LE 2 Flashcards
1
Q
WHICH OF THE FOLLOWING CONDITIONS CAN CAUSE A DECREASE IN THE EFFECTIVE CIRCULATING VOLUME?
A. MASSIVE HEMATOMA FORMATION
B. THIRD SPACE LOSS
C. PERIPHERAL VASODILATATION
D. ALL OF THE ABOVE
A
D. ALL OF THE ABOVE
All of the mentioned conditions can cause a decrease in the effective circulating volume:
A. Massive hematoma formation leads to blood pooling outside of the circulatory system.
B. Third space loss refers to the loss of fluid into spaces where it’s not easily accessible or usable (like the interstitial space or the peritoneal cavity).
C. Peripheral vasodilatation can decrease the effective circulating volume by expanding the vascular space without a corresponding increase in fluid volume.
2
Q
- Which of the ff. conditions can cause a decrease in the effective circulating volume
A. Massive Hematoma Formation
B. Third Space loss
C. Peripheral Vasodilation
D. All of the above
A
D. All of the above
3
Q
3 THE PLASMA VOLUME IN A 50 KG MAN WILL BE
A. 7.5 LITERS
B. 1LITER
C. 2 LITERS
D. 2.5 LITERS
A
D. 2.5 LITERS
4
Q
- A 25 yr old (40kg) male in because of vomiting and LBM. His estimated intracellular volume will be
A. 20 liters
B. 2 liters
C. 8 liters
D. 16 liters
A
D. 16 liters
5
Q
- A PX CAME IN TO THE ER HIS BLOOD SUGAR WAS 800 MG% (N= 100MG%). HIS SERUM SODIUM (N= 140MEQ/L) IS EXPECTED TO BE ABOUT *
A. NORMAL
B. HIGHER THAN NORMAL
C. LOWER THAN NORMAL
D. NONE OF THE ABOVE
A
C. LOWER THAN NORMAL
In hyperglycemia, elevated blood glucose levels can cause an osmotic effect, drawing water out of the cells into the extracellular fluid. This dilution effect can result in a laboratory artifact known as pseudohyponatremia, where the measured sodium concentration appears lower than the actual physiologic concentration.
For every 100 mg% increase in blood glucose above normal, the serum sodium is expected to decrease by about 1.6 to 2.4 mEq/L.
In this case, the blood sugar is 700 mg% higher than the normal (800 mg% - 100 mg% = 700 mg%). This could cause a reduction in the serum sodium value by approximately 11.2 to 16.8 mEq/L (using the range of 1.6 to 2.4 mEq/L per 100 mg%).
Given a normal serum sodium value of 140 mEq/L, this decrease would lead to an expected sodium level well below the normal range.
Therefore, the correct answer is:
C. LOWER THAN NORMAL
6
Q
A 60 yr old px came into the ER with difficulty of breathing. On auscultation there was decrease breath sound on the right lung field with audible wheezing. His ABG will reveal
A. Metabolic alkalosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic acidosis
A
B. Respiratory acidosis
Respiratory Acidosis: Hypoventilation
Respiratory Alkalosis: Hyperventilation
Respiratory acidosis occurs when there is an accumulation of CO2 in the blood due to hypoventilation or inadequate ventilation. The decreased breath sounds and wheezing suggest that this patient is not ventilating effectively, leading to a buildup of CO2 in the blood.
The given clinical scenario provides the following information:
The patient is experiencing difficulty breathing.
On auscultation, there is decreased breath sound on the right lung field with audible wheezing.
Based on the given information, it seems the patient might have an obstruction (possibly due to a foreign body, mucus plug, or other causes) or a condition such as asthma or chronic obstructive pulmonary disease (COPD) that’s causing the wheezing and decreased breath sounds. When there’s an obstruction or difficulty in ventilation, there is typically a decrease in the elimination of carbon dioxide (CO2) from the lungs. CO2 is an acid, so when it accumulates in the blood, it causes the blood to become more acidic.
7
Q
- ON PHYSICAL EXAMINATION THE FONTANELLES ARE DEPRESSED. THE INFANT MAY BE SUFFERING FROM
A. VOLUME LOSS
B. WATER DEFICIT
C. VOLUME DEFICIT
D. WATER EXCESS
A
C. VOLUME DEFICIT
8
Q
- A 25 Year Old Male Diagnosed With Cushing Syndrome Came In With The Following Lab Results Urine Na > 20meq/L And Serumosmolality > 300mosmole . This Condition Is Compatible W/ ?
A. NORVOLEMIC HYPERNATREMIA
B. HYPOVOLEMIC HYPERNATREMIA
C. HYPERVOLEMIC HYPERNATREMIA
d. NONE OF THE ABOVE
A
C. HYPERVOLEMIC HYPERNATREMIA
Given a patient with Cushing Syndrome, elevated urine sodium (>20 mEq/L), and serum osmolality > 300 mOsmol/L, this suggests that the patient is losing free water in the urine. Thus, this patient is likely concentrating their urine but still excreting sodium, suggestive of HYPERVOLEMIC HYPERNATREMIA typically seen with conditions like Cushing syndrome where there’s an excess of mineralocorticoids.
9
Q
21.Total body water in the obese is less than the normal because fat contains more water.
A. Statement is true
B. Statement is false
C. Statement is true but reason is false
D. Both statement and reason are false
A
C. Statement is true but reason is false
The first part of the statement, “Total body water in the obese is less than the normal,” is true. Obese individuals have a lower percentage of their total body weight made up of water because fat tissue contains less water compared to lean tissue.
The reason provided, “because fat contains more water,” is false. In fact, fat contains less water than lean tissue.
Young and Lean = High TBW
Elderly and Obese = Low TBW
Obese = REDUCE TBW by 10-20% (FAT > Muscle)
Malnourished = ADD TBW by 10% (Dec. FAT = Dec. Muscle)
10
Q
23.A PX PRESENTED WITH 1ST DEGREE AV BLOCK WITH A FLATTENED T WAVE, SHORTENED QRS. THIS CONDITION IS SEEN IN
A. HYPERKALEMIA
B. HYPOKALEMIA
C. HYPERCALCEMIA
D. HYPOCALCEMIA
A
B. HYPOKALEMIA
11
Q
- IN A PX WITH NORMAL KIDNEY FUNCTION , THE URINE SODIUM WAS FOUND TO BE < 20MEQ/L . THIS CONDITION IS SEEN IN
A. WATER EXCESS
B. TRUE HYPONATREMIA
C. WATER DEFICIT
D. NONE OF THE ABOVE
A
C. WATER DEFICIT
The condition where urine sodium is < 20 mEq/L in the context of hypernatremia and with a patient with normal kidney function is seen in:
Hypovolemic hypernatremia.
