final exam year 1 Flashcards by Sandra Jos

C-reactiveprotein(CRP)
A. Is secreted in a circadian rhythm with higher levels in the morning
B. Increases after eating a large meal
C. Does not increase in response to stress in patients with liver failure
D. Is less sensitive than erythrocyte sedimentation rate as
a marker of inflammation

Does not increase in response to stress in patients with liver failure

How well did you know this?

Not at all

Perfectly

which of the following is true regarding the inflammatory response after a traumatic injury.
A. There is an acute proin infammatory response caused by stimulation of the adaptive immune system.
B. There is an anti-in inflammatory response that leads to a return of homeostasis accompanied by suppression of the
innate immune system.
C. The degree of inflammation is proportional to injury severity.
D. Systemic inflammation following trauma is related to the immune response to microbes

The degree of inflammation is proportional to injury severity.

How well did you know this?

Not at all

Perfectly

High-mobility group protein B1 (HMGB1)
A. Is associated with the best-characterized damage associated molecular pattern (DAMP), detectable in the circulation within 30 minute so trauma
B. Is a protein secreted by immune-competent cells stimulated by pathogen-associated molecular patterns
(PAMPs)or inflammatory cytokines
C. Is also secreted by endothelial cells, platelets, and also asa part of cell death
D. All of the above

D. All of the above

How well did you know this?

Not at all

Perfectly

The most abundant amino acid in the human body is

A. Carnitine B. Arginine C. Glutamine D. Methionine

Glutamine

How well did you know this?

Not at all

Perfectly

What is the role of mitochondrial DAMPs in the injury mediated inflammatory response?
A. Mitochondrial DNA induces production of HMGB1.
B. Mitochondrial DNA and peptides from damaged mitochondria activate the macrophage inflammasome.
C. Mitochondrial DNA and peptides modulate the anti- in ammatory response that suppresses the adaptive
immune system.
D. Mitochondrial DNA is directly toxic to the liver and lung in high amounts.

Mitochondrial DNA and peptides from damaged mitochondria activate the macrophage inflammasome.

How well did you know this?

Not at all

Perfectly

Which is FALSE regarding the hypothalamic-pituitary- adrenal (HPA) axis and injury-associated stress?
A. the HPA is initiated by the hypothalamus producing corticotropin releasing hormone (CRH) in response to inflammatory cytokines.
B. CRH acts on the anterior pituitary to stimulate adrenocorticotropin hormone (AC H) secretion.
C. CRH simulates the zona fasciculata of the adrenal gland to synthesise and secrete glucocorticoids.
D. Insufficient cortisol in response to critical illness can lead to tachycardia, hypotension, weakness, hypoglycemia, hyponatremia, and hyperkalemia.

CRH simulates the zona fasciculata of the adrenal gland to synthesise and secrete glucocorticoids.

How well did you know this?

Not at all

Perfectly

Nutritional formulas used to treat pulmonary failure typically increase the fat intake of a patient’s total caloric intake to
A. 50% B. 20% C. 80% D. 10%

A. 50%

How well did you know this?

Not at all

Perfectly

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

C Severe diarrhea

How well did you know this?

Not at all

Perfectly

All are possible causes of post operative hyponatremia EXCEPT.
A. excessive infusion of normal saline intraoperatively B. Administration of antipsychotic medication.
C. Transient decrease in ADH hormone secretion.
D. excessive oral water intake.

Transient decrease in ADH hormone secretion.

How well did you know this?

Not at all

Perfectly

Which of the followings 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

How well did you know this?

Not at all

Perfectly

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

A. Congestive heart failure

How well did you know this?

Not at all

Perfectly

The next most appropriate test to order in a patient with a pH of 7.1, pco2 of 40, sodium of 132, potassium of 4.2, and chloride of 105 is
A. Serum bicarbonate B. Serum magnesium C. Serum ethanol
D. Serum salicylate

A. Serum bicarbonate

How well did you know this?

Not at all

Perfectly

Which fo 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 in initial resuscitation
D. Increases cerebral perfusion

B. Should be avoided in closed head injury

How well did you know this?

Not at all

Perfectly

normal saline is
A 135 mEq NaCl/L
B 145 mEq NaCl/L 
C 148 mEq NaCl/L 
D 154 mEq NaCl/L

D 154 mEq NaCl/L

How well did you know this?

Not at all

Perfectly

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

Can lead to pulmonary edema

How well did you know this?

Not at all

Perfectly

Water constitutes what percentage of total body weight
A. 30–40%
B. 40–50% 
C. 50–60% 
D. 60–70%

C. 50–60%

How well did you know this?

Not at all

Perfectly

if a patients serum glucose increases by 180 mg/dL, what is the increase in serum osmolarity, assuming all other lab values remain constant.
A. Doesnt change
B. 8
C. 10
D. 12

C. 10

How well did you know this?

Not at all

Perfectly

What is the actual potassium a patient with pH 7.8 and serum potassium of 2.2
A. 2.2
B. 2.8
C. 3.2
D. 3.4

D. 3.4

How well did you know this?

Not at all

Perfectly

the free water deficit of a 70kg man with serum sodium of 154 is
A.0.1L B. 0.7L C. 1L D. 7L

D. 7L

How well did you know this?

Not at all

Perfectly

A patient with serum calcium of 6.8 and albumin of 1.2 has a corrected claim of 
A. 7.7
B. 8.0
C. 8.6
D. 9.2

D. 9.2

How well did you know this?

Not at all

Perfectly

all of the following treatments of hyperkalemia reduce serum potassium except
A. Bicarbonate
B. Kayexalate
C. Glucose infusion with insulin D. Calcium

D. Calcium

How well did you know this?

Not at all

Perfectly

An alcoholic patient with serum albumin 3.9, K 3.1, Mg 2.4, Ca 7.8, and PO4 3.2 receives three boluses IV potassium and has serum potassium 3.3. You should
A. Continue to bolus potassium until the serum level is more than 3.6
B. Give MgSO4 IV.
C. Check the ionized calcium
D. check the BUN and creatine

B. Give MgSO4 IV.

How well did you know this?

Not at all

Perfectly

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

B. 2100

How well did you know this?

Not at all

Perfectly

A patient who has spasms in the hand when a blood presssure cuff is blown up most likely has:
A. Hyper alcemia
B. Hyp alcemia
C. Hypermagnesemia
D. Hyp magnesemia

B. Hypoalcemia

How well did you know this?

Not at all

Perfectly

The actual AG of a chronic alcholic with Na 133, K 4, Cl-101, HCO3-22,albumin of 2.5ng/dL is
A. 6
B. 10
C.14
D. 15

D. 15

How well did you know this?

Not at all

Perfectly

The efective osmotic pressure between the plasma and
interstitial fluid compartments is primarily controlled by
A. Bicaarbonate B.Chlridein C.Potassiumin D. Protein

D. Protein

How well did you know this?

Not at all

Perfectly

The metabolic derangement most commonly seen in patients with profuse vomiting
A. Hyp hl remi ,hyp kalemi metab li alkal sis
B. Hyp hl remi ,hyp kalemi metab li a id sis
C. Hyp hl remi ,hyperkalemi metab li alkal sis D. Hyp hl remi ,hyperkalemi metab li a id sis

B. Hypochloremic ,hypokalemic metabolic acidosis

How well did you know this?

Not at all

Perfectly

Symptoms and signs of extra cellular fluid volume defecit
include all the following EXCEPT A. An rexia
B. Apathy
C. De reased b
wing EXCEP
dy temperature
D. Highpulsepressure

D. High pulse pressure

How well did you know this?

Not at all

Perfectly

A low urinary [NH+] with a hyperchloremic acidosis
indicates what cause?
A. Ex essive v miting
B. Enter utane us stula C. Chr ni diarrhea
D. Renaltubulara id sis

D. Renal tubular acidosis

How well did you know this?

Not at all

Perfectly

When lactic acid is produced in response to injury, the body minimizes pH change by A.Dereasingprdutin sdiumbiarbnatein
tissues
B. Ex reting arb n di xide thr ugh the lungs
C. Ex reting la ti a id thr ugh the kidneys
D. Metab lizingthela ti a idintheliver

B. Excreting carbon dioxide through the lungs

How well did you know this?

Not at all

Perfectly

What is the best determinant of whether a patient has a metabolic acidosis versus alkalosis
A. Arterial pH B.Serumbiarbnate
C. Pco2
D. Serum CO2 level

A. Arterial pH

How well did you know this?

Not at all

Perfectly

If a patient’s arterial Pco2 is found to be 25 mm Hg, the arterial pH will be approx?
A. 7.52
b. 7.40
c. 7.32
d. 7.28

D. 7.28

How well did you know this?

