LE 2

Question 1

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

Answer 1

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.

Question 2

2. 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

Answer 2

D. All of the above

Question 3

3 THE PLASMA VOLUME IN A 50 KG MAN WILL BE
A. 7.5 LITERS
B. 1LITER
C. 2 LITERS
D. 2.5 LITERS

Answer 3

D. 2.5 LITERS

Question 4

4. 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

Answer 4

D. 16 liters

Question 5

7. 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

Answer 5

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

Question 6

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

Answer 6

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.

Question 7

10. 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

Answer 7

C. VOLUME DEFICIT

Question 8

20. 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

Answer 8

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.

Question 9

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

Answer 9

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)

Question 10

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

Answer 10

B. HYPOKALEMIA

Question 11

24. 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

Answer 11

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.

Question 12

27. 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

Answer 12

B. STATEMENT IS FALSE

Water Loss (Insensible)
Lungs (25%)
Skin (75%)

Question 13

35. 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

Answer 13

D. All of the above

Question 14

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

Answer 14

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.

Question 15

39. The minimum volume of urine to expel body waste is
    A. 800 cc
    B. 500 cc
    C. one liter
    D. 600 cc

Answer 15

B. 500 cc

Obligatory Urine Volume:
500-800 mL urine/day

Question 16

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

Answer 16

b. Na-K pump

Question 17

47.THE PREDOMINANT ANION IN THE EXTRACELLULAR SPACE IS
A. SULFATES
B. PROTEIN
C. PHOSPHATES
D. CHLORIDE

Answer 17

D. CHLORIDE

Cation
(1) PiSo (2) MiCo
Anion
(1) PhiClo (2) SuliBio

Question 18

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

Answer 18

C. Hypocalcemia

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

58. 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

Answer 21

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.

Question 22

60. A dry sticky mucus membrane is pathognomonic of what condition
    A. Volume deficit
    B. Hypernatemia
    C. Hyponatremia
    D. Volume excess

Answer 22

B. Hypernatemia

Question 23

62. 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

Answer 23

C. 2.0 Liters

Question 24

64. 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

Answer 24

B. STATEMENT IS FALSE

Question 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

Answer 25

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.

Question 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

Answer 26

D. 800 ML

Question 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

Answer 27

B. STATEMENT IS FALSE

Cation
(1) PiSo (2) MiCo
Anion
(1) PhiClo (2) SuliBio

Question 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

Answer 28

A. 2.0 L

Question 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

Answer 29

A Volume deficit

Question 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

Answer 30

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.

Question 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

Answer 31

A. 10 MEQ

Question 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

Answer 32

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.

Question 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

Answer 33

B. 1 Liter

Question 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

Answer 34

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.

Question 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

Answer 35

D. All Of The Above

Question 36

94. What is the most predominant cation in the extracellular fluid space
    A. Sodium
    B. Potassium
    C. Magnesium

Answer 36

A. Sodium

Cation
(1) PiSo (2) MiCo
Anion
(1) PhiClo (2) SuliBio

Question 37

99. The amount of calcium found in the extracellular fluid space
    A. 20%
    B. 10%
    C. 30%
    D. 1%

Answer 37

D. 1%

Question 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

Answer 38

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.

Question 39

2. The following hormones are increased in shock except:
   A. Glucagon
   B. Insulin
   C. Cortisol
   D. ADH
   E. NOTA

Answer 39

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.

Question 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

Answer 40

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.

Question 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%

Answer 41

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.

Question 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

Answer 42

C. intracranial

Question 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

Answer 43

E. None of the above

Question 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

Answer 44

E. half-life 60 minutes

Question 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

Answer 45

E. All of the above

Question 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

Answer 46

B. Angiotensin 2

Question 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

Answer 47

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

Question 48

11 Hypoperfusion and hypoxia can induce cell death by apoptosis
A. TRUE
B. FALSE

Answer 48

A. TRUE

Question 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

Answer 49

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.

Question 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

Answer 50

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.

Question 51

15. hypoxia inhibits the production of erythrocyte 2, 3 diphosphoglycerate (2,3DG)
    A. True
    B. False

Answer 51

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.