12
Q
- 25% OF THE INSENSIBLE LOSS IS FROM THE SKIN EVAPORATION
A. STATEMENT IS TRUE
B. STATEMENT IS FALSE
C. STATEMENT IS TRUE BUT REASON IS FALSE
D. BOTH STATEMENT
A
B. STATEMENT IS FALSE
Water Loss (Insensible)
Lungs (25%)
Skin (75%)
13
Q
- The main determinant/s of body osmolality is/are
A. Na
B. BUN
C. glucose
D. All of the above
E. None of the above
A
D. All of the above
14
Q
37 A 45 year old female came in with persistent vomiting of previously ingested food 2 days prior to consultation. Her ABG will show
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
A
A. Metabolic alkalosis
Persistent vomiting leads to a loss of gastric acid (hydrochloric acid). This loss of acid can cause a rise in the blood pH, leading to metabolic alkalosis.
15
Q
- The minimum volume of urine to expel body waste is
A. 800 cc
B. 500 cc
C. one liter
D. 600 cc
A
B. 500 cc
Obligatory Urine Volume:
500-800 mL urine/day
16
Q
45.The concentration gradient of the intracellular and extracellular space is maintained by
a. starling’s principle
b. Na-K pump
c. Gibbs donnan equilibrium
d. none of the above
A
b. Na-K pump
17
Q
47.THE PREDOMINANT ANION IN THE EXTRACELLULAR SPACE IS
A. SULFATES
B. PROTEIN
C. PHOSPHATES
D. CHLORIDE
A
D. CHLORIDE
Cation
(1) PiSo (2) MiCo
Anion
(1) PhiClo (2) SuliBio
18
Q
49 A px was diagnosed to be suffering from acute pancreatitis . Which of the following is expected ?
A. Hypokalemia
B. Hyponatremia
C. Hypocalcemia
D. None of the above
A
C. Hypocalcemia
19
Q
50 MOVEMENT OF THE FLUID BETWEEM COMPARTMENTS IS DETERMINED BY HYDOSTATIC AND ONCOTIC PRESSURES . THIS IS KNOWN AS
A. PASSIVE DIFFUSION
B. ACTIVE TRANSPORT
C. STARLING FORCES
D. GIBBS DONAN EQUILIBRIUM
A
C. STARLING FORCES
The movement of fluid between compartments (e.g., between blood vessels and interstitial fluid) due to hydrostatic and oncotic pressures is described by the Starling equation. These forces are known as:
C. STARLING FORCES
Hydrostatic pressure tends to push fluid out of blood vessels, while oncotic pressure (due to proteins in the blood) tends to pull fluid back in. The balance of these forces determines the net movement of fluid across capillary walls. Starling’s principle or the Starling equation describes this phenomenon.
20
Q
The metabolic derangement most commonly seen in patients with profuse vomiting
A. Hypochloremic, hyperkalemic metabolic acidosis
B. Hypochloremic, hypokalemic metabolic acidosis
C. Hypochloremic, hyperkalemic metabolic alkalosis
D. Hypochloremic, hypokalemic metabolic alkalosis
A
D. Hypochloremic, hypokalemic metabolic alkalosis
Profuse vomiting leads to a loss of gastric acid (hydrochloric acid). The loss of hydrochloric acid causes:
A decrease in chloride ions, leading to hypochloremia.
A compensatory loss of potassium ions in the kidneys in exchange for sodium and hydrogen ions, leading to hypokalemia.
A loss of hydrogen ions (due to the loss of hydrochloric acid), leading to a primary metabolic alkalosis.
21
Q
- A patient who has spasms in the hand when a blood pressure cuff’s blown up most likely has?
A. Hypercalcemia
B. Hypermagnesia
C. Hypomagnesia
D. Hypocalcemia
A
D. Hypocalcemia
The phenomenon you are describing is known as Trousseau’s sign. When a blood pressure cuff is inflated on the arm and causes spasms in the hand and forearm, it is indicative of Trousseau’s sign, which is a clinical sign for latent tetany associated with hypocalcemia.
22
Q
- A dry sticky mucus membrane is pathognomonic of what condition
A. Volume deficit
B. Hypernatemia
C. Hyponatremia
D. Volume excess
A
B. Hypernatemia
23
Q
- A 5 MONTH OLD INFANT (5 KG) CAME IN THE ER BECAUSE OF VOMITING . HIS ESTIMATED INTRACELLULAR VOLUME WILL BE
A. 1.0 Liters
B. 0.25 Liters
C. 2.0 Liters
D. 3.0 Liters
A
C. 2.0 Liters
24
Q
- The body needs at least 1.5 liters of fluid intake/ day.
A. STATEMENT IS TRUE
B. STATEMENT IS FALSE
C. STATEMENT IS TRUE BUT REASON IS FALSE
D. BOTH STATEMENT AND REASON ARE FALSE
A
B. STATEMENT IS FALSE
25
67.The key to the correction of metabolic alkalosis will be the replacement of *
A. Chloride
B. Bicarbonate
C. Carbonic acid
D. None of the above
A. Chloride
Metabolic alkalosis is characterized by an elevation of serum bicarbonate. One of the common causes of metabolic alkalosis is the loss of gastric acid (for instance, from vomiting or gastric suctioning), which results in a loss of chloride ions. When chloride is lost, the body compensates by retaining bicarbonate, leading to alkalosis.
To correct metabolic alkalosis, especially when it's due to chloride loss, chloride needs to be replaced. This will allow the kidneys to excrete excess bicarbonate, thereby correcting the alkalosis.
26
69. THE MINIMUM VOLUME OF URINE TO EXPEL BODY WASTE IS
A. 1.5 LITERS
B. 600 ML
C. 400 ML
D. 800 ML
D. 800 ML
27
72. CALCIUM IS MOSTLY FOUND IN THE INTRACELLULAR SPACE .
A. STATEMENT IS TRUE
B. STATEMENT IS FALSE
C. STATEMENT IS TRUE BUT REASON IS FALSE
D. BOTH STATEMENT AND REASON ARE FALSE
B. STATEMENT IS FALSE
Cation
(1) PiSo (2) MiCo
Anion
(1) PhiClo (2) SuliBio
28
76. THE TOTAL BODY WATER WILL BE ESTIMATED AT:
A. 2.0 L
B. 1.0 L
C. 3.0 L
D. 4.0 L
A. 2.0 L
29
79 WHAT IS THE MOST COMMON FLUID PROBLEM IN A SURGICAL PATIENT
A Volume deficit
B. Water deficit
C. Water excess
D. Volume excess
A Volume deficit
30
80. A 25 year old female was brought to ER after ingesting 100 tablets of INH. What is the expected ABG findings
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
D. Metabolic acidosis
Isoniazid (INH) is an antitubercular medication. Overdose with isoniazid can lead to seizures and metabolic acidosis, especially lactic acidosis. This is due to the inhibition of several enzymes in the pyridoxine (vitamin B6) metabolic pathway by INH, which can lead to a buildup of toxic intermediates.
