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Residency > Schwatrz's absite review question bank > Flashcards

Schwatrz's absite review question bank Flashcards

1
Q

clinical situation where CRP does not increase following inflammation

A

in patient with liver cirrhosis

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2
Q

high-mobility group
protein B1 (HMGB1)

A

DAMP molecules secreted by various cells in response to injury

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3
Q

high-mobility group
protein B1 (HMGB1) function

A

1) release of cytokine
2)increase epithelial permeability
3)chemotactic
4)increase procoagulant activity

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4
Q

Nutritional formulas used to treat pulmonary failure typically
increase the at intake of a patient’s total caloric
intake to

A

50%

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5
Q

ECG changes that may be seen with hyperkalemia

A

Peaked T waves (EARLY)
flattened P waves
prolonged PR interval
widened QRS complex
sinus wave formation
V.fib

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6
Q

symptoms of hyperkalemia

A

GI syx: N,V,Colic,Diarrhea
Neuromusc. syx: weakness, ascending paralysis, resp. failure
CVS syx: arrhythmia, arrest

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7
Q

severe hypocalcemia effect on the heart

A

congestive heart failure

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8
Q

ECG changes associated with severe hypocalcemia

A

prolonged QT interval
T wave inversion
v.fib

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9
Q

which type of fluid is an arteriolar vasodilator

A

hypertonic saline

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10
Q

normal saline can lead to what acid base disorder

A

hyperchloremic metabolic acidosis

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11
Q

Albumin 5% osmolality

A

300 mOsm/L

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12
Q

Albumin 25% osmolality

A

1500 mOsm/L

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13
Q

The highest percentage
TBW is found in newborns , with approximately 80% their
total body weight composed of water. This decreases to about
65% at what age

A

1 year

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14
Q

Free water deficit formula in hypernatremic patients

A

((serum sodium-140)/140))*TBW

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15
Q

calcium adjustment formula in the setting of low albumin

A

Adjust total serum calcium down by 0.8 mg/dL for every
1 g/dL decrease in albumin

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16
Q

Corrected Anion Gap in case of hypoalbuminemia

A

low albumin lowers actual anion gap

Corrected AG = actual AG + [2.5(4.5 – albumin)]

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17
Q

Low urinary NH4+ in the face of hyperchloremic metabolic acidosis would indicate

A

renal cause of the acidosis

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18
Q

electrolyte abnormalities seen in acute renal failure patients

A

hyperkalemia, hypermagnesemia, hyperphosphatemia,
hypocalcemia

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19
Q

Hypermagnesemia ECG findings

A

similar to hyperkalemia ECG changes

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20
Q

Treatment of the cardiac effect of hypermagnesemia is by giving

A

Calcium gluconate

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21
Q

Factor X is al known as

A

Stuart-prower factor

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22
Q

Which factor deficiency is associated with delayed bleeding after initial homeostasis

A

Factor XIII (13)

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23
Q

In a previously unexposed patient, when does the platelet
count fall in heparin-induced thrombocytopenia (HIT)

A

5-7 days

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24
Q

In a previously exposed patient, when does the platelet
count fall in heparin-induced thrombocytopenia (HIT)

A

1-2 days

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25
Q

What are the initial key initiators in the development of acute coagulopathy of trauma (ACoT)

A

shock and tissue injury

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26
Q

The most common intrinsic platelet defect

A

storage pool disease
(loss of dense and alpha granules)

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27
Q

What is the risk of Hepatitis C and HIV-1 transmission
with blood transfusion

A

1:1000,000

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28
Q

What is the risk of Hepatitis B transmission
with blood transfusion

A

1:300,000

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29
Q

Factor IX (9) is also known as

A

christmas factor

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30
Q

The most common clinical manifestation following a hemolytic transfusion reaction

A

oliguria

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31
Q

increased R or K value in TEG u give

A

FFP

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32
Q

Decreased angle in TEG u give

A

Cryo

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33
Q

Decreased Ma in TEG u give

A

platelets

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34
Q

Difference of baroreceptors present in the atria and (carotid body/aortic arch)

A

those present in atria respond to low volume hemorrhage

while those in carotid body and aortic arch respond to high volume hemorrhage

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35
Q

baroreceptor function when they are not stretched in response to a reduction of blood volume

A

they stop giving inhibitory signals to the ANS

ANS starts working leading to increase HR and vasoconstriction

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36
Q

Chemoreceptors in the aorta and carotid body sense the following

A

o2 tension
CO2
Hydrogen ions

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37
Q

septic shock not responding to levophed u should add

A

ADH (arginine vasopressin)

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38
Q

critically ill and septic patients should have intensive glucose control in the range of

A

80-110

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39
Q

MC cause of cardiogenic shock is

A

Myocardial infarction

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40
Q

MC type of shock in trauma patient with spinal cord injury

A

hypovolemic shock !!

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41
Q

Class 1D surgical wound is

A

Class 1 surgical wound + prosthetic device (eg mesh in hernia surgery)

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42
Q

The diagnosis of UTI is established by the following parameters

A

> 104 CFU/mL of
microbes are identified by culture techniques in Symptomatic
patients, or >105 CFU/mL in Asymptomatic individuals

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43
Q

scenario where u have low virulence organism (eg staph epidermidis) infecting a central catheter and u cant obtain another access beside this one what to do

A

14-21 day course of antibiotic
keep the central catheter
this will treat around
60% of cases

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44
Q

Patients with a penicillin allergy are LEAST likely to have
a cross-reaction with

A

Monobactams

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45
Q

The estimated risk of transmission from
a needlestick from a source with HIV-infected blood is estimated
at

A

0.3%

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46
Q

Closure of an appendectomy wound in a patient with
perforated appendicitis who is receiving appropriate
antibiotics will result in a wound infection in what percentage
of patients?

A

3-4%

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47
Q

seroconversion rate of hepatitis C after accidental
needlestick approximately

A

1.8%

48
Q

in what percentage of patients with Hep C will go on to develop chronic hep C infections

A

75-80%

49
Q

post exposure prophylaxis for HIV consists of

A

2 or 3 drug combinations started within hours post exposure

50
Q

During the circulation section of the primary survey, four life threatening
injuries must be identified promptly:

A
  1. Massive hemothorax
    2.hemoperitoneum
    3.cardiac tamponade
    4.unstable pelvic fractures with bleeding
51
Q

Focused assessment with sonography for trauma (FAST) should include views of

A

(1) the hepatorenal recess (Morison pouch), (2) the perisplenic area, (3) the subxiphoid pericardial window, and (4) the suprapubic window (Douglas pouch).

52
Q

Soft signs of vasuclar injury

A
  1. proximity to vasculature
    2.nerve injury
    3.A-A index <0.9
    4.Thrill/Bruit
    5.significant hematoma
53
Q

A-A index soft sign of vascular injury is

A

systolic BP of injured limb/Systolic BP of contralateral uninjured limb

54
Q

MC site for blunt cerebrovascular injury in trauma

A

distal part of internal carotid artery

55
Q

MC MOI in blunt CV injuries

A

hyperextension and rotational injury

56
Q

how to treat duodenal hematomas

A

repeated NG suctioning
parenteral nutrition for 7-10 days

most likely will resolve if not go in and evacuate the hematoma

57
Q

The goal of Damage control surgery

A

control bleeding and limit GI spillage

58
Q

Therapy for increased intracranial pressure (ICP) in a
patient with a closed head injury is instituted when the
ICP is greater than

A

20

59
Q

one of the most common sequelae of high voltage electrical injury

A

Cataract

60
Q

burn ointment contraindicated on or around skin grafts

A

silver sulfadiazine

61
Q

The hypermetabolic response in burn injury may raise
baseline metabolic rates by as much as

A

200%

62
Q

The genetic defect associated with Marfan’s syndrome is a
mutation

A

FBN-1 gene encoding fibrillin

63
Q

Collagen synthesis in the
GI tract is carried out by

A

fibroblasts AND smooth muscles

64
Q

What type of nerve injury involves disruption of axonal
continuity with preserved Schwann cell basal lamina

A

Axonotemesis

65
Q

What type of nerve injury involves disruption of axon and myelin sheath (whole nerve is disrupted)

A

Neurotmesis

66
Q

The age adjusted cancer incidence is increasing for the following cancers

A

melanoma, thyroid, liver Ca, Breast Ca (in women)

67
Q

chemoprevention meaning

A

the systemic or local administration of a therapeutic agent to PREVENT development of cancer

68
Q

which kidney is preferred for donation and why?

A

The donor’s left kidney is usually preferable because
of the long vascular pedicle

69
Q

The most common diagnosis leading to the need for a heart transplant

A

ischemic dilated cardiomyopathy

70
Q

One o the most significant side effects of sirolimus

A

Hypertriglyceridemia

71
Q

The most common delayed complication following CEA

A

MI

72
Q

Most accurate parameter of intra-arterial pressure monitoring system

A

MAP

73
Q

which ECG lead is the most sensitive in detecting perioperative ischemia

A

V4

74
Q

The most common arrhythmia seen during laparoscopy is

A

bradycardia

75
Q

The human genome contains approximately

A

25,000-30,000 genes

76
Q

the initiating event in shock

A

tissue hypoperfusion and cellular energy deficit

77
Q

below what value of SBP do trauma patients have increased mortality

A

below 110

78
Q

What type of shock seems to be the final common pathway of prolonged shock of any etiology

