IL-10

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67
Q

Tumor necrosis factor-alpha (TNF-a)
A. Can be released as a response to bacteria or endotoxin
B. Increased more in trauma than septic patients
C. Induces procoagulant activity and peripheral vasoconstriction
D. Contributes to anemia of chronic illness

A

A. Can be released as a response to bacteria or endotoxin

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68
Q

A 70-kg male patient presents to ED following a stab wound to the abdomen. He is hypotensive, markedly tachycardic, and appears confused. What percent of blood volume has he lost?
A. 5% B. 15% c. 35% D. 55%

A

D. 55%

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69
Q

Vasodilatory shock
A. Is characterized by failure of vascular smooth muscle to constrict due to low levels of catecholamines
B. Leads to suppression of the renin-angiotensin system
C. Can also be caused by carbon monoxide poisoning
D. Is similar to early cardiogenic shock

A

C. Can also be caused by carbon monoxide poisoning

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70
Q

A patient in septic shock remains hypotensive despite adequate fluid resuscitation and initiation of norepinephrine. What is often given to patients with hypotension refractory to norepinephrine?
A. Dopamine
B. Arginine vasopressin
C. Dobutamine
D. Milrinone

A

B. Arginine vasopressin

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71
Q

Tight glucose management in critically ill and septic patients
A. Requires insulin to keep serum glucose < 140 B. Has no effect on mortality
C. Has no effect on ventilator support
D. Decreases length of antibiotic therapy

A

D. Decreases length of antibiotic therapy

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72
Q

Cardiogenic shock
A. Is most commonly caused by exacerbation of congestive heart failure.
B. Cardiogenic shock following an acute myocardial infarction is typically present on admission.
C. Cardiogenic shock occurs in 5 to 10% of acute Mis.
D. Is characterized by hypotension, reduced cardiac index, and reduced pulmonary artery wedge pressure.

A

C. Cardiogenic shock occurs in 5 to 10% of acute Mis.

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73
Q

All of the following result from the placement of an intraaortic balloon pump in a patient with acute myocardial failure EXCEPT
A. Reduction of systolic afterload
B. Increased cardiac output
C. Increased myocardial 02 demand
D. Increased diastolic perfusion pressure

A

C. Increased myocardial 02 demand

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74
Q

Which constellation of clinical findings is suggestive of cardiac tamponade?
A. Hypotension, wide pulse pressure, tachycardia
B. Tachycardia, hypotension, jugular venous distension
C. Hypotension, wide pulse pressure, jugular venous distension
D. Hypotension, muffled heart tones, jugular venous distension

A

D. Hypotension, muffled heart tones, jugular venous distension

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75
Q

A 43-year-old man is struck by a motor vehicle while crossing the street; he arrives in the ED hypotensive, bradycardic, and unable to move his extremities. What is the most likely cause of his hypotension?
A. Hypovolemic shock
B. Obstructive shock
C. Neurogenic shock
D. Vasodilatory shock

A

A. Hypovolemic shock

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76
Q

Corticosteroids in the treatment of septic shock
A. Improves rates of shock reversal in patients requiring vasopressors
B. Improves mortality in patients with relative adrenal insufficiency
C. Is contraindicated in patients with positive bacterial blood cultures
D. None of the above

A

Improves mortality in patients with relative adrenal insufficiency

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77
Q

What is FALSE about serum lactate?
A. Generated from pyruvate in the setting of insufficient 02.
B. Metabolized by the liver and kidneys.
C. Is an indirect measure of the magnitude and severity of shock.
D. The time to peak lactate from admission predicts rates of survival.

A

D. The time to peak lactate from admission predicts rates of survival.

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78
Q

Transferrin plays a role in host defense by
A. Sequestering iron, which is necessary for microbial growth
B. Increasing the ability of fibrinogen to trap microbes C. Direct injury to the bacterial cell membrane
D. Direct injury to the bacterial mitochondria

A

A. Sequestering iron, which is necessary for microbial growth

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79
Q

The best method for hair removal from an operative field is
A. Shaving the night before
B. Depilating the night before surgery
C. Shaving in the operating room
D. Using hair clippers in the operating room

A

D. Using hair clippers in the operating room

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80
Q

Which is NOT a component of systemic inflammatory response syndrome (SIRS)?
A. Temperature
B. White blood cell (WBC) count
C. Blood pressure
D. Heart rate

A

Blood pressure

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81
Q

A patient with necrotizing pancreatitis undergoes computed tomography (CT)-guided aspiration, which results in growth of Escherichia coli on culture. The most appropriate treatment is
A. Culture-appropriate antibiotic therapy
B. Endoscopic retrograde cholangiopancreatography with sphincterotomy
C. CT-guided placement of drain(s)
D. Exploratory laparotomy

A

D. Exploratory laparotomy

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82
Q

Which factor does NOT influence the development of surgical site infections ( SSis)?
A. Duration of procedure
B. Degree of microbial contamination of the wound
C. Malnutrition
D. General anesthesia

A

D. General anesthesia

83
Q

During a laparoscopic appendectomy, a large bowel injury was caused during trochar placement with spillage of bowel contents into the abdomen. What class of surgical wound is this?
A. Class I (clean)
B. Class II (dean/contaminated) C. Class III (contaminated)
D. Class IV (dirty)

A

C. Class III (contaminated)

84
Q

The most appropriate treatment of a 4-cm hepatic abscess is
A. Antibiotic therapy alone
B. Aspiration for culture and antibiotic therapy
C. Percutaneous drainage and antibiotic therapy
D. Operative exploration, open drainage of the abscess, and antibiotic therapy

A

C. Percutaneous drainage and antibiotic therapy

85
Q

Postoperative urinary tract infections (UTis)
A. Are usually treated with a 7- to 10-day course of antibiotics.
B. Initial therapy should be directed by results of urine culture.
C. Are established by >104 CFU/mL of bacteria in urine culture in asymptomatic patients.
D. Can be reduced by irrigating indwelling Foley catheters daily.