31
81. A shipwrecked 50kg Px was brought to the ER. His serum [Na] = 130MEQ/L (N+ 135-145MEQ/L). His Urine sodium is normal. The total deficit would be?
A. 10 MEQ
B. 300 MEQ
C. 30 MEQ
D. NOTA
A. 10 MEQ
32
82. A 16 year old female came in to the ER because of sweating after a break-up with her boyfriend. Her respiratory rate was noted to be 140/min. Her ABG will reveal
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
B. Respiratory alkalosis
Respiratory Acidosis: Hypoventilation
Respiratory Alkalosis: Hyperventilation
A respiratory rate of 140/min is extremely high and suggests hyperventilation. Hyperventilation leads to an increased removal of carbon dioxide (CO₂) from the bloodstream, resulting in a decreased partial pressure of CO₂ (PaCO₂) in the arterial blood.
A decreased PaCO₂ will cause a rise in blood pH due to a reduction in carbonic acid concentration. This condition is termed respiratory alkalosis.
33
87. A 5 MONTH OLD INFANT (5 KG) CAME IN THE ER BECAUSE OF VOMITING .The extracellular fluid space must be?
A. 4 Liters
B. 1 Liter
C. 0.75 Liters
D. 2 Liters
B. 1 Liter
34
90. THE DETERMINANT /S OF BODY OSMOLALITY IS/ARE *
A. Sodium
B. BUN
C. Glucose BUN
D. ALL OF THE ABOVE
E. NONE OF THE ABOVE
D. ALL OF THE ABOVE
Body osmolality is a measure of the solute concentration in body fluids. The major determinants of plasma osmolality are:
Sodium (and its associated anions) - Sodium is the primary extracellular cation and is a major contributor to serum osmolality.
Blood urea nitrogen (BUN) - Urea is a product of protein metabolism and contributes to osmolality.
Glucose - Elevated glucose levels can significantly affect serum osmolality.
35
92. An 18 Yr Old Female Came In Because Of Weakness And Abdominal Distention. Her Serum K = 2.5meq/L (N= 3.5 -5.0 Meq/L). Which Of The Following Findings Are Compatible With Her Condition
A. U Waves
B. Flattened T Waves
C. Paralysis
D. All Of The Above
E. None Of The Above
D. All Of The Above
36
94. What is the most predominant cation in the extracellular fluid space
A. Sodium
B. Potassium
C. Magnesium
A. Sodium
Cation
(1) PiSo (2) MiCo
Anion
(1) PhiClo (2) SuliBio
37
99. The amount of calcium found in the extracellular fluid space
A. 20%
B. 10%
C. 30%
D. 1%
D. 1%
38
1. The following statements are true regarding cellular effects of shock except?
A. Decreased intracellular pH does not lead to changes in cellular gene expression, impair cellular metabolic pathways and impede cell membrane ion exchange
B. Decreased intracellular pH (intracellular acidosis) can alter the activity of cellular enzymes
C. Acidosis leads to cellular changes in calcium metabolism and calcium mediated cellular signaling which alone can interfere with the activity of specific enzymes and cell function
D. Changes in the normal cell function may progress to cellular injury or cell death
E. None of the above
A. Decreased intracellular pH does not lead to changes in cellular gene expression, impair cellular metabolic pathways and impede cell membrane ion exchange
A decrease in intracellular pH (acidosis) can indeed lead to changes in cellular gene expression, impair cellular metabolic pathways, and impede cell membrane ion exchange.
39
2. The following hormones are increased in shock except:
A. Glucagon
B. Insulin
C. Cortisol
D. ADH
E. NOTA
B. Insulin
In the context of shock:
A. Glucagon: Increases in response to stress, promoting glycogenolysis and raising blood glucose levels.
B. Insulin: Typically, insulin levels decrease in response to acute stress or shock. The body prioritizes increasing blood glucose levels to provide energy for essential organs and tissues during these conditions. Elevated glucagon, cortisol, and other counterregulatory hormones inhibit insulin secretion and action.
C. Cortisol: Increases in response to stress. It is a major stress hormone released from the adrenal cortex and plays a role in increasing blood glucose levels, among other effects.
D. ADH (Antidiuretic hormone): Also known as vasopressin, it increases in shock. It promotes water reabsorption in the kidneys and vasoconstriction, both of which help to raise blood pressure.
40
3. Activated PMNs generate and release a number of substances that may induce cell or tissue injury. Except?
A. Cathepsin G
B. Elastase
C. Leukotrienes
D. Platelet- Activating Factor
E. None of the above
E. None of the above
Polymorphonuclear leukocytes (PMNs) or neutrophils play a vital role in the body's defense against infections. When activated, PMNs release various substances that help in the killing and digestion of microbes. However, in some conditions, especially in excessive or inappropriate activation, these substances can induce tissue injury.
Let's evaluate each substance:
A. Cathepsin G: It's a serine protease released by neutrophils that can degrade extracellular matrix proteins, contributing to tissue damage.
B. Elastase: It's another protease released by neutrophils. It can degrade elastin and other tissue components, leading to tissue injury.
C. Leukotrienes: These are lipid mediators produced by leukocytes, including neutrophils. They are involved in inflammation and can contribute to tissue damage and inflammation.
D. Platelet-Activating Factor (PAF): It's a phospholipid mediator that can be produced by various cells, including neutrophils. PAF can stimulate platelet aggregation, induce inflammation, and contribute to tissue damage.
41
4 Agitated patient including cool clammy extremities, tachycardia, weak or absent peripheral pulses, and hypotension. This type of shock results from at least how much blood loss?
A. >40%
B. 30-40%
C. 25-30%
D. 15-25%
E. <15%
B. 30-40%
Clinical signs of shock:
o Agitation
o Cool clammy extremities
o Tachycardia
o Week or absent peripheral pulses
o Hypotension (atleast 25% of blood loss)
Classification of Hemorrhagic Shock:
1. Class I (Loss of up to 15% of blood volume):
* Little to no change in vital signs.
* Pulse and blood pressure remain near baseline.
* Symptoms are usually minimal or absent.
2. Class II (Loss of 15-30% of blood volume):
* Mild tachycardia.
* Slight hypotension might be present.
* Increased heart rate, but still compensatory and not severe.
3. Class III (Loss of 30-40% of blood volume):
* Significant tachycardia.
* Notable hypotension.
* Decreased urinary output.