Not at all

Perfectly

Which of the following are NOT characteristic findings of
acute renal failure?
A. BUN>100mg/dL
B. Hyp kalemia C.Severeaidsis
D. Uremi peri arditis
E. Uremi en ephal pathy

A. BUN>100mg/dL

How well did you know this?

Not at all

Perfectly

An elderly diabetic patient who has acute cholecystitis is found to have a serum sodium level 122 mEq/L and a bood glucose 600 mg/dL. After correcting the glucose concentration to 100 mg/dL with insulin, the serum
sodium concentration would
A. De rease signi antly unless the patient als
re eived
3%saline
B. De rease transiently but return t appr ximately
122 mEq/L with ut spe i therapy
C. Remain essentially un hanged
D. In rease t the n rmal range with ut spe i
therapy

D. Increase to the normal range without specific

therapy

How well did you know this?

Not at all

Perfectly

Excessive administration of normal saline for fluid resuscitation can lead to what metabolic derangement?
A. Metab li alkal sis
B. Metab li a id sis
C. Respirat ryalkal sis
D. Respirat rya id sis

b. metabolic acidosis acidosis

How well did you know this?

Not at all

Perfectly

The first step in the management of 
acute hypercalcemia should be
A. C rre ti n de it extra ellular uid v lume
B. Hem dialysis.
C. Administrati n 
D. Administrati n
ur semide. mithramy in.

A. Correction of deficit extra cellular fluid volume

How well did you know this?

Not at all

Perfectly

A victim of a motor vehicle accident arrives in hemorrhagic shock. His arterial blood gases are pH, 7.25; Po2, 95mmHg;Pco,25mmHg;HCO–,15mEq/L. The patient’s metabolic acidosis would be treated best with
A. Ampule s dium bi arb nate B.Sdiumbiarbnateinusin
C. La tated Ringer s luti n
D. Hyperventilati n

C. Lactated Ringer solution

How well did you know this?

Not at all

Perfectly

three days after surgery for gastric carcinoma, a 50yr old alcoholic male exhibits delirium, muscle tremors, and hyperactive tendon reflexes. magnesium deficiency is suspected. all of the following statements are true EXCEPT:
A. decision to administer magnesium should be based on the serum magnesium level
b. adequate cellular replacement of magnesium will require 1-3weeks.

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

How well did you know this?

Not at all

Perfectly

Refeeding syndrome can be associated with all of the following EXCEPT:
A. Respirat ry ailure
B. Hyperkalemia
C. C n usi n
D. Cardia arrhythmias

B. Hyperkalemia

How well did you know this?

Not at all

Perfectly

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

B. Vasodilatation

How well did you know this?

Not at all

Perfectly

Which is required for platelet adherence to injured endothelium?
A. T romboxaneA2
B. Glycoprotein(GP)IIb/IIIa
C. Adenosinediphosphate(ADP) 
D. Von Willebrand actor (vWF)

D. Von Willebrand actor (vWF)

How well did you know this?

Not at all

Perfectly

which of the following clotting factors is the first factor common to both intrinsic and extrinsic pathways?
A. Factor I ( brinogen)
B. FactorIX(Christmas actor)
C. FactorX(Stuart-Prower actor)
D. Factor XI (plasma thromboplasma antecedent)

C. FactorX(Stuart-Prower actor)

How well did you know this?

Not at all

Perfectly

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

D. Factor XIII

How well did you know this?

Not at all

Perfectly

In a previously unexposed patient, when does the platelet count fall in heparin induced thrombocytopenia(HIT)?
A. <24hours
B. 24–28hours
C. 3–4days D. 5–7days

D. 5–7days

How well did you know this?

Not at all

Perfectly

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

C.Disseminated intravascular coagulation(DIC)

How well did you know this?

Not at all

Perfectly

What is true about coagulopathy related to trauma?
A. Acute coagulopathy o trauma is mechanistically simi-
lar to DIC.
B. Coagulopathy can develop in trauma patients ollow-
ing acidosis, hypothermia, and dilution o coagulation actors, though coagulation is normal upon admission.
C. Acute coagulopathy o trauma is caused by shock and
tissueinjury.
D. Acute coagulopathy o trauma is mainly a dilutional
coagulopathy.

C. Acute coagulopathy o trauma is caused by shock and

tissueinjury.

How well did you know this?

Not at all

Perfectly

What is the best laboratory test or determine degree of anticoagulation with dabigatran and rivaroxaban?
A. Prothrombin time/international normalised ratio (P /INR)
B. partial thromboplastin time (P
C. Bleedingtime
D. None of
the above

D. None of the above

How well did you know this?

Not at all

Perfectly

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 or every 100 units of heparin most recently administered.
C.Immediate administration o FFP.
D. transfusion of 10 units of platelets.

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

How well did you know this?

Not at all

Perfectly

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 pur-
pura ( TPP).
D. Is a disease of impaired platelet production, unknown cause.

Includes Hit as a subtype of drug-induced ITP.

How well did you know this?

Not at all

Perfectly

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

D. Storage pool disease

How well did you know this?

Not at all

Perfectly

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

D. Splenomegaly

How well did you know this?

Not at all

Perfectly

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.

Following bypass, platelets’ morphology and ability to

aggregate are irreversibly altered.

How well did you know this?

Not at all

Perfectly

Following a recent abdominal surgery, your patient is in the icu with septic shock. Below what level of haemoglobin would a blood transfusion be indicated. 
A. <12g/dL
B. <10g/dL
C. <8g/dL
D. <7g/dL

D. <7g/dL

How well did you know this?

Not at all

Perfectly

Less than 0.5% o 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 in infection

A. transfusion-related acute lung injury

How well did you know this?

Not at all

Perfectly

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

D. none of the above

How well did you know this?

Not at all

Perfectly

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

B. 1:1,000,000

How well did you know this?

Not at all

Perfectly

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

D. 2,3-DPG toxicity

How well did you know this?

Not at all

Perfectly

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

C. Human error

How well did you know this?

Not at all

Perfectly

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

C. Antihemophilic factor

How well did you know this?

Not at all

Perfectly

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

C. Oliguria

How well did you know this?

Not at all

Perfectly

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. Gram-negative

How well did you know this?

Not at all

Perfectly

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

A. Binding of actor XII to subendothelial collagen

How well did you know this?

Not at all

Perfectly

What are the uses of thromboelastography
A. Predicting need for life saving interventions after arrival for trauma
B. Predicting 24-hour and 30-day mortality Following trauma
c. Predicting early transfusion of RBc, plasma, platelets and cryoprecipitate
D. All of the above

D. All of the above

How well did you know this?

Not at all

Perfectly

Bank blood is appropriate or replacing each o the following EXCEPT
A. Factor I ( brinogen)
B. FactorII(prothrombin)
C. FactorVII(proconvertin)
D. FactorVIII(antihemophilic actor)

FactorVIII(antihemophilic actor)

How well did you know this?

Not at all

Perfectly

1. Shock caused by a large tension pneumothorax is categorised as
A. trauma shock
B. Vasodilator shock
C. Cardiogenic shock
D. Obstructive shock

D. Obstructive shock

How well did you know this?

Not at all

Perfectly

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.

Receptors in the aortic arch and carotid bodies inhibit

the autonomic nervous system (ANS) when stretched.

How well did you know this?

Not at all

Perfectly

Chemoreceptors in the aorta and carotid bodies do NOT sense which of the following?
A. Changes in O2 tension
B. H+ ion concentration
C. HCO3 – concentration 
D. Carbon dioxide (CO2) levels

C. HCO3 – concentration

How well did you know this?

Not at all

Perfectly

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

Decreased peripheral vascular resistance

How well did you know this?

Not at all

Perfectly

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 EXCEP
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.

D. Extracellular fluid volume deficit is restored

How well did you know this?

Not at all

Perfectly

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

D. A & C

How well did you know this?

Not at all

Perfectly

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

A. ADH acts as a potent mesenteric vasoconstrictor.

How well did you know this?

Not at all

Perfectly

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

A. Hepatic glycogenolysis

How well did you know this?

Not at all

Perfectly

A patient has a blood pressure o 70/50 mm Hg and a
serum lactate level o 30 mg/100 mL (normal: 6–16). His
cardiac output is 1.9 L/min, and his central venous pressure is 2 cm H2O. T e most likely diagnosis is
A. Congestive heart ailure
B. Cardiac tamponade
C. Hypovolemic shock
D. Septic shock

C. Hypovolemic shock

How well did you know this?

Not at all

Perfectly

umor necrosis actor-alpha ( NF-α)
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 o chronic illness

A. Can be released as a response to bacteria or

endotoxin

How well did you know this?

Not at all

Perfectly

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

D. 55%

How well did you know this?

Not at all

Perfectly

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

C. Can also be caused by carbon monoxide poisoning

How well did you know this?

