LE3 Flashcards by

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.

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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.

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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.

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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.

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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

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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

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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

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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

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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

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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

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

A. TRUE

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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.

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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.

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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.

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

A. True

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

A. True

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

A. True

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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

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

B. False

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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

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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

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

A. IL-2

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

D. IL-1b

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

A. IL-10

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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

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.

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.

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.)

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

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

.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

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

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

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

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%

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%

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

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.

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

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

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

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.

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

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.

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.

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.

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).

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

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

CAN CAUSE A DECREASE IN CONDITIONS EFFECTIVE CIRCULATING VOLUME A. MASSIVE HEMATOMA FORMATION B. THIRD SPACE LOSS C. PERIPHERAL VASODILATATION D. ALL OF THE ABOVE

D. ALL OF THE ABOVE

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

D. All of the above

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

D. 2.5 LITERS

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

D. 16 liters

5. The strongest chemotactic factor for fibroblast is what? a. tumor necrosis factor b. platelet derived growth factor c. lactate d. nitric oxide

b. platelet derived growth factor Chemotactic factors are substances that attract cells to the site of injury for healing and repair. Among the options given, platelet-derived growth factor (PDGF) is known to be a significant chemotactic agent for fibroblasts.

6. Which of the following is true of interleukin 4? A. Important in antibody activated immunity B. Produced by activated type 2-lymphocytes (Th2) C. Potent anti-inflammatory activity against activated macrophages D. All of the above

D. All of the above

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

c. LOWER THAN NORMAL With a blood sugar of 800 mg%, which is extremely high, the serum sodium level is expected to be lower than normal. This is due to the osmotic effect of glucose pulling water into the vascular space and diluting the sodium concentration, known as translocational hyponatremia.

9. After incision and drainage of midline laparotomy infection, it was noted that there is good granulation tissue without signs of cellulitis after A. Primary intention B. Tertiary intention C. Delayed wound infection D. Secondary intention

D. Secondary intention

11. What is the cornerstone of treatment of venous ulcers? A. Compression Therapy B. Use of growth factors C. Control of Blood sugar. D. Vasodilators

A. Compression Therapy This helps to reduce edema, improve venous return, and increase the rate of healing of the ulcers.

12. A patient has a chronic leg ulcer with associated dryness of skin, pallor and absence of hair. What is most likely the diagnosis? A. Venous stasis ulcer B. Decubitus ulcer C. Ischemic arterial ulcer D. Pressure Ulcer

C. Ischemic arterial ulcer The description provided suggests a lack of arterial blood flow to the leg, indicated by dry skin, pallor, and absence of hair. These are characteristic signs of an C. Ischemic arterial ulcer, which occurs due to poor arterial blood supply.

13. Tensile strength of wound reaches normal levels after how many days? A. 30 days B. Never C.7 days D. 1 year

B. Never Wound healing is a complex process, and the tensile strength of a wound increases over time as collagen is deposited and remodeled. It is generally accepted that a wound's tensile strength reaches approximately 70-80% of the normal skin by A. 1 year. It never regains 100% of the unwounded skin's tensile strength, so B could also be considered correct depending on the interpretation of "normal levels."

14. Patient have previous laparotomy due to a ruptured appendicitis, what is the most probable condition that might happen as a result of excessive healing of intestines? A. Incisional hernia B. Intestinal obstruction C. Inguinal hernia D. Fistula formation

A. Incisional hernia

15. The following is classified as Chronic wound, ЕХСЕРТ? A. Recurrent diabetic wound for 7 weeks B. Venous stasis ulcers for 8 weeks C. Delayed healing of ischemic arterial ulcer for 6 weeks D. Delayed healing of decubitus ulcer for 4 weeks

D. Delayed healing of decubitus ulcer for 4 weeks

16. Bone is considered strong enough to allow weight bearing and appear healed on radiographs in what phase of bone healing? A. Hard Callus B. Hematoma C. Remodeling D. Soft callus

A. Hard Callus

17. Which of the ff: is true of macrophage inhibitory factor A. Acts against the effect of gram (-) organism B. Reverses the immunosuppressive effect of cortisol C.produced by the adrenal cortex D. All of the above E. None of the above

B. Reverses the immunosuppressive effect of cortisol

18. What are the characteristics of keloid scar? A. Scar extend beyond the border of original wound B. Rarely seen in Spanish and Asian and Africans C. Scar rises above skin level but stay within the confines of original wound D. Scar often regress with time

A. Scar extend beyond the border of original wound

A 26-year-old female presented to the clinic with severe right lower quadrant pain radiating to the back, which began 48 hours prior to her visit. Physical examination (P.E) revealed an afebrile patient with a temperature of 38.5°C, blood pressure of 110/80 mm Hg, a pulse rate of 104 beats per minute, and a respiratory rate of 20 breaths per minute. The CBC results were as follows: Hemoglobin (Hb): 12 g/L White Blood Cell count (WBC): 13,000 cells/microliter Lymphocytes: 10% Neutrophils : 86% Bands: 4% A. SYTEMIC INFLAMMATORY RESPONSE (SIRS) B. MULTIPLE ORGAN DISFUNCTION (MODS) C. SEVERE SEPSIS D. MULTIPLE ORGAN FAILURE (MOF) E. SEPSIS

A. SYSTEMIC INFLAMMATORY RESPONSE (SIRS)

22. The neuroendocrine response can be stimulated by A. Emotional stress B. Hypoglycemia C. Laceration D. Acidosis E. All of the above

E. All of the above

25. Which of the following in NOT commonly seen in healing of cartilage? A. Slow to heal B. Synthesis of collagen dependent on chrondrocyte C. Hyaline cartilage restores functional and structural integrity D. Often heal without structural defects

D. Often heal without structural defects

26. The usual healing of Pressure sores is mostly by: A. Primary intention B. Tertiary intention C. Surgical excision D. Secondary intention

D. Secondary intention

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 and Reason are false

C. Statement is true but reason is false

28. Which of the following is true of Interleukin-l A. Stabilizes cortisol effect B. Has a long half-life C. Stays in the circulation for 24 hours D. Exert its effect thru the cell membrane contact

D. Exert its effect thru the cell membrane contact

29. Which of the following is true of IL6 A. Inhibited by TNF and IL1 B. Short half life C. Detected in the serum within 6 hours after injury D. Level is not proportional to extent of injury

C. Detected in the serum within 6 hours after injury

30. The concentration of calcium in the extracellular space is controlled by: A. Thyroxine B. Catecholamine C. Aldosterone D. Parathormone

D. Parathormone

31 Which of the following type of wound dressing is recommended to create a warm moist environment that promote debridement and healing? A. Semipermeable film like tegaderm B. Gauze C. Hydrocolloid D. Tulle like sofratulle

C. Hydrocolloid

32. Anastomotic leak has the lowest incidence in which of the following? A. well vascularized bowel loop anastomosis B. water tight anastomosis with slight tension C. well approximated edematous bowel D. All of the above

B. water tight anastomosis with slight tension

33 The surgeon should include this layer of intestinal wall considered as the layer with the greatest tensile strength and suture holding capacity to prevent dehiscence, anastomotic leaks and fistula formation. A. Serosa B. Mucosa C. Submucosa D. Muscularis

C. Submucosa

34.which of the ff: is the effect of TNF A. Muscle anabolism B. Inhibit proteolysis C. Increases the level of D. Platelet activating factor E. all of the above

B. Inhibit proteolysis

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

A. Na

36. Delayed wound healing of wounds of diabetic patients with good sugar control is due to what factors? A. Peripheral ischemia B. Vascular occlusive disease C. Malnutrition D. All of the above E. None of the above

A. Peripheral ischemia

38. WHICH OF THE FOLLOWING STATEMENTS IS/ARE TRUE OF EICOSANOIDS * A. SECRETED BY ALL NUCLEATED CELLS EXCEPT THE MONOCYTES B. STORED IN THE LIVER HEPATOCYTES AND RAPIDLY SYNTHESIZED C. DERIVATIVE OF MEMBRANE PHOPSHOLIPID ARACHIDONIC ACID D. ALL OF THE ABOVE

C. DERIVATIVE OF MEMBRANE PHOPSHOLIPID ARACHIDONIC ACID

40. Which of the following is/are the most active in enhancing wound fibroplasia and significantly increase wound collagen deposition? A. Arginine B. Vitamin A C. Vitamin C D. All of the above

A. Arginine

41. What layer of the intestine whereein healing can occur without scarring A. Mucosa B. Serosa C. Both of the above D. None of the above

C. Both of the above

42. WHICH OF THE FOLLOWING IS/ARE THE EFFECTS OF CORTISOL A. INHIBITS THE RELEASE OF FREE FATTY ACIDS B. INCREASE MONOCYTE CAPACITY FOR INTRACELLULAR KILLING C. INDUCES INSULIN SENSITIVITY OF THE MUSCLE AND ADIPOSE TISSUE D. INCREASE HEPATIC GLUCONEOGENESIS

D. INCREASE HEPATIC GLUCONEOGENESIS

43. WHICH OF THE FOLLOWING IS TRUE OF INTERLEUKIN 2 A. INCREASED PRODUCTION MAY CAUSE A TRANSIENT IMMUNOCOMPROMISED STATE B. DECREASE IMMUNOGLOBULIN PRODUCTION C. PRIMARY INHIBITOR OF THE PROLIFERATION OF T- LYMPHOCYTES D. PROMOTES GUT BARRIER INTEGRITY

D. PROMOTES GUT BARRIER INTEGRITY

44. WHICH OF THE FF; IS/ARE THE EFFECTS OF MACROPHAGE INHIBITORY FACTOR A. GLUCOCORTICOID AGONIST B. SYNTHESIZED IN THE ADRENAL CORTEX C. POTENTIATES GRAM (- ) SEPSIS D. POTENTIATES THE ANTI- INFLAMMATORY EFFECT OF CORTISOL

C. Potentiates Gram (-) Sepsis: MIF has been implicated in the pathogenesis of sepsis, and high levels of MIF are associated with increased severity of sepsis. Therefore, it is said to potentiate sepsis, including that caused by Gram-negative bacteria.

46. Which of the following is not associated with Macrophages? A. Modulation of wound environment B. Present in wound until wound healing is complete C. Recruitment and activation of cells via mediators, cytokines and growth factors D. Wound debridement by phagocytosis

A. Modulation of wound environment

51. In bone healing, at what stage there is soft tissue deposition and neovascularization serving as internal splint and achieving fibrocartilaginous union? a. remodeling b. hard callus C. Soft callus d. hematoma

C. Soft callus

52. What is the likely diagnosis of a patient with ligament and joint laxity, hernia and increased bruisability of skin but is not hyperextensible. A. Acrodermatitis enteropathica B. Ehlers Danlos syndrome C. Osteogenesis imperfecta D. Marfans syndrome

C. Osteogenesis imperfecta

53. What serves as scaffolding for the migration into the wound of inflammatorycells, neutrophils and monocytes? A. Metalloproteinases B. Fibroblast C. Collagen D. Fibrin clot

D. Fibrin clot

56. The early integrity of anastomosis is dependent on what factors? A. Mucosal repair B. Fibrin seal on the serosa C. Both D. NOTA

B. Fibrin seal on the serosa

57. THE LIVER PRODUCE GLUCOSE IN TIME OF STRESS VIA A. Cori's Cycle B. Hexose Monophosphate shunt C. Lipid Metabolism D. Protein Metabolism

C. Lipid Metabolism

63. Most appropriate type of wound dressing recommended for minimally exudative infected diabetic wound? A. Tulle dressing B. Gauze dressing C. Hydrocolloid with silver D. Transparent dressing

C. Hydrocolloid with silver

65. WHAT CELL PRODUCES THE TUMOR NECROSIS FACTOR? A. Erythrocytes B. Monocytes C. Lymphocytes D. B-Cells

C. Lymphocytes

66. a type of wound dressing recommended for exudative venous statsis ulcer? A. Hydrogel dressing B. Transparent dressing C. Gauze dressing D. Foam dressing

A. Hydrogel dressing

68. IF THE PATIENT IS IN THE EBB PHASE, WHICH OF THE THE FOLLOWING CAN BE OBSERVED? A. INCREASED ACETYCHOLINE B. INCREASED INSULIN LEVELS C. INCREASED GONADOTROPINS d. Increase catecholamine levels

d. Increase catecholamine levels

70. A chronically debilitated patient with spinal cord injury develops a decubitus ulcer, appropriate management is/are A. Wound debridement B. Frequent turning C. Adequate nutrition D. All of the above E. A and C only

E. A and C only

71. What is the likely diagnosis of a patient with lax ligaments with no delay in wound healing. Patients arm span is longer than his height and also has inguinal hernia. A. Ehler Danlos Syndrome B. Osteogenesis imperfecta C. Acrodermatitis enteropathica D. Marfans syndrome

D. Marfans syndrome

73. IN ORDER FOR THE RESPONSE TO BE EFFECTED THE FOLLOWING SHOULD BE PRESENT: * A. INTACT KIDNEYS B. INTACT CEREBRUM C. INTACT CEREBELLUM D. INTACT SPINOTHALAMIC TRACT

D. INTACT SPINOTHALAMIC TRACT

74. A boy accidentally slipped and sustained a laceration on the scalp, when is the initial step of wound healing? A. Release of metalloproteinases B. Fibroblast proliferation C. Collagen deposition D. Fibrin clot formation

D. Fibrin clot formation

75. Which of the following is caused by catecholamines A. Stimlates aldosterone release B. Increased insulin release C. Glycogenesis D. Increased glucagon release

D. Increased glucagon release

77. Which of the ff: is true of c –reactive protein is A. Produced by lymphocytes B. Has a diurnal pattern C. Affected by feeding D. Produced by hepatocytes E. All of the above

D. Produced by hepatocytes C-reactive protein (CRP) is primarily produced by hepatocytes (liver cells).

78. A 25 year-old patient sustained severe blunt trauma from a vehicular accident. The level of his response will be affected by the ff: A. weather temperature at the time of accident B. extent of injury C. manner of accident D. type of patient car E. all of the above

B. extent of injury

83 stat exploration showed purulent peritoneal fluid, with a Perforated appendix at the m/3. This is called A. Sepsis B. Severe sepsis C. Multiple-organ failure D. Systemic inflammatory response syndrome E. Multiple organ dysfunction syndrome

B. Severe sepsis

84. ALDOSTERONE EXERTS IT’S ACTION OF SODIUM CONSERVATION AT THE * A. LOOP OF HENLE B. PROXIMAL CONVOLUTED TUBULES C. DISTAL CONVOLUTED TUBULES E. RENAL MEDULLA

C. DISTAL CONVOLUTED TUBULES

85. Coverage of skin graft is markedly increased by ? A. Use biobrane B. Use mesher C. Both of the above D. None of the above

B. Use mesher

86 The main cause of hypercalcemia in hospitalized patient is A. Hyperthyroidism B. Malignancy C. Pancreatitis D. Hyperparathyroidism

D. Hyperparathyroidism

88. WHICH OF THE FF: IS TRUE OF INTERLEUKIN 6 A. LEVEL IS NOT PROPORTIONAL TO EXTENT OF INJURY B. SHORT HALF-LIFE C. DETECTED IN THE SERUM W/IN 6 HOURS AFTER INJURY D. INHIBITED BY TNF AND IL-1

C. DETECTED IN THE SERUM W/IN 6 HOURS AFTER INJURY

89. What abnormalities in the phases of wound healing will lead to development of keloids and hypertrophic scars ? A. inflammatory and proliferative phase B. matrix synthesis phase C. proliferative and remodeling phase D. hemostasis and inflammatory phase

B. matrix synthesis phase

91. THE CONCENTRATION OF CALCIUM IN THE EXTRACELLULAR SPACE IS CONTROLLED BY A. ALDOSTERONE B. PARATHORMONE C. CATECHOLAMINES D. THYROID HORMONE

B. PARATHORMONE

93. Which of the ff; is/are the effects of macrophage inhibitory Factor A. Potentiates the anti- inflammatory effect of cortisol B. Glucocorticoid agonist C. Synthesized in the adrenal cortex D. Potentiates gram (-) sepsis

D. Potentiates gram (-) sepsis

96 WHICH OF THE FOLLOWING STATEMENTS IS/ARE TRUE OF EICOSANOIDS A. SECRETED BY ALL NUCLEATED CELLS EXCEPT THE MONOCYTES B. STORED IN THE LIVER HEPATOCYTES AND RAPIDLY SYNTHESIZED C. DERIVATIVE OF MEMBRANE PHOPSHOLIPID ARACHIDONIC ACID D. ALL OF THE ABOVE

C. DERIVATIVE OF MEMBRANE PHOPSHOLIPID ARACHIDONIC ACID

97. What promotes gastrointestinal healing with minimal complications? a. anastomosis without tension b. presence of distal obstruction C. absence of adequate nutrition d. presence of hypoxemia

a. anastomosis without tension

98. What is the main stimulus for ACTH release? A. Interleukins B. Eicosanoids C. Catecholamines D. Tumor Necrosis Factor

C. Catecholamines

A 25 year old patient sustained severe blunt trauma from a vehicular accident. The level of his response will be affected by the A. Weather temperature at the time of accident B. Extent of the injury C. Manner of the accident D. Type of patient car E. All of the above

B. Extent of the injury