* Cool, clammy skin.
* Changes in mental status might start to be evident.
4. Class IV (Loss of more than 40% of blood volume):
* Marked tachycardia and hypotension.
* Profound shock with severe alterations in mental status.
* Minimal to no urine output.
* Cold and clammy extremities.
42
5. A 30 y/o male after sustaining motorcycle crush injury presented at the ER with VS of BP 80/50, HR 120, RR 24. Where are the potential sources of massive hemorrhage EXCEPT?
A. intrathoracic
B. intraabdominal
C. intracranial
D. long bones
E. retroperitoneal
C. intracranial
43
6. The following statements are true EXCEPT?
A. Diagnostic and therapeutic tube thoracostomy may be indicated in stable patients based on clinical findings and clinical suspicion
B. Each pleural cavity can hold 2 to 3 L of blood and can therefore be a site of significant blood loss.
C. Major retroperitoneal hemorrhage typically occurs in association with pelvic fractures
D. Findings with intra- abdominal hemorrhage include abdominal distension, abdominal tenderness, or visible abdominal wounds
E. None of the above
E. None of the above
44
7.The following statements are true regarding IL-1B except?
A. augments the secretion of ACTH, glucocorticoids, and beta-endorphins
B. stimulate the release of other cytokines such as interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-8 (IL-8)
C. A and B
D. produces a febrile response to injury by activating prostaglandins in the posterior hypothalamus
E. half-life 60 minutes
E. half-life 60 minutes
45
8. The renin-angiotensin system is activated in shock. Which of the following conditions will cause release of renin from juxtaglomerular cells of the kidneys?
A. Beta-adrenergic stimulation
B. Increased renal tubular sodium concentration
C. Decreased renal artery perfusion
D. A and D
E. All of the above
E. All of the above
46
9. Which among the products of the renin angiotensin system is considered both a potent vasoconstrictor of splanchic and peripheral beds as well as secretion of ADH?
A. Angiotensin 1
B. Angiotensin 2
C. Renin
D. Angiotensinogen
E. Aldosterone
B. Angiotensin 2
47
10. The ff. are true statements regarding the treatment of septic shock, EXCEPT?
A. Evaluation of patient in septic shock begins with an assessment of the adequacy of their airway and ventilation
B. Vasopressors as necessary
C. Intravenous fluid
D. Antibiotics must be started after results of culture and sensitivity comes out
E. Evaluation of the patient in septic shock begins with an assessment of their airway and ventilation
D. Antibiotics must be started after results of culture and sensitivity comes out
A. Evaluation of patient in septic shock begins with an assessment of the adequacy of their airway and ventilation
B. Vasopressors as necessary (Catecholamines/ Arginine Vasopressin)
C. Intravenous fluid (Fluid resuscitation and restoration of circulatory volume w/ balanced salt solution - at least 30 mL/kg w/ the first 4-6 hrs)
D. Antibiotics must be started after results of culture and sensitivity comes out (Broad-spectrum, empiric even w/o isolated bacteria)
E. Evaluation of the patient in septic shock begins with an assessment of their airway and ventilation
48
11 Hypoperfusion and hypoxia can induce cell death by apoptosis
A. TRUE
B. FALSE
A. TRUE
49
12 the intestinal mucosa cells apoptosis may compromise bowel integrity and lead to translocation of bacteria and endotoxins into the portal circulation during shock
A. TRUE
B. FALSE
A. TRUE
During shock, there can be decreased perfusion to various organs, including the intestines. Reduced blood flow to the intestines can result in injury to the intestinal mucosa. This injury can cause apoptosis (programmed cell death) of the mucosal cells.
When the integrity of the intestinal mucosa is compromised, there's an increased risk of bacteria and endotoxins from the intestines entering the bloodstream, specifically the portal circulation. This phenomenon is known as bacterial translocation, and it can lead to systemic inflammatory responses and sepsis.
50
13. patients who fail to respond to initial resuscitative efforts should be assumed to have ongoing active hemorrhage from large vessels and require extensive diagnostic tests.
A. TRUE
B. FALSE
B. FALSE
The statement implies that if a patient does not respond to initial resuscitative efforts, the automatic assumption should be ongoing active hemorrhage from large vessels and that they should undergo extensive diagnostic tests.
While ongoing active hemorrhage from large vessels is a possibility in patients who don't respond to initial resuscitation, it's not the only possibility. Other causes, such as cardiac tamponade, tension pneumothorax, or severe traumatic brain injury, among others, could also contribute to the failure of resuscitative measures.
Moreover, the term "extensive diagnostic tests" is quite broad. While it's essential to identify the cause of shock quickly, not every patient may need "extensive" tests. What's crucial is that the tests and interventions are appropriate to the clinical scenario.
51
15. hypoxia inhibits the production of erythrocyte 2, 3 diphosphoglycerate (2,3DG)
A. True
B. False
B. False
2,3-diphosphoglycerate (2,3-DPG) plays a crucial role in the oxygen-binding curve of hemoglobin. An increase in its concentration within erythrocytes makes hemoglobin release oxygen more readily to the tissues.
When tissues experience hypoxia, one of the compensatory mechanisms is to increase the production of 2,3-DPG within erythrocytes. This increase ensures that more oxygen is offloaded from hemoglobin to the tissues, where it's needed.
52
Innate immune response can help restore homeostasis, or if it is excessive, promote cellular and organ dysfunction
A. True
B. False
A. True
53
17. Activation of the complement cascade can contribute to the development of organ dysfunction.
A. True
B. False
A. True
54
18.Magnitude of the oxygen debt correlates with the severity and duration of hypoperfusion.
A. True
B. False
A. True
55
19.Activated Complement factors C3a, C4a, and C5a are potent mediators of increased vascular permeability, smooth muscle contraction, histamine, and arachidonic acid by product release and adherence of neutrophils to vascular endothelium.
