Mock Exam Part 1, #16-30 Reviewer

Question 1

In compartment syndrome, irreversible nerve and muscle damage occurs after _______

Answer 1

4-6 hours
“Pressures >30 mm HG produce muscle ischemia; irreversible muscle damage occurs after 4-6 hours.”

Question 2

Class A bioterrorism agents

Answer 2

SAFE-BA-Yan-Talaga

Smallpox (Variola major)
Arenavirus
Filovirus
Ebolavirus

Botox (Clostridium botulinum)
Anthrax (Botulinum anthracis)

Yersnia pestis
Tularemia (Francisella tularensis)

Class A agents has the most severe potential to cause harm

Question 3

Identify the lesion:

Answer 3

Ulcer and eschar of cutaneous anthrax

Question 4

Prophylaxis for this lesion:

Answer 4

Ciprofloxacin or doxycycline for 60 days is preferred.

Question 5

In bioterrorism, the following are included in the Class A Biologic agents, EXCEPT:
A. BACILLUS ANTHRACIS
B. RICKETTSIA PROWAZEKII
C. CLOSTRIDIUM BOTULINUM
D. FRANCISELLA TULARENSIS

Answer 5

B. RICKETTSIA PROWAZEKII

Question 6

Organ system that first to be affected with radiation as little as 2 Gy radiation exposure

Answer 6

Hematopoietic

Question 7

most readily available marker to grade the extent of radiation injury to the bone marrow cells

Answer 7

Peripheral lymphocyte count
Lymphocytes are preferentially destroyed.

Since granulocytes and platelets are markers of inflammation, their counts initially rise following exposure, but reach a nadir within 30days of injury.

Question 8

radiation exposure from chest radiograph

Answer 8

0.1 mGy (milligray)
10 mrem

*(table 10-4)

1 rad = 1 rem = 10 mGy = 1000 mrem

Question 9

radiation exposure to the uterus/fetus with chest radiography with shielding of the maternal abdomen

Answer 9

<0.001 mGy
(table 99-9)

Question 10

threshold for human teratogenesis

Answer 10

100 mGy

50 mGy - accepted as safe in pregnancy

(table 99-9)

Question 11

MI and sudden cardiac death most likely happen when?

Answer 11

first few hours after awakening from sleep because of increased sympathetic stimulation

B-blockade provides some protection from sudden cardiac death, particularly in patients with known coronary artery disease who have had myocardial infarction and have a low ejection fraction.

Question 12

What is the major cause of sudden cardiac death in adults?

Answer 12

Coronary artery disease (80%)

cardiomyopathy: 10-15%
miscellaneous: 5-10%

Question 13

This valve involvement can trigger syncope and sudden cardiac death

Answer 13

Aortic stenosis

Question 14

most common cause of aortic stenosis

Answer 14

bicuspid aortic valve

Question 15

typical finding in hemodynamically significant aortic stenosis

Answer 15

harsh, late-peaking systolic murmur at the upper right sternal border with radiation to the neck

Question 16

In distributive shock, there is relative intravascular volume depletion due to vasodilatation, which is seen in the following, EXCEPT:

A. Capillary leak from burns
B. Neurogenic shock
C. Sepsis
D. Anaphylaxis

Answer 16

A. Capillary leak from burns

Question 17

Blood pressure may not drop even in the presence of decreased cardiac output causing decreased perfusion (shock) if the patient is or has:

Answer 17

peripheral vascular disease
For this reason, blood pressure is an insensitive marker for global tissue hypoperfusion
Shock may occur with a normal BP, and hypotension may occur without shock
No single vital sign is diagnostic of shock.

Question 18

The following may be done to optimize circulation in patients in shock, EXCEPT:
a. place patient in Trendelenburg position
b. careful vasopressor infusion
c. provide PLRS over normal saline
d. central venous access is the preferred route for long-term vasopressors

Answer 18

A. Place patient inTrendelenburg position

The Trendelenburg position does not improve cardiopulmonary performance compared with the supine position.
It may worsen pulmonary gas exchange and predispose to aspiration

Passive leg raising above the level of the heart with the patient supine may be effective.

If passive leg raising results in an increase in BP or cardiac output, fluid resuscitaiton is indicated

Question 19

The following measures are effective in ensuring adequate oxygen delivery, EXCEPT:
A. pain control
B. muscle relaxation
C. pRBC tranfusion
D. cold treatment rooms

Answer 19

D. cold treatment rooms
it should be warm covering

other measures are:
- anxiolytics
- paralytics when appropriate

Also:
Restore arterial oxygen saturation to ≥91%
In shock states, consider a transfusion of PRBCs to maintain Hgb ≥7 g/dL

Question 20

Hypotensive resuscitation in trauma is NOT done when?

Answer 20

traumatic brain injury

maintain MAP ≥80 mm Hg in TBI

Question 21

What is hypotensive resuscitation

Answer 21

used when there’s active bleeding in trauma (but deferred if with concomitant TBI)

In hypotensive resuscitation (permissive hypotension), maintain:
MAP of 60 mm Hg
SBP approx 80-90 mm Hg
(Military Medicine chapter, p2010)

Question 22

A trauma patient came in due to a stab wound in the abdomen. BP was 90/60, HR of 130. What will NOT be included in your managment
A. perform FAST
B. order of massive tranfusion protocol
C. Surgical hemostasis
D. Low plasma-to-RBC ratio resuscitation

Answer 22

D. Low plasma-to-RBC ratio resuscitation

High plasma-to-PRBC ratio resuscitation appears to also offer survival benefit independent of coagulopathy, and plasma may enhance cell survival by endothelial repair and reducing vascular permeability.

It may also be that plasma is simply a superior fluid for perfusion and tissue oxygenation restoration

1:1:1 ratio pa rin for MTP. It’s just that high plasma-to-PRBC ratio is better than low plasma-to-PRBC ratio, yun napansin nila in the combat setting.

Question 23

The Assessment of Blood Consumption score uses 4 values to determine need for MTP. These 4 values are:

Answer 23

1.) Penetrating mechanism of injury
2.) Positive FAST
3.) BP <90 mm Hg
4.) PR >120 bpm

The presence of 2 or more variable has a sensitivity for massive transfusion of 76-90%, with a specificity of 67-87%

Question 24

A patient come in your ED with generalized urticaria with shortness of breath after intake of seafood. What will be your first priority?

A. airway protection
B. decontamination
C. epinephrine
D. IV crystalloids

Answer 24

A. airway protection
In severe anaphylaxis, securing the airway is the first priority

Question 25

treatment of choice for anaphylaxis

Answer 25

Epinephrine 0.3-0.5 mg IM
(0.3 -0.5 mL of 1:1000 dilution)

Question 26

Pedia dose for epinephrine in anaphylaxis

Answer 26

0.01 mg/kg IM
or 0.01mL/kg of 1:1000 dilution

Question 27

TRUE or FALSE
Injections to the deltoid area are more effective at achieving peak blood levels than injections into the thigh area.

Answer 27

FALSE
Injections to the thigh are more effective.

Question 28

In rabies vaccination, it is not recommended to inject where due to high failure rates?

Answer 28

Gluteal area

Question 29

The only acceptable site of rabies vaccination for adults and older children

Answer 29

deltoid area

For younger children, the anterolateral aspect of the thigh may be used

Question 30

Rate of epinephrine for symptomatic bradycardia

Answer 30

2-10 mcg/min