Not at all

Perfectly

A patient in septic shock remains hypotensive despite
adequate uid resuscitation and initiation o norepinephrine. What is o en given to patients with hypotension
re ractory to norepinephrine?
A. Dopamine
B. Arginine vasopressin
C. Dobutamine
D. Milrinone

B. Arginine vasopressin

How well did you know this?

Not at all

Perfectly

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

D. Decreases length o antibiotic therapy

How well did you know this?

Not at all

Perfectly

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

C. Cardiogenic shock occurs in 5 to 10% o acute MIs.

How well did you know this?

Not at all

Perfectly

All o the ollowing result rom the placement o an intraaortic balloon pump in a patient with acute myocardial
ailure EXCEP
A. Reduction o systolic a erload
B. Increased cardiac output
C. Increased myocardial O2
demand
D. Increased diastolic per usion pressure

C. Increased myocardial O2

demand

How well did you know this?

Not at all

Perfectly

Which constellation o clinical ndings is suggestive o
cardiac tamponade?
A. Hypotension, wide pulse pressure, tachycardia
B. achycardia, hypotension, jugular venous distension
C. Hypotension, wide pulse pressure, jugular venous
distension
D. Hypotension, mu ed heart tones, jugular venous
distension

D. Hypotension, mu ed heart tones, jugular venous

distension

How well did you know this?

Not at all

Perfectly

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 o his hypotension?
A. Hypovolemic shock
B. Obstructive shock
C. Neurogenic shock
D. Vasodilatory shock

A. Hypovolemic shock

How well did you know this?

Not at all

Perfectly

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

B. Improves mortality in patients with relative adrenal

insuf ciency

How well did you know this?

Not at all

Perfectly

What is FALSE about serum lactate?
A. Generated rom pyruvate in the setting o insuf cient
O2
.
B. Metabolized by the liver and kidneys.
C. Is an indirect measure o the magnitude and severity
o shock.
D. T e time to peak lactate rom admission predicts rates
o survival.

D. T e time to peak lactate rom admission predicts rates

o survival.

How well did you know this?

Not at all

Perfectly

rans errin plays a role in host de ense by
A. Sequestering iron, which is necessary or microbial
growth
B. Increasing the ability o brinogen to trap microbes
C. Direct injury to the bacterial cell membrane
D. Direct injury to the bacterial mitochondria

A. Sequestering iron, which is necessary or microbial

growth

How well did you know this?

Not at all

Perfectly

Which is NO a component o systemic in ammatory
response syndrome (SIRS)?
A. emperature
B. White blood cell (WBC) count
C. Blood pressure
D. Heart rate

C. Blood pressure

How well did you know this?

Not at all

Perfectly

T e best method or hair removal rom an operative eld is
A. Shaving the night be ore
B. Depilating the night be ore surgery
C. Shaving in the operating room
D. Using hair clippers in the operating room

D. Using hair clippers in the operating room

How well did you know this?

Not at all

Perfectly

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

D. Exploratory laparotomy

How well did you know this?

Not at all

Perfectly

Which actor does NO in uence the development o surgical site in ections (SSIs)?
A. Duration o procedure
B. Degree o microbial contamination o the wound
C. Malnutrition
D. General anesthesia

D. General anesthesia

How well did you know this?

Not at all

Perfectly

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

C. Class III (contaminated)

How well did you know this?

Not at all

Perfectly

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

C. Percutaneous drainage and antibiotic therapy

How well did you know this?

Not at all

Perfectly

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

B. Initial therapy should be directed by results o urine

culture

How well did you know this?

Not at all

Perfectly

T e rst step in the evaluation and treatment o a patient
with an in ected bug bite on the leg with cellulitis, bullae,
thin grayish uid draining rom the wound, and pain out
o proportion to the physical ndings is
A. Obtain C-reactive protein
B. C scan o the leg
C. Magnetic resonance imaging (MRI) o the leg
D. Operative exploration

D. Operative exploration

How well did you know this?

Not at all

Perfectly

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

B. In high-risk patients, prophylactic antibiotics in used
through the catheter can reduce rate o catheter
in ections.

How well did you know this?

Not at all

Perfectly

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

D. Monobactams

How well did you know this?

Not at all

Perfectly

What is the estimated risk o transmission o human
immunode ciency virus (HIV) rom a needlestick rom
a source with HIV-in ected blood?
A. <0.5%
B. 1%
C. 5%
D. 10%

A. <0.5%

How well did you know this?

Not at all

Perfectly

Closure o an appendectomy wound in a patient with
per orated appendicitis who is receiving appropriate
antibiotics will result in a wound in ection in what percentage o patients?
A. 3–4%
B. 8–12%
C. 15–18%
D. 22–25%

A. 3–4%

How well did you know this?

Not at all

Perfectly

A chronic carrier state occurs with hepatitis C in ection
in what percentage o patients?
A. 90–99%
B. 75–80%
C. 50–60%
D. 10–30%

B. 75–80%

How well did you know this?

Not at all

Perfectly

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

B. Cipro oxacin or doxycycline

How well did you know this?

Not at all

Perfectly

T e most e ective postexposure prophylaxis or a surgeon
stuck with a needle while operating on an HIV-positive
patient is
A. None (no e ective treatment is known).
B. wo- or three-drug therapy started within hours o
exposure.
C. Single drug therapy started within 24 hours o
exposure.
D. riple drug therapy started within 24 hours o
exposure.

B. wo- or three-drug therapy started within hours o

exposure

How well did you know this?

Not at all

Perfectly

What is NO an early goal in treatment o 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

D. Serum lactate <2 mmol/L

How well did you know this?

Not at all

Perfectly

A patient in the ICU has been on ventilator support or 3
weeks. He has new onset elevated WBC count, ever, 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 C .

B. Obtain bronchoalveolar lavage.

How well did you know this?

Not at all

Perfectly

Patients with severe, necrotizing pancreatitis should be
treated with
A. No antibiotics unless C -guided aspiration o the area
yields positive cultures
B. Empiric ce oxitin or ce otetan
C. Empiric ce uroxime plus gentamicin
D. Empiric carbapenems or uoroquinolones

D. Empiric carbapenems or uoroquinolones

How well did you know this?

Not at all

Perfectly

A patient with a localized wound in ection af er 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

D. Incision and drainage alone

How well did you know this?

Not at all

Perfectly

Which areas likely do NO contain resident
microorganisms?
A. erminal ileum
B. Oropharynx
C. Main pancreatic duct
D. Nares

C. Main pancreatic duct

Cricothyroidotomy
A. Should not be per ormed in children younger than 12
years
B. Should only be per ormed in patients who are not good
candidates or a tracheostomy
C. Requires the use o an endotracheal tube smaller than
4 mm in diameter
D. Is pre erable to the use o percutaneous transtracheal
ventilation

A. Should not be per ormed in children younger than 12

years

Which o the ollowing is NO a sign o tension
pneumothorax?
A. racheal deviation
B. Decreased breath sounds
C. Respiratory distress with hypertension
D. Distended neck veins

C. Respiratory distress with hypertension

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

C. Air embolism

A trauma patient arrives ollowing a stab wound to the le
chest with systolic blood pressure (SBP) 85 mm Hg, which
improves slightly with intravenous (IV) uid resuscitation.
Chest X-ray demonstrates clear lung elds. What is the
most appropriate next step?
A. Computed tomography (C ) scan o the chest
B. Pelvic X-ray
C. Focused abdominal sonography or trauma (FAS )
examination
D. ube thoracostomy o the le chest

C. Focused abdominal sonography or trauma (FAS )

examination

5. Primary repair o the trachea should be carried out with
A. Wire suture
B. Absorbable mono lament suture
C. Nonabsorbable mono lament suture
D. Absorbable braided suture

B. Absorbable mono lament suture

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 o cardiopulmonary resuscitation (CPR) with no signs o li e.
C. Patient with chest stab wound, SBP decreasing to
50 mm Hg.
D. Patient with chest stab wound, became asystolic during
transport with 20 minutes o CPR with no signs o li e

D. Patient with chest stab wound, became asystolic during

transport with 20 minutes o CPR with no signs o li e.

A patient with spontaneous eye opening, who is con used
and localizes pain has a Glasgow Coma Score (GCS) o
A. 9
B. 11
C. 13
D. 15

C. 13

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 o
the mandible, zone II between the thoracic outlet and
angle o mandible, and zone III in erior to the
clavicles.
C. All patients with neck injury should receive computed
tomography angiogram (C A) o the neck.
D. Patients with dysphagia, hoarseness, hematoma,
venous bleeding, hemoptysis, or subcutaneous emphysema should undergo neck exploration.