A. True
B. False
A. True
56
20. Activated PMNs and their products cannot produce cell injury and organ dysfunction.
A. True
B. False
B. False
57
21. In the nontrauma pt. with shock, the gastrointestinal tract must always be considered as a site for blood loss
A. True
B. False
A. True
Non-trauma: GIT must always be considered
o Upper or Lower GIT bleeding
o With hematemesis or bleeding
o Hx & PE is important
58
22. Play a role in the development of diffuse alveolar damage and ARDS
A. TNF-a
B. IL-1 B
C. IL-6
D. IL-10
C. IL-6
59
23. Produced by activated T cells
A. IL-2
B. TNF-a
C. IL-1b
D. IL-6
E. IL-10
A. IL-2
60
24. Very short half life of 6 minutes
A. IL-10
B. IL-6
C. TNF-a
D. IL-1b
D. IL-1b
61
25. Anti inflammatory cytokine that may have immunosuppressive properties
A. IL-10
B. IL-2
C. IL-6
D. IL-1b
A. IL-10
62
26. Peak within 90 minutes of stimulation and return frequently to baseline levels within 4 hours.
A. IL-6
B. TNF-a
C. TNF-b
D. IL-10
B. TNF-a
63
27. Which is the following statement/s is/are true regarding shock.
A. Resultant cellular injury is usually reversible
B. Inadequate delivery of oxygen and nutrients to maintain normal tissue and cellular function.
C. Clinical manifestations are the result of stimulation of the sympathetic and neuroendocrine stress responses.
D. A and B
E. All of the above
E. All of the above
A. Resultant cellular injury is usually reversible:
This statement is partially true. In the early stages of shock, cellular injury can be reversible. However, if shock is prolonged and severe, the cellular injury can become irreversible, leading to cell death.
B. Inadequate delivery of oxygen and nutrients to maintain normal tissue and cellular function:
True. One of the fundamental characteristics of shock is the inadequate delivery of oxygen and essential nutrients to tissues, which compromises cellular function.
C. Clinical manifestations are the result of stimulation of the sympathetic and neuroendocrine stress responses:
True. The body's response to shock involves the activation of the sympathetic nervous system and the neuroendocrine stress response. This results in clinical manifestations such as tachycardia, vasoconstriction, and increased alertness, among others.
64
28.Which of the statements/is/are true?
A. While the quantitative nature of the physiologic response in shock will vary wth the etiology of shock, the qualitative nature of the response to shock is similar with common pathways in all types of shock
B. The magnitude of the physiologic response is proportional to both the degree and the duration of the shock
C.The physiologic responses to hypovolemia are directed at preservation of perfusion to the lungs and kidneys
D. A nd B
E. All of the above
D. A and B
A. While the quantitative nature of the physiologic response in shock will vary with the etiology of shock, the qualitative nature of the response to shock is similar with common pathways in all types of shock:
True. Regardless of the specific cause (etiology) of shock, there are common physiologic pathways and responses activated in the body. The specific magnitude or degree of these responses might vary based on the cause, but the overall direction and nature of the response are similar across different types of shock.
B. The magnitude of the physiologic response is proportional to both the degree and the duration of the shock:
True. The body's response will be more pronounced and severe if the shock is more profound (degree) or if it lasts longer (duration).
C. The physiologic responses to hypovolemia are directed at preservation of perfusion to the lungs and kidneys:
This statement is partially true. In the face of hypovolemia (low blood volume), the body prioritizes perfusion to vital organs such as the brain and heart. While the kidneys are important and the body does make efforts to preserve their perfusion, they might experience decreased blood flow in severe hypovolemia as the body prioritizes other vital organs. The lungs, on the other hand, don't "perfuse" in the same way as other organs – they receive the entirety of cardiac output. The statement might be misconstrued to suggest that the lungs and kidneys are the primary focus, which isn't accurate.
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29.What kind of shock is seen in patient with arrythmias?
A. Cardiogenic shock
B. Septic shock
C. Obstructive shock
D. Neurogenic shock
A. Cardiogenic shock
A. Cardiogenic shock
(Impaired cardiac function, myocardial infarction, arrhythmias, valve dysfunction, cardiomyopathy.)
B. Septic shock (Sepsis)
C. Obstructive shock
(Tension Pneumothorax, Cardiac Tamponade, Pulmonary Embolism)
D. Neurogenic shock
(Spinal cord injury, loss of sympathetic tone, vasodilation.)
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30. A 23 y/o male sustained a stab wound on the left chest 4th ICS MAL. He was rushed to the ER with difficulty of breathing, vital signs BP 90/60, HR 110, RR 28. What are your differential diagnosis?
A. Cardiac tamponade
B. Hemothorax
C. Tension Pneumothorax
D. A and B
E. All of the above
C. Tension Pneumothorax
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31.A 33 y/o male sustained a stab wound on the left chest 4th ICS MAL. He was rushed to the ER with difficulty of breathing, vital signs BP 90/60, HR 110, RR 28. Physical exam showed diminished breath sounds over the left hemithorax, hyperresonance to percussion, jugular venous distention, and shift of mediastinal structures to the unaffected side with tracheal deviation. What is the most likely diagnosis?
A. Esophageal Perforation
B. Hemothorax
C. Cardiac Tamponade
D. Tension Pneumothorax
D. Tension Pneumothorax
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.A 33 y/o male sustained a stab wound on the left chest 4th ICS MAL. He was rushed to the ER with difficulty of breathing, vital signs BP 90/60, HR 110, RR 28. Physical exam showed diminished breath sounds over the left hemithorax, hyperresonance to percussion, jugular venous distention, and shift of mediastinal structures to the unaffected side with tracheal deviation. What is the best treatment?
A.CTT Insertion
B.Pericardiocentesis
C. Thoracic needling
D.Open Thoracotomy
A.CTT Insertion
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33. Which of the follow is/are true of neurogenic shock?
A. Diminished tissue perfusion as a result of loss of vasomotor tone to peripheral arterial bed
B. Loss of vasoconstrictor impulses results in increased vascular capacitance, decreased venous return and decreased cardiac output
C. Usually secondary to spinal cord injuries from vertebral body fractures of the cervical or high thoracic region that disrupt sympathetic regulation of the peripheral vascular tone
D. A and B
D. AOTA
D. AOTA
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34. Acute spinal cord injury results in activation of multiple secondary injury mechanisms except:
A. loss of cellular membrane integrity and impaired energy metabolism
B. vascular compromise to the spinal cord with loss of autoregulation, vasospasm, and thrombosis
C. hypotension contributes to the worsening of acute spinal cord injury as the result of further reduction in blood flow to the spinal cord
D. none of the above
E. all of the above
D. none of the above
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35. Classic description of neurogenic shock consist of the following except
A. Warm extremities
B. Hypotension
C. Tachycardia
D. Vertebral column fracture
E. NOTA
C. Tachycardia
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36. A 45 y/o male sustained a single stab wound on the left lower quadrant. Her vital signs at the emergency room as follows: BP = 80/60, HR = 118/min, RR = 26/min and confusion. How much blood volume must have been lost?
A. <15%
B. 15 to 25%
C. 25-30%
D. 30-40%
E. >40%
D. 30-40%
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37. The following statements is/are true regarding cardiogenic. Except?