Question 52

Innate immune response can help restore homeostasis, or if it is excessive, promote cellular and organ dysfunction
A. True
B. False

Answer 52

A. True

Question 53

17. Activation of the complement cascade can contribute to the development of organ dysfunction.
    A. True
    B. False

Answer 53

A. True

Question 54

18.Magnitude of the oxygen debt correlates with the severity and duration of hypoperfusion.
A. True
B. False

Answer 54

A. True

Question 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

Answer 55

A. True

Question 56

20. Activated PMNs and their products cannot produce cell injury and organ dysfunction.
    A. True
    B. False

Answer 56

B. False

Question 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

Answer 57

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

Question 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

Answer 58

C. IL-6

Question 59

23. Produced by activated T cells
    A. IL-2
    B. TNF-a
    C. IL-1b
    D. IL-6
    E. IL-10

Answer 59

A. IL-2

Question 60

24. Very short half life of 6 minutes
    A. IL-10
    B. IL-6
    C. TNF-a
    D. IL-1b

Answer 60

D. IL-1b

Question 61

25. Anti inflammatory cytokine that may have immunosuppressive properties
    A. IL-10
    B. IL-2
    C. IL-6
    D. IL-1b

Answer 61

A. IL-10

Question 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

Answer 62

B. TNF-a

Question 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

Answer 63

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.

Question 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

Answer 64

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.

Question 65

29.What kind of shock is seen in patient with arrythmias?
A. Cardiogenic shock
B. Septic shock
C. Obstructive shock
D. Neurogenic shock

Answer 65

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.)

Question 66

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

Answer 66

C. Tension Pneumothorax

Question 67

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

Answer 67

D. Tension Pneumothorax

Question 68

.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

Answer 68

A.CTT Insertion

Question 69

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

Answer 69

D. AOTA

Question 70

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

Answer 70

D. none of the above

Question 71

35. Classic description of neurogenic shock consist of the following except
    A. Warm extremities
    B. Hypotension
    C. Tachycardia
    D. Vertebral column fracture
    E. NOTA

Answer 71

C. Tachycardia

Question 72

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%

Answer 72

D. 30-40%

Question 73

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

Answer 73

B. Mortality rates for cardiogenic shock are 30%

Question 74

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

Answer 74

c. dopamine

Question 75

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

Answer 75

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.

Question 76

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

Answer 76

B. ECG

Question 77

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

Answer 77

B. Septic Shock

Question 78

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

Answer 78

D. Vasodilatory shock

Question 79

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

Answer 79

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.

Question 80

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

Answer 80

E. B and C

Question 81

45 Preferred to support the diagnosis of cardiac tamponade
A. ECG
B. Ultrasound
C. CVP
D. 2D echo
E. Chest Xray

Answer 81

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.

Question 82

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

Answer 82

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.

Question 83

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

Answer 83

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.

Question 84

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

Answer 84

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).

Question 85

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

Answer 85

E. B and C

Question 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

Answer 86

C. Mitochondria

Question 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

Answer 87

B. 70%

Question 88

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

Answer 88

a. Saves time during hemostasis

Question 89

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

Answer 89

A. Single transfusion greater than 2,500 mL

Question 90

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

Answer 90

d. 48-year-old male with a history of AMI killip IV

Question 91

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

Answer 91

A. Pringle maneuver

Question 92

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

Answer 92

B. Inadequate mechanical hemostasis

Question 93

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

Answer 93

c. Arachidonic acid

Question 94

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

Answer 94

A. Intake of aspirin

Question 95

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

Answer 95

C. Late-onset Von Willebrand’s disease

Question 96

61. These are the types of local hemostasis except:
    A. Thermal
    B. Chemical
    C. Mechanical
    D. Cryogenic

Answer 96

D. Cryogenic

Question 97

62.The following diseases are transmissible through blood transfusion EXCEPT:
A. malaria
B. brucellosis
C. chaga’s disease
D. hepatitis A

Answer 97

D. hepatitis A

Question 98

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

Answer 98

B. Warming the blood to approximate patient’s body temperature

Question 99

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

Answer 99

a. Vascular constriction, platelet plug formation, fibrin formation, fibrinolysis