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

Appropriate surgical management o 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
o vessels or bronchi
D. Wedge resection o the injured lung

C. Pulmonary tractotomy with a stapler and oversewing

o vessels or bronchi

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

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

A er an automobile accident, a 30-year-old woman is
discovered to have a posterior pelvic racture. Hypotension and tachycardia respond marginally to volume
replacement. Once it is evident that her major problem is
ree intraperitoneal bleeding and a pelvic hematoma in
association with the racture, appropriate management
would be
A. Application o medical antishock trousers with in ation o the extremity and abdominal sections.
B. Arterial embolization o the pelvic vessels.
C. Celiotomy and ligation o the internal iliac arteries
bilaterally.
D. Celiotomy and pelvic packing.
E. External xation application to stabilize the pelvis.

D. Celiotomy and pelvic packing.

. Which is true o vascular injuries o the extremities?
A. In the absence o hard signs o vascular injury, i the
dif erence between SBP in an injured limb is within
15% o the uninjured limb, no urther evaluation is
needed.
B. Occult pro unda emoris injuries can result in compartment syndrome and limb loss.
C. All patients with signi cant hematoma should be surgically explored.
D. Vascular injury repair should be per ormed prior to
realignment o bony ractures or dislocations.

B. Occult pro unda emoris injuries can result in compartment syndrome and limb loss.

Which o the ollowing statements about blunt carotid
injuries is true?
A. Magnetic resonance imaging is the diagnostic modality o choice in patients at risk.
B. Approximately 50% o patients have a delayed
diagnosis.
C. T e mechanism o injury is usually cervical exion
and rotation.
D. Such injuries are always treated operatively when
identi ed.

B. Approximately 50% o patients have a delayed

diagnosis.

Massive trans usion protocols
A. Should include trans usion o plasma and platelets in
addition to packed RBCs
B. Should only be initiated a er blood typing, but crossmatch is not needed
C. Should be initiated in patients with tachycardia
despite administration o 3.5 L o crystalloid uids
D. Should include testing or coagulopathies, present in
5% o patients requiring massive trans usion

A. Should include trans usion o plasma and platelets in

addition to packed RBCs

T e most appropriate treatment or a duodenal hematoma that occurs rom blunt trauma is
A. Exploratory laparotomy and bypass o the
duodenum.
B. Exploratory laparotomy and evacuation o the
hematoma.
C. Exploratory laparotomy to rule out associated
injuries.
D. Observation.

D. Observation.

Damage control surgery (DCS)
A. Limits enteric spillage by rapid repair o partial small
bowel injuries with whipstitch, and complete transection with a GIA stapling device.
B. Aims to control surgical bleeding and identi y injuries that can be managed conservatively or with interventional radiology.
C. Is indicated when patients develop intraoperative
re ractory hypothermia, serum pH >7.6, or re ractory coagulopathy.
D. Abdominal wall should be closed with penetrating
towel clips.

A. Limits enteric spillage by rapid repair o partial small

bowel injuries with whipstitch, and complete transection with a GIA stapling device.

T erapy or 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

B. 20

Cerebral per usion 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

D. Can be increased by lowering ICP and avoiding

hypotension

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

E. Explore the abdomen.

A 36-year-old patient arrives in the trauma bay with a
stab wound to the le chest. A er placement o a le thoracostomy tube and uid resuscitation, his breathing is
stable with BP 160/74 mm Hg and heart rate o 110 beats
per minute. C 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 le heart bypass
B. Endovascular repair with stent
C. Esmolol drip
D. Admission to SICU with repeat C in 24 hours

C. Esmolol drip

A patient with penetrating injury to the chest should
undergo thoracotomy i
A. T ere is more than 500 mL o blood which drains
rom the chest tube when placed.
B. T ere is more than 200 mL/h o blood or 3 hours
rom the chest tube.
C. T ere is an air leak that persists or >48 hours.
D. T ere is documented lung injury on C scan.

B. T ere is more than 200 mL/h o blood or 3 hours

rom the chest tube.

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

B. Admission to SICU with serial complete blood count.

A 25-year-old man has multiple intra-abdominal injuries
a er a gunshot wound. Celiotomy reveals multiple injuries to small and large bowel and major bleeding rom the
liver. A er repair o 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 uid, and intra-abdominal pressure
exceeds 35 mm Hg. T e immediate step in managing this
problem is to
A. Administer albumin intercavernously
B. Give an IV diuretic
C. Limit IV uid administration
D. Open the incision to decompress the abdomen

D. Open the incision to decompress the abdomen

Which o the ollowing 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 nding in postsplenectomy patients.
B. Delayed rebleeding or rupture will typically occur
within 48 hours o injury.
C. Common complications a er splenectomy include
subdiaphragmatic abscess, pancreatic tail injury, and
gastric per oration.
D. Postsplenectomy vaccines against encapsulated bacteria is optimally administered preoperatively or
immediately postoperative.

C. Common complications a er splenectomy include
subdiaphragmatic abscess, pancreatic tail injury, and
gastric per oration

T e most appropriate treatment or a duodenal hematoma that occurs rom blunt trauma is
A. Exploratory laparotomy and bypass o the duodenum
B. Exploratory laparotomy and evacuation o the
hematoma
C. Exploratory laparotomy to rule out associated
injuries
D. Observation

D. Observation

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

C. Distal pancreatectomy with splenic preservation

T e most appropriate treatment or a gunshot wound to
the hepatic exure o the colon that cannot be repaired
primarily is
A. End colostomy and mucous stula.
B. Loop colostomy.
C. Exteriorized repair.
D. Resection o the right colon with ileocolostomy

D. Resection o the right colon with ileocolostomy.

Which o the ollowing statements is FALSE regarding
traumatic genitourinary injury?
A. I exploratory laparotomy is per ormed or trauma, all
blunt and penetrating wounds to the kidneys should
be explored.
B. Renal vascular injuries are common a er penetrating
trauma, and can be deceptively tamponaded by surrounding ascia.
C. Success o renal artery repair a er blunt trauma is
slim, but can be attempted i injury occurred within 5
hours or patient does not have any reserve renal unction (solitary kidney or bilateral injury).
D. Suspected ureteral injuries in patients with penetrating trauma or pelvic ractures can be evaluated intraoperatively with methylene blue or indigo carmine
administered intravenously.
E. Bladder injuries with extraperitoneal extravasation
can be managed with Foley decompression or 2
weeks.

A. I exploratory laparotomy is per ormed or trauma, all
blunt and penetrating wounds to the kidneys should
be explored.

9. At what pressure is operative decompression o a compartment mandatory?
A. 15 mm Hg
B. 25 mm Hg
C. 35 mm Hg
D. 45 mm Hg

D. 45 mm Hg

Which is true regarding trauma in geriatric patients?
A. Admission GCS score a er severe head injury is a
good predictor o outcome.
B. Rib ractures are associated with pulmonary contusion in 35% o patients, and complicated by pneumonia in 10 to 30% o patients.
C. Approximately 10% o patients older than 65 years
will sustain a rib racture rom a all <6 .
D. Chronologic age older than 65 years is associated with
higher morbidity and mortality a er trauma

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

A 22-year- ld man s br ught t the emergency room after a house fire. he has burns around his mouth and his voice is hoarse but breathing is unlabored. what is next step in management
A. Immed ate end tra heal ntubat n.
B. Examination of oral cavity and pharynx, with ber pt laryng s pe ava lable.
C. Pla e n supplemental xygen.
D. Pla ement tw large-b re ntraven us (IV) atheters
w th u d resus tat n.

B. Examination of oral cavity and pharynx, with ber pt laryng s pe ava lable.

What percentage burn does a patient have who has suffered burns to one leg have
A. 18%
B. 27%
C. 36%
D. 45%

D. 45%

A 40-year- after industrial fire at plastic manufacturing plant with burn to face and arm. what is next step
A. C rre t n a d s s by add ng s d um b arb nate
t IV u ds.
B. Administration of 100% oxygen and hydrocobaxmib balam n.
C. ransth ra e h ard gram.
D. Bl d ulture w th IV ant b t s

B. Administration of 100% oxygen and hydrocobaxmib balam n.

Which of the following is a common sequelae of electrical injury?
A. Card a arrhythm as
B. Paralys s
C. Bra n damage
D. Cataracts

D. Cataracts

An 8-year- boy borught to the emergency room after touching hot iron. there is blisters what degree
A. F rst degree
B. Se nd degree
C. T rd degree
D. F urth degree

B. Second degree

3 hours after burn injury that as 3rd degree burns at wrist and elbow. mOTOR FUNCTION IS INTACT. mOST APPROPRIATE TREATMENT IS.
A. Elevat n the extrem ty, D ppler ultras n graphy
every 4 h urs, and d stal pulses are absent 8 h urs
later, mmed ate es har t my.
B. Palpat n r d stal pulses and mmed ate es har t my
pulses are absent.
C. Doppler ultrasoundgraphy r assessment peripheral flow
w and mmed ate es har t my w s de reased.
D. Immed ate es har t my under general anesthes a
r m ab ve the elb w t bel w the wr st n b th
med al and lateral aspe ts the arm.