A. Involves vicious cycle of myocardial ischemia which causes myocardial dysfunction, which results in more myocardial ischemia
B. Mortality rates for cardiogenic shock are 30%
C. Circulatory pump failure leading to diminished forward flow and subsequent tissue hypoxia in setting of adequate intravascular volume
D. A and B
E. A and C
B. Mortality rates for cardiogenic shock are 30%
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38. Which of the following medications is preferable in the treatment of cardiac dysfunction in hypotensive patients?
a. Dobutamine
B. Epinephrine
c. dopamine
d. morphine
c. dopamine
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39. Which of the following drugs does not stimulate alpha receptors, thus without vasoconstriction effect in the peripheral vessels?
A. Morphine
B. Epinephrine
C. Dopamine
D. Dobutamine
A. Morphine:
Morphine is an opioid analgesic. It does not act on alpha receptors and does not cause vasoconstriction. In fact, morphine can cause vasodilation.
B. Epinephrine:
Epinephrine (adrenaline) stimulates both alpha and beta receptors. Its stimulation of alpha receptors can lead to vasoconstriction.
C. Dopamine:
Dopamine, at varying doses, can stimulate dopamine, beta, and alpha receptors. At higher doses, dopamine can stimulate alpha receptors, leading to vasoconstriction.
D. Dobutamine:
Dobutamine is a synthetic catecholamine that primarily stimulates beta-1 receptors, leading to increased cardiac contractility. It has minimal effect on alpha receptors and does not cause significant vasoconstriction.
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40. Confirmation of cardiac source for shock requires which of the following?
A. Cardiac enzymes
B. ECG
C. 2D Echo
D. A and B
E. B and C
B. ECG
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41 What type of shock is characterized by both peripheral vasodilation with resultant hypotension
A. Neurogenic Shock
B. Septic Shock
C. Hemmorrhagic Shock
D. Obstructive Shock
E. Cardiogenic Shock
B. Septic Shock
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42. What type of shock represents the final common pathaway for profound and prolonged shock of any etiology?
A. Hemorrhagic shock
B. Neurogenic Shock
C. Cardiogenic Shock
D. Vasodilatory shock
D. Vasodilatory shock
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3. A 60 y/o male admitted at the ICU because of pneumonia with positive bacterial culture in the sputum. There is note of fever, leukocytosis, tachcardia and urine output of 15cc per hour for the past 4 hrs. His VS: BP 110/60, HR 108, RR 24. What is the most likely diagnosis?
A. Bacteremia
B. Sepsis
C. Septic shock
D. Severe Sepsis
C. Septic shock
To determine the most likely diagnosis, let's analyze the provided clinical features:
1. Pneumonia with positive bacterial culture in the sputum: This indicates a confirmed bacterial infection.
2. Fever and leukocytosis: These are signs of a systemic inflammatory response.
3. Tachycardia (HR 108): This is an elevated heart rate.
4. Urine output of 15cc per hour for the past 4 hours: This is a reduced urine output, indicating potential kidney dysfunction.
5. Blood Pressure (BP) 110/60: The blood pressure is within a normal range and is not indicative of shock.
Given the criteria for sepsis and related conditions:
* Bacteremia: Presence of bacteria in the blood.
* Sepsis: A life-threatening organ dysfunction caused by a dysregulated host response to infection.
* Septic shock: A subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. It's usually characterized by hypotension that's unresponsive to fluid resuscitation.
* Severe Sepsis: Sepsis with evidence of organ dysfunction, hypoperfusion, or hypotension.
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44. Lactate is generated by conversion of pyruvate to lactate to lactate dehydrogenase in the setting of insufficient oxygen. Lactate is released into the circulation and is predominantly taken up by which organ?
A. Pancreas
B. Kidney
C. Liver
D. A and B
E. B and C
E. B and C
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45 Preferred to support the diagnosis of cardiac tamponade
A. ECG
B. Ultrasound
C. CVP
D. 2D echo
E. Chest Xray
D. 2D echo
D. 2D echo (Two-dimensional echocardiography): This is the gold standard for diagnosing cardiac tamponade as it allows direct visualization of the pericardial effusion and its hemodynamic consequences on the heart.
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46. A patient undergoing elective open cholecystectomy under spinal anesthesia develops a BP 70/50. There are no signs of bleeding and sepsis. What is the most appropriate initial therapy?
A. Transfusion of blood
B. 2L of plain LR
C. Beta adrenergic stimulator
D. Alpha mimetic drug
E. Administration of corticosteroids
D. Alpha mimetic drug
In the scenario described, the patient undergoes an elective open cholecystectomy under spinal anesthesia and develops hypotension without signs of bleeding or sepsis. This suggests the hypotension is likely related to the spinal anesthesia.
Spinal anesthesia can cause hypotension due to sympathetic blockade. This leads to vasodilation of the blood vessels, particularly in the lower extremities, causing a reduction in systemic vascular resistance and subsequent hypotension.
Given the probable cause of the hypotension and the provided options:
A. Transfusion of blood: This is not the first choice as there is no sign of bleeding.
B. 2L of plain LR (Lactated Ringer's solution): Rapid fluid resuscitation can be beneficial to counteract the vasodilation and increase preload, thereby improving blood pressure.
C. Beta adrenergic stimulator: This is not the primary choice for treatment of hypotension due to spinal anesthesia.
D. Alpha mimetic drug: Drugs that stimulate alpha receptors cause vasoconstriction. Alpha mimetics, like phenylephrine, are commonly used to treat hypotension resulting from spinal anesthesia.
E. Administration of corticosteroids: Not indicated in this scenario.
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47. A patient has a BP 60/40 and serum lactate level of 30mg/100 ml. His cardiac outpus is 1.9L/min central venous pressure of 2 cm H2O, O2 sat 98% The most likely diagnosis is?
A. Hypovolemic Shock
B. Cardiac Tamponade
C. Tension pneumothorax
D. Pulmonar embolism
E. Septic shock
A. Hypovolemic Shock
1. Hypotension (BP 60/40): Indicates a shock state.
2. Elevated serum lactate (30mg/100 ml): Indicates tissue hypoperfusion.
3. Low cardiac output (1.9L/min): Further supports a shock state.
4. Low central venous pressure (2 cm H2O): Indicates decreased venous return or decreased blood volume.
5. Normal oxygen saturation (O2 sat 98%): Indicates adequate oxygenation, which can help us rule out certain causes.
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48. All of the following are true except?
A. Dopamine decreases renal blood flow
B. Dobutamine has predominantly inotrophic effects
C. Vassopressors that have primarily alpha adrenergic effect have little value in shock
D. A and C
E. None of the Above
D. A and C
A. Dopamine decreases renal blood flow:
* This statement is not universally true. At low doses (typically < 5 µg/kg/min), dopamine has a vasodilatory effect on renal and mesenteric vessels due to stimulation of dopamine-1 receptors, which can actually increase renal blood flow. At higher doses, it stimulates beta and alpha-adrenergic receptors, which can increase heart rate, contractility, and vasoconstriction.