A

B. Initial therapy should be directed by results of urine culture.

86
Q

The first step in the evaluation and treatment of a patient with an infected bug bite on the leg with cellulitis, bullae, thin grayish fluid draining from the wound, and pain out of proportion to the physical findings is
A. Obtain C-reactive protein
B. CT scan of the leg
C. Magnetic resonance imaging (MRI) of the leg D. Operative exploration

A

D. Operative exploration

87
Q

What is FALSE regarding intravascular catheter infections?
A. Selected low-virulence infections can be treated with a prolonged course of antibiotics.
B. In high-risk patients, prophylactic antibiotics infused through the catheter can reduce rate of catheter infections.
C. Bacteremia with gram-negative bacteria or fungi should prompt catheter removal.
D. Many patients with intravascular catheter infections are asymptomatic.

A

B. In high-risk patients, prophylactic antibiotics infused through the catheter can reduce rate of catheter infections.

88
Q

Patients with a penicillin allergy are LEAST likely to have a cross-reaction with
A. Synthetic penicillins
B. Carbapenems
C. Cephalosporins
D. Monobactams

A

D. Monobactams

89
Q

What is the estimated risk of transmission of human immunodeficiency virus (HIV) from a needlestick from a source with HIV-infected blood?
A. <0.5%
B. 1%
c. 5%
D. 10%

A

A. <0.5%

90
Q

Closure of an appendectomy wound in a patient with perforated appendicitis who is receiving appropriate antibiotics will result in a wound infection in what percentage of patients?
A. 3-4%
B. 8-12%
c. 15-18%
D. 22-25%

A

A. 3-4%

91
Q

A chronic carrier state occurs with hepatitis C infection in what percentage of patients?
A. 90-99%
B. 75-80%
c. 50-60%
D. 10-30%

A

B. 75-80%

92
Q

Possible exposure to anthrax should be initially treated with
A. Colistin
B. Ciprofloxacin or doxycycline
C. Amoxicillin
D. Observation

A

B. Ciprofloxacin or doxycycline

93
Q

The most effective postexposure prophylaxis for a surgeon stuck with a needle while operating on an HIV- positive patient is
A. None (no effective treatment is known).
B. Two- or three-drug therapy started within hours of exposure.
c. Single drug therapy started within 24 hours of exposure.
D. Triple drug therapy started within 24 hours of exposure

A

B. Two- or three-drug therapy started within hours of exposure.

94
Q

What is NOT an early goal in treatment of severe sepsis?
A. Mean arterial pressure >65 mm Hg
B. Central venous pressure 8 to 2 mm Hg C. Urine output >0.5 cc/kg/h
D. Serum lactate <2 mmol!L

A

D. Serum lactate <2 mmol!L

95
Q

A patient in the ICU has been on ventilator support for 3 weeks. He has new onset elevated WBC count, fever, and consolidation seen on chest X-ray. What is an appropriate next step?
A. Exchange endotracheal tube and change respiratory circuit.
B. Obtain bronchoalveolar lavage.
C. Start treatment with empiric penicillin G.
D. Obtain chest CT.

A

B. Obtain bronchoalveolar lavage.

96
Q

Patients with severe, necrotizing pancreatitis should be treated with
A. No antibiotics unless CT -guided aspiration of the area yields positive cultures
B. Empiric cefoxitin or cefotetan
C. Empiric cefuroxime plus gentamicin
D. Empiric carbapenems or fluoroquinolones

A

D. Empiric carbapenems or fluoroquinolones

97
Q

A patient with a localized wound infection after surgery should be treated with
A. Antibiotics and warm soaks to the wound B. Antibiotics alone
C. Antibiotics and opening the wound
D. Incision and drainage alone

A

D. Incision and drainage alone

98
Q

Which areas likely do NOT contain resident microorganisms?
A. Terminal ileum
B. Oropharynx
c. Main pancreatic duct
D. Nares

A

Main pancreatic duct

99
Q

Cricothyroidotomy

A. Should not be performed in children younger than 12 years
B. Should only be performed in patients who are not good candidates for a tracheostomy
C. Requires the use of an endotracheal tube smaller than 4 mm in diameter
D. Is preferable to the use of percutaneous transtracheal ventilation

A

A. Should not be performed in children younger than 12 years

100
Q

Which of the following is NOT a sign of tension pneumothorax?
A. Tracheal deviation
B. Decreased breath sounds
C. Respiratory distress with hypertension
D. Distended neck veins

A

C. Respiratory distress with hypertension

101
Q

Which of the following is a cause of cardiogenic shock in a trauma patient?
A. Hemothorax
B. Penetrating injury to the aorta
C. Air embolism
D. Iatrogenic increased afterload due to pressors

A

C. Air embolism

102
Q

A trauma patient arrives following a stab wound to the left chest with systolic blood pressure (SBP) 85 mm Hg, which improves slightly with intravenous (IV) fluid resuscitation. Chest X-ray demonstrates clear lung fields. What is the most appropriate next step?
A. Computed tomography (CT) scan of the chest
B. Pelvic X-ray
C. Focused abdominal sonography for trauma (FAST) examination
D. Tube thoracostomy of the left chest

A

C. Focused abdominal sonography for trauma (FAST) examination

103
Q

Primary repair of the trachea should be carried out with
A. Wire suture
B. Absorbable monofilament suture
C. Nonabsorbable monofilament suture
D. Absorbable braided suture

A

B. Absorbable monofilament suture

104
Q

In which patient is emergency department thoracotomy contraindicated?
A. Motor vehicle accident victim, cardiac tamponade seen on ultrasound, SBP decreasing to 50 mm Hg.
B. Motor vehicle accident victim, became asystolic during transport with 5 minutes of cardiopulmonary resuscitation (CPR) with no signs oflife.
C. Patient with chest stab wound, SBP decreasing to SOmmHg.
D. Patient with chest stab wound, became asystolic during transport with 20 minutes of CPR with no signs oflife.

A

D. Patient with chest stab wound, became asystolic during transport with 20 minutes of CPR with no signs oflife.

105
Q

A patient with spontaneous eye opening, who is confused and localizes pain has a Glasgow Coma Score ( GCS) of
A. 9
B. 11
C. l3
D. 15

A

C. l3

106
Q

Neck injuries:

A. Less than 15% penetrating injuries require neck exploration, a majority can be managed conservatively.
B. Divided into three zones, with zone I above the angle of the mandible, zone II between the thoracic outlet and angle of mandible, and zone III inferior to the clavicles. C. All patients with neck injury should receive computed tomography angiogram ( CTA) of the neck.
D. Patients with dysphagia, hoarseness, hematoma, venous bleeding, hemoptysis, or subcutaneous emphysema should undergo neck exploration.

