2008 with explanations (2008_exam_all_reviewed) Flashcards
- Which bug is MOST common in surgical infections?
a. S. aureus
b. Coag Neg. Staph
c. E. Coli
d. Some other wrong answer
Answer: A.
- All of the following are true of Hep C, EXCEPT:
a. It is an RNA flavavirus
b. 75% of infected people become chronic carriers
c. Risk of transmission via needle stick is 2%
d. Some other answer
Answer: ? (previous answer C). HCV is an RNA flavavirus. HCV typically leads to chronic infection; 60 to 80 percent of cases develop chronic hepatitis (abnormal liver enzymes). 20 to 30 percent of chronically infected individuals develop cirrhosis over a 20- to 30-year period of time The average incidence of seroconversion to HCV after unintentional needle sticks or sharps exposures from an HCV-positive source is 1.8 percent (range, 0-7 percent). The overall rate of HCV transmission after an exposure ranges from essentially zero to about 10%
Source: Up to date. , JAMA. 2002.
- Electrical Voltage is converted to heat (burns) by a person’s body based on what?
a. Directly proportional to voltage and resistance of the body
b. Inversely proportional to voltage and resistance of the body
c. Directly proportional to the current and resistance of the body
d. Inveresely proportional to the current and resistance of the body
Answer: C.
- 70kg male pt requires how much daily glucose to prevent the catabolism of protein?
a. 10 g
b. 50 g
c. 200 g
d. 500 g
Answer: C. 100g of dextrose daily provided enough to spare protein catabolism. You may require about 125 g of glucose.
Source: Nutrition support for the critically ill.
Schwarz says avg person needs 80-120g of protein per day. And every 6 grams of protein = 1g of Nitrogen
- What does the Kaplan Meier Curve measure?
a. Survival
b, c, d- Wrong answers
Answer: A.
- Which of the following is the most common anaerobic bug in post op infections?
a. Actinomyces
b. Bacteroides
c. Clostridium
d. Another bug
Answer: B.
- While consenting a pt, it appears she isn’t paying attention. At the completion of your disclosure, the patient states, “I don’t want to hear about all the bad things. I trust you, let’s do it.” Should you:
a. Have someone else explain it to her.
b. Tell her this is important and that she needs to pay attention or you won’t operate on her
c. Document in the chart that disclosure has been provided and that the patient wishes to proceed.
d. Some other answer
Answer: C. may have an answer to the effect of bringing someone else in the room to help explain
- Pt. injured, unable to consent for emergent op, no one else to give consent. You decide to operate, this is an example of :
a. Beneficience
b. Nonmaleficience
c. Something else
d. Something else
Answer: A Beneficience - Concept involves the physician making the decisions that are best for the patient, without regard to personal gain or the interests of others. “Do good and avoid evil. Nonmaleficence, which derives from the maxim, is one of the principal precepts that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that “given an existing problem, it may be better to do nothing than to do something that risks causing more harm than good.” It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.
- Coherent pt. states pre-op that he does not want blood for religious reasons, pt. undergoes AAA repair and becomes unstable in ICU. Wife tells you to disregard his decision and transfuse him. You should:
a. Abide by wife’s wishes because pt. is no longer competent
b. Give him blood but don’t tell him
c. Continue to resuscitate him, but don’t give blood.
d. Something else
Answer: C.
- Pt. wants to know highest risk of receiving blood product. You tell him:
a. HIV
b. Bacterial Sepsis
c. HBV
d. Something else
Answer: B. ??
Schwartz says that PRBC’s with bacteria is very rare. More common with plt transfusion.
General non-hemolytic fever is more common though (1%), and is secondary to prformed cytokines in donor blood. In the table, this has the highest incidence
Allergic reactions also more common (1%). Often not serious and more frequently associated with plts and FFP
Transfusion related deaths, although rare, do occur and are related primarily to transfusion-related acute lung injury (TRALI) (16%–22%), ABO hemolytic transfusion reactions (12%–15%), and bacterial contamination of platelets (11%–18%).86
- Most like bug from receiving blood product:
a. Treponema Pallidum
b. Staph
c. Something else
d. Something else
Answer: A.
- In obtaining informed consent, you must provide all of the following EXCEPT:
a. Standard accepted rates of success/failure
b. General risks
c. Special & unique risks
d. Alternatives to the procedure
Answer: C.