Doppler ultrasoundgraphy r assessment peripheral flow

What s the fluid requirement a 50-kg man w first degree burns
A. 4.5 L ver 8 h urs, ll wed by 4.5 L ver 16 h urs
B. 4.5 L ver 8 h urs, ll wed by 6 L ver 16 h urs
C. 6 L ver 8 h urs, ll wed by 6 L ver 16 h urs
D. 6 L ver 8 h urs, ll wed by 9 L ver 16 h urs

A. 4.5 L ver 8 h urs, ll wed by 4.5 L ver 16 h urs

. A patient with a 90% burn encompassing the entire torso develops an increasing gpco2 and peak inspiratory pressure. what resolves this problem
A. In rease the del vered t dal v lume.
B. In rease the resp rat ry rate.
C. In rease the Fio2
.
D. perform a thoracic eschartomy

perform a thoracic eschartomy

which of the following is false regrind silver sulfazine

A. Used as pr phylax s aga nst burn w und n e t ns
w th a w de range ant m r b al a t v ty.
B. safe to use on full and partial thickness burns and skin grafts
C. Has l m ted system abs rpt n.
D. May nh b t ep thel al m grat n n part al th kness
w und heal ng.

safe to use on full and partial thickness burns and skin grafts

successful antibiotics penetration of a burn eschar can be achieved with
A. Mafenideacetate
B. Ne my n
C. S lver n trate
D. S lver sul ad az ne

Mafenideacetate

which is true regarding nutritional need of burn patients
A. T e hypermetab l resp nse t burn w unds typ -
ally ra ses the bas metab l rate by 120%.
B. Oxandr l ne, an anab l ster d, an mpr ve lean
b dy mass but an be ass ated w th hypergly em a
and l n ally s gn ant r se n hepat transam n t s.
C. Early enteral eed ng s sa e when burns are less than
20% BSA, therw se enteral eed ng sh uld awa t
return b wel un t n t av d eed ng a pat ent
w th gastr leus.
D.for patients with greater than 40% tBSA, caloric needs are 25 k al/kg/day plus 40
k al/% BSA/day.

for patients with greater than 40% tBSA, caloric needs are 25 k al/kg/day plus 40
k al/% BSA/day.

A 14-year- sustains a steam burn measuring 6 by 7 inches. all can be used except
A. Appl at n s lver sul ad az ne ream (S lvadene)
and da ly washes, but n dress ng.
B. Appl at n ma en de a etate ream (Sul amyl n),
but n da ly washes r dress ng.
C. H m gra appl at n w th ut sutures t se ure t n
pla e, but n da ly washes r dress ng.
D. Heterograft (pig skin) application with sutures

Heterograft (pig skin) application with sutures

which is false regarding surgical treatment of burn wounds
A. angent al ex s n ns sts tangent al sl es
burn t ssue unt l bleed ng t ssue s en untered. T us,
ex s n an be ass ated w th p tent ally s gn ant
bl d l ss.
B. Human cadaver allograft is a permanent alternative
to split thickness
C. Bleed ng r m tangent al ex s n an be helped w th
nje t n ep nephr ne tumes en e s lut n, pneumat t urn quets, ep nephr ne s aked mpresses,
and br n gen and thr mb n spray sealant.
D. Meshed spl t th kness sk n gra s all w ser sangu -
n us dra nage t prevent gra l ss and pr v de a
greater area w und verage.

Human cadaver allograft is a permanent alternative

to split thickness

A 45-year- is admitted into hospital due to 3rd degree burn injury 40% her TBSA, and her wounds are treated with silver saline cream.
the most appropriate management is
A. Repeat the b psy and ulture n 24 h urs.
B. Start subeschar lysis with antibiotics
C. Adm n ster system ant b t s.
D. Surg ally ex se the burn w unds

Start subeschar lysis with antibiotics

Fourteen days after admission to hospital for a 30% partial thickness burn wound. application of catheter best treatment is
A. Ex hange entral ven us atheter ver gu dew re,
ulture t p prev us atheter.
B. reat pat ent w th IV ant b t s unt l bl d ultures
drawn r m atheter are negat ve.
C. remove central venous catheter culture tip and replace with new catheter on contalaterl site
D. Rem val atheter and treat pat ent w th ral ant b -
t s and pa n med at n as needed

remove central venous catheter culture tip and replace with new catheter on contalaterl site

Which o the ollowing 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 brin clot generated at the wound site
as sca olding or migration into the wound.
C. Neutrophil migration is stimulated by local prostaglandins, complement actors, interleukin-1 (IL-1),
tumor necrosis actor-α ( NF-α), trans orming growth
actor-β ( GF-β), platelet actor 4, or bacterial
products.
D. PMNs are the rst cells to in ltrate the wound, peaking
at 24 to 48 hours.
E. Neutrophils release cytokines that later assist with collagen deposition and epithelial closure.

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

T e proli erative phase o wound healing occurs how long
a er the injury?
A. 1 day
B. 2 days
C. 7 days
D. 14 days

C. 7 days

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

C. Even though the tensile strength o a wound reaches a
plateau a er several weeks, the tensile strength will
increase over another 6 to 12 months due to bril ormation and cross-linking.

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

C. Direct or recurrent hernias in children.

. Patients with Mar an syndrome are associated with what
genetic decect?
A. MFN-1 gene deletion
B. ype I collagen gene mutation
C. COL7A1 gene mutation
D. FBN-1 gene mutation

D. FBN-1 gene mutation

When a long bone racture is repaired by internal xation
with plates and screws
A. Callus at the racture site orms more rapidly.
B. Delayed union is prevented.
C. Direct bone-to-bone healing occurs without so callus
ormation.
D. Endochondral ossi cation is more complete.

C. Direct bone-to-bone healing occurs without so callus

ormation.

Which o the ollowing is FALSE regarding healing o ullthickness injuries o the GI tract?
A. Serosal healing is essential to orm a water-tight barrier
to the lumen o the bowel.
B. Extraperitoneal segments o bowel that lack serosa
have higher rates o anastomotic ailure.
C. T ere is an early decrease in marginal strength due to
an imbalance o greater collagenolysis versus collagen
synthesis.
D. Collagen synthesis is done by broblast and smooth
muscle cells.
E. T e greatest tensile strength o the GI tract is provided
by the serosa

E. T e greatest tensile strength o the GI tract is provided

by the serosa

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

A. Decreasing angiogenesis and macrophage migration

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

B. Axonotemesis

T e major cause o impaired wound healing is
A. Anemia
B. Diabetes mellitus
C. Local tissue in ection
D. Malnutrition

C. Local tissue in ection

How does diabetes mellitus impair wound healing?
A. Local hypoxemia, reduced angiogenesis, and inf ammation due to vascular disease.
B. Glycosylation o 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. Local hypoxemia, reduced angiogenesis, and inf ammation due to vascular disease.

Supplementation o which o the ollowing micronutrients improves wound healing in patients without micronutrient de ciency?
A. Vitamin C
B. Vitamin A
C. Selenium
D. Zinc

B. Vitamin A

. Which type o collagen is most important in wound
healing?
A. ype III
B. ype V
C. ype VII
D. ype XI

A. ype III

What is FALSE regarding healing o cartilage?
A. Cartilage is avascular and depends on di usion o
nutrients.
B. Super cial cartilage wounds are not associated with
an inf ammatory response.
C. Cartilage injuries o en heal slowly and result in permanent structural de ects.
D. A major source o nutrients to cartilage is rom nearby
periosteum.

D. A major source o nutrients to cartilage is rom nearby

periosteum

Signs o malignant trans ormation in a chronic wound
include
A. Persistent granulation tissue with bleeding
B. Overturned wound edges
C. Nonhealing a er 2 weeks o therapy
D. Distal edema

B. Overturned wound edges

What is the di erence between hypertrophic scars (H S)
and keloids?
A. Keloids are an overabundance o broplasia as a result
o healing, hypertrophic scars are a ailure o collagen
remodeling.
B. Hypertrophic scars o en regress over time, whereas
keloids rarely regress.
C. Hypertrophic scars are more common in darkerpigmented ethnicities.
D. Hypertropic scars extend beyond the border o the
original wound.

B. Hypertrophic scars o en regress over time, whereas

keloids rarely regress.

T e treatment o choice or keloids is
A. Excision alone
B. Excision with adjuvant therapy (eg, radiation)
C. Pressure treatment
D. Intralesional injection o steroids

B. Excision with adjuvant therapy (eg, radiation)

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

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

Which growth actor has been ormulated and approved
 or treatment o diabetic oot ulcers?
A. PDGF
B. IGF-1
C. IL-8
D. Keritinocyte growth actor
E. Laminin-5

A. PDGF

T e annual age-adjusted cancer incidence rates among
men and women are decreasing or all o the ollowing
EXCEP
A. Colorectal
B. Oropharynx
C. Lung
D. T yroid

D. T yroid

Which o the ollowing is NO a hallmark o cancer?
A. Ability to invade and metastasize
B. Ability to evade apoptosis
C. Ability to evade autophagy
D. Ability to evade immune destruction

C. Ability to evade autophagy

Characteristics o tumorigenic trans ormation o cells
include which o the ollowing?
A. Enhanced sur ace adherence
B. Monolayer con uence inhibition
C. Acquisition o chemoresistance
D. Immortalization

D. Immortalization

T e cell cycle includes all o the ollowing phases EXCEP
A. S phase
B. G1 phase
C. G2 phase
D. G3 phase

D. G3 phase

Which o the ollowing actors are suggestive o a hereditary cancer?
A. umor development at a younger than normal age.
B. Presence o bilateral disease.
C. Association with paraneoplastic syndrome.
D. Presence o multiple primary malignancies.

C. Association with paraneoplastic syndrome.

Which o the ollowing are associated with amilial adenomatous polyposis (FAP)
A. Osteomas
B. Glioblastoma multi orme
C. Meckel diverticulum
D. Esophageal atresia

A. Osteomas

Which mutated gene malignant disease association is
correct
A. PTEN and Li-Fraumeni syndrome
B. RET and MEN2 syndrome
C. P16 and synovial sarcoma
D. BRCA1 and adrenocortical carcinoma

B. RET and MEN2 syndrome

8. Risk or invasive breast cancer development is increased
 or each actor EXCEP
A. Age at menarche <12.
B. Age at f rst live birth >30.
C. Biopsy-proven atypical hyperplasia.
D. No previous breast biopsy

D. No previous breast biopsy.

Routine ongoing cancer screening is recommended or
which o the ollowing malignancies?
A. Ovary
B. Leukemia
C. Carcinoma o the kidney
D. Sarcoma

A. Ovary

Depending on the tumor, acceptable approaches to
biopsy include any o the ollowing EXCEP
A. Fine-needle aspiration
B. Core needle biopsy
C. Incisional biopsy
D. Morcellation

D. Morcellation

Anticancer chemotherapy agents include all o the ollowing EXCEP
A. Alkylating agents
B. Antitumor antibiotics
C. Prometabolites
D. Plant alkaloids

C. Prometabolites

Approved strategies or cancer chemoprevention include
all o the ollowing EXCEP
A. Neurontin or malignant peripheral nerve sheath
tumor
B. amoxi en or breast cancer
C. Celecoxib or FAP syndrome
D. 13-cis-retinoic acid or oral leukoplakia

A. Neurontin or malignant peripheral nerve sheath

tumor

. Hyperacute rejection is caused by
A. Pre ormed antibodies
B. B-cell–generated antidonor antibodies
C. -cell–mediated allorejection
D. Nonimmune mechanism

A. Pre ormed antibodies

T e mechanism o action o azathioprine (AZA) is
A. Inhibition o calcineurin
B. Inter erence with DNA synthesis
C. Binding o FK-506 binding proteins
D. Inhibition o P7056 kinase

B. Inter erence with DNA synthesis

Which o the ollowing is NO a side e ect o cyclosporine?
A. Interstitial f brosis o the renal parenchyma
B. Gingival hyperplasia
C. Hirsutism
D. Pancreatitis

D. Pancreatitis

Postrenal transplant gra thrombosis usually occurs
A. Within 2 to 3 days
B. Within 2 weeks
C. Within 1 month
D. Within 3 months

A. Within 2 to 3 days

T e 1-year gra survival a er renal transplantation is
A. 35–40%
B. 50–55%
C. 75–80%
D. 92–96.5%

D. 92–96.5%

A er completion o the vascular anastomoses, drainage o
a transplanted pancreas is accomplished by anastomosis to
A. Right colon
B. Le colon
C. Duodenum
D. Bladder or small bowel

D. Bladder or small bowel

All o the ollowing are absolute contraindications in considering a candidate or orthotopic cardiac transplantation
EXCEP
A. Active in ection
B. Age over 65 years
C. History o medical noncompliance
D. Severe pulmonary hypertension

B. Age over 65 years

8. Heart transplant donors and recipients are matched using
the ollowing criteria EXCEP
A. Status on the UNOS waiting list
B. Gender
C. Blood type
D. Size

B. Gender

. Required laboratory tests in evaluation o a patient under
consideration or heart transplantation include all o the
ollowing EXCEP
A. Psychosocial evaluation
B. Cardiac catheterization
C. Dental examination
D. All o the above

D. All o the above

Immunologic rejection is mediated by the recipient’s
A. Eosinophils
B. Lymphocytes
C. Neutrophils
D. Plasma cells

B. Lymphocytes

In the prevention o gra rejection, cyclosporine
A. Blocks transcription o interleukin-1 (IL-1) and
tumor necrosis actor-α ( NF-α)
B. Inhibits lymphocyte nucleic acid metabolism
C. Results in rapid decrease in the number o circulatory
lymphocytes
D. Selectively inhibits -cell activation

B. Inhibits lymphocyte nucleic acid metabolism

T e most common cause o renal ailure in the United
States is
A. Chronic glomerulonephritis
B. Chronic pyelonephritis
C. Diabetes mellitus
D. Obstructive uropathy

C. Diabetes mellitus

T e best method o monitoring the development o acute
rejection in a patient a er cardiac transplantation is
A. Dipyridamole thallium study
B. Electrocardiogram
C. Endomyocardial biopsy
D. Ultrasound examination o the heart

C. Endomyocardial biopsy

Absolute contraindications to renal transplantation or a
patient with chronic renal ailure include all o the ollowing EXCEP
A. Chronic active hepatitis
B. Colorectal cancer
C. Psychiatric illness
D. Sickle cell disease

D. Sickle cell disease

. All o the ollowing is true or living renal transplant
EXCEP
A. Donor’s kidneys with multiple renal arteries should
be avoided.
B. T e donor’s le kidney is pre erable.
C. T ere is no medical benef t to the donor.
D. T e intraperitoneal approach is most o en used or
harvest.

B. T e donor’s le kidney is pre erable.

T e single most important actor in determining whether
to per orm a transplant between a specif c donor and
recipient is
A. Mixed lymphocyte culture assays o the donor and
recipient
B. HLA types o the donor and recipient
C. ABO blood types o the donor and recipient
D. Peripheral -cell count o the recipient

C. ABO blood types o the donor and recipient

T e most common diagnosis leading to a heart transplant is
A. COPD
B. Congenital heart disease
C. Ischemic dilated cardiomyopathy
D. Idiopathic dilated myopathy

C. Ischemic dilated cardiomyopathy

All o the ollowing are side e ects o cyclosporine administration or prevention o organ rejection EXCEP
A. Hyperkalemia
B. Hirsutism
C. remor
D. Bone marrow depression

D. Bone marrow depression

All o the ollowing are true o extracorporeal membrane
oxygenation (ECMO) EXCEP
A. Cannulation occurs a er withdrawal o li e support.
B. Minimizes ischemic injury to organs o cardiac death
donors.
C. Organs are per used with warm oxygenated blood
a er declaration o cardiac death.
D. Cannulation occurs be ore withdrawal o li e support.

A. Cannulation occurs a er withdrawal o li e support.

T e most signif cant side e ect o sirolimus is
A. Anemia
B. Leukopenia
C. Impaired wound healing
D. Hypertriglyceridemia

D. Hypertriglyceridemia

T e Donabedian model o measuring quality identi es all
o the ollowing as main types o improvements EXCEP
A. Changes to structure
B. Changes to process
C. Changes to culture
D. Changes to outcomes

C. Changes to culture

T e most common delayed complication ollowing carotid
endarterectomy is
A. Arteriovenous stulae
B. Myocardial in arction
C. Expanding neck hematoma
D. Localized neurologic de cit

B. Myocardial in arction

T e most appropriate treatment or a seroma a er a so -
tissue biopsy is
A. Multiple attempts o aspiration with application o
pressure dressings.
B. Immediate return to the OR or drainage.
C. Single attempt at aspiration with return to the OR i it
recurs.
D. Observation.

A. Multiple attempts o aspiration with application o

pressure dressings

Prophylaxis using low-dose un ractionated heparin reduces
the incidence o atal pulmonary embolisms (PE) by
A. 45%
B. 50%
C. 60%
D. 35%

B. 50%

Which o the ollowing is the best test to predict success ul
extubation o a patient?
A. Respiratory rate
B. Negative inspiratory pressure
C. obin index
D. Minute ventilation

C. tobin index

T e root cause o the majority o wrong-site surgeries
result rom
A. Communication errors
B. Emergency surgery
C. Multiple procedures
D. Multiple surgeons

A. Communication errors

Which o the ollowing have been shown to decrease the
time o postoperative ileus?
A. Cyclooxygenase-1 inhibitors
B. Morphine patient-controlled analgesia
C. Nasogastric drainage until ull return o bowel
unction
D. Erythromycin

D. Erythromycin

In order to reduce the overall risk o stress gastritis in ICU
patients mechanically ventilated or >48 hours, their gastric pH level should be kept greater than
A. 3
B. 5
C. 2
D. 4

D. 4

T e treatment o choice or a biloma a er laparoscopic
cholecystectomy is
A. Reoperation, closure o the leak, and drainage
B. Percutaneous drainage
C. Biliary stent
D. Observation

C. Biliary stent

T e most requent nosocomial in ection is
A. Urinary tract in ection (U I)
B. Sepsis
C. Pneumonia
D. Fungal in ection

A. Urinary tract in ection (U I)

T e rst step in treating a 70-kg patient with a platelet
count o 12,000 due to heparin-induced thrombocytopenia is
A. Anticoagulation
B. rans usion o our units o platelets
C. rans usion o eight units o platelets
D. rans usion o 12 units o platelets

D. rans usion o 12 units o platelets

VAP in ventilated ICU patients reaches a 70% probability at
A. 5 days
B. 15 days
C. 30 days
D. 45 days

C. 30 days

Which o the ollowing is the only thing that has been
shown to decrease wound in ections in surgical patients
with contaminated wounds?
A. Use o iodophor-impregnated polyvinyl drapes.
B. Saline irrigation o the peritoneum and wound.
C. Antibiotic irrigation o the peritoneum and wound.
D. 24 hours o appropriate antibiotics postoperatively (in
addition to preoperative dose).

B. Saline irrigation o the peritoneum and wound.

racheostomy may decrease the incidence o VAP, overall
length o ventilator time, and the number o ICU patient
days when per ormed
A. Be ore the h day o ventilator support
B. Be ore the 10th day o ventilator support
C. Be ore the 15th day o ventilator support
D. Be ore the 20th day o ventilator support

B. Be ore the 10th day o ventilator support

Which o the ollowing is a dominant cytokine in the
pathogenesis o systemic inf ammatory response syndrome (SIRS)?
A. Interleukin-2 (IL-2)
B. IL-5
C. IL-6
D. IL-7

C. IL-6

T e most common cause o postrenal ailure is
A. A clogged urinary catheter
B. An unintentional ligation o ureters
C. A large retroperitoneal hematoma
D. Acute kidney ailure

A. A clogged urinary catheter

Laryngoscopic ndings a er a superior laryngeal nerve
injury include
A. Ipsilateral vocal cord in a paramedian position
B. Ipsilateral vocal cord in a middling position
C. Asymmetry o the glottic opening
D. Normal examination

C. Asymmetry o the glottic opening

All o the ollowing are true statements regarding wound
in ection EXCEP
A. Irrigation o the operative eld and surgical wound
with saline solution is bene cial.
B. Prophylactic use o antibiotics continued beyond
48 hours is bene cial.
C. Irrigation with an antibiotic-based solution has not
been shown to be bene cial.
D. Antibacterial-impregnated polyvinyl placed over the
operative wound area or the duration o the surgical
procedure is not bene cial

B. Prophylactic use o antibiotics continued beyond

48 hours is bene cial.

T e most common cause o an empyema in the postoperative patient is
A. Pneumonia
B. Systemic sepsis
C. Esophageal per oration
D. Retained hemothorax

A. Pneumonia

T e primary cause o hyperbilirubinemia in the surgical
patient is
A. Sepsis
B. Hematoma rom trauma
C. Cholestasis
D. Increased unconjugated bilirubin due to hemolysis

C. Cholestasis

T e point o critical oxygen delivery (DO2crit)
A. Represents the transition rom supply-independent to
supply-dependent oxygen uptake and is decreased in
sepsis.
B. Represents the minimal rate o oxygen delivery needed
or aerobic metabolism and is decreased in sepsis.
C. Represents the transition rom supply-independent to
supply-dependent oxygen uptake and is increased in
sepsis.
D. Represents the minimal rate o oxygen delivery needed
or aerobic metabolism and is increased in sepsis

C. Represents the transition rom supply-independent to
supply-dependent oxygen uptake and is increased in
sepsis.

O the ollowing parameters, which is the least in uenced
by an underdamped or overdamped intra-arterial blood
pressure monitoring system?
A. Systolic blood pressure
B. Mean arterial blood pressure
C. Diastolic blood pressure
D. Pulse pressure

B. Mean arterial blood pressure

Regarding electrocardiographic (ECG) monitoring in
the ICU
A. A standard 3-lead ECG will detect 95% o ischemia,
whereas a 12-lead ECG will detect greater than 98%.
B. Lead V4
is the most sensitive or detecting perioperative ischemia.
C. A standard 3-lead ECG will detect ischemia at the same
rate as a12-lead ECG; however, it is in erior at identi ying dysrhythmias.
D. Lead V2
is the most sensitive or detecting perioperative ischemia

B. Lead V4

is the most sensitive or detecting perioperative ischemia

Regarding preload, which o the ollowing is true?
A. It is approximated by the systemic vascular resistance
which is calculated by dividing mean arterial pressure
(MAP) by cardiac output.
B. It is approximated by the right ventricular end-diastolic pressure (EDP) as estimated with pulmonary
artery occlusion pressure.
C. It is approximated by the right ventricular EDP as estimated with central venous pressure (CVP).
D. It is approximated by the le ventricular EDP as estimated with pulmonary artery occlusion pressure.

D. It is approximated by the le ventricular EDP as estimated with pulmonary artery occlusion pressure.

All o the ollowing are true EXCEP
A. T e relationship between EDP and preload is linear.
B. EDP is determined by both volume and compliance o
the ventricle.
C. T e relationship between EDP and end-diastolic volume (EDV) can be changed with pharmacologic
agents.
D. EDP is o en used as a surrogate or EDV because it is
easier to approximate in the clinical setting

A. T e relationship between EDP and preload is linear.

T e end-systolic pressure-volume line
A. Provides a good estimation o le ventricular
compliance.
B. Uses small changes in preload and a erload between
cardiac cycles to determine contractility, which is represented by the x-intercept o the line.
C. T e slope will become steeper i contractility is
increased.
D. Requires preload to be held approximately constant to
be measured.

C. T e slope will become steeper i contractility is

increased.

T e thermodilution technique or determining cardiac
output
A. Calculates Q with the Fick equation
B. Underestimates cardiac output at low values
C. Should be per ormed with a cold indicator liquid to
increase the signal-to-noise ratio
D. Is in uenced by respiratory cycle due to changes in
blood temperature and Q

D. Is infuenced by respiratory cycle due to changes in

blood temperature and QT

All o the ollowing are true regarding the ractional saturation o hemoglobin in mixed venous blood (SVO2
)
EXCEP
A. It will decrease with worsening heart ailure.
B. It will decrease with increased sedation.
C. It will decrease with worsening anemia.
D. It will decrease with ever.

B. It will decrease with increased sedation.

T e Surviving Sepsis Campaign guidelines recommend
which o the ollowing regarding the initial resuscitation o
sepsis-induced hypoper usion?
A. Goal MAP ≥60 mm Hg.
B. Goal SVO2
o 80%.
C. Goal urine output ≥ 1 mL/kg/h.
D. T at goals o resuscitation be met within the rst 6
hours o management.

D. T at goals o resuscitation be met within the rst 6

hours o management.

Noninvasive methods o measuring cardiac output
A. Allow or continuous measurement o Q
B. Show excellent correlation with Q as measured by
thermodilution
C. Have rarely been adopted into clinical practice due to
the increased training burden
D. Have similar complication rates as the use o a pulmonary artery catheter

A. Allow or continuous measurement o Q

Using pulse pressure variability (PPV) to determine preload responsiveness
A. Is reliable or a patient in rate-controlled atrial brillation, but not or a patient in atrial utter.
B. Is a better predictor o preload responsiveness than
CVP.
C. De nes PPV as the dif erence between the maximal
pulse pressure and the minimal pulse pressure observed
at dif erent points in the respiratory cycle.
D. Is unreliable in mechanically ventilated patients due
to decreased venous return during inspiration.

B. Is a better predictor o preload responsiveness than

CVP.