A

A. Less than 15% penetrating injuries require neck exploration, a majority can be managed conservatively.

107
Q

Appropriate surgical management of a through- and-through gunshot wound to the lung with minimal bleeding and some air leak is
A. Chest tube only
B. Oversewing entrance and exit wounds to decrease the air leak
C. Pulmonary tractotomy with a stapler and oversewing of vessels or bronchi
D. Wedge resection of the injured lung

A

C. Pulmonary tractotomy with a stapler and oversewing of vessels or bronchi

108
Q

What is true regarding the evaluation ofblunt abdominal trauma?
A. Patients with abdominal wall rigidity and negative abdominal CT should undergo diagnostic peritoneal lavage (DPL) to rule out small bowel injury.
B. If FAST examination is negative in a hemodynamically unstable patient then DPL is indicated to rule out abdominal bleeding.
C. FAST examination cannot detect intraperitoneal fluid if the total volume is < 1000 mL.
D. Bowel injury can be ruled out in hemodynamically stable patients with abdominal CT scanning.

A

B. If FAST examination is negative in a hemodynamically unstable patient then DPL is indicated to rule out abdominal bleeding.

109
Q

After an automobile accident, a 30-year-old woman is discovered to have a posterior pelvic fracture. Hypotension and tachycardia respond marginally to volume replacement. Once it is evident that her major problem is free intraperitoneal bleeding and a pelvic hematoma in association with the fracture, appropriate management would be

A. Application of medical antishock trousers with inflation of the extremity and abdominal sections.
B. Arterial embolization of the pelvic vessels.
C. Celiotomy and ligation of the internal iliac arteries bilaterally.
D. Celiotomy and pelvic packing.
E. External fixation application to stabilize the pelvis.

A

D. Celiotomy and pelvic packing.

110
Q

Which is true of vascular injuries of the extremities?

A. In the absence of hard signs of vascular injury, if the difference between SBP in an injured limb is within 15% of the uninjured limb, no further evaluation is needed.
B. Occult profunda femoris injuries can result in compartment syndrome and limb loss.
C. All patients with significant hematoma should be surgically explored.
D. Vascular injury repair should be performed prior to realignment of bony fractures or dislocations.

A

B. Occult profunda femoris injuries can result in compartment syndrome and limb loss.

111
Q

Which of the following statements about blunt carotid injuries is true?
A. Magnetic resonance imaging is the diagnostic modality of choice in patients at risk.
B. Approximately 50% of patients have a delayed diagnosis.
C. The mechanism of injury is usually cervical flexion and rotation.
D. Such injuries are always treated operatively when identified.

A

B. Approximately 50% of patients have a delayed diagnosis.

112
Q

Massive transfusion protocols

A. Should include transfusion of plasma and platelets in addition to packed RBCs
B. Should only be initiated after blood typing, but crossmatch is not needed
C. Should be initiated in patients with tachycardia despite administration of3.5 L of crystalloid fluids
D. Should include testing for coagulopathies, present in 5% of patients requiring massive transfusion

A

A. Should include transfusion of plasma and platelets in addition to packed RBCs

113
Q

The most appropriate treatment for a duodenal hematoma that occurs from blunt trauma is
A. Exploratory laparotomy and bypass of the duodenum.
B. Exploratory laparotomy and evacuation of the hematoma.
C. Exploratory laparotomy to rule out associated injuries.
D. Observation.

A

D. Observation.

114
Q

Damage control surgery (DCS)

A. Limits enteric spillage by rapid repair of partial small bowel injuries with whipstitch, and complete transection with a GIA stapling device.
B. Aims to control surgical bleeding and identify injuries that can be managed conservatively or with interventional radiology.
C. Is indicated when patients develop intraoperative refractory hypothermia, serum pH >7.6, or refractory coagulopathy.

A

A. Limits enteric spillage by rapid repair of partial small bowel injuries with whipstitch, and complete transection with a GIA stapling device.

115
Q

Therapy for increased intracranial pressure (ICP) in a patient with a closed head injury is instituted when the ICP is greater than

A. 10
B. 20
c. 30
D. 40

A

B. 20

116
Q

Cerebral perfusion pressure (CPP)

A. Equals the SBP minus ICP
B. Should be targeted to be greater than 100 mm Hg C. Is lowered with sedation, osmotic diuresis, paralysis, ventricular drainage, and barbiturate coma
D. Can be increased by lowering ICP and avoiding hypotension

A

D. Can be increased by lowering ICP and avoiding hypotension

117
Q

An 18-year-old man is admitted to the ED shortly after being involved in an automobile accident. He is in a coma (GCS = 7). His pulse is barely palpable at a rate of 140 beats per minute, and BP is 60/0. Breathing is rapid and shallow, aerating both lung fields. His abdomen is moderately distended with no audible peristalsis. There are closed fractures of the right forearm and the left lower leg. After rapid IV administration of 2 L of lactated Ringer solution in the upper extremities, his pulse is 130 and BP 70/0. The next immediate step should be to
A. Obtain cross-table lateral X-rays of the cervical spine. B. Obtain head and abdominal CT scans.
C. Obtain supine and lateral decubitus X-rays of the abdomen.
D. Obtain an arch aortogram.
E. Explore the abdomen.

A

E. Explore the abdomen.

118
Q

A 36-year-old patient arrives in the trauma bay with a stab wound to the left chest. After placement of a left thoracostomy tube and fluid resuscitation, his breathing is stable with BP 160/7 4 mm Hg and heart rate of 110 beats per minute. CT scanning reveals a descending thoracic pseudoaneurysm and no intracranial or intra- abdominal injury. What is the most appropriate next step?
A. Open repair with partial left heart bypass
B. Endovascular repair with stent
C. Esmolol drip
D. Admission to SICU with repeat CT in 24 hours

A

C. Esmolol drip

119
Q

A patient with penetrating injury to the chest should undergo thoracotomy if

A. There is more than 500 mL of blood which drains from the chest tube when placed.
B. There is more than 200 mL/h of blood for 3 hours from the chest tube.
C. There is an air leak that persists for >48 hours. D. There is documented lung injury on CT scan.