- Nerve most at risk in fasciotomy of ant. compartment of lower leg:
a. Superficial Peroneal N.
b. Tibial N.
c. Femoral N.
d. Common Peroneal N.
Answer: A.
- Guy cuts his forearm with a box knife, unable to feel his thumb and index finger. Cannot flex PIP. Initial management should consist of:
a. I&D in ER, explore and repair damage to deep structures
b. Give Keflex, keep wound open, splint with MCP flexed and refer to hand surgeon the next day.
c. I&D in ER, explore and repair damage to deep structures, suture wound closed and refer to hand surgeon later.
Answer: B. (previous A). Cannot feel his thumb index – VOLAR. Median nerve. Flexors are median nerve. I would not explore the wound in the ER. No emergent need to repair lacerated nerves – hand is not ischemic where time is a factor.
Source: M.Bernstein, M.D.
I think I would just irrigate, close skin, dress, splint in safety refer to plastics in the morning
- Which of the following will not increase the likelihood of an incision having healing problems?
a. COPD
b. Previous surgery
c. NIDDM
d. Corticosteroids
Answer: B. Increases healing.
- Keloids have the following characteristics, EXCEPT:
a. Occur more commonly in dark skinned people
b. Are cause of scar overgrowth
c. Intralesional steroid injections are helpful
d. Something else
Answer: ? (previous answer C). Certain individuals, most commonly blacks, develop a hyperproliferation of fibroblasts in response to trauma or, less commonly, de novo. Intralesional corticosteroids are first-line therapy for most keloids. A systematic review found that up to 70 percent of patients respond to intralesional corticosteroid injection with flattening of keloids, although the recurrence rate is high in some studies (up to 50 percent at five years
Source: Up to date.
- Motorcycle rider crashes and has grossly contaminated open mid tibia (Grade IIIB). Besides I&D, tetanus, etc, you should start:
a. Cefazolin
b. Cefazolin and Gentamicin
c. Cefazolin, Gentamicin, and Penicillin
d. Something else
Answer: C. (previous B). The “grossly” suggests that you need to include anaerobic coverage (i.e. PCN).
Source: M.Bernstein
Orthobullet: penicillin only if you suspect anaerobes (farm or bowel)
- 70 kg. guy with burns is being treated with IVF per Parkland formula. Between hours 4-8 his urine output is 45 cc, 75 cc, 50 cc. You should:
a. Observe and wait
b. Bolus with 1000cc RL
c. Increase IVF by one-third
d. Something else
Answer: A. (previous C) 70 kg adult should have at least 0.5 cc/kg/hr. that is, > 35 cc/hr. He is meeting this goal, therefore observe and wait.
- Older male pt. with hx of smoking presents with painless gross hematuria. Most likely diagnosis:
a. Prostate CA
b. Renal Calculus
c. Bladder CA
d. Something else
Answer: C.
- Tobacco smoke is a known carcinogenic factor in all of the following types of cancer EXCEPT:
a. Lung
b. Liver
c. Cervical
d. Oral
Answer: B.
- All of the following require emergent exploratory laparotomy except:
a. Fractured Kidney
b. Gunshot wound that goes through gut
c. Something else
d. Something else
Answer: A.
- Pt. with Breast CA develops severe headaches. MRI shows large cerebral mass. You should:
a. Palliative care
b. Resect and XRT
c. XRT
d. Something else
Answer: B. SURGERY — Surgery is used to provide rapid relief of symptoms resulting from the mass effect of a large tumor, to improve local control of brain metastases, and to establish a histologic diagnosis when a brain metastasis is suspected. Advances in neuroanesthesia and neurosurgery have significantly improved the safety of surgical resection of brain metastases, making this approach applicable to a larger number of patients, including lesions in both eloquent and noneloquent regions of the brain [16,17].
However, complications are not rare. In a series of 400 craniotomies patients with brain tumors (206 with gliomas and 194 with metastasectomy), 13 percent suffered major complications including neurologic worsening (8.5 percent) and meningitis (1 percent) [17]. In another series of 382 patients operated on for brain metastases, there was one death (respiratory, in a patient who had a previous pneumonectomy) and 27 other complications (7 percent). These included three cerebral hemorrhages and three cerebral infarcts [18].
