SURGERY 2ND BMEX EXAM Flashcards by Abby David

Which of the following types of surgical wounds would not need a dose of antibiotic before commencing surgery?

A. Class 1D
B. Class 1
C. Class II
D. Class III

B. Class 1

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Which of the following types of surgical wound should be left partially opened to heal by secondary intention?

A. Incisional stab wound consequent to an elective surgery
B. Incisional wound consequent to an emergency abdominal exploratory surgery for a shotgun blast
injury to the abdomen with multiple small and large bowel perforations
C. Incisional wound of an appendectomy for a non-ruptured appendicitis
D. Incisional wound consequent to an emergency abdominal exploratory surgery for a penetrating abdominal stab wound with a non-bleeding liver injury

B. Incisional wound consequent to an emergency abdominal exploratory surgery for a shotgun blast injury to the abdomen with multiple small and large bowel perforations

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Regarding surgical wounds that result from a clean-contaminated surgical procedure, which of the following significantly decreases the risk of surgical site infection?

A. Hand antisepsis by the operative team
B. Giving preoperative antibiotic prophylaxis
C. Preoperative shaving of operative site with the use of hair clipper
D. Wearing of surgical caps, masks, and gloves

B. Giving preoperative antibiotic prophylaxis

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During the first 48-96 hours post-surgery, which of the following predominate the wound site?

A. Platelets
B. Macrophages
C. Monocytes
D. Polymorphonuclear leukocytes

B. Macrophages

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What is the expected time frame for the proliferative phase of healing to occur after injury?

A. 1-2 days
B. 4-7 days
C. 7-14 days
D. 2-3 days

B. 4-7 days

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Which of the following is true about antimicrobial agents in controlling surgical infection?

A. Administration of antibiotics can delay the need for surgical intervention
B. These are only of secondary importance to effective surgery with regard to treatment overall outcome
C. Aggressive type of surgical infections can be treated only by the administration of antibiotics
D. They are entirely of no use in microbial control of surgical infection

B. These are only of secondary importance to effective surgery with regard to treatment overall outcome

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Which of the following statements is true of antimicrobial prophylaxis?

A. Antibiotic administration is started during the intraoperative period only when significant spillage of bowel contents has occurred
B. Antibiotics should only be administered during the postoperative period
C. Antibiotic administration is limited to the period immediately prior to incision
D. Involves continuing the antibiotic administration for 3-5 days post-operatively

C. Antibiotic administration is limited to the period immediately prior to incision

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Which of the following predominantly comprise the colonic microflora?

A. Bacteroides fragilis, Fusobacterium, Peptostreptococcus, Clostridium sp.
B. Staphylococcus sp., Streptococcus species, Corynebacterium, Clostridium sp.
C. Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa
D. Salmonella sp., Shigella, Enterococcus faecalis, Enterococcus faecium

A. Bacteroides fragilis, Fusobacterium, Peptostreptococcus, Clostridium sp.

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Superficial skin and skin appendages infection such as cellulitis, folliculitis, erysipelas, and furuncles are commonly caused by what microorganisms?

A. Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa
B. Bacteroides fragilis, Peptostreptococcus, Fusobacterium
C. Enterococcus faecalis, Enterococcus faecium, Enterobacter
D. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus sp.

D. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus sp.

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Which of the following statements is true regarding colonization resistance?

A. Refers to the ability of phagocytes to control the invading microorganisms at the site of tissue invasion
B. Ability of the epithelial and mucosal gut barrier to prevent microbial invasion
C. Refers to the action of resident microbial commensals to prevent the attachment, invasion, and proliferation of non-commensal pathogenic microbes
D. It is the action of the blood-borne components of the adaptive immune response to prevent the systemic dissemination of the pathogens

C. Refers to the action of resident microbial commensals to prevent the attachment, invasion, and proliferation of non-commensal pathogenic microbes

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Burn patients are at risk for developing sepsis secondary to

A. suppurative thrombophlebitis
B. pneumonia
C. catheter related infections
D. All are correct

D. All are correct

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The phenomenon in healing of partial thickness burns is attributed to the presence of

A. myocytes
B. epidermal appendages such as sweat glands, sebaceous glands, hair follicles
C. cells of the stratum corneum
D. nerve endings

B. epidermal appendages such as sweat glands, sebaceous glands, hair follicles

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Where will you find the dermis to be thickest?

A. Eyelids
B. Palms
C. Back
D. Soles

C. Back

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Alkali solution produce what type of tissue injury?

A. Liquefaction necrosis
B. Desiccation
C. Anoxic necrosis
D. Coagulation necrosis

A. Liquefaction necrosis

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A live wire accidentally touched a metal rail which an electrician was holding. He sustained a 5cm x 4cm full thickness burn entry wound on the right palm. At the ER he was given IV fluids, tetanus prophylaxis and antibiotics. One hour later patient’s urine output was noted to be the color of black tea. Patient’s condition is called

A. alkaline urine
B. pyuria
C. hematuria
D. myoglobulinuria

D. myoglobulinuria

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Melanoma most commonly manifests as a cutaneous disease that has asymmetric irregular borders, color variation, elevation, and a diameter greater than

A. 1 cm
B. 6mm
C. 2 mm
D. 2 cm

B. 6mm

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This cutaneous cyst forms on the scalp of females and lack a granular layer

A. Dermoid cyst
B. Epidermal cyst
C. Trichilemmal cyst
D. Sebaceous cyst

C. Trichilemmal cyst

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Seborrheic keratosis will likely transform into

A. Kaposi sarcoma
B. melanoma
C. squamous cell ca
D. basal cell ca

C. squamous cell ca

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What is the antibiotic of choice for Fournier’s gangrene (+) MRSA?

A. Clindamycin
B. Vancomycin
C. Ciprofloxacin
D. Linezolid

B. Vancomycin

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What is the pathophysiologic mechanism of hidradenitis suppurativa?

A. Hyperandrogenism
B. Follicular rupture
C. Follicular occlusion
D. An apocrine disorder

C. Follicular occlusion

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For a clean wound that is approximated (sutured) primarily you would expect the process of epithelialization to be completed within what time frame?

A. Within 7 days
B. Within 24 hours
C. Within 3 days
D. Within 48 hours

D. Within 48 hours

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The formation of a mature, avascular, acellular wound scar with maximal tensile strength is achieved within

A. 6-12 months post-injury
B. 30 days post-injury
C. 4-6 months post-injury
D. 2 months post-injury

A. 6-12 months post-injury

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Wound contraction due to the action of myofibroblasts starts and increases after what time period post-injury?

A. After 4 weeks
B. 4-6 months
C. 6-21 days
D. 6-15 days

C. 6-21 days

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Which of the following statements is true about keloids?

A. Associated with high rate of recurrence after surgical excision
B. They are precancerous lesions
C. They do not extend beyond the margins of the wound
D. Usually develops within 4 weeks after injury

A. Associated with high rate of recurrence after surgical excision

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What is the treatment of choice of keloid? A. Radiation therapy B. Intralesional corticosteroid injection + surgical excision C. Wide excision and primary closure D. Silicone application

B. Intralesional corticosteroid injection + surgical excision

In the surgical re-approximation (anastomosis) of resected bowel ends, which layer of the bowel wall imparts the greatest suture-holding capacity and the greatest tensile strength hence, it must be included in the suture bite to prevent bowel leaks and dehiscence? A. Tunica muscularis B. Tunica serosa C. Tunica submucosa D. Tunica mucosa

C. Tunica submucosa

Which of the following technical surgical principles does not have a significant impact in the achievement of a well healing, complication-free gastrointestinal anastomosis? A. Ensuring the absence of tension over the suture line or line of anastomosis B. Overzealous fluid administration C. Type of suturing technique used D. Preserving an adequate blood supply to the area of anastomosis

C. Type of suturing technique used

What is the strongest chemotactic factor for fibroblast migration and proliferation? A. Platelet-derived growth factor B. Tumor necrosis factor-e C. Transforming growth factor-T D. Interleukin-1

A. Platelet-derived growth factor

Which of the following statements is true regarding the differences between keloid and hypertrophic scar (HTS)? A. Keloid rises above skin level and stays within the confines of the wound while HTS does not B. Keloid dermal fibroblasts have higher proliferation rate than HTS fibroblasts C. Keloids seldom regress while HTS can spontaneously involute D. Keloid is best treated by surgery while HTS is treated by steroid injection

C. Keloids seldom regress while HTS can spontaneously involute

Which vitamins, if deficient, can seriously impair wound healing? A. Vitamin D B. Zinc C. Vitamin E D. Vitamin C

D. Vitamin C

This hereditary connective tissue disease is characterized by low serum level of zinc caused by an inherited inability to absorb zinc from the gut A. Marfan’s syndrome B. Acrodermatitis enteropathica C. Ehlers-Danlos syndrome D. Epidermolysis bullosa

B. Acrodermatitis enteropathica

Which of the following is not true regarding the causes contributing to the slow healing of cartilages? A. The cartilage is avascular B. Presence of hypovascularized perichondrium C. Active inflammatory response to injury D. Cartilage receives its nutrient solely by diffusion from surrounding perichondrium

B. Presence of hypovascularized perichondrium

Which of the following conditions does not significantly delay wound healing? A. On steroid medication B. Diabetes mellitus C. Presence of malignancy D. Presence of hypertension

D. Presence of hypertension

During the first 48-96 hours post-injury, which of the following predominate the wound site? A. Polymorphonuclear leukocytes B. Monocytes C. Macrophages D. Platelets

C. Macrophages

What is the expected time frame for the proliferative phase of healing to occur after injury? A. 2-3 days B. 7-14 days C. 1-2 days D. 4-7 days

D. 4-7 days

A contaminated wound was debrided & irrigated with the surrounding skin cleansed with povidone iodine solution and covered with the sterile gauze dressing. This wound will heal by what type of healing? A. Healing by primary intention B. Healing by tertiary intention C. Healing by secondary intention D. Formation of hypertrophic scar

C. Healing by secondary intention

A 30 y.o. male came to your clinic seeking consultation for a lacerated wound on his left forearm sustained 3 days ago when it got caught in a barbed fence wire while he was trying to flee from his bolo-wielding father-in-law. Upon inspection, the wound appears grayish with foul-smelling, creamy yellowish discharge and surrounding signs of inflammation. Which of the following is considered as optimal wound management plan for this patient? A. Debridement, wound irrigation, tetanus ppx, antibiotics, healing by secondary intention B. Debridement, wound irrigation, tetanus ppx, antibiotics, healing by primary intention C. Debridement, wound irrigation, tetanus ppx, antibiotics, healing by tertiary intention D. Irrigate the wound, apply povidone iodine over the wound, tetanus ppx, antibiotics, healing by primary intention

A. Debridement, wound irrigation, tetanus ppx, antibiotics, healing by secondary intention

This refers to the presence of bacterial proliferation in a tissue without any host inflammatory response A. Contamination B. Infection C. Colonization D. Superinfection

C. Colonization

In the local treatment of wounds, the best irrigating solution to employ in the cleansing of the wound bed is A. normal saline B. hydrogen peroxide C. povidone iodine D. chlorhexidine gluconate

A. normal saline

Due to its most important role in the activation and recruitment of other cells by the release of cytokines and growth factors, which of the following intensifies the inflammatory host response to injury? A. Polymorphonuclear leukocytes B. Monocytes C. Macrophages D. Platelets

C. Macrophages

The following sites does not have its own resident microflora, except: A. biliary tract B. distal respiratory tract C. genitourinary tract D. oropharynx

D. oropharynx

Which of the following groups of microorganisms causes a large percentage of surgical site infection? A. E. coli, K. pneumoniae, P. aeruginosa B. Staph. aureus, Staph. epidermidis, Strep. pyogenes C. E. faecalis, E. faecium D. C. albicans, A. fumigatus, B. dermatitidis, C. neoformans

B. Staph. aureus, Staph. epidermidis, Strep. pyogenes

Which of the following are the causative agents of nosocomial infections in immunocompromised and chronically ill surgical patients? A. E. coli, K. pneumoniae, P. aeruginosa, Enterobacter sp., S. marcescens B. E. faecalis, E. faecium, C. albicans, A. fumigatus, H. simplex, Varicella-zoster C. S. aureus, S. epidermidis, Strep. pyogenes, Clostridium sp. D. Bacteroides fragilis, Fusobacterium, Peptostreptococcus

B. E. faecalis, E. faecium, C. albicans, A. fumigatus, H. simplex, Varicella-zoster

In an elective surgical procedure which entails entry into a hollow intra-abdominal organ (e.g. colorectal surgery), which of the following is not considered sound surgical practice in the use of antimicrobials? A. Give additional dose if the duration of surgery exceeds the serum half-life of the drug B. Administer prophylactic antimicrobials 0-120 minutes prior to the surgical procedure C. Choose antimicrobials that are active against microbes likely to be present D. Administer the antimicrobial only in the immediate postoperative period

D. Administer the antimicrobial only in the immediate postoperative period

In a highly suspected surgical infection, surgical principles to observe include the following, EXCEPT: A. prioritize Gram-stain and culture before initiating antimicrobial treatment B. surgically intervene only after antimicrobial have been started intervention C. maintain antibiotic regimen if patient shows positive clinical response even if the antibiotic regimen selected is at variance with the microbiologic data D. start antimicrobials immediately based on knowledge of normal resident microflora at the site of infection

A. prioritize Gram-stain and culture before initiating antimicrobial treatment

Which of the following determinants gives complete assurance that infection has been eradicated? A. Absence of microbial growth on repeat culture studies B. Effective surgical source control of the infection achieved C. Long duration of antibiotic treatment D. Lysis of fever, absence of leukocytosis on WBC count

D. Lysis of fever, absence of leukocytosis on WBC count

In patients with severe necrotizing pancreatitis, current standard of care includes which of the following? A. Assess first the extent of pancreatitis by helical contrast enhanced CT & by prognostic scoring system then surgically intervene immediately B. Immediate surgical intervention is warranted in patients exhibiting signs of systemic inflammatory response (fever, chills, tachycardia, elevated WBC count) C. Delay surgical intervention for 2 weeks coupled with ICU monitoring and helical contrast-enhanced CT scan assessment of extent of involvement D. Administer prophylactic antibiotics to prevent development of secondary infection

Inara: C. Delay surgical intervention for 2 weeks coupled with ICU monitoring and helical contrast-enhanced CT scan assessment of extent of involvement Haraya: A. Assess first the extent of pancreatitis by helical contrast enhanced CT & by prognostic scoring system then surgically intervene immediately

Which of the following statements is not true of nosocomial infections? A. Usually due to prolonged use of indwelling tubes & catheters B. Usually monomicrobial in etiology C. Treatment involves removal of indwelling devices and empiric antibiotic treatment D. Can be prevented solely with the administration of antimicrobial prophylaxis

D. Can be prevented solely with the administration of antimicrobial prophylaxis

Which of the following statements is true regarding fungi as causative agent of surgical infection? A. Wound discharge from surgical site infection should routinely be subjected to special stains for fungal identification B. Fungi are part of the pathogens of the common types of community-acquired surgical infection C. Fungi are classified as opportunistic pathogens which cause infection in the immunocompromised host D. They are common causative agents of necrotizing soft tissue infection as part of a polymicrobial infection

C. Fungi are classified as opportunistic pathogens which cause infection in the immunocompromised host

With your knowledge of host resident microflora, what class/es of antibiotics would be appropriate for a patient with infected skin laceration? A. Penicillin derivatives with e-lactamase inhibitor or 1st generation cephalosporins B. Fluoroquinolones or macrolides C. 2nd & 3rd generation cephalosporins plus anti anaerobes D. Aminoglycosides or carbapenems

A. Penicillin derivatives with e-lactamase inhibitor or 1st generation cephalosporins

A 25 y.o. jeepney driver was brought to the ER complaining of severe, generalized abdominal pain. Hx revealed that the pain started 3 days PTA as a vague, periumbilical discomfort which then migrated to the RLQ and became persistent 2 days PTA. A day PTA, the pain increased in severity and became generalized accompanied by febrile episodes. On PE, there is direct and rebound tenderness all over the abdomen with muscle rigidity. Which of the following conditions would you highly consider? A. Tertiary microbial peritonitis B. Secondary microbial peritonitis C. Primary microbial peritonitis D. Organ-specific intra-abdominal infection

B. Secondary microbial peritonitis

Following the precept of surgical infection treatment, what would be the plan of treatment for a patient with secondary microbial peritonitis? A. Start empiric antibiotics intraoperatively, debridement/ clean-up peritoneal cavity, control source of infection, contamination, drainage, gm-stain/culture sample B. Start pre-op empiric antibiotics, do percutaneous drainage of the peritoneal cavity, and get sample for gm-stain & culture C. Start pre-op empiric antibiotics, debridement/clean up of peritoneal cavity, control of the source of infection and contamination, and drainage D. Start pre-op empiric antibiotics, debridement/clean-up and drainage of the peritoneal cavity, get sample for gm-stain & culture

C. Start pre-op empiric antibiotics, debridement/clean up of peritoneal cavity, control of the source of infection and contamination, and drainage

You performed an emergency exploratory laparotomy. At the 3rd hour of the surgery, you entertained the idea of giving a 2nd dose of your prophylactic antibiotic. Which of the following situations would prompt you to make that decision? A. If the operative duration will reach the 5th hour B. You have already incurred about 1.0 L or more operative blood loss C. If you are operating in a dirty operative environment or operating room D. An unexpected contamination of the operative field is encountered

A. If the operative duration will reach the 5th hour

Class 1 surgical wounds should be allowed to heal by which of the following? A. Skin grafting B. Healing by tertiary intention C. Healing by secondary intention D. Healing by primary intention

D. Healing by primary intention

Which of the following preoperative factors significantly decrease the enteric endogenous microbial flora as a causative agent of SSI? A. Wearing of sterile surgical masks, caps, and gowns by the surgical team B. Mechanical cleansing of the bowel by laxatives and enemas C. Administration of antimicrobial prophylaxis D. Antiseptic preparation of the site of incision

C. Administration of antimicrobial prophylaxis

A colorectal surgery was conducted without spillage of hollow organ contents. Which of the following is considered good surgical judgment with regard antimicrobial usage? A. Obtain specimen from the hollow organ content for Gram-stain and culture microbial sensitivity study then change antimicrobial based on the microbiologic report B. Give additional dose of antimicrobial and discontinue the drug postoperatively C. Discontinue the antimicrobial post-operatively D. Continue the antimicrobial for 3-5 days post operatively

C. Discontinue the antimicrobial post-operatively

Which of the following is true of empiric antibiotic therapy in surgical infection? A. Should be started when there is presence of systemic manifestations of inflammatory response even with no evidence of local site of infection B. Should be limited to a short course of 3-5 days C. Antibiotic selected should be changed solely on the basis of microbiologic data once it is available D. Initial antibiotic agent/s selected should be based on microbiologic data

B. Should be limited to a short course of 3-5 days

Regarding treatment for incisional surgical site infections, which of the following statements is true? A. Removal of sutures, open drainage, empiric antimicrobial administration, and healing by secondary intention represent the most complete treatment for any incisional surgical site infection B. Antimicrobial treatment alone suffices for superficial incisional surgical site infection C. All patients should receive antimicrobial treatment irregardless if the depth of involvement D. In patients w/o manifestations of SIRS, removal of sutures and open drainage with healing by secondary intention will suffice as surgical treatment

D. In patients w/o manifestations of SIRS, removal of sutures and open drainage with healing by secondary intention will suffice as surgical treatment

Regarding the approach to management of aggressive soft tissue infection, which of the following statements is true? A. Immediate surgical intervention with empiric antibiotic administration is warranted once the diagnosis is strongly considered on clinical grounds B. Radiologic imaging should first be requested prior to surgical intervention to assess the extent and depth of tissue involvement C. Antimicrobials should be started only after gm-stain/ culture sensitivity data is available D. Diagnosis is based solely on gm-stain and culture studies result

A. Immediate surgical intervention with empiric antibiotic administration is warranted once the diagnosis is strongly considered on clinical grounds

You performed an elective colonic surgery on a 60 y.o. man for removal of a colonic malignant tumor. Intraoperatively the intestinal clamp which occluded one end of the resected colonic segment slipped causing slippage of colonic contents. Aside from a thorough peritoneal lavage (clean-up), what else would you do to decrease the risk of sepsis & SSI? A. Convert your prophylactic antibiotic treatment into an empiric antibiotic treatment B. Give a second dose of your prophylactic antibiotic intraoperatively then discontinue postoperatively C. Don’t give any more intraoperative and postoperative doses since the operative duration is less than the drug half-life and a complete colonic bowel cleansing (bowel prep) was done preoperatively D. Continue the antibiotic you gave operatively for 2 more doses in the postoperative period

A. Convert your prophylactic antibiotic treatment into an empiric antibiotic treatment

Superficial skin and skin appendages infection such as cellulitis, folliculitis, erysipelas, and furuncles are commonly caused by what microorganisms? A. Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa B. Bacteroides fragilis, peptostreptococcus, fusobacterium C. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus sp. D. Enterococcus faecalis, Enterococcus faecium, Enterobacter

C. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus sp.

Which of the following statements is true regarding colonization resistance? A. Refers to the action of resident microbial commensals to prevent the attachment, invasion, and proliferation of non-commensal pathogenic microbes B. Refers to the ability of phagocytes to control the invading microorganisms at the site of tissue invasion C. Ability of the epithelial and mucosal gut barrier to prevent microbial invasion D. It is the action of the blood-borne components of the adaptive immune response to prevent the systemic dissemination of the pathogens

A. Refers to the action of resident microbial commensals to prevent the attachment, invasion, and proliferation of non-commensal pathogenic microbes

Which of the following is true about antimicrobial agents in controlling surgical infection? A. Aggressive type of surgical infections can be treated only by the administration of antibiotics B. These are only of secondary importance to effective surgery with regard to treatment overall outcome C. They are entirely of no use in microbial control of surgical infection D. Administration of antibiotics can delay the need for surgical intervention

B. These are only of secondary importance to effective surgery with regard to treatment overall outcome

Which of the following statements is true of antimicrobial prophylaxis? A. Antibiotic administration is started during the intra operative period only when significant spillage of bowel contents has occurred B. Involves continuing the antibiotic administration for 3-5 days postoperatively C. Antibiotics should only be administered during the postoperative period D. Antibiotic administration is limited to the period immediately prior to incision

D. Antibiotic administration is limited to the period immediately prior to incision

Which of the following predominantly comprise the colonic microflora? A. Staphylococcus sp., Streptococcus species, Corynebacterium, Clostridium sp. B. Bacteroides fragilis, Fusobacterium, Peptostreptococcus, Clostridium sp. C. Salmonella sp., Shigella, Enterococcus faecalis, Enterococcus faecium D. Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa

B. Bacteroides fragilis, Fusobacterium, Peptostreptococcus, Clostridium sp.

Non excision or delayed excision protocol (2 weeks or more) for burn wounds is detrimental to the patient because A. it promotes formation of pro-inflammatory and later on anti-inflammatory substances that make patient prone to sepsis, negative nitrogen balance and delayed wound healing. B. it lessens evaporative water losses C. it prevents contractures D. it preserves thermoregulation

A. it promotes formation of pro-inflammatory and later on anti-inflammatory substances that make patient prone to sepsis, negative nitrogen balance and delayed wound healing.

Meshed split thickness skin grafts are usually applied A. when skin graft donor sites are limited and burns are large. B. when cosmesis is important and the “cobblestone” look is to be avoided. C. on the face. D. when mesher and dermcarriers are not available.

A. when skin graft donor sites are limited and burns are large

Burn wound colonization by Pseudomonas and other Gram negative bacteria during patient’s admission to a Burn Unit is caused by A. cross contamination from use of hydrotherapy tank, nursing personnel, and/or patient’s own gut flora. B. cross contamination from burn nursing personnel who handle multiple patients. C. contamination from patient’s own gut flora. D. cross contamination from use of a hydrotherapy tank.

A. cross contamination from use of hydrotherapy tank, nursing personnel, and/or patient’s own gut flora

Partial thickness burns are re-epithelialized provided invasive infection does not set in. The layer capable of producing new epithelial cells/keratinocytes is the A. epidermis B. subcutaneous tissue C. fascia D. dermis

A. epidermis

Burn patients are at risk for developing sepsis secondary to A. catheter related infections B. suppurative thrombophlebitis C. pneumonia, indwelling catheter, and/or suppurative thrombophlebitis D. pneumonia

C. pneumonia, indwelling catheter, and/or suppurative thrombophlebitis

SIRS (Systemic Inflammatory Response Syndrome) is characterized by A. need for pharmacologic support B. end organ damage C. features of systemic inflammation D. identified bacterial pathogen

C. features of systemic inflammation

In electric burns of the scalp a long term complication is A. contractures B. keloids C. compartment syndrome D. cataracts

D. cataracts

Effect of hydrofluoric acid in chemical burns A. Bind free electrons in tissue proteins B. Binds calcium essential to tissue function C. Denatures tissue proteins D. Oxidation that produces toxic byproducts

B. Binds calcium essential to tissue function

First aid to chemical burns is removal from the source of the chemical and continuous, copious irrigation with water. The exception/s to immediate water irrigation is/are A. phenol B. phenol, sulfuric acid, and/or muriatic acid C. sulfuric acid D. muriatic acid

A. phenol

Treatment for acute renal failure secondary to electrical burns consists of A. lithotripsy B. blood transfusion C. antibiotics D. aggressive hydration and alkalization of urine

D. aggressive hydration and alkalization of urine

Compartment syndrome is a complication of A. IV fluid resuscitation for burns on top of burn edema B. electrical burns C. circumferential full thickness burns of extremities and trunk D. IV fluid resuscitation for burns on top of burn edema, circumferential full thickness burns, and/or electrical burns

D. IV fluid resuscitation for burns on top of burn edema, circumferential full thickness burns, and/or electrical burns

Scald burns in a “trouser” pattern of distribution in children should alert the physician to A. possible seizure disorder in child B. probably pure accidental scalding C. intentional immersion and possible child abuse D. spilling or splatter mechanism

C. intentional immersion and possible child abuse

The hallmark of second degree or partial thickness burns is/are A. pale, edematous burn that blanches on pressure B. hard, charred eschar C. blisters D. erythema

C. blisters

Large, extensive blisters should be A. excised and grafted B. left alone C. debrided thoroughly after which topical antimicrobials are applied D. aspirated

C. debrided thoroughly after which topical antimicrobials are applied

What is/are the limits to burn wound excision and grafting? A. 15-20% TBSA each operation and availability of skin graft donor site B. The availability of skin graft donor C. 15% to 20% TBSA at each operation D. 45% of 50% TBSA

B. The availability of skin graft donor

A 40-year-old man with a history of electrical burn presents 12 hours after with the following: a very swollen arm, tense blisters on the wrist, no radial or ulnar pulses palpated, nailbeds were dusky, and fingers were unable to move. He developed a condition called A. burn edema B. compartment syndrome C. burn shock D. thromboangitis obliterans

B. compartment syndrome

The management for compartment syndrome is A. administer colloids B. give IV fluids and vasopressors C. heparinize patient D. perform fasciotomy and elevate extremity

D. perform fasciotomy and elevate extremity

The PRIMARY goal of burn surgery is A. prevention of contractures B. timely burn wound closure C. prevention of infection D. prevention of keloids and hypertrophic scars

B. timely burn wound closure

If left untreated, myoglobinuria may lead to A. urinary tract infection B. kidney stones C. anemia D. acute renal failure

D. acute renal failure

Following caustic injury to the skin w/ an alkaline agent the affected area should be: A. treat w/ running water or saline for 2 hours B. treat w/ running water or saline for 30 mins C. treat w/ neutralizing agent D. treat w/ topical emollients and oral steroids

A. treat w/ running water or saline for 2 hours

Scalds are most common in: A. young adults B. children C. elderly D. middle aged males in heavy industries

B. children

Most common sites of distant metastasis for melanoma include the following, EXCEPT A. brain B. bone C. lung D. liver

B. bone

Which of the following is TRUE about Kaposi’s sarcoma? A. Unifocal, purple, hard nodules B. Treatment with antibacterial therapy C. Surgical biopsy is important for diagnosis D. Diagnosed before 40 years old

C. Surgical biopsy is important for diagnosis

This disease is non-infectious neutrophilic dermatoses and is commonly associated with rheumatoid arthritis A. Actinic keratosis B. Stevens Johnson syndrome C. Hidradenitis suppurativa D. Pyoderma gangrenosum

D. Pyoderma gangrenosum

Fundamental cells of the dermis and all connective tissues that synthesize all types of fibers and ground substance A. Fibroblast B. Mast cells C. Dendrocytes D. Lipocytes

A. Fibroblast

Most important prognostic indicator/s of survival in melanoma A. Ulceration B. Tumor thickness C. Mitotic rate D. Mitotic rate and tumor thickness

B. Tumor thickness

Specialized epithelial cells/structures function as lubrication, sensation, and heat loss A. Epidermal appendages B. Merkel cells C. Pilosebaceous follicles D. Sweat glands

A. Epidermal appendages

The main cells of the hypodermis are the A. dendrocytes B. adipocytes C. mast cells D. melanocytes

B. adipocytes

Which of the following malignant skin cancers has the ability to metastasize? A. Melanoma B. Melanoma and SCC C. SCC D. BCC

B. Melanoma and SCC

Factor/s that renders high risk for SCC A. Size greater than 2cm and involvement of epidermis only B. Size greater than 1cm in diameter C. Size greater than 2cm and involvement of subcutaneous tissue D. Size greater than 0.5cm

C. Size greater than 2cm and involvement of subcutaneous tissue

A 55-year-old patient with 0.5mm thick melanoma should have an adequate margin of: A. 2cm B. 1cm C. 0.5cm D. 3cm

B. 1cm

SLNB is recommended for melanoma according to NCCN guidelines with a thickness of: A. 1-2mm B. 1-2cm C. 3-4cm D. 1-4mm

D. 1-4mm

A rare and aggressive neuroendocrine tumor of the skin most commonly found in Caucasian with a mean age of 70 years A. SCC B. Merkel cell carcinoma C. Melanoma D. Kaposi’s sarcoma

B. Merkel cell carcinoma

The skin tumor is slow growing asymptomatic, violaceous plaque involving the trunk head neck or extremities, behaves aggressively with finger like extensions A. Kaposi’s sarcoma B. Dermatofibrosarcoma protuberans C. Myxofibrosarcoma D. Fibrous histiocytoma

B. Dermatofibrosarcoma protuberans

SCC is commonly associated with what type of HPV? A. Type 6 and 8 B. Type 20 and 21 C. Type 16 and 18 D. Type 14 and 12 infection

C. Type 16 and 18

An important characteristic of extramammary Paget’s disease: A. Associated with very high mortality rate B. Associated with GI and genitourologic malignancies C. Rare adenocarcinoma arises in the neck and tongue D. Presence of multiple LAD

B. Associated with GI and genitourologic malignancies

Regarding melanoma in pregnant women A. Prognosis is not similar to women who are nulliparous B. Local anesthesia should not be utilized C. General anesthesia should be considered in late pregnancy D. SLNB must be performed before delivery

C. General anesthesia should be considered in late pregnancy

These melanomas are found anywhere in the body except the hands and feet and are the most common subtype: A. Superficial spreading B. Nodular C. Polypoid D. Amelanotic

A. Superficial spreading

The general behavior of actinic keratosis A. Spontaneously resolved B. Premalignant lesion with velvet like texture C. Regression, progression, and persistence D. Benign behavior

C. Regression, progression, and persistence

The following are treatment options for hemangioma, EXCEPT: A. Resection B. Embolization C. Steroid D. Photoradiation

D. Photoradiation

Which of the following statements regarding the role of collagen in wound healing is TRUE? A. Collagen synthesis in the initial phase of injury is the sole responsibility of the endothelial cells B. Tensile strength of the wound increases gradually for several months after injury, however, it generally does not reach the level of uninjured tissue C. Net collagen content increases for up to 2 years after injury D. At 2 weeks after injury, more than 50% of the tensile strength of the wound has been restored

B. Tensile strength of the wound increases gradually for several months after injury, however, it generally does not reach the level of uninjured tissue

Which of the following statements regarding wound epithelialization is true? A. There is increased attachment of the epidermal cells to the underlying dermis provided by tight cell junctions B. Epidermal growth factors, transforming growth factor-b have been shown to promote epithelialization C. Early tensile strength of the wound is a direct result of collagen deposition D. A re-epithelialized wound develops hair follicles and sweat glands like those seen in the normal skin

C. Early tensile strength of the wound is a direct result of collagen deposition

A 68-year-old diabetic man undergoes a below-knee amputation. The patient’s post-op course is complicated by severe depression and anorexia. Before discharge, the patient is started on a multivitamin regimen. Which of the following statements regarding wound healing is TRUE? A. Zinc deficiency results in delayed early wound healing B. High doses of vitamin C improve wound healing C. Vitamin A is needed for hydroxylation of lysine and proline in collagen synthesis D. Vitamin E is involved in the stimulation of fibroplasia, collagen cross-linking and epithelialization

A. Zinc deficiency results in delayed early wound healing

Which of the following statements on wound contractions is TRUE? A. Movement of myofibroblasts with concomitant reorganization of the cytoskeleton is responsible for contraction B. Myofibroblasts are already present immediately after injury C. Wound contraction is best observed on wounds allowed to heal by tertiary intention D. Wound contraction starts after the proliferative phase of healing

A. Movement of myofibroblasts with concomitant reorganization of the cytoskeleton is responsible for contraction

Which of the following statements regarding wound healing is TRUE? A. Fibroblasts migrate to the acute wound after the appearance of granulation tissue B. Granulation tissue results from the cross-linking of coagulation debris C. Myoepithelial cell-derived growth factors cause fibroblast differentiation D. It is during the proliferative phase that the scaffolding for tissue repair is laid

D. It is during the proliferative phase that the scaffolding for tissue repair is laid

Diabetes mellitus impairs wound healing by the following mechanisms, EXCEPT: A. Defects in granulocyte function B. Local tissue acidosis C. Defects in angiogenesis D. Impairment in fibroblast proliferation

B. Local tissue acidosis

The following conditions cause significant delay wound healing, EXCEPT: A. Presence of malignancy B. Diabetes mellitus C. Concomitant distant organ infection D. Presence of end stage liver disease

D. Presence of end stage liver disease

Which of the following anatomic features contribute to the slow healing of cartilages? A. The cartilage is avascular B. Presence of perichondrium C. Receives its nutrient solely by diffusion from surrounding perichondrium D. Absence of inflammatory response to injury

A. The cartilage is avascular

Which of the following technical surgical principles does NOT have a significant impact in the achievement of a well being complication-free gastrointestinal anastomoses? A. Judicious fluid administration B. Ensuring the absence of tension over the suture line or line of anastomosis C. Duration of surgery D. Preserving an adequate blood supply to the area of anastomosis

C. Duration of surgery

Referring to the picture below, what is the type of wound healing? A. Healing by tertiary intention B. Healing by secondary intention C. Healing of a Class 1 wound D. Healing by primary intention

D. Healing by primary intention

The most common factor causing abdominal wound dehiscence is: A. poor surgical technique B. anemia C. premature suture material breakdown D. vitamin C deficiency

C. premature suture material breakdown

All the following significantly influence wound healing, EXCEPT A. renal failure B. diabetes mellitus C. vitamin B group deficiency D. vitamin C deficiency

A. renal failure

This hereditary connective tissue disease is characterized by low serum level of zinc caused by an inherited inability to absorb zinc from the gut A. Epidermolysis bullosa B. Ehler-Danlos syndrome C. Acrodermatitis enteropathica D. Marfan syndrome

C. Acrodermatitis enteropathica

What is the strongest chemotactic factor for fibroblast migration and proliferation? A. Tumor necrosis factor e B. Interleukin 1 C. Transforming growth factor T D. Platelet-derived growth factor

D. Platelet-derived growth factor

Which of the following is TRUE regarding tetanus infection? A. Tetanus immunoglobulin is indicated in any patient with an unknown tetanus vaccination history B. Tetanus infection has purely upper motor neuron effects C. Tetanus-prone wounds include contaminated wounds (i.e. soil, saliva, and stool), crush wounds, or burn wounds D. Tetanus is caused by tetanus toxin, which is produced by C. tetani, an aerobic Gram-positive bacillus

A. Tetanus immunoglobulin is indicated in any patient with an unknown tetanus vaccination history

A 52-year-old man with a history of chronic pancreatitis from alcohol abuse presents to an emergency department with complaints of fevers and abdominal pain. On examination, he is febrile to 100.8⁰F. He is jaundiced and has right upper tenderness. His liver enzymes are elevated with a new leukocytosis. A CT scan of the abdomen demonstrates cirrhotic liver morphology, calcifications along the pancreas and a rim-enhancing hyperechoic liver lesions. Which of the following is TRUE regarding the diagnosis of a pyogenic liver abscess (PLA)? A. Percutaneous drainage is recommended for all PLAs if the drainage is technically feasible B. Most PLAs are polymicrobial with E. coli as the most commonly isolated organism C. Most PLAs are found in the left hepatic lobe D. The most common etiology of PLAs is seeding from another intra-abdominal infection via the portal vein

B. Most PLAs are polymicrobial with E. coli as the most commonly isolated organism

Which of the following statements regarding anaerobic bacterial infection is TRUE? A. Proper treatment of anaerobic infections consists of surgical drainage, debridement of necrotic tissue and appropriate antibiotic therapy B. Anaerobic bacteria are normal inhabitants of the skin and mucous membranes C. Bacteroides spp. are the most common isolates in intraabdominal anaerobic infections D. All of these options

D. All of these options

A 78-year-old man with a history of urinary retention and a chronic indwelling urinary catheter is admitted to the hospital from his nursing home with a new onset altered mental status and a catheter-associated urinary tract infection is suspected. Which of the following is TRUE regarding nosocomial UTI? A. Urine specimens being sent for culture can be obtained from the catheter bag B. UTI can be sufficiently diagnosed by the presence of greater than 10 cfu/ml or at least one bacterial species in a urine specimen C. Treatment can be started even without Gram-stain and culture results D. Treatment for 3 to 5 days with a single antimicrobial coupled with removal of indwelling catheter

D. Treatment for 3 to 5 days with a single antimicrobial coupled with removal of indwelling catheter

Which of the following statements is TRUE of antimicrobial prophylaxis? A. Antibiotics should be administered the night before the operative procedure B. Antimicrobial is given at least within 120 minutes prior to surgery C. Antimicrobial is given just prior to incision and continued for 3-5 days postoperatively D. Antibiotic administration is started when significant spillage of bowel contents has occurred

B. Antimicrobial is given at least within 120 minutes prior to surgery

Which of the following is TRUE of empiric antibiotic therapy in surgical infection? A. Antibiotics should only be started when there is evidence of established infection B. Antibiotics is given when the risk of infection is high based on clinical manifestations C. Should be started when there is presence of systemic manifestations of inflammatory response even with no evidence of local or systemic infection D. Initial antibiotics should be started when there is culture and sensitivity studies

B. Antibiotics is given when the risk of infection is high based on clinical manifestations

In an elective surgery procedure which entails entry into a hollow intra-abdominal organ (colorectal surgery), which of the following is considered not sound surgical practice in the use of antimicrobials? A. Administer the antimicrobial only in the immediate postoperative period B. Give additional dose of the antimicrobial if the duration of surgery exceeds 6 hours C. Choose antimicrobials that are active against microbes likely to be present on the surgical site D. Administer prophylactic antimicrobials at the time of surgical incision

A. Administer the antimicrobial only in the immediate postoperative period

A 22y.o. male medical student was brought to the MRXU after he sustained 1.5 cm laceration over the knuckle of his hand after hitting his classmate on the “kisser” resulting in a traumatic extraction of his classmate’s two front teeth. Based on the classification of surgical wounds, this wound would be classified as A. clean wound B. dirty wound C. clean-contaminated wound D. contaminated wound

D. contaminated wound

What would be the expected pathogens in secondary microbial peritonitis? A. Gm-negative aerobic bacilli and anaerobes B. Gm-negative aerobic organisms, anaerobes, fungi C. Gm-positive aerobic organisms D. This is a nosocomial anaerobic infection

A. Gm-negative aerobic bacilli and anaerobes

Early burn wound excision and closure result in: A. control of burn wound infection B. positive nitrogen balance in patient C. earlier rehabilitation and mobilization D. positive nitrogen balance, control of infection, and early rehabilitation

D. positive nitrogen balance, control of infection, and early rehabilitation

A 40-year-old man with a history of electrical burn presents 12 hours after with the following: a very swollen arm, tense blisters on the wrist, no radial or ulnar pulses palpated, nailbeds were dusky, and fingers were unable to move. He developed a condition called A. burn edema B. burn shock C. compartment syndrome D. thromboangitis obliterans

C. compartment syndrome

Large, extensive burns should be A. aspirated B. debrided thoroughly after which topical antimicrobials are applied C. left alone D. excised and grafted

B. debrided thoroughly after which topical antimicrobials are applied

Non-excision or delayed excision protocol (2 weeks or more) for burn wounds is detrimental to the patient because A. it promotes formation of pro-inflammatory and later on anti-inflammatory substances that make patient prone to sepsis, negative nitrogen balance and delayed wound healing B. it preserves thermoregulation C. it prevents contractures D. it lessens evaporative water losses

A. it promotes formation of pro-inflammatory and later on anti-inflammatory substances that make patient prone to sepsis, negative nitrogen balance and delayed wound healing

A patient present with a biopsy-proven melanoma of the face which is 5-mm thick on histologic examination. At the time of excision, how wide should the margins be? A. 1.5 cm B. 2.0 cm C. 0.5 cm D. 1.0 cm

D. 1.0 cm

These are cells with a clear cytoplasm and are located within the nipple epidermis in 10% of both males and females. They may be precursors of Paget’s cell carcinoma. A. Langerhans cells B. Toker cells C. Melanocytes D. Merkel cells

B. Toker cells

Which of the following is NOT a predisposing factor to the development of melanoma? A. Xeroderma pigmentosum B. Familial dysplastic nevus syndrome C. Pseudoxanthoma elasticum D. Giant congenital melanocytic nevus

C. Pseudoxanthoma elasticum

This layer has high mitotic activity and large nuclei and basophilic staining on light microscopy. It also serves as a regenerative source of epithelium in the event of partial thickness wounds: A. Stratum basale B. Stratum lucidum C. Stratum spinosum D. Stratum corneum

A. Stratum basale

A surfing instructor from Surigao sought consult to a general MD due to a 1-cm mass on his nose, referred to a specialist and biopsy done revealed basal cell carcinoma. You want to operate on this patient. What is the recommended margin of excision? A. 15 mm B. 4 mm C. 10 mm D. 5 mm

B. 4 mm

A university professor sought consult to his family physician because of a purple flesh colored papules on his chest. No palpable masses on the axilla or neck. The doctor is highly suspicious for a malignant skin cancer. This procedure is the standard staging technique for clinically node-negative skin cancer A. Ultrasound-guided FNAB B. PET CT scan C. Sentinel lymph node biopsy D. Lymphoscintigraphy

C. Sentinel lymph node biopsy

A 29-year-old male tiktoker is complaining of a slow growing, violaceous plaque on his neck. It has a low distant metastatic potential. Work-up done positive for CD34 and negative for factor XIII. What is the most important prognostic indicator or variable on this case? A. Tumor depth B. Tumor load C. Rate of metastasis D. Lymph node involvement

D. Lymph node involvement

A male military officer came to you with an uncommon, cutaneous, spindle-cell, soft tissue sarcoma on her left leg. They present as solitary, soft to firm, skin-colored subcutaneous nodules. Complete surgical resection is the treatment of choice. Your initial diagnosis is A. fibrosarcoma protuberans B. Kaposi sarcoma C. angiosarcoma D. fibrous histiocytoma

D. fibrous histiocytoma

A 75-year-old female patient sought consult at your clinic with a rapidly growing, flesh-colored to red or purple papule on his elbow with history of UV exposure and confirmed cytokeratin 20 positive. Most likely diagnosis A. Pleomorphic sarcoma B. Merkel cell carcinoma C. Myxofibrosarcoma D. Malignant melanoma

B. Merkel cell carcinoma

A sebaceous cyst remove from the scalp of a 52-year-old man. Which of the following would be expected on histologic examination? A. Presence of sebum B. Presence of granular layer C. Presence of exocrine glands D. Presence of epidermis covered by basal layer

B. Presence of granular layer

Management of patients with suspected necrotizing infections should include the following A. Broad spectrum antibiotics B. Optimization of nutrition C. Exploration and debridement D. All of these options

D. All of these options

A 3rd year medical student presented to a surgeon with a mass on her back about 3 cm cystic, movable, with keratin plugged punctum at the skin surface. Most likely impression is A. epidermoid cyst B. acrochordons C. basal cell carcinoma D. dermoid cyst

A. epidermoid cyst

A 51-year-old male construction worker is complaining of non-healing wound with a draining sinus on his right buttocks for 2 months. Sought consult and biopsy done revealed atrophy of the sebaceous gland, followed by inflammation of the pilosebaceous unit, causing hyperkeratosis and eventual granuloma formation. The likely diagnosis is A. pyoderma gangrenosum B. actinomycosis C. hidradenitis suppurativa D. squamous cell carcinoma

C. hidradenitis suppurativa

What is the main cause of septic burn shock? a. Septicemia b. Hypovolemia and Cardiac Dysfunction c. Hypoperfusion d. Neurogenic Cause

a. Septicemia

The most accurate method in establishing burn surface area in pediatric patients is? a. Rule of Nines b. Rule of Ones c. Palm surface rule using examiner’s palm d. Lund and Browder Chart

d. Lund and Browder Chart

What is the Curreri formula a. 25 kcal + 40kcal%TBSA = daily caloric need b. 4kcal x %TBSA = 1st 24hr caloric intake c. 2cc x %TBSA = daily caloric intake d. 1000+ 30 x %TBSA = daily caloric need

a. 25 kcal + 40kcal%TBSA = daily caloric need

Scenario: A 28 year old male, housepainter, touched a live wire. Right hand - 2% full thickness burn Right foot - 3% full thickness burn Right axilla - 1% partial thickness burn Anterior chest - 7% partial thickness. Burn The burns of the hand and feet are probably: a. Arc burn b. Entry and exit wound c. Flash burn d. Contact burn

b. Entry and exit wound

In 48 hours, a history of electrical burn represents a very swollen arm, tense blisters on the wrist, no radial or ulnar pulses palpated, nail beds were dusky, and fingers were unable to move. He developed a condition called a. Burn edema b. Burn shock c. Compartment syndrome d. Thromboangitis obliterans

c. Compartment syndrome

How do you manage the above case? (In 48 hours, a history of electrical burn represents a very swollen arm, tense blisters on the wrist, no radial or ulnar pulses palpated, nail beds were dusky, and fingers were unable to move. He developed a condition called compartment syndrome) a. Perform fasciotomy and elevate extremity b. Give IV fluids andvasopressors c. Heparinize patient d. Administer colloids

a. Perform fasciotomy and elevate extremity

The most common sequela of deep partial thickness burn that heal beyond 3 weeks is a. Keloids and hypertrophic scarring b. Ectopic calcification c. Degeneration into malignancy d. Burn wound sepsis

a. Keloids and hypertrophic scarring

What is the management of #7 (Keloids and hypertrophic scarring)? a. Silicone gel sheet and compression garment b. Wide excision c. Antibiotic,wound excision and skin grafting d. Conservative management

a. Silicone gel sheet and compression garment

Most common pathogen in burn wound sepsis is a. Staphylococcus epidermidis b. Pseudomonas aeruginosa c. Clostridium difficile d. MRSA

b. Pseudomonas aeruginosa

Most common etiology of burn in pediatric age group a. Flame b. Chemical c. Electrical d. Scald

d. Scald

Concentric area of injury in burned tissues was first modeled by a. Wallace b. Parkinson c. Jackson d. Monafo

c. Jackson

Fluid shifts occurs both unburned and burned as TBSA% exceed a. 80% b. 60% c. 20% d. 10%

c. 20%

Presence of inhalational injury classifies the patient as a. Minor injury b. Moderate injury c. Major injury d. Emergency injury

c. Major injury

Burns of the genitalia and perineum requires a. Admission b. Local wound care at OPD c. Irrigation at OPD d. Oral antibiotics at OPD

a. Admission

The new consensus for IV fluid resuscitation for the first 24 hours requires: a. 4cc/kg/%TBSA b. 2-2.5cc/kg/%TBSA c. 0.5 cc/kg/%TBSA d. 6 cc/kg/%TBSA

b. 2-2.5cc/kg/%TBSA

The resuscitation fluid of choice for pediatric patients in the first 24 hrs: a. D5LR b. Plain LR c. 0.45 NaCl d. 0.90 NaCl

a. D5LR

The best route for delivering nutrients in burn patients a. No feeding at all b. Parenteral route c. Enteral route d. Crystalloid IV fluid only

c. Enteral route

Resuscitation IV is given in a. All patients regardless the TBSA b. 5% full thickness TBSA c. 15-20% or more TBSA d. 9% partial thickness for a child with good suck and appetite

c. 15-20% or more TBSA

Burn wound sepsis occurs a. In all burn wound since it is colonized by surface bacteria b. In pink, moist, clean partial thickness burn dressed daily with topical antimicrobials c. In wound bacterial count of 10 x 1000 per gram tissue d. When there is bacterial invasion of the deeper tissues, wound conversion and signs of septicemia

d. When there is bacterial invasion of the deeper tissues, wound conversion and signs of septicemia

Rule of nine was invented by a. Wallace b. Parkland c. Jackson d. Monafo

a. Wallace

Overhydration of a burned patient on IV resuscitation is most likely caused by a. Delayed arrival in the ER b. Overestimation of TBSA and use of parkland formula c. Underestimation of TBSA d. Underestimation of body weight

b. Overestimation of TBSA and use of parkland formula

Most ideal, safe and widely used topical burn antimicrobial a. Mafenide b. Silver nitrate 0.5% c. Mupirocin cream d. Silver sulfadiazine cream 1.0%

d. Silver sulfadiazine cream 1.0%

Full thickness, circumferential chest burns that restrict respiration and increase work of breathing are indications for a. Mechanical support b. Fluid restriction c. Escharotomy and ventilatory support d. Systemic steroids

c. Escharotomy and ventilatory support

Dark or tea colored urine in a patient sustaining high voltage electrical injury require a. Aggressive hydration and acidification of urine b. Aggressive hydration and alkalization of urine c. Hemodialysis d. Oral hydration

b. Aggressive hydration and alkalization of urine

High voltage electrical injury may result in a. Acute renal failure, cardiac arrhythmias, compartment syndrome, gangrene b. Pneumonia, UTI c. Pulmonary edema, cerebral edema, compartment syndrome d. Contractures, keloids, Marjolin's ulcer

a. Acute renal failure, cardiac arrhythmias, compartment syndrome, gangrene

Basal cell carcinoma is characterized by: a. Long and indolent course, regional node and distant metastases b. Long and indolent course, locally invasive c. Fast course, regional node and distant metastases d. Fast course, locally invasive

b. Long and indolent course, locally invasive

Melanoma is characterized by a. Long and indolent course, regional node and distant metastases b. Long and indolent course, locally invasive c. Fast growth, regional node and distant metastases d. Fast growth, locally invasive

c. Fast growth, regional node and distant metastases

Non-surgical modality for hemangioma treatment a. Imiquimod, 5FU b. Radiotherapy c. Propranolol, intralesional steroid d. Oral steroid

c. Propranolol, intralesional steroid

Benign epidermal lesions caused by viruses a. Verruca vulgaris, Molluscum contagiosum b. Toxic epidermal necrolysis c. Pyoderma gangrenosum d. Fournier's gangrene

a. Verruca vulgaris, Molluscum contagiosum

Malignant skin lesions caused by virus: a. BCC b. Malignant Melanoma c. Cutaneous TB d. SCC, Kaposi sarcoma

d. SCC, Kaposi sarcoma

Surgical treatment for 1cm diameter basal cell CA a. Simple fishmouth excision, no margin b. Enucleation c. Excision 1 mm margin d. Wide excision biopsy, 3-4 mm margin

d. Wide excision biopsy, 3-4 mm margin

Surgical treatment for 1cm intradermal nevus a. Simple excision, with no margin b. Enucleation c. Excision with 1 mm margin d. Wide excision biopsy, 3-4 mm margin

a. Simple excision, with no margin

Actively dividing cells in the skin are found in: a. Stratum Basale b. Stratum Spinosum c. Stratum Granulosum d. Stratum Corneum

a. Stratum Basale

Pressure injury is caused by: a. Tissue temperature exceeding 70 degrees Celsius b. Tissue pressure exceeding the arterial vascular pressure of 32-33 mmHg. c. Tissue pressure exceeding the venous vascular pressure of 20 mmHg. d. O2 Tension in tissue of less than 95%

b. Tissue pressure exceeding the arterial vascular pressure of 32-33 mmHg.

Metastases in Primary Melanoma can be found in the primary tumor lesions and nearest regional nodal basin is called: a. Satellitosis b. Nodal Metastases c. Metastases in transit d. Distant Metastases

b. Nodal Metastases

Which of the following is a precursor of a malignant melanoma a. Verruca vulgaris b. Dermatofibroma c. Seborrheic keratosis d. Dysplastic nevus

d. Dysplastic nevus

SCC that results from chronic, non-healing wounds a. Cushing's ulcer b. Marjolin's ulcer c. Peptic ulcer d. Pressure ulcer

b. Marjolin's ulcer

A 1 cm brown mole that turned bluish-black with ulceration over a 1 year period. What is the best management? a. Wide excision biopsy b. Cauterization c. Topical steroids d. Irradiation

a. Wide excision biopsy

Which lesion is at risk of developing to SCC a. Seborrheic keratosis b. Actinic keratosis c. Congenital melanocytic nevus d. Cherry hemangioma

b. