NBR 2 - Clinical Skills/Critical Care Flashcards
For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all. A. enflurane B. etomidate C. halothane . D. isoflurane E. ketamine F. thiopental 1. increases cerebral blood flow (CBF) and cerebral metabolic rate of oxygen consumption (CRM02)
Jawab : E
For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all. A. enflurane B. etomidate C. halothane . D. isoflurane E. ketamine F. thiopental 2. Of the volatile anesthetics, it increases CBF the least.
Jawab : D
For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all. A. enflurane B. etomidate C. halothane . D. isoflurane E. ketamine F. thiopental 3. induces seizure discharges
Jawab : A
For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all. A. enflurane B. etomidate C. halothane . D. isoflurane E. ketamine F. thiopental 4. dissociative anesthetic
Jawab : E
For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all. A. enflurane B. etomidate C. halothane . D. isoflurane E. ketamine F. thiopental 5. decreases CBF and CRM02 and produces cardiovascular depression
Jawab : F
For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all. A. enflurane B. etomidate C. halothane . D. isoflurane E. ketamine F. thiopental 6. decreases CBF and CRM02 and suppresses adrenocortical response to stress
Jawab : B
7. Which antiemetic medication lowers seizure threshold A. Phenergan B. droperidol C. Tigan D. Zofran E. Reglan
Jawab : A
8. The most appropriate drug to administer to a stable patient with a narrow complex upraventricular tachycardia (no serious signs or symptoms) after vagal stimulation is A. adenosine B. figoxin C. procainamide D. quinidine E. verapamil
Jawab : A
Adenosineatan initial doseof6mg over 1 to 3 seconds, followed by a repeat of 12 mg in 1 to 2 minutes prn, is the initial drug of choice. If lidocaine is ineffective,procainamide at a dose of20to30mglmin for a maximum of 17mglkg is given.
- Each is true of fat embolism except
A. Cerebral manifestations frequently occur in the absence of pulmonary manifestations.
B. Increased serum lipase occurs in up to half of all patients.
C. Petechia over the shoulders and chest is a classic finding.
D. Symptoms typically occur 12 to 48 hours after trauma.
E. Tachycardia and tachypnea are characteristic.
Jawab : A
Sch p. 459.Neurologic involvement does not develop in the absence of pulmonary abnormalities unless there is the rare event of a paradoxical embolus through a patent foramen ovale.
10. Gamma irradiation of blood helps prevent A. graft-versus-host disease B. hemolytic transfusion reactions C. hepatitis B transmission D. nonhemolytic transfusion reactions E. transfusion siderosis
Jawab : A
Har p. 737.Transfusion-associated graft-versus-host disease may result if viable lymphocytes in blood are not irradiated
- Citrate toxicity from massive transfusions results from the
A. binding of free ionized Ca2+
B. decrease of 2,3-diphosphoglyceric acid (DPG) levels
C. inactivation of factors 5 and 8
D. interaction with platelets, rendering them dysfunctional
E. precipitation of autoimmune hemolytic anemia
Jawab : A
For questions 12 to 14, match the description with the disease.
A. Cushing’s disease
B. ectopic adrenocorticotropic hormone (ACTH) production
C. both
D. neither
12. Cortisol is suppressed with low-dose dexamethasone.
Jawab : D
For questions 12 to 14, match the description with the disease.
A. Cushing’s disease
B. ectopic adrenocorticotropic hormone (ACTH) production
C. both
D. neither
13. Cortisol is suppressed with high-dose dexamethasone.
Jawab : A
For questions 12 to 14, match the description with the disease.
A. Cushing’s disease
B. ectopic adrenocorticotropic hormone (ACTH) production
C. both
D. neither
- increase in urinary 17-hydroxycorticosteroids after a metyrapone test.
Jawab : A
- Which of the following scenarios reflects hypochromic, microcytic anemia?
A. decreased mean corpuscular volume (Mev) and decreased total iron binding capacity (TIBC)
B. decreased MCV and increased TIBC
C. decreased Mev and normal TIBC
D. increased MCV and decreased TIBC
E. increased Mev and increased TIBC
Jawab : B
16. Prolongation of bleeding time usually occurs in I. von Willebrand's disease II. use of nonsteroidal anti-inflammatory agents III. uremia IV. factor VII deficiency A. I, II, III B. I, III C. II, IV D. IV E. all of the above
Jawab : A
Har pp. 358-359.Although patients with von Willebrand’s disease usually have an abnormal bleeding time, it may occasionally be normal due to cycli- cal variations in the von Willebrand factor. Factor VII deficiency causes pro- longation of the prothrombin time (PT) and partial thromboplastin time (PlT).Uremia and the use of nonsteroidal anti-inflammatory agents result in platelet dysfunction (the latter by decreasing cyclooxygenaseactivity).
17. Drugs that antagonize the anticoagulant effect of warfarin (Coumadin) include I. cholestyramine II. phenobarbital III. rifampin IV. cimetidine A. I, II, III B. I, Ill C. II, IV D. IV E. all of the above
Jawab : A
Har pp. 427-428.Trimethoprim sulfamethoxazole (Bactrim) increases the effect of Coumadin by decreasing clearance. Barbiturates and rifampim accel- erate Coumadin clearance by inducing hepatic metabolizing enzymes, and cimetidine inhibits its oxidative metabolism.
18. Contraindications to the use of thiazide diuretics include I. diabetes mellitus II. hyperuricemia III. primary aldosteronism IV. lupus erythematosus A. I, II, III B. I, III C. II, IV D. IV E. all of the above
Jawab : A
Har p. 1326.Metabolic side effects of thiazide diuretics include hypokalemia from renal potassium loss, hyperuricemia from uric acid retention, carbohy- drate intolerance, and hyperlipidemia.