The patient’s performance status and the extent of extracranial disease are the most important factors in determining whether or not surgery is appropriate. Patients with extensive or uncontrolled systemic disease generally have a poor prognosis and only rarely benefit from surgery. Other factors affecting prognosis and hence the appropriateness of surgery include the number and location of brain metastases. A short interval between diagnosis of the primary tumor and the development of a brain metastasis is generally associated with a poor prognosis [16]. In patients treated with surgery, WBRT is often used postoperatively
- BEST way to initially assess damage to optic nerve:
a. Fundoscopic Exam
b. Peripheral Vision
c. Visual Acuity
d. Something else
Answer: C. repeat. Best exam to alert the physician for eye injury is initial visual acuity exam.
Source: M.Bernstein, M.D.
- Pt. unable to be intubated due to stricture and in resp. distress, you should do which of the following?
a. Cricothyrotomy
b. Tracheostomy
c. Nasotracheal intubation
d. Something else
Answer: A. Need emergent airway. Cricothyroidostomy is indicated when an urgent surgical airway is needed.
- Guy involved in trauma, non responsive. At the scene, all are signs that someone is receiving adequate ventilation, EXCEPT:
a. Normal chest expansion
b. Good air entry via nose & mouth
c. Good breath sounds
d. Pulse oximetry
Answer: D. In respiratory physiology, ventilation (or ventilation rate) is the rate at which gas enters or leaves the lung. It is categorised under the following definitions:
Source: Wikipedia
- PET scan useful for detecting CA based on what?
a. Increase blood flow to CA
b. Increased glucose at CA
c. Something else
d. Something else
Answer: B (previous A). If the biologically active molecule chosen for PET is FDG, an analogue of glucose, the concentrations of tracer imaged then give tissue metabolic
activity, in terms of regional glucose uptake
Source: Wikipedia.
- First cells to arrive at wound healing:
a. PMNs
b. Macrophage
c. Fibroblasts
d. Lymphocytes
Answer: A. (previous answer B). PMNs are the first infiltrating cells to enter the wound site, peaking at 24 to 48 hours. Macrophages are the dominant cell type in the first phase (inflammatory) but are not the first to appear (macrophages are the second cell to enter)
Source: Schwartz’s Surgery
- Tumors are attacked by:
a. Cell mediated immunity
b. Humoral mediated immunity
c. Cell and Humoral mediated immunity
d. Navy SEALs
Answer: A.
- Which of the following is an example of a heterotopic allograft?
a. Lung
b. Liver
c. Kidney
d. Cornea
Answer: C. Heterotopic suggests that the transplanted organ will be placed in a non-native anatomic location. Lung and cornea can obviously not be heterotopic. Kidney are often transplanted into the pelvis. Conversely, orthotopic transplantation such as that occurs in the liver = in its natural position.
Source: Schwartz
33. Pt is stabbed in neck at cricoid. Stab wound is in Zone 1. Zone one is between cricoid and which structure? a. Angle of mandible b. Cricothyroid membrane c. Hyoid bone d. Clavicle
Answer: D.
Look at an image of zones of the neck
- During thoracotomy, surgeon notices draining thoracic duct. He should:
a. Ligate it
b. Disregard it
c. Something else
d. Something else
Answer: A
- During surgery, pt. has temp of 34°C & oozing of wound. Coag factors are fine. Why is he oozing?
a. Hypothermia
b. Something else
c. Something else
d. Something else
Answer: A.
- Female involved in MVA in snow. Pt. hands appear to have frost bite. Best way to warm them?
a. Rub snow on them
b. Place them in 40° C water
c. Something else
d. Something else
Answer: B.
Schwarz:
Treatment of frostbite includes rapid rewarming to 40 to 42°C, analgesia, debridement of blisters, hydrotherapy,
elevation, topical antimicrobials, topical antithromboxanes (aloe vera), and systemic antiprostaglandins (aspirin).
UTD:
Once the patient has reached the hospital, definitive care consists of rapid rewarming, wound care, efforts to enhance tissue viability, and prevention of complications [31].Rewarming - Rewarming is most effectively accomplished by immersing the affected area in a waterbath heated to 40º to 42ºC. Such water feels warm but not hot to an unaffected hand. Higher temperatures may result in burns. Dry heat is difficult to regulate and not recommended. Thawing is usually complete in 15 to 30 minutes, at which point the tissue is red or purple and soft to the touch. Source: up to date.
- Surgeon is legally responsible for which of the following:
a. Anesthetist
b. OR room nurses
c. Student observers
d. His office staff
Answer: C. repeat.