Question 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

Answer 100

a. Thrombocytopenia

Question 101

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

Answer 101

C. 3-4 times the amount

Question 102

67.Lifespan of platelets
A. 120 days
B.64 days
C. 28 days
D. 8 days

Answer 102

D. 8 days

7-10 days

Question 103

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

Answer 103

D. Storage pool disease

Question 104

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

Answer 104

C. Arachidonic acid

Question 105

70. What blood type may be utilized in the event of an emergency blood transfusion?
    A. AB+
    B. B-
    C. O+
    D. A+

Answer 105

C. O+

Question 106

71. Usual mode of inheritance of Von Willebrand’s disease?
    A. Autosomal dominant
    B. Autosomal recessive
    C. X-linked recessive
    D. X-linked dominant

Answer 106

A. Autosomal dominant

Question 107

72. These are the types of local hemostasis except:
    A. Thermal
    B. Chemical
    C. Mechanical
    D. Cryogenic

Answer 107

D. Cryogenic

Question 108

73. Complications of blood transfusion include the following except:
    A. Circulatory overload
    B. Dilutional thrombocytopenia
    C. Impaired platelet function
    D. Hypokalemia

Answer 108

D. Hypokalemia

Question 109

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

Answer 109

C. For major surgery or life- threatening bleeding, levels of deficient factor should be at least 80- 100% of normal preoperatively

Question 110

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

Answer 110

B. Von Willebrand’s disease

Question 111

76. Most common indication for blood transfusion in surgical patients
    A. Volume replacement
    B. Anemia
    C. Coagulation Disorder
    D. Immune reaction

Answer 111

A. Volume replacement

Question 112

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

Answer 112

D. Ecchymosis

Question 113

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

Answer 113

C. Acute blood loss

Question 114

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

Answer 114

A. Packed red blood cell

Question 115

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%

Answer 115

B. 30-40%

Question 116

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

Answer 116

C. 600-2,000 mL given over 1-2 hours

Question 117

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

Answer 117

D. Halt infusion and place patient in a sitting position

Question 118

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

Answer 118

C. Low Perivascular Pressure

Question 119

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

Answer 119

c. Hepatitis C

Question 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

Answer 120

c. Transmit pressure against wound surface and interstices provide a scaffold on which the clot organize.

Question 121

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

Answer 121

C. Thromboxane

Question 122

87 The following sutures evoke less tissue reaction than absorbable materials:
A. Polygalactin
B. Catgut
C. Vicryl
D. Polyethylene

Answer 122

C. Vicryl

Question 123

88.Preferred fluids for rapid plasma expansion: *
a. Dextran
b. Plain NSS
c. Dextrose 5%
d. Sterile water

Answer 123

a. Dextran

Question 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

Answer 124

B. Thrombocytopenia

Question 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

Answer 125

c. Partial thromboplastin time

Question 126

91 What cells interfere with platelet recruitment by inactivation of adenosine diphosphate (ADP)?
A. Reticular cells
B. Endothelial cells
C. Megakaryocytes
D. Eosinophils

Answer 126

B. Endothelial cells

Question 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

Answer 127

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.

Question 128

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

Answer 128

B. May lead to extrusion or sinus tract formation

Question 129

94. This factor is required for platelet adhesion to subendothelial collagen:
    A. Thrombin
    B. Collagenase
    C. Bernard-Soulier Factor
    D. Von Willebrand Factor

Answer 129

D. Von Willebrand Factor

Question 130

95. Glanzmann’s Thrombasthenia is aplatelet disoreder which involves deficient?
    A. Aggregation
    B. Adhesion
    C. Fibrinolysis
    D. Formation

Answer 130

A. Aggregation

Question 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

Answer 131

C. 5 days

Question 132

97. Origin of platelets
    A. White blood cells
    B. Red blood cells
    C. Megakaryocytes
    D. Neutrophils

Answer 132

C. Megakaryocytes

Question 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

Answer 133

D. Within 15 seconds

Question 134

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

Answer 134

a. Menorrhagia

Question 135

100. The initial response to injury:
     A. Fibrin formation
     B. Bleeding
     C. Vascular constriction
     D. Platelet plug formation

Answer 135

C. Vascular constriction