A

B. There is more than 200 mL/h of blood for 3 hours from the chest tube.

120
Q

After sustaining a gunshot wound to the right upper quadrant of the abdomen, the patient has no signs
of peritonitis. Her vital signs are stable, and CT scan shows a grade III liver injury. What is the next step in management?
A. Exploratory laparotomy with control of hepatic parenchymal hemorrhage.
B. Admission to SICU with serial complete blood count.
C. Admission to SICU with repeat CT in 24 hours.
D. Hepatic angiography.

A

B. Admission to SICU with serial complete blood count.

121
Q

A 25-year-old man has multiple intra-abdominal injuries after a gunshot wound. Celiotomy reveals multiple injuries to small and large bowel and major bleeding from the liver. After repair of the bowel injuries, the abdomen is closed with towel clips, leaving a
large pack in the injured liver. Within 12 hours, there is massive abdominal swelling with edema fluid, and intra- abdominal pressure exceeds 35 mm Hg. The immediate step in managing this problem is to
A. Administer albumin intercavernously
B. Give an IV diuretic
C. Limit IV fluid administration
D. Open the incision to decompress the abdomen

A

D. Open the incision to decompress the abdomen

122
Q

Which of the following statements is correct regarding traumatic spleen injury?
A. An elevation in WBC to 20,000/mm3 and platelets to 300,000/mm3 on postoperative day 7 is a common benign finding in postsplenectomy patients.
B. Delayed rebleeding or rupture will typically occur within 48 hours of injury.
C. Common complications after splenectomy include subdiaphragmatic abscess, pancreatic tail injury, and gastric perforation.
D. Postsplenectomy vaccines against encapsulated bacteria is optimally administered preoperatively or immediately postoperative

A

C. Common complications after splenectomy include subdiaphragmatic abscess, pancreatic tail injury, and gastric perforation.

123
Q

The most appropriate treatment for a duodenal hematoma that occurs from blunt trauma is
A. Exploratory laparotomy and bypass of the duodenum
B. Exploratory laparotomy and evacuation of the hematoma
C. Exploratory laparotomy to rule out associated injuries
D. Observation

A

D. Observation

124
Q

A 19-year-old man fell off his skateboard, reporting blunt injury to his upper abdomen. Abdominal CT
and magnetic resonance cholangiopancreatography (MRCP) confirmed he suffered transection of the main pancreatic duct at the middle of the pancreatic body. Which of the following would be the most appropriate next step in management?
A. Nonoperative treatment
B. Endoscopic retrograde cholangiopancreatography (ERCP) with stenting of pancreatic duct
C. Distal pancreatectomy with splenic preservation
D. Primary repair of pancreatic duct with closed suction drainage

A

C. Distal pancreatectomy with splenic preservation

125
Q

The most appropriate treatment for a gunshot wound to the hepatic flexure of the colon that cannot be repaired primarily is

A. End colostomy and mucous fistula.
B. Loop colostomy.
C. Exteriorized repair.
D. Resection of the right colon with ileocolostomy.

A

D. Resection of the right colon with ileocolostomy.

126
Q

Which of the following statements is FALSE regarding traumatic genitourinary injury?
A. If exploratory laparotomy is performed for trauma, all blunt and penetrating wounds to the kidneys should be explored.
B. Renal vascular injuries are common after penetrating trauma, and can be deceptively tamponaded by surrounding fascia.
C. Success of renal artery repair after blunt trauma is slim, but can be attempted if injury occurred within 5 hours or patient does not have any reserve renal function (solitary kidney or bilateral injury).
D. Suspected ureteral injuries in patients with penetrating trauma or pelvic fractures can be evaluated intraoperatively with methylene blue or indigo carmine administered intravenously.

A

D. Suspected ureteral injuries in patients with penetrating trauma or pelvic fractures can be evaluated intraoperatively with methylene blue or indigo carmine administered intravenously.

127
Q

At what pressure is operative decompression of a compartment mandatory?
A. 15mmHg
B. 25mmHg
C. 35mmHg
D. 45mmHg

A

D. 45mmHg

128
Q

Which is true regarding trauma in geriatric patients?

A. Admission GCS score after severe head injury is a good predictor of outcome.
B. Rib fractures are associated with pulmonary contusion in 35% of patients, and complicated by pneumonia in 10 to 30% of patients.
C. Approximately 10% of patients older than 65 years will sustain a rib fracture from a fall <6 ft.
D. Chronologie age older than 65 years is associated with higher morbidity and mortality after trauma.

A

B. Rib fractures are associated with pulmonary contusion in 35% of patients, and complicated by pneumonia in 10 to 30% of patients.

129
Q

A 22-year-old man is brought to the emergency room after a house fire. He has burns around his mouth and his voice is hoarse, but breathing is unlabored. What most appropriate next step in management?

A. Immediate endotracheal intubation.
B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available.
C. Place on supplemental oxygen.
D. Placement oftwo large-bore intravenous (IV) catheters with fluid resuscitation.

A

B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available.

130
Q

What percentage burn does a patient have who has suffered burns to one leg (circumferential), one arm (circumferential), and the anterior trunk?
A. 18%
B. 27%
c. 36%
D. 45%

A

D. 45%

131
Q

A 40-year-old woman is admitted to the burn unit after an industrial fire at a plastics manufacturing plant with burns to the face and arms. Her electrocardiogram (ECG) shows S-T elevation, and initial chemistry panel and arterial blood gas reveal an anion gap metabolic acidosis with normal arterial carboxyhemoglobin. What is the most appropriate next step?
A. Correction of acidosis by adding sodium bicarbonate to IV fluids.
B. Administration of 100% oxygen and hydroxocobalamin.
C. Transthoracic echocardiogram.
D. Blood culture with IV antibiotics.