- A woman with breast CA can sue her surgeon for all of the following, EXCEPT:
a. Delay in diagnosis
b. Failure to treat properly
c. Something else
d. Recurrence of CA while participating in a clinical trial.
Answer: D.
- Pt. with hypothermia is receiving warmed IV fluids, is placed in warm room with blankets. What else should you do?
a. Peritoneal lavage with warm fluid
b. Pleural lavage with warm fluid
c. Observe and keep pt. warm
d. Something else
Answer: C.
- Fluid rate for 4 kg kid with vomiting, etc. secondary to pyloric stenois:
a. Something else
b. Something else
c. D5 ½ NS with 20-30 meq KCL at 25 cc/hr
d. Something else
Answer: C. 4 kg child. Use 4:2:1: rule. First 10kg, multiply weight by 4. I.e. 4 kg, 4 x 4 is 16 cc/hr. Infants presenting with normal electrolyte values and mild dehydration, as is the case with more than 60 percent of patients, should receive maintenance intravenous fluids such as 5 percent dextrose with 0.25 percent NaCl and 2 meq KCl per 100 mL. Infants with moderate or severe dehydration require more involved fluid management with higher NaCl concentrations (0.5 percent to normal saline) and higher rates of administration (1.5 to 2 times maintenance), perhaps combined with bolus administration initially. The correction of alkalosis prior to surgery is imperative because alkalosis has been associated with an increased risk of post-operative apnea
Source: up to date.
- Pt with splenomegaly. Which of the following are TRUE?
a. Decrease platelet life
b. Increased total body platelet mass
c. Thrombocytosis
d. Spherocytosis
Answer: C.
Previous answer was C, but I don’t think splenomegaly causes increased plts. Its sequesters them and thus causes thrombocytopenia…
From Schwarz:
Thrombocytopenia may result from excessive sequestration of platelets as well as accelerated
platelet destruction in the spleen. Splenomegaly may result in sequestration of up to 80% of the platelet pool. The spleen may also contribute to the immunologic alteration of platelets, which leads to thrombocytopenia in the absence of splenomegaly (e.g., idiopathic thrombocytopenic purpura [ITP]).
- Guy with hemophilia. His wife’s family has no hx of disease. The guy has 4 kids- 2 girls and 2 boys. Which of the following is true:
a. All of the kids will have the disease.
b. All of his kids will be carriers of the disease
c. Half of the girls will be carriers of the disease and the boys will have the disease
d. All of the girls will be carriers of the disease and the boys will not have the disease
Answer: D Hemophilia A and B are X-linked recessive disorders, which explains who is likely to bleed and the modes of genetic transmission [2]. These hemophilias occur almost exclusively in a male having one defective copy of the relevant gene on his X chromosome (ie, he is hemizygous for the defect). Because the affected male will transmit a normal Y chromosome to all his sons and an abnormal X chromosome to all his daughters, his sons will not be affected and all of his daughters will be carriers (ie, they are heterozygous for the defect).
Source: Up to date.
- You wish to compare data between 3 groups. You should use:
a. ANOVA
b. A calculator
c. Your fingers
d. Toothpicks
Answer: A
- Besides Double Blinded Randomized control study, which is least likely to include selection bias:
a. Case Control
b. Cohort
c. Something else
d. Meta analysis
Answer: D.
- In order to use a t-test, which of the following must be true:
a. Data must be normally distributed
b. Something else
c. Something else
d. Something else
Answer: A. A t-test is any statistical hypothesis test in which the test statistic has a Student’s t distribution if the null hypothesis is true. It is applied when the population is assumed to be normally distributed but the sample sizes are small enough that the statistic on which inference is based is not normally distributed because it relies on an uncertain estimate of standard deviation rather than on a precisely known value.
Source: Up to date.
- All of the following increase the sickling phenomenon, EXCEPT:
a. Presence of HgbF
b. Acidosis
c. Hypotension
d. Decrease in cell water concentration
Answer: A. HbF is protective.
Source: up to date.
- Pt. s/p elbow ORIF, now c/o decreasing ROM. XR shows heterotopic ossification. All are true, EXCEPT:
a. Can be prevented with NSAIDs
b. XR evidence shows before limitation of ROM
c. Common with head injury
d. Immobilization can cause it
Answer: B
- Why is morphine preferred over meperidine in post-op pain?
a. Meperidine has agonist/antagonist properties
b. Mep has no specificity for opioid receptors
c. Meperedine has a higher ceiling effect
d. Worry about buildup of meperidine metabolites.