B. Dobutamine has predominantly inotropic effects:
* True. Dobutamine primarily stimulates beta-1 adrenergic receptors, leading to increased myocardial contractility (inotropic effect) with less impact on heart rate (chronotropic effect). It has limited effects on peripheral vasculature.
C. Vasopressors that have primarily alpha-adrenergic effects have little value in shock:
* False. Alpha-adrenergic agonists cause vasoconstriction, which can increase systemic vascular resistance and help restore blood pressure in shock states, especially when hypotension is due to vasodilation (e.g., septic shock).
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49. The goal of the neuroendocrine response to shock is to maintain perfusion to what organ/s
A. Liver
B. Heart
C. Kidneys
D. A and B
E. B and C
E. B and C
86
50. In the cellular level, which organelle is the most susceptible to inadequate oxygen delivery to tissues?
A. Ribosomes
B. Endoplasmic reticulum
C. Mitochondria
D. Golgi bodies
C. Mitochondria
87
51. Determining blood loss by weighing sponges reflects only how much percent of true loss?
A. 10%
B. 70%
C. 5%
D. Reflects the exact amount of blood loss
B. 70%
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53.What is the biggest advantage of using electrocautery?
a. Saves time during hemostasis
b. Less necrosis than precise ligature
c. Easier setup
d. Hemostasis of great major arterial bleeding
a. Saves time during hemostasis
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54. Massive transfusion is described as:
A. Single transfusion greater than 2,500 mL
B. Transfusion of 2 units of blood
C. Transfusion of 1000 mL over 24 hours
D. Transfusion of platelets, and packed RBCs simultaneously
A. Single transfusion greater than 2,500 mL
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55. Who of the following is more prone to overtransfusion?
a. 53-year-old male with a 10-year history of hyptertension
b. 19-year-old male with no medical problems
c. 80-year-old male with no medical problems
d. 48-year-old male with a history of AMI killip IV
d. 48-year-old male with a history of AMI killip IV
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56. Occluding the hepatic artery in the hepatoduodenal ligament as a method of controlling bleeding from a transected cystic artery or from the surface of the liver is also known as:
A. Pringle maneuver
B. Heimlich maneuver
C. Murphy's maneuver
D. Chemical hemostasis
A. Pringle maneuver
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57 Excessive bleeding from the field of the procedure, unassociated with bleeding from other sites (CVP line, IV line) usually suggests:
A. a genetic abnormality
B. Inadequate mechanical hemostasis
C. Lack of transfused blood
D. Poor asepsis/antisepsis technique
B. Inadequate mechanical hemostasis
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58 Thromboxane is a powerful vasoconstrictor derived from the release of what substance from platelets?
a. Deoxycolic acid
b. Lipoic acid
c. Arachidonic acid
d. Cyclooxygenase
c. Arachidonic acid
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59. A 60-year-old male came in with a comminuted fracture in the left lower extremity resulting from a vehicular accident. He has had a history PTB 10 years prior (resolved), childhood BA (last attach 1 year ago), and of a heart attack 2 years prior to consult. Open reduction of the fracture is contemplated. What would be most pertinent in the patient’s history prior to OR?
A. Intake of aspirin
b. Previous history of PTB
c. Patient's childhood BA
d. Patient's age
A. Intake of aspirin
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60. A 74-year-old male was brought in the ED for massive GI bleeding. He was later found to have diverticulitis. Pre-op, the patient’s bleeding time was noted to be delayed. The patient has no previous history of medical problems. What is the most likely cause for the patient’s delayed bleeding time?
A. Patient’s age
B. Diverticulitis predisposes patient to blood disorders
C. Late-onset Von Willebrand’s disease
D. Lab clerical error
C. Late-onset Von Willebrand’s disease
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61. These are the types of local hemostasis except:
A. Thermal
B. Chemical
C. Mechanical
D. Cryogenic
D. Cryogenic
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62.The following diseases are transmissible through blood transfusion EXCEPT:
A. malaria
B. brucellosis
C. chaga's disease
D. hepatitis A
D. hepatitis A
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63. While transfusing blood, this simple maneuver significantly decreases the incidence of intra-op cardiac arrests:
A. Cooling the blood in order to preserve blood components
B. Warming the blood to approximate patient’s body temperature
C. Shaking blood bag vigorously prior to infusion in order to mix settled blood components
D. No special maneuver is necessary
B. Warming the blood to approximate patient’s body temperature
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4.The following are physiologic processes involved in hemostasis:
a. Vascular constriction, platelet plug formation, fibrin formation, fibrinolysis
b. Thrombus formation, platelet plug formation, vascular constriction
c. Fibrinolysis, vascular constriction, platelet plug formation, hemodilution
d. Vascular constriction, platelet plug formation, emboli formation, fibrinolysis
a. Vascular constriction, platelet plug formation, fibrin formation, fibrinolysis
100
65.This may be induced acutely by administration of heparin and may be associated with thrombotic and hemorrhagic complications:
a. Thrombocytopenia
b. Leucopenia
c. DIC
d. Lymphopenia
a. Thrombocytopenia
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66. If electrolyte solutions are used to replace blood volume, how many times the amount of blood lost is required?
A. Same amount
B. 8-9 times the amount
C. 3-4 times the amount
D. Electrolyte solutions are contraindicated for blood replacement
C. 3-4 times the amount
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67.Lifespan of platelets
A. 120 days
B.64 days
C. 28 days
D. 8 days
D. 8 days
7-10 days
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68. In this blood disorder, platelets lack the storage capability of ADP required for aggregation:
A. Glanzmann’s thrombasthenia
B. Bernard-Soulier syndrome
C. Hemophilia A
D. Storage pool disease
D. Storage pool disease
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69. This is released from platelet membranes and is converted by cyclooxygenase to prostaglandin G2 and PGH2
A. Pantothenic acid
B. Citric acid
C. Arachidonic acid
D. Lipoic acid
C. Arachidonic acid
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70. What blood type may be utilized in the event of an emergency blood transfusion?