A

B. Administration of 100% oxygen and hydroxocobalamin.

132
Q

Which of the following is a common sequelae of electrical injury?
A. Cardiac arrhythmias
B. Paralysis
C. Brain damage
D. Cataracts

A

D. Cataracts

133
Q

An 8-year-old boy is brought to the emergency room after accidentally touching a hot iron with his forearm. On examination, the burned area has weeping blisters and is very tender to the touch. What is the burn depth?
A. First degree
B. Second degree
C. Third degree
D. Fourth degree

A

B. Second degree

134
Q

Three hours after a burn injury that consisted of circumferential, third -degree burns at the wrist and elbow of the right arm, a patient loses sensation to light touch in his fingers. Motor function of his digits, however, remains intact. The most appropriate treatment for this patient now would consist of
A. Elevation of the extremity, Doppler ultrasonography every 4 hours, and if distal pulses are absent 8 hours later, immediate escharotomy.
B. Palpation for distal pulses and immediate escharotomy if pulses are absent.
C. Doppler ultrasonography for assessment of peripheral flow and immediate escharotomy if flow is decreased.
D. Immediate escharotomy under general anesthesia from above the elbow to below the wrist on both medial and lateral aspects of the arm.

A

C. Doppler ultrasonography for assessment of peripheral flow and immediate escharotomy if flow is decreased.

135
Q

What is the fluid requirement of a 50-kg man with firstdegree burns to his left arm and leg, circumferential second-degree burn to his right arm, and third-degree burns to his torso and right leg. What is the rate of initial fluid resuscitation?
A. 4.5 Lover 8 hours, followed by 4.5 Lover 16 hours
B. 4.5 Lover 8 hours, followed by 6 Lover 16 hours
C. 6 L over 8 hours, followed by 6 L over 16 hours
D. 6 L over 8 hours, followed by 9 L over 16 hours

A

A. 4.5 Lover 8 hours, followed by 4.5 Lover 16 hours

136
Q

A patient with a 90% burn encompassing the entire torso develops an increasing Pco2 and peak inspiratory pressure. Which of the following is most likely to resolve this problem?
A. Increase the delivered tidal volume.
B. Increase the respiratory rate.
C. Increase the Fro2•
D. Perform a thoracic escharotomy.

A

D. Perform a thoracic escharotomy.

137
Q

Which of the following is FALSE regarding silver sulfadiazine?
A. Used as prophylaxis against burn wound infections with a wide range of antimicrobial activity.
B. Safe to use on full and partial thickness burn wounds, as well as skin grafts.
C. Has limited systemic absorption.
D. May inhibit epithelial migration in partial thickness wound healing.

A

B. Safe to use on full and partial thickness burn wounds, as well as skin grafts.

138
Q

Successful antibiotic penetration of a burn eschar can be achieved with
A. Mafenide acetate
B. Neomycin
C. Silver nitrate
D. Silver sulfadiazine

A

A. Mafenide acetate

139
Q

Which of the following is true regarding nutritional needs ofburn patients?

A. The hypermetabolic response to burn wounds typically raises the basic metabolic rate by 120%.
B. Oxandrolone, an anabolic steroid, can improve lean body mass but can be associated with hyperglycemia and clinically significant rise in hepatic transaminitis.
C. Early enteral feeding is safe when burns are less than 20% TBSA, otherwise enteral feeding should await return of bowel function to avoid feeding a patient with gastric ileus.
D. For patients with greater than 40% TBSA, caloric needs are estimated to be 25 kcal!kg/day plus 40 kcal!% TBSA/ day.

A

D. For patients with greater than 40% TBSA, caloric needs are estimated to be 25 kcal!kg/day plus 40 kcal!% TBSA/ day.

140
Q

A 14-year-old girl sustains a steam burn measuring 6 by 7 inches over the ulnar aspect of her right forearm. Blisters develop over the entire area of the burn wound, and by the time the patient is seen 6 hours after the injury, some of the blisters have ruptured spontaneously. All of the following therapeutic regimens might be considered appropriate for this patient EXCEPT
A. Application of silver sulfadiazine cream (Silvadene) and daily washes, but no dressing.
B. Application of mafenide acetate cream (Sulfamylon), but no daily washes or dressing.
C. Homograft application without sutures to secure it in place, but no daily washes or dressing.
D. Heterograft (pigskin) application with sutures to secure it in place and daily washes, but no dressing.

A

Heterograft (pigskin) application with sutures to secure it in place and daily washes, but no dressing.

141
Q

Which is FALSE concerning surgical treatment of burn wounds?
A. Tangential excision consists of tangential slices of burn tissue until bleeding tissue is encountered. Thus, excision can be associated with potentially significant blood loss.
B. Human cadaveric allograft is a permanent alternative to split-thickness skin grafts when there are insufficient donor sites.
C. Bleeding from tangential excision can be helped with injection of epinephrine tumescence solution, pneumatic tourniquets, epinephrine soaked compresses, and fibrinogen and thrombin spray sealant.
D. Meshed split thickness skin grafts allow serosanguinous drainage to prevent graft loss and provide a greater area of wound coverage.

A

B. Human cadaveric allograft is a permanent alternative to split-thickness skin grafts when there are insufficient donor sites.

142
Q

A 45-year-old woman is admitted to a hospital because of a third-degree burn injury to 40% of her TBSA, and her wounds are treated with topical silver sulfadiazine cream (Silvadene). Three days after admission, a burn wound biopsy semiquantitative culture shows 104 Pseudomonas organisms per gram of tissue. The patient›s condition is stable at this time. The most appropriate management for this patient would be to
A. Repeat the biopsy and culture in 24 hours.
B. Start subeschar clysis with antibiotics.
C. Administer systemic antibiotics.
D. Surgically excise the burn wounds.

A

B. Start subeschar clysis with antibiotics.

143
Q

Fourteen days after admission to the hospital for a 30% partial thickness burn and hemodynamic instability requiring central venous access, a patient develops a spiking temperature curve. On physical examination, the central venous catheter insertion site was red, tender, and warm. The best treatment for this complication is to
A. Exchange of central venous catheter over guidewire, culture tip of previous catheter.
B. Treat patient with IV antibiotics until blood cultures drawn from catheter are negative.
C. Removal of central venous catheter, culture tip, and placement of new catheter on contralateral site.
D. Removal of catheter and treat patient with oral antibiotics and pain medication as needed.

