Med Year Exam

Question 1

presence of microorganisms in a wound

Answer 1

Contamination

Question 2

When organisms invade the tissue and produce ill effects (inflammation)

Answer 2

Infection

Question 3

Non-suppurative invasive infection of the skin + subcutaneous tissues

Answer 3

Cellulitis

Question 4

Acute spreading inflammation of the outer dermis + superficial lymphatics.

Answer 4

Erysipelas

Question 5

is a localized suppurative inflammation.

Answer 5

Acute abscess

Question 6

Rapidly progressive poly-microbial cellulitis, of the sublingual + submandibular space Involving floor of mouth + suprahyoid area (both sides of the neck)

Answer 6

Ludwig’s angina

Question 7

Inadequate tissue perfusion with decreased oxygen delivery + impaired cellular metabolism

Answer 7

Shock

Question 8

End diastolic ventricular volume (represented by: end diastolic pressure)

Answer 8

Preload

Question 9

Vascular resistance (represented by: mean arterial blood pressure MAP)

Answer 9

Afterload

Question 10

Diminished blood volume

Answer 10

Hypovolemic shock:

Question 11

Due to pump failure. Alteration of the heart failure + inability maintain adequate cardiac output OR restriction of cardiac work.

Answer 11

Cardiogenic shock:

Question 12

Mal-distribution of blood flow leads to inadequate tissue perfusion in spite of NORMAL BLOOD VOLUME + normal cardiac function.

Answer 12

Distributive shock:

Question 13

Allergic reaction IgE antibodies against certain antigens (drugs, insect bite, foods)

Answer 13

Anaphylactic shock:

Question 14

Persisting hypotension despite adequate volume resuscitation, occurring in a patient with SEPSIS.

Answer 14

Septic shock:

Question 15

presence of bacteria in the blood stream

Answer 15

Bacteremia

Question 16

presence of toxins in blood stream

Answer 16

Toxemia

Question 17

presence of both bacteria + toxins

Answer 17

Septicemia

Question 18

Aqueous solution of low molecular weight ions (salt) with or without glucose (dextrose)

Answer 18

Crystalloids

Question 19

Solution containing high molecular weight substances such as proteins or large glucose polymers

Answer 19

Colloids

Question 20

Mere presence of microorganisms in a wound.

Answer 20

Contamination

Question 21

When organisms invade the tissues and produce ill effects (inflammation)

Answer 21

Infection

Question 22

Q1- What are Components of wound healing?

Answer 22

1. Wound contraction
2. Granulation tissue formation
3. Epithelialization

Question 23

Q2- what are Stages of wound healing?

Answer 23

1- Haemostasis and inflammation phase, 72 hours
2- Proliferation phase
3- Maturation and remodeling phase

Question 24

Q3- what are Types of wound healing?

Answer 24

1- Healing by primary intention
2- Healing by secondary intention
3- Healing by tertiary intention

Question 25

Q4- what are general Factors affecting wound healing?

Answer 25

1- Age 2- Nutritional state 3- Debilitating diseases 4- Drug intake Steroids

Question 26

Q5- what are local Factors affecting wound healing?

Answer 26

1- Vascularity 2- Irradiation 3- Tension 4- Infection delays healing 5- Foreign bodies

Question 27

Q6- what are Classification of surgical wound?

Answer 27

1- Clean wound 2- Clean contaminated wound 3-Contaminated wound 4-Dirty infected wound

Question 28

Q1- What are the definition of shock?

Answer 28

is a state of inadequate tissue perfusion with decreased oxygen delivery & impaired cellular metabolism.

Question 29

Q2- what are Types of shock?

Answer 29

1-Cardiogenic shock 2-Hypovolaemic shock

Question 30

Q3- Types of Cardiogenic shock?

Answer 30

Cardiomyopathy Myocardial infarction CHF - ventricular anuerysm Depressed myocardium Arrythmias - Pulmonary hypertension, drugs

Question 31

Q4- Types of Hypovolaemic shock?

Answer 31

1 - Constrictive 2 - Distributive

Question 32

Q4- Types of constrictive Hypovolaemic shock?

Answer 32

Tension pneumothorax Pulmonary embolism constrictive pericarditis pericardial tamponade

Question 33

Q4- Types of Distributive Hypovolaemic shock?

Answer 33

Anaphylactic Septic Neurogenic Endocrine Hypo and hyperthyroidism Adrenal insufficiency

Question 34

Q5- what are Effect of shock on organs?

Answer 34

• Heart... / COP, hypotension, myocardial depression - Lung.... V gas exchange , lung oedema tachypnea - Renal ... I GF, I urine out put - GIT .... Mucosal ischemia, bleeding .... Liver damage - Blood .... Coagulation abnormalities , DIC - Endocrine .... ^ADH - 1 water retention • CNS ... V Perfusion, altered mental function

Question 35

Q6- What are Classification of hemorrhagic shock?

Answer 35

1-Class I hemorrhage (<15% or 750 cc blood loss) 2-Class Il hemorrhage (15% to 30% or 750 to 1500 cc blood loss) 3-Class IIl hemorrhage (30% to 40% or 1500 to 2000 cc blood loss) 4-Class IV hemorrhage (> 40% or >2000 cc blood loss)

Question 36

Q7- what are Symptoms and sign of hypovolaemic shock?

Answer 36

O Thirst, anxiety O Fainting O Sweating O Coldness And shivering O Systolic pressure may not drop till loss of 30% of blood volume O Tachycardia in adults > 100 BPM

Question 37

Q8-what are Goals for emergency treatment?

Answer 37

1. - Maximize oxygen delivery 2. - Control further blood loss 3. - Fluid resuscitation

Question 38

Q9- what is Management of hypovolaemic shock?

Answer 38

1-Apply A B C D E of resuscitation in injured patients 2-Give oxygen 100% , May need intubation 3-Secure venous access by two large bore short cannulas 4-Do ABG 5-Start fluid therapy , (Crystalloid - Ringer Lactate or Hartmann solution)

Question 39

010- How to get venous access ?

Answer 39

0 - Arm veins. 0 - Intra osseous route . 0 - Central lines. 0 - Cut down of long saphenous vein

Question 40

Q11- what is Endpoints of resuscitation?

Answer 40

* - Vital sign ..pulse<100,, BP>100 * - Urine output >=0.5ml /hr/1kg * - CVP .. 5-10 cm H20 * - MAP 65-90 * - Central venous oxygen concentration > 70% - Improvement in mental state

Question 41

012- what are causes of Cardiogenic shock?

Answer 41

• Acute mvocardial infarction • Aortic or mitral stenosis , Myocarditis • Sepsis & myocardial depression • Myocardial contusion, Cardiomyopathy, Arrhythmias. • Massive pulmonary embolism.

Question 42

013- what are Clinical picture of the original cause:?

Answer 42

O Pulse decreased or increase. O Dyspnea, Tachypnea. O Blood pressure decreased, Hypotention O Congested neck veins with high CVP. O Cool mottled skin of extremities. - SBP < 90 mmHg - PCWP > 18 mmHg

Question 43

Q14- Management of Cardiogenic shock?

Answer 43

18 Oxygen therapy 28 continuous fluid therapy, ( according to pt. condition) 31 treat underlying cause 42 support myocardium 57 needs special management in ICU

Question 44

Q15- what are causes of Anaphylactic shock?

Answer 44

* - Drugs : contrast media, vaccines, local anesthetic drugs, * - Insect bite * - foods

Question 45

Q16- Management of anaphylactic shock?

Answer 45

B Oxygen therapy. 02 mask. R Airway management, may need intubation, ICU care. A Intravenous access , start IV fluids, needs large volume. A Adrenaline 1:1000 0.2-0.5ml & 0.01 mg/kg in children S/C or IM El Repeat the dose 2-3 times in 10-15min. Antihistamines, provide dramatic relief of symptoms B Use of nebulizers if wheezing or respiratory distress - IV Aminophylline may be considered A Use of steroids , Hydrocortisone IV

Question 46

Q17- Causes of septic shock?

Answer 46

>Most common is bacteria - Gram negative in two thirds 2/3 - Gram positive in one third 1/3 > Gram negative as eg. - E. coli, klebsiella - Entrobacteria, bacteriods > Gram positive as - Streptococci, Staph, Pneumococci, Clostridia

Question 47

018- What are Clinical picture two stages?

Answer 47

1-Hyper dynamic (warm) septic shock i.e-early stage, Fever. 2-Hypo-volaemic (cold) septic shock: - late stage.

Question 48

Q19- - Treatment ( principle of treatment)?

Answer 48

> - Needs I.C.U if no response to initial ED treatment > - Oxygen >- fluid therapy correct hypo perfusion > - Antibiotics

Question 49

Q20- Treatment started with?

Answer 49

A) - Dealing with the infection by : - • - Drainage of abscesses or peritonitis etc.... • -I.V. strong antibiotics B) Anti-shock measure as : - • Fluid replacement and may be fresh blood until normal urine output and normal C.V.P. • Drugs as inotropics and vasopressors. • Oxygen support.