19. Plasma levels of phenytoin (Dilantin) are increased by all of the following except A. carbamazepine B. cimetidine C. Coumadin D. isoniazide E. sulfonamides
Jawab : A
Har pp. 427,2364-2365.Carbamazepine (Tegretol)decreases plasma levels of phenytoin (Dilantin).
- The most common electrocardiogram (EKG) finding in patients with pulmonary emboli is
A. a peaked T wave
B. an Sl-Q,-T 3 pattern
C. rightward shift of the QRS axis
D. sinus tachycardia (ST) and T wave changes
E. tachycardia
Jawab : D
Sch p. 1017.Nonspecific sinus tachycardia (ST) and T wave changes occur in 66%of patients
- Which of the following disorders leads to hypernatremia?
A. Addison’s disease
B. hyperaldosteronism
C. hypothyroidism
D. renal failure
E. syndrome of inappropriate antidiuretic hormone (SIADH)
Jawab : B
- The most common acid-base disturbance in mild to moderately injured patients without severe renal, circulatory, or pulmonary decompensation is
A. respiratory acidosis and metabolic alkalosis
B. respiratory alkalosis and metabolic acidosis
C. respiratory or metabolic acidosis
D. respiratory or metabolic alkalosis
Jawab : D
- The reabsorption of Na+ ions in the thin ascending Henle’s loop
A. is by active transport
B. is by a Na+ -K+ exchange pump
C. passively follows the active transport of Cl- ions
D. passively follows the active transport of water molecules
Jawab : C
For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all.
A. abciximab (Reopro)
B. aspirin
C. clopidogrel (Plavix)
D. eptifibatide (Integrilin)
E. ticlopidine (Ticlid)
24. Of the two prod rugs that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. it has a slightly more favorable toxicity profile.
Jawab : C
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.
For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all.
A. abciximab (Reopro)
B. aspirin
C. clopidogrel (Plavix)
D. eptifibatide (Integrilin)
E. ticlopidine (Ticlid)
25. is the Fab fragment of a monoclonal antibody directed against the lIb/IlIa receptor
Jawab : A
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.
For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all.
A. abciximab (Reopro)
B. aspirin
C. clopidogrel (Plavix)
D. eptifibatide (Integrilin)
E. ticlopidine (Ticlid)
26. is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the glycoprotein lIb/IlIa
Jawab : D
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.
For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all. A. abciximab (Reopro) B. aspirin C. clopidogrel (Plavix) D. eptifibatide (Integrilin) E. ticlopidine (Ticlid)
- blocks production of thromboxane A2
Jawab : B
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.
- Which laboratory findings in disseminated intravascular coagulation (DIC) correlates most closely with bleeding?
A. decreased fibrinogen
B. increased fibrin degradation products
C. increased prothrombin time (PT)
D. increased partial thromboplastin time (PTI)
E. increased thrombin time (IT)
Jawab : A
- The definition of oxygen saturation is the
A. amount 0” oxygen dissolved in plasma
B. fractional concentration of inspired oxygen
C. partial pressure of oxygen in the blood
D. percentage of hemoglobin that is bound to oxygen
E. ratio of unbound to bound hemoglobin
Jawab : D
30. Metabolic responses to trauma include each of the following except A. hypoglycemia B. increased rate of lipolysis C. increased Na+ reabsorption D. increased water reabsorption E. metabolic' alkalosis
Jawab : A
Sch pp. 26-33.Hyperglycemia, not hypoglycemia, is one of the metabolic responses to trauma.
31. A normal PT. a prolonged PTI. and a bleeding disorder would result from a deficiency off actor A. II B. V C. VIII D. X E. XII
Jawab : C
Har p. 359. Deficiency of factors 11. V, or X causes prolonged IT and PTT. A deficiency of factor XI1 causes a prolonged PITbut no clinical bleeding.
For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all. A. factor II B. factor VII C. factor VIII D. factor IX E. factor X 32. shortest half-life
Jawab : B
For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all. A. factor II B. factor VII C. factor VIII D. factor IX E. factor X 33. reflects the extrinsic pathway
Jawab : B
For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
34. deficient or abnormal in hemophilia A (classic)
Jawab : C
For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
35. deficient in hemophilia B (Christmas disease)
Jawab : D
For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
36. All except this factor are vitamin K-dependent factors.
Jawab : C
For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
37. Deficiency of factor II or this factor results in prolonged PT and PTI.
Jawab : E
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
38. antithrombin III deficiency
Jawab : E
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
39. DlC
Jawab : A
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
40. von Willebrand’s disease
Jawab : D
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
- dysfibrinogenemia
Jawab : A
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
42. malnutrition
Jawab : B
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
- factor VII deficiency
Jawab : B
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
- factor XIII deficiency
Jawab : C
For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
- factor VIII deficiency
Jawab : F
For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
46. often occurs with hypokalemia
Jawab : C
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.
For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
- Addison’s disease
Jawab : B
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.
For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
48. salicylate overdose (early stage)
Jawab : D
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.
For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
- myasthenia gravis
Jawab : D
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.
For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
- ethylene glycol overdose
Jawab : A
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.
For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
- Cushing’s disease
Jawab : C
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.
For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
- primary aldosteronism
Jawab : C
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.
53. The formula for mean arterial pressure is (OBP = diastolic blood pressure; SBP = systolic blood pressure) A. (OBP + SBP)/2 B. OBP + (SBl- OBP)/2 C. OBP/2 + SBP/3 D. OBP + (SBP - OBP)/3 E. OBP/2 + (SBP - OBP)/3
Jawab : D
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.
For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither
54. parathyroid hyperplasia or adenoma
Jawab : C
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.