A

C. Removal of central venous catheter, culture tip, and placement of new catheter on contralateral site.

144
Q

Which of the following is FALSE regarding polymorphonuclear neutrophils (PMNs) and their role in wound healing?
A. PMNs release proteases that degrade ground substance within the wound site.
B. Neutrophils use fibrin clot generated at the wound site as scaffolding for migration into the wound.
C. Neutrophil migration is stimulated by local prostaglandins, complement factors, interleukin-1 (IL-l), tumor necrosis factor-a (TNF-a), transforming growth factor- (TGF- ), platelet factor 4, or bacterial products.
D. PMNs are the first cells to infiltrate the wound, peaking at 24 to 48 hours.
E. Neutrophils release cytokines that later assist with collagen deposition and epithelial closure.

A

E. Neutrophils release cytokines that later assist with collagen deposition and epithelial closure.

145
Q

The proliferative phase of wound healing occurs how long after the injury?
A. 1 day B. 2 days C. 7 days D. 14days

A

C. 7 days

146
Q

Which of the following is true regarding the
fibroblastic phase of wound healing?
A. Early during wound healing, the predominant composititon of the matrix is fibronectin and type II collagen.
B. After complete replacement of the scar with type
III collagen, the mechanical strength will equal that of uninjured tissue approximately 6 to 12 months postinjury.
C. Even though the tensile strength of a wound reaches a plateau after several weeks, the tensile strength will increase over another 6 to 12 months due to fibril formation and cross-linking.
D. As the scar matures, matrix metalloproteinases (MMPs) break down type I collagen and replace it with type III collagen.

A

C. Even though the tensile strength of a wound reaches a plateau after several weeks, the tensile strength will increase over another 6 to 12 months due to fibril formation and cross-linking.

147
Q

Which of the following is commonly seen in EhlersDanlos syndrome (EDS)?
A. Small bowel obstructions.
B. Spontaneous thrombosis.
C. Direct or recurrent hernias in children.
D. Abnormal scarring of the hands with contractures.

A

C. Direct or recurrent hernias in children.

148
Q

Patients with Marfan syndrome are associated with what genetic decect?
A. MFN-1 gene deletion
B. Type I collagen gene mutation
C. COL7A 1 gene mutation
D. FBN-1 gene mutation

A

D. FBN-1 gene mutation

149
Q

When a long bone fracture is repaired by internal fixation with plates and screws
A. Callus at the fracture site forms more rapidly.
B. Delayed union is prevented.
C. Direct bone-to-bone healing occurs without soft callus formation.
D. Endochondral ossification is more complete.

A

C. Direct bone-to-bone healing occurs without soft callus formation.

150
Q

Which of the following is FALSE regarding healing of fullthickness injuries of the GI tract?
A. Serosal healing is essential to form a water-tight barrier to the lumen of the bowel.
B. Extraperitoneal segments of bowel that lack serosa have higher rates of anastomotic failure.
C. There is an early decrease in marginal strength due to an imbalance of greater collagenolysis versus collagen synthesis.
D. Collagen synthesis is done by fibroblast and smooth muscle cells.
E. The greatest tensile strength of the GI tract is provided by the serosa.

A

E. The greatest tensile strength of the GI tract is provided by the serosa.

151
Q

Steroids impair wound healing by
A. Decreasing angiogenesis and macrophage migration
B. Decreasing platelet plug integrity
C. Increasing release oflysosomal enzymes
D. Increasing fibrinolysis

A

A. Decreasing angiogenesis and macrophage migration

152
Q

What type of nerve injury involves disruption of axonal continuity with preserved Schwann cell basal lamina?
A. Neurapraxia
B. Axonotemesis
C. Neurotmesis
D. Axonolysis

A

B. Axonotemesis

153
Q

The major cause of impaired wound healing is
A. Anemia
B. Diabetes mellitus
C. Local tissue infection
D. Malnutrition

A

C. Local tissue infection

154
Q

How does diabetes mellitus impair wound healing?
A. Local hypoxemia, reduced angiogenesis, and inflammation due to vascular disease.
B. Glycosylation of proteoglycans and collagen in wound bed due to hyperglycemia.
C. Decreased collagen accretion noted in patients with type II diabetes mellitus.
D. Increased bacterial load to due to hyperglycemia.

A

A. Local hypoxemia, reduced angiogenesis, and inflammation due to vascular disease.

155
Q

s wound healing in patients without micronutrient deficiency?
A. VitaminC
B. VitaminA
C. Selenium
D. Zinc

A

B. VitaminA

156
Q

Which type of collagen is most important in wound healing?
A. Typeiii
C. Type VII
B. TypeV
D. TypeXI

A

A. Typeiii

157
Q

What is FALSE regarding healing of cartilage?
A. Cartilage is avascular and depends on diffusion of nutrients.
B. Superficial cartilage wounds are not associated with an inflammatory response.
C. Cartilage injuries often heal slowly and result in permanent structural defects.
D. A major source of nutrients to cartilage is from nearby periosteum.

A

D. A major source of nutrients to cartilage is from nearby periosteum.

158
Q

Signs of malignant transformation in a chronic wound include
A. Persistent granulation tissue with bleeding
B. Overturned wound edges
C. Nonhealing after 2 weeks of therapy
D. Distal edema

A

B. Overturned wound edges

159
Q

What is the difference between hypertrophic scars (HTS) and keloids?
A. Keloids are an overabundance of fibroplasia as a result of healing, hypertrophic scars are a failure of collagen remodeling.
B. Hypertrophic scars often regress over time, whereas keloids rarely regress.
C. Hypertrophic scars are more common in darkerpigmented ethnicities.
D. Hypertropic scars extend beyond the border of the original wound.

A

B. Hypertrophic scars often regress over time, whereas keloids rarely regress.

160
Q

The treatment of choice for keloids is
A. Excision alone
B. Excision with adjuvant therapy ( eg, radiation)
C. Pressure treatment
D. Intralesional injection of steroids

A

B. Excision with adjuvant therapy ( eg, radiation)

161
Q

What is FALSE about peritoneal adhesions?
A. Most peritoneal adhesions are a result of intraabdominal surgery.
B. Intra-abdominal adhesions are the most common cause of small bowel obstruction.
C. Operations in the upper abdomen have a higher chance of causing adhesions that cause small bowel obstruction, especially involving the jejunum.
D. Adhesions are a leading cause of secondary infertility in women.