A. AB+
B. B-
C. O+
D. A+
C. O+
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71. Usual mode of inheritance of Von Willebrand's disease?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. X-linked dominant
A. Autosomal dominant
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72. These are the types of local hemostasis except:
A. Thermal
B. Chemical
C. Mechanical
D. Cryogenic
D. Cryogenic
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73. Complications of blood transfusion include the following except:
A. Circulatory overload
B. Dilutional thrombocytopenia
C. Impaired platelet function
D. Hypokalemia
D. Hypokalemia
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74.Appropriate treatment of Hemophilia A involves:
A. For joint and muscle bleeding and major hemorrhages, levels of deficient factor should at least be 10% of normal
B. For major surgery or life- threatening bleeding, levels of deficient factor should be at least 40- 50% of normal preoperatively
C. For major surgery or life- threatening bleeding, levels of deficient factor should be at least 80- 100% of normal preoperatively
D. No treatment indicated
C. For major surgery or life- threatening bleeding, levels of deficient factor should be at least 80- 100% of normal preoperatively
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75.Clinically indistinguishable from Hemophilia A, with patients showing prolonged partial thromboplastin time *
A. Ehlers-Danlos Syndrome
B. Von Willebrand’s disease
C. Hemophilia B
D. Bernard-Soulier Syndrome
B. Von Willebrand’s disease
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76. Most common indication for blood transfusion in surgical patients
A. Volume replacement
B. Anemia
C. Coagulation Disorder
D. Immune reaction
A. Volume replacement
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77.Circulatory Overloading is manifested through the following except:
A. Rise in venous pressure
B. Dyspnea
C. Cough
D. Ecchymosis
E. Rales heard over lung bases
D. Ecchymosis
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78. The following conditions are managed by platelet transfusion except:
A. Bernard-Soulier syndrome
B. Glanzmann’s thrombasthenia
C. Acute blood loss
D. Storage pool disease
C. Acute blood loss
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79. Red cell viability is improved in which of the following blood products?
A. Packed red blood cell
B. Whole blood
C. Platelet concentrate
D. Leukocyte-poor wash cells
A. Packed red blood cell
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80. What percentage of blood loss would result in tachycardia, tachypnea, hypotension, oliguria and changes in mental status?
A. 5-10%
B. 30-40%
C. 90-100%
D. 1-5%
B. 30-40%
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81. What is the minimum amount of fresh frozen plasma to be given for it to have an effect on coagulation?
A. 600-2,000 mL given over 48 hours
B. 50-100 mL given over 1- 2 hours
C. 600-2,000 mL given over 1-2 hours
D. 300 mL given over 4 hours
C. 600-2,000 mL given over 1-2 hours
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2. In the event of over transfusion, what is the initial management?
A. Stopping infusion and placing patient in jack knife position
B. Stopping infusion and placing patient in lithotomy position
C. Resume infusion but giving patient a 40mg furosemide bolus IV
D. Halt infusion and place patient in a sitting position
D. Halt infusion and place patient in a sitting position
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83. Why does bleeding tend to be more persistent in patients with muscle atrophy accompanying aging, on prlonged steroid therapy and patients with Ehlers- Danlos Syndrome
A. Hemoconcentration
B. Blood Viscosity Decreased
C. Low Perivascular Pressure
D. Increased WBC
C. Low Perivascular Pressure
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84. The most common type of hepatitis to be transmitted through blood transfusion:
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis G
c. Hepatitis C
120
85. How does oxidized regenerated cellulose (surgical) provide hemostasis?
a. Contains epinephrine which induces vasoconstriction
b. Has lidocaine that provides analgesia along with hemostasis
c. Transmit pressure against wound surface and interstices provide a scaffold on which the clot organize.
d. Organizes a clot depending on the patient’s hemostatic mechanisms
c. Transmit pressure against wound surface and interstices provide a scaffold on which the clot organize.
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6. This results from release of arachidonic acid from platelet membranes during
aggregation and is a powerful vasoconstrictor:
A. Bradykinin
B. Prostacyclin
C. Thromboxane
D. Serotonin
C. Thromboxane
122
87 The following sutures evoke less tissue reaction than absorbable materials:
A. Polygalactin
B. Catgut
C. Vicryl
D. Polyethylene
C. Vicryl
123
88.Preferred fluids for rapid plasma expansion: *
a. Dextran
b. Plain NSS
c. Dextrose 5%
d. Sterile water
a. Dextran
124
89. Most common abnormality of hemostasis that results in bleeding in the surgical patient:
A. Polycythemia
B. Thrombocytopenia
C. Leukemia
D. Dengue hemorrhagic fever
B. Thrombocytopenia
125
90. What lab value is usually prolonged in the x-linked disorder hemophilia A?
a. Bleeding time
b. Prothrombin time
c. Partial thromboplastin time
d. Reticulocyte count
e. ESR
c. Partial thromboplastin time
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91 What cells interfere with platelet recruitment by inactivation of adenosine diphosphate (ADP)?
A. Reticular cells
B. Endothelial cells
C. Megakaryocytes
D. Eosinophils
B. Endothelial cells
127
92. A 15-year-old male came into the ED complaining of left knee pain and swelling that was warm to the touch. He mentioned that his brother had the same problem, but on the other knee. He also mentioned to have a history of recurrent epistaxis. It was later found that he had hemarthoses. What blood disorder is most likely? *
a. Glanzmann’s Throbasthenia
b. Factor 8 deficiency
c. Von Willebrand’s disease
d. Storage Pool disease
b. Factor 8 deficiency (Hemophilia A)
The presentation of hemarthroses (bleeding into the joints), along with recurrent epistaxis (nosebleeds) and a familial pattern (brother having a similar issue), is most consistent with hemophilia. Hemophilia A is caused by a deficiency of Factor VIII.
The correct answer is:
b. Factor 8 deficiency.
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93. Disadvantage of non-absorbable sutures
A. More tissue reaction
B. May lead to extrusion or sinus tract formation
C. Only one color
D. Unable to do mattress sutures
B. May lead to extrusion or sinus tract formation
129
94. This factor is required for platelet adhesion to subendothelial collagen:
A. Thrombin
B. Collagenase
C. Bernard-Soulier Factor
D. Von Willebrand Factor
D. Von Willebrand Factor
130
95. Glanzmann's Thrombasthenia is aplatelet disoreder which involves deficient?
A. Aggregation
B. Adhesion
C. Fibrinolysis
D. Formation
A. Aggregation
131
96.Within how many hours of blood donation must platelet concentrates be used before they become unfit for transfusion?
A. Right after donation
B. 10 days
C. 5 days
D. 12 days
C. 5 days
132
97. Origin of platelets
A. White blood cells
B. Red blood cells
C. Megakaryocytes
D. Neutrophils
C. Megakaryocytes
133
98. Approximately within how many seconds do platelets adhere to the intima following an injury to the intima? *
A. Within 2 seconds
B. Within 10 seconds
C. Within 1 minute
D. Within 15 seconds
D. Within 15 seconds
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99. Which of the following is most significant in evaluating a surgical patient as a hemostatic risk?
a. Menorrhagia
b. History of asthma
c. History of CAD
d. Prolonged urination
e. Diarrhea
a. Menorrhagia
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100. The initial response to injury:
A. Fibrin formation
B. Bleeding
C. Vascular constriction
D. Platelet plug formation
C. Vascular constriction