A

vasodilatory shock

79
Q

known side effect of mirlinone

A

thrombocytopenia

80
Q

Class 2 colorectal surgery SSI risk

A

10-25%

81
Q

class 2 GI, hepatobiliary surgery SSI risk

A

2-10%

82
Q

cricothyrotomy is contraindicated in

A

patient under the age of 11 du to the risk of developing subglottic stenosis

83
Q

Massive hemothorax in a pediatric population is

A

more than third total blood volume (70ml/kg)

84
Q

estimated blood loss of each fracture
One rib fracture
Tibial fracture
femur fracture
pelvic fracture

A

100-200
300-500
800-1000
>1000

85
Q

hallmark early symptom of lower extremity compartment syndrome

A

numbness between first and second toe
compression of peroneal nerve ant. comp.

86
Q

bladder pressure above which u need a decompressive laparotomy

A

> 35 mmhg

87
Q

the affinity of CO to hemoglobin is how much greater than that for O2

A

200-250 times greater

88
Q

Guidelines for referral to a burn center

A

*Partial-thickness burns greater than 10% TBSA
*Burns involving the face, hands, feet, genitalia, perineum, or
major joints
*Third-degree burns in any age group
*Electrical burns, including lightning injury
*Chemical burns
*Inhalation injury
*Burn injury in patients with complicated pre-existing
medical disorders
Patients with burns and concomitant trauma in which
the burn is the greatest risk. If the trauma is the greater
immediate risk, the patient may be stabilized in a trauma
center before transfer to a burn center.
*Burned children in hospitals without qualified personnel for
the care of children
*Burn injury in patients who will require special social,
emotional, or rehabilitative intervention

89
Q

Most common cancer in the world

A

lung Ca

90
Q

supplementation with which amino acid improves healing

A

Arginine

91
Q

what are the essential physiological properties of a cancer

A

*Self sufficiency of growth signals
*Insensitive to growth inhibitors
*evasion of apoptosis
potential for limitless replication
*angiogenesis
*invasion and metastasis
*Reprogramming of energy metabolism
*evading immune destruction

92
Q

field effect

A

increased oncogene amplification or increase in tumor suppressor gene function in a group of cells

93
Q

what percentage of breast cancer is hereditary

A

5-10%

94
Q

the most commonly used solution for preservation in organ transplant

A

university of wisconsin solution

95
Q

The mc side effect of sirolimus

A

thrombocytopenia and neutropenia

96
Q

cyclosporine is metabolised via

A

CYT-P 450

97
Q

cold ischemia time for pancreatic transplant

A

less than 24 hours

98
Q

cold ischemia time for heart and lung transplant

A

less than 6 hours

99
Q

cold ischemia time for liver

A

less than 16 hours

100
Q

the most appropriate management for lymphocele following kidney transplant is

A

lap or open peritoneal window

101
Q

The major cause of death following renal transplant

A

vascular ( MI or stroke)

102
Q

The major cause of graft loss following kidney transplant

A

recipient death (usually from cardiovascular causes) with a functioning kidney

103
Q

what is the scoring system used in allocation of liver transplant

A

MELD score

104
Q

The most common indication for pediatric liver transplant is

A

biliary atresia

105
Q

The most dramatic and serious complication of tracheostomy is

A

TIAF (Tracheoinnominate artery fistula)

106
Q

why do we turn the patient every 2 hours maximum to prevent decubitus ulcers

A

ischemic changes of the skin occurs after 2 hours in the same position

107
Q

normal abdominal compartment pressure

A

<20

108
Q

MC causes of abdominal compartment syndrome

A

*Trauma
*burns
*retroperitoneal injuries
*retroperitoneal surgery

109
Q

Intra-abdominal hypertension

A

bladder pressure >20

110
Q

abdominal compartment syndrome diagnosis criteria

A

bladder pressure >25
with one of the following:
*compromised respiration/ventilation
*oliguria
*increased ICP

111
Q

The point of critical O2 delivery occurs below which O2 delivery value

A

4.5ml/kg/min

112
Q

The width of a blood pressure cuff should be what percentage of the patient’s arm circumference

A

40%

113
Q

difference between N2O and CO2 pneumoperitoneum

A

N2O pneumo causes less pain and less Acid-Base imbalances

114
Q

How much can the bone absorb CO2 in lap pneumo

A

up to 120L

115
Q

The most common arrhythmia seen in Lap surgery

A

Sinus Brady due to vagal stimulation from peritoneal stretch

116
Q

What is CRP

A

Is a soluble pattern recognition molecule of the pentraxin
family.

117
Q
A

Residency (6 decks)

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