A

C. Operations in the upper abdomen have a higher chance of causing adhesions that cause small bowel obstruction, especially involving the jejunum.

162
Q

Which growth factor has been formulated and approved for treatment of diabetic foot ulcers?

A

PDGF

163
Q

Following caustic injury to the skin with an alkaline agent the effected area should initially be
A. Treated with running water or saline for 30 minutes
B. Treated with running water or saline for 2 hours
C. Treated with a neutralizing agent
D. Treated with topical emollients and oral analgesics

A

B. Treated with running water or saline for 2 hours

164
Q

The area most amenable to salvage by resuscitative and wound management techniques following thermal injury is called the
A. Zone of hyperemia
B. Zone of coagulation
C. Zone of stasis
D. Zone of scalding

A

C. Zone of stasis

165
Q

The treatment of a hydrofluoric acid skin burn is
A. Application of calcium carbonate gel
B. Irrigation with sodium bicarbonate
C. Injection of sodium bicarbonate
D. Local wound care only

A

A. Application of calcium carbonate gel

166
Q

Tissue ischemia resulting in wounds that are characterized as a partial-thickness injury with a blister is considered
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage4

A

B. Stage 2

167
Q

The presence of sulfur granules in a draining wound should lead to the use of which of the following antibiotics?
A. Rifampin
B. Gentamicin
C. Penicillin
D. Amphotericin

A

C. Penicillin

168
Q

Initial treatment of non purulent, complicated cellulitis is
A. Vancomycin
B. B-lactam
C. Linezolid
D. Clindamycin

A

B. B-lactam

169
Q

A 3-mm basal cell carcinoma (BCC) of the skin should be treated with
A. Biopsy and gross total excision
B. Dermatologic laser vaporization
C. Excision with 2- to 4-mm normal margin
D. Electrodesiccation

A

C. Excision with 2- to 4-mm normal margin

170
Q

Trichilemmal cysts
A. Are the most common type of cutaneous cysts
B. Are found between the forehead to nose tip
C. Are typically found on the scalp of females
D. Occasionally develop bone, tooth, or nerve tissue

A

C. Are typically found on the scalp of females

171
Q

More than half of patients treated for BCC will experience a recurrence within
A. 6months B. 1 years C. 2 years D. 3years

A

D. 3years

172
Q

The primary risk factor for the development of squamous cell carcinoma (SCC) is
A. UV exposure
B. Cigarette smoking
C. Chemical agents
D. Chronic, nonhealing wounds

A

A. UV exposure

173
Q

In the ABCDE of melanoma, the D stands for diameter greater than
A. 2mm
C. 6mm
B. 4mm
D. 8mm

A

C. 6mm

174
Q

The most common site of distant metastasis for melanoma is

A. Brain
C. Gastrointestinal tract
B. Lung
D. Distant skin

A

B. Lung

175
Q

The most common subtype of melanoma is
A. Lentigo maligna
B. Acrallentiginous
C. Superficial spreading
D. Nodular

A

C. Superficial spreading

176
Q

Ocular melanoma
A. Exclusively metastasizes to the lungs
B. Exclusively metastasizes to the brain
C. Exclusively metastasizes to regional lymph nodes
D. Exclusively metastasizes to the liver

A

D. Exclusively metastasizes to the liver

177
Q

The following is NOT true in regard to Merkel cell carcinoma
A. It is commonly found in white men with a median age of70 years.
B. It is characterized by a rapidly growing, flesh-colored papule.
C. Treatment should begin with examination of nodal basins.
D. Recurrence is uncommon.

A

D. Recurrence is uncommon.

178
Q

What is the most common melanoma in patients with dark skin?
A. Nodular
C. Acrallentiginous
B. Superficial spreading
D. Lentigo maligna

A

C. Acrallentiginous

179
Q

Kaposi sarcoma

A. Excision is the treatment of choice
B. Is predominantly found on the skin
C. Appears as rubbery, blue nodules
D. Is most often seen in patients in their fifth decade of life

A

A. Excision is the treatment of choice

180
Q

The following is NOT a prognostic indicator for patients with a sentinel node containing metastatic melanoma
A. Patient age
B. Site of metastasis
C. Number of positive nodes

A

B. Site of metastasis

181
Q

A patient with a 5-mm deep melanoma of the thigh and no clinically positive nodes should undergo which procedure?
A. Resection of the primary only
B. Superficial femoral node resection
C. Superficial and deep femoral node resection
D. Resection of femoral and inguinal nodal basins

A

A. Resection of the primary only

182
Q

A 65-year-old patient who spends winters in Florida presents with a painless, ulcerated lesion on his right cheek. The lesion has been present for 1 year. Physical examination of the patient›s neck reveals no lymph node enlargement. The most likely diagnosis is
A. Melanoma
c. sec
B. BCC
D. Sebaceous cyst

A

B. BCC

183
Q

The chronic inflammatory disease presenting as painful subcutaneous nodules is
A. Pyoderma gangrenosum
B. Toxic epidermal necrolysis syndrome
C. Hidradenitis suppurative
D. Steven-Johnson syndrome

A

C. Hidradenitis suppurative

184
Q

Correct statements about toxic epidermal necrolysis (TEN) include all of the following EXCEPT
A. Toxic epidermal necrolysis is believed to be an immunologic problem.
B. Lesions are similar in appearance to partial thickness burns.
C. The process develops at the dermoepidermal junction.
D. Corticosteroid use is a primary part of therapy.

A

D. Corticosteroid use is a primary part of therapy.

185
Q

The rare adenocarcinoma of the apocrine gland that often appears as a nonpigmented plaque is
A. Angiosarcoma
B. Extramammary Paget disease
C. Malignant fibrous histiocytoma
D. Dermatofibrosarcoma protuberans

A

B. Extramammary Paget disease

186
Q

Which of the following statements about normal breast anatomy is true?
A. The breast typically contains 10 lobes.
B. Cooper ligaments are only found in the upper quadrants of the breast.
C. The upper inner quadrant of the breast contains the most breast tissue.
D. The tail of Spence extends across the anterior axillary fold.

A

D. The tail of Spence extends across the anterior axillary fold.

187
Q

Which of the following changes in the breast is NOT associated with pregnancy?
A. Accumulation oflymphocytes, plasma cells, and eosinophils within the breast.
B. Enlargement of breast alveoli.
C. Release of colostrum.
D. Accumulation of secretory products in minor duct lumina.

A

C. Release of colostrum.

188
Q

The breast receives its blood supply from all of the following EXCEPT
A. Branches of the internal mammary artery
B. Branches of the superior epigastric artery
C. Branches of the posterior intercostal arteries D. Branches of thoracoacromial artery

A

B. Branches of the superior epigastric artery

189
Q

Which of the following statements is INCORRECT?
A. Level I lymph nodes are those that are lateral to the pectoralis minor muscle.
B. Level II lymph nodes are located deep to the pectoralis minor muscle.
C. Level III lymph nodes are located medial to the pectoralis minor muscle.
D. Level IV lymph nodes are the ipsilateral internal mammary lymph nodes.

A

D. Level IV lymph nodes are the ipsilateral internal mammary lymph nodes.

190
Q

Concerning breast development before and during pregnancy, which hormonal activity pairing is INCORRECT?
A. Estrogen: Initiates ductal development
B. Progesterone: Initiates lobular development
C. Prolactin: Initiates lactogenesis
D. Follicle stimulating hormone: Cooper ligament relaxation

A

D. Follicle stimulating hormone: Cooper ligament relaxation

191
Q

Concerning gynecomastia, which of the following is true?
A. During senescence gynecomastia is usually unilateral. B. During puberty gynecomastia is usually bilateral.
C. Is not associated with breast cancer except in EhlersDanlos patients.
D. Is classified as per a three-grade system.

A

D. Is classified as per a three-grade system.

192
Q

Inflammatory conditions of the breast include all of the following EXCEPT
A. Necrotizing viral mastitis
B. Zuska disease (recurrent preductal mastitis)
C. Mondor disease (superficial breast thrombophlebitis)
D. Hidradenitis suppurativa

A

A. Necrotizing viral mastitis

193
Q

Lesions with malignant potential include all of the followingEXCEPT
A. Intraductal papilloma
B. Atypical ductal hyperplasia
C. Sclerosing adenosis
D. Atypical lobular hyperplasia

A

C. Sclerosing adenosis

194
Q

Risk factors for the development of breast cancer include
A. Early menarche
B. Nulliparity
C. Late menopause
D. Longer lactation period

A

D. Longer lactation period

195
Q

Drugs useful in breast cancer prevention include
A. Raloxifene
B. Tamoxifen
C. Aspirin
D. Aromatase inhibitors

A

C. Aspirin

196
Q

Which of the following is true regarding breast cancer metastasis?
A. Metastases occur after breast cancers acquire their own blood supply.
B. Batson plexus facilitates metastasis to the lung.
c. Natural killer cells have no role in breast cancer immunosurveillance.
D. Twenty percent of women who develop breast cardnoma metastases will do so within 60 months of treatment.

A

A. Metastases occur after breast cancers acquire their own blood supply.

197
Q

All of the following are true concerning breast LCIS EXCEPT
A. Develops only in the female breast.
B. Cytoplasmic mucoid globules are a distinctive cellular feature.
c. Frequency ofLCIS cannot be reliably determined.
D. The average age at diagnosis is 65 to 70 years.

A

D. The average age at diagnosis is 65 to 70 years.

198
Q

Which of the following concerning breast cancer staging is correct?

A. Stage I tumors have no metastases to either lymph nodes or distant sites.
B. Stage III tumors include some with distant metastases (Ml disease).
C. Inflammatory carcinoma is considered T4 disease.
D. N4 disease includes metastases to highest contralateral axillary nodes.

A

C. Inflammatory carcinoma is considered T4 disease.

199
Q

Factors that determine the type of therapy offered to patients after diagnosis of breast cancer include all of the following EXCEPT
A. Whether or not a therapy has been proven effective in clinical trials
B. Stage of disease
C. General health of patient
D. Biologic subtype

A

A. Whether or not a therapy has been proven effective in clinical trials

200
Q

Which of the following statements about the management of distal carcinoma in situ (DCIS) is true?
A. DCIS treated by mastectomy has a local recurrence rate of2%.
B. Extensive DCIS should be treated with tamoxifen followed by lumpectomy.
C. Specimen mammography is only useful for patients with small amounts ofDCIS.
D. Postoperative tamoxifen is useful in DCIS patients whose tumors are estrogen-receptor (ER) negative.

A

A. DCIS treated by mastectomy has a local recurrence rate of2%.

201
Q

All of the following are true about accelerated partial breast irradiation (APBI) EXCEPT
A. APBI is delivered in an abbreviated fashion and a lower total dose than standard course of whole breast radiation. B. Suitable patients for APBI include women older than or equal to 60 years.
C. Suitable patients for APBI include patients whose tumor margins are greater than or equal to 2 mm.
D. Suitable patients for APBI include those with multifocal disease.

A

D. Suitable patients for APBI include those with multifocal disease.

202
Q

Patients not suitable for sentinel lymph node (SLN) biopsy include all of the following EXCEPT
A. Inflammatory carcinoma of the breast.
B. Prior axillary surgery.
C. Biopsy-proven distant metastases.
D. Lower inner quadrant of breast primary carcinoma.

A

D. Lower inner quadrant of breast primary carcinoma.

203
Q

Which of the following is true concerning breast cancer during pregnancy?
A. Metastases to lymph nodes occur in approximately 75% of patients.
B. Approximately 50% of breast nodules developing during pregnancy are malignant.
C. Mammography is especially useful in localizing small lesions.
D. There is risk of chemotherapy teratogenicity if used during the second, but not the third, trimester of pregnancy.

A

A. Metastases to lymph nodes occur in approximately 75% of patients.

Surgery (9 decks)

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