Answer: D
Metabolites are shown to have serotonergic effect so can cause serotonin syndrome
- Pt. very pregnant, best position for surgery?
a. R Lateral decubitus
b. Supine
c. Reverse Trendelenburg
d. Something else
Answer: B (previous answer A.) L lateral decubitus position would offload her IVC. R lateral would be bad. It depends on the surgery.
- At what level of training is resident most likely to suffer accidental needle stick?
a. I
b. II
c. III
d. V
Answer: D vs A. According to the study by the NEJM in 2007, 99% of PGY-5 trainees had suffered a needlestick injury. 99% of residents had a needlestick injury before their training ended.
Source: Makary et al. NEJM. 2007. Needlestick injuries among surgeons in training.
- Question comparing and contrasting Apoptosis and Necrosis, which is true?
a. They can occur simultaneously after ischemia/reperfusion injury.
a
- Norepinephrine mainly acts on which of the following receptors:
a. α1
b. α2
c. β1
d. β2
Answer: A. (previous C) Norepi has little beta-2 agonist activity. It acts on both alpha1 and beta1 receptors. Alpha1 having slight higher affinity.
Source: Eric, Pharmacist at MGH
- Proto-oncogenes can become oncogenes by all of the following, EXCEPT:
a. Loss of both alleles
b. Frameshift mutation
c. Translocation
d. Something else
Answer: A.
Schwarz:
Proto-oncogenes can be activated (show increased activity) or overexpressed (expressed at increased protein levels) by translocation (e.g., abl), promoter insertion (e.g., c-myc), mutation (e.g., ras), or amplification (e.g., HER2/neu).
A proto-oncogene is a normal gene that can become an oncogene due to mutations or increased expression. Upon activation, a proto-oncogene (or its product) becomes a tumor-inducing agent, an oncogene.[7] Examples of proto-oncogenes include RAS, WNT, MYC, ERK and TRK. Activation: The proto-oncogene can become an oncogene by a relatively small modification of its original function. There are three basic activation types: 1. A mutation within a proto-oncogene can cause a change in the protein structure, causing an increase in protein (enzyme) activity a loss of regulation 2. An increase in protein concentration, caused by an increase of protein expression (through misregulation) an increase of protein stability, prolonging its existence(chunky time) and thus its activity in the cell a gene duplication (one type of chromosome abnormality), resulting in an increased amount of protein in the cell. 3. A chromosomal translocation (another type of chromosome abnormality), causing an increased gene expression in the wrong cell type or at wrong times the expression of a constitutively active hybrid protein. This type of aberration in a dividing stem cell in the bone marrow leads to adult leukemia. Mutations in microRNAs can lead to activation of oncogenes.[8] New research indicates that small RNAs 21-25 nucleotides in length called microRNAs (miRNAs) can control expression of these genes by downregulating them.[9]Antisense messenger RNAs could theoretically be used to block the effects of oncogenes.
- Vitamin K levels can be decreased by all of the following except
a. Coumadin
b. Vit B12
c. Something else
d. Something else
Answer: B.
- Pt. comes in, requires urgent OR, on coumadin with INR 3.6. What should you do?
a. Give 10 mg Vit K and wait 12 hours
b. Stop coumadin and wait for INR to normalize
c. Give 10 mg Vit K and FFP and go to OR
d. Something else
Answer: C.
- Pt. post op after some random surgery, develops renal failure on POD #2, next day develops heart and liver failure. His mortality rate is approximately:
a. Doubles with each new organ failure
b. 50%
c. 90%
d. Something else
Answer: C. The mortality rate for isolated renal failure is about 10%; however when greater it is multi-organ failure, as the case here, the mortality rate is great than 90%. Although Morrell notes says 50-60% when 3 organs involved.
Source: Internal Medicine, Jay Stein. P2263
- All of the following are signs of anticholinergics, EXCEPT:
a. Fever
b. Cramping
c. Hallucinations
d. Sweating
Answer: D. Red as a beet” - Cutaneous vasodilation occurs as a means to dissipate heat by shunting blood to the skin, in order to compensate for the loss of sweat production.
“Dry as a bone” (anhidrosis) - Sweat glands are innervated by muscarinic receptors, so anticholinergic medications produce dry skin.
“Hot as a hare” (anhydrotic hyperthermia) - Interference with normal heat dissipation mechanisms (ie, sweating) frequently leads to hyperthermia.
“Blind as a bat” (nonreactive mydriasis) - Muscarinic input contributes to both pupillary constriction and effective accommodation. Anticholinergic medications generally produce pupillary dilation and ineffective accommodation that frequently manifests as blurry vision.
“Mad as a hatter” (delirium; hallucinations) - Blockade of muscarinic receptors in the central nervous system (CNS) accounts for these findings. Manifestations may include: anxiety, agitation, dysarthria, confusion, disorientation, visual hallucinations, bizarre behavior, delirium, psychosis (usually paranoia), coma, and seizures. Hallucinations are often described as “Alice in Wonderland-like” or “Lilliputian type,” where people appear to become larger and smaller. Patients with altered mental status often present with agitation and may appear to grab invisible objects from the air [11]. Although central and peripheral anticholinergic effects are commonly seen together, in some cases, central effects may persist after resolution of peripheral symptoms.
“Full as a flask” - The detrusor muscle of the bladder and the urethral sphincter are both under muscarinic control; anticholinergic substances reduce detrusor contraction (thereby reducing or eliminating the desire to urinate) and prevent normal opening of the urethral sphincter (contributing to urinary retention).
Source: Up to date.
- Signs of Hypercalcemia, EXCEPT:
a. Proximal muscle weakness
b. Carpopedal spasm
c. Something else
d. Coma
Answer: B. Fatigue, abdominal pain, anorexia, weakness, depression, vomiting, and constipation. Severe hypercalcemia may cause acute pancreatitis, and peptic ulcer disease secondary to prolonged hypercalcemia is also common. With ionized calcium concentrations above 3.0 mmol/L, cognitive dysfunction becomes more prominent, and above 4.0 mmol/L psychosis, stupor, and coma are expected. Although a shortened QTc interval may be seen on EKG, hemodynamically significant arrhythmias are rare.
Source: Morris, Emergency Medicine.
- Trauma pt. with blood from meatus. You should:
a. Cystogram
b. Retrograde Cysto
c. Something else
d. Something else
Answer: B.
- Least sensitive indicator of compartment syndrome:
a. Parasthesia
b. Pain out of proportion
c. Decreased pulses
d. Pain with passive stretch
Answer: C. earliest sign is pain on passive stretch.
Source: M.Bernstein, M.D.
- Trauma pt. with pelvic and femur fx. Pt becomes hypotensive with dropping HCT. You should do which FIRST:
a. Stabilize the fractures
b. Give pRBCs
c. Give fluids
d. Something else
Answer: C. (previous answer A) ABCs. C = circulation, first fluid administration is IV bolus of fluid and determine if responsive.
Source: M.Bernstein, M.D.
- Most common cause of Carpal Tunnel Syndrome:
a. Volar ganglion cyst
b. Trauma
c. Tenosynovitis
d. Masturbation
Answer: B An entrapment neuropathy from compression of the median nerve in the carpal tunnel, particularly from synovitis of the tendon sheaths or carpal joints and recent or poorly healed fracture
- Which oncogene is associated with MEN II?
a. k-ras
b. p53
c. p diddy
d. ret
Answer: D.
- Epstein-Barr virus is associated with which of the following:
a. Liver cancer
b. Nasopharyngeal cancer
c. Kaposi’s Sarcoma
d. Something else
Answer: B. Kaposi’s is associated with HTLV.
67 The median is the best measure of central tendency in which of the following cases?
a. skewed population sample
b. small sample size
Answer: A.
68 To better write prescriptions a couple of changes were discussed, all would be useful EXCEPT?
a. Add zero to left of dose (e.g. 0.12 mg )
b. Add zero to right of dose (e.g. 12.0 mg)
c. Not to write international unit as “IU”
d. Not write QD, OS and OD
Answer: B.
69 Patient fell from horse on head had seizure then was brought to ER with stable vitals and normal CT and clinical exam what would you do to prevent seizures?
a. Iv fluids
b. Trendelenburg position
c. Loading dose of phenytoin “dilantin”
d. Observe
Answer: C
70 Mutation found in MEN II?
a. K-Ras oncogene
b. Ret oncogene
c. P53
d. CEA
Answer: B
71 Patient head injury, what is most likely prognostic facture of having seizures?
a. Occipital lesion
b. Use of illicit drugs
c. Age
d. GCS
Answer: D