Strategies or increasing oxygen delivery in mechanically
ventilated, critically ill patients include
A. Increasing Sao2
by increasing inspiratory time
B. Increasing Sao2
by increasing respiratory rate
C. Increasing SVO2
by switching to a reversed inspiratory to expiratory ratio ventilation strategy
D. Increasing SVO2
by increasing positive end-expiratory
pressure (PEEP)

A. Increasing Sao2

by increasing inspiratory time

All o the ollowing are true regarding airway pressures
EXCEP
A. Bronchospasm will cause increased peak pressure
with a relatively normal plateau pressure.
B. Pneumothorax will cause increased peak and plateau
pressures.
C. Lobar atelectasis will cause increased plateau pressures with relatively normal peak pressures.
D. Plateau pressure is independent o airway resistance.

C. Lobar atelectasis will cause increased plateau pressures with relatively normal peak pressures.

Causes o an increase in end-tidal-CO2
 include
A. Massive pulmonary embolism
B. Reduced cardiac output
C. Sustained hyperventilation
D. Reduced minute ventilation

D. Reduced minute ventilation

Which o the ollowing is NO an indication or intracranial pressure (ICP) monitoring?
A. Glasgow Coma Scale (GCS) less than or equal to 8
with an abnormal computed tomography (C ) scan.
B. Severe traumatic brain injury ( BI) in a patient
older than 40 years and systolic blood pressure less
than 90 mm Hg.
C. Intracranial hemorrhage without intraventricular
blood.
D. Fulminant hepatic ailure with coma and cerebral
edema on C .

C. Intracranial hemorrhage without intraventricular

blood

Currently accepted uses o transcranial Doppler ( CD)
include all o the ollowing EXCEP
A. Diagnosing vasospasm a er subarachnoid hemorrhage
B. Estimating cerebral per usion pressure
C. Con rming brain death a er clinical examination in
patients under the in uence o central nervous system (CNS) depressants.
D. Con rming brain death a er clinical examination in
patients with metabolic encephalopathy

B. Estimating cerebral per usion pressure

Regarding jugular venous oximetry in patients with BI
A. It requires placement o a catheter in the jugular bulb.
B. Low jugular venous oxygen saturation (Sjo2
) has not
been show to predict poor clinical outcomes.
C. It is less invasive than placing an intraventricular
monitor, but does not allow or continuous
monitoring.
D. It can replace ICP monitoring in patients without evidence o regional variation in cerebral blood ow.

A. It requires placement o a catheter in the jugular bulb.

Monitoring local brain tissue oxygen tension (PbtO2
) in
patients with severe BI
A. Has shown that normal ICP and CPP generally precludes the presence o brain tissue ischemia
B. Has been shown to lower mortality when compared
with ICP monitoring alone
C. Has not been adopted into routine clinical practice
due to additional adverse ef ects rom additional,
potentially unnecessary, interventions
D. Has been shown to increase stroke rate as a complication o catheter placement

B. Has been shown to lower mortality when compared

with ICP monitoring alone

T e most common arrhythmia seen during laparoscopy is
A. Atrial brilation
B. Sinus tachycardia
C. Premature ventricular contractions
D. Sinus bradycardia

D. Sinus bradycardia

Capacitive coupling
A. Results when energy bleeds rom a port sleeve or laparoscope into adjacent (but not touching) bowel
B. Is always recognized at the time o surgery
C. Can result in mal unction o the electrocardiogram
monitor
D. Can result in inaccurate image transmission to the digital monitor

A. Results when energy bleeds rom a port sleeve or laparoscope into adjacent (but not touching) bowel

Which o the ollowing are true regarding sa e laparoscopic surgery in pregnancy.
A. T e patient should be position in the lef lateral
position.
B. Open abdominal access (Hasson) is recommended
versus direct puncture laparoscopy (Veress neelde).
C. T e surgery should be per ormed during the second
trimester i possible.
D. All o the above.

D. All o the above.

Systemic e ects o CO2
 rom pneumoperitoneum can
cause all o the ollowing EXCEP
A. Hypercarbia
B. Increased myocardial oxygen demand
C. Alterations in preload
D. Increased af er load

C. Alterations in preload

While per orming a laparoscopic Nissen undoplication
during the transhiatal dissection the mediastinal pleura is
compromised and a CO2
pneumothorax develops. What is
the initial pre erred management o the pneumothorax?
A. Needle thoracostomy over the second intercostal
space, mid-clavicular line.
B. Enlargement o the de ect and placement o an
18-French red rubber catheter across the de ect.
C. Abort the procedure and emergent tube thoracostomy
with a 28-French chest tube.
D. No intervention is needed. Continue with the planned
procedure.

B. Enlargement o the de ect and placement o an

18-French red rubber catheter across the de ect.

When compared to traditional laparoscopic surgery, the
advantages o computer-enhanced surgery are
A. Natural wrist movements and improved manual
dexterity
B. Ergonomically com ortable workstation with 3-D
imaging
C. remor elimination
D. All o the above

D. All o the above

A patient undergoing laparoscopic colon resection is
noted to have decreased urine output during the last hour
o the case. A bolus is given at the end o the case. One hour
later, there is still very poor urine output. T e appropriate
treatment is
A. Repeat bolus
B. Intravenous (IV) urosemide
C. Check urine electrolytes
D. None o the above

D. None o the above

T e process that occurs during translational control o
eukaryotic gene expression is
A. Protein degradation
B. RNA processing
C. Posttranslational control
D. ranscription

A. Protein degradation

All o the ollowing transcription mechanisms occur in
eukaryotes EXCEP
A. Chromatin structure changes to allow DNA to be
accessible to the polymerase.
B. T ree separate RNA polymerases are involved.
C. Proteins or initiation actors are not required.
D. O en packaged with histone and nonhistone proteins
into chromatins.

C. Proteins or initiation actors are not required.

T e human genome contains approximately
A. 35,000 to 40,000 genes
B. 20,000 to 25,000 genes
C. 25,000 to 30,000 genes
D. 30,000 to 35,000 genes

C. 25,000 to 30,000 genes

I cyclin-dependent kinase (CDK) is to a cell as an engine
is to a car, then cyclins and CKI are
A. T e key and ignition, respectively.
B. T e gas pedal and brakes, respectively.
C. T e distributor and the spark plug, respectively.
D. T e windows and the tires, respectively

B. T e gas pedal and brakes, respectively.

In cellular apoptosis, the release o cytochrome c activates the
A. Fas receptor
B. Death receptor
C. umor necrosis actor receptor
D. Caspase cascade

D. Caspase cascade

Dysregulation o trans orming growth actor-beta ( GF-β)
signaling is associated with all o the ollowing EXCEP
A. Cancer
B. Inguinal hernias
C. Mar an syndrome
D. T oracic aortic aneurysm

B. Inguinal hernias

T e only gene expression detection method that provides
in ormation regarding mRNA size is
A. Polymerase chain reaction (PCR)
B. Southern blot hybridization
C. Northern blot hybridization
D. Immunoblotting

C. Northern blot hybridization

All o the ollowing are cell-sur ace receptors EXCEP
A. ransmitter-gated ion channels
B. Seven-transmembrane-G-protein–coupled receptors
(GPCRs)
C. Enzyme-linked receptors
D. Adhesive receptors

D. Adhesive receptors

T e process o decoding in ormation on mRNA to synthesize proteins is called
A. ranscription
B. ranslation
C. Replication
D. Signaling

B. ranslation

T e cell cycle period in which DNA is duplicated is
 A. S
 B. G1
 C. M
 D. G2

A. S

In the transcription o prokaryotes, binding o RNA polymerase to the speci c promoter region is achieved by
 A. Sigma actors
 B. Operon
 C. Elongation actors
 D. Rho actors

A. Sigma actors

When per orming cell culture, cells should be
A. Maintained in culture inde nitely.
B. Fed with resh medium every 2 to 3 days and split
when they reach conf uency.
C. Prepared on sur aces wiped with a 50% ethyl alcohol
solution.
D. Maintained in a dehumidi ed carbon dioxide incubator at 37°F

B. Fed with resh medium every 2 to 3 days and split

when they reach conf uency.

All o the ollowing are involved in gene regulation
EXCEP
A. Introns
B. Control o messenger RNA (mRNA) stability
C. Lack o modi cation o mRNA
D. Control o export o mRNA rom the nucleus to the
cytoplasm

C. Lack o modi cation o mRNA

Which o the ollowing is a regulator o the cell cycle?
 A. CDK
 B. yrosine kinase
 C. Pol II holoenzyme
 D. Caspase

A. CDK

Which o the ollowing drugs is a monoclonal antibody to
an oncogene?
 A. rastuzumab
 B. Methotrexate
 C. Adriamycin
 D. Gleevec

A. rastuzumab

Brainscape's Knowledge GenomeTM

final exam year 1 Flashcards

Brainscape's Knowledge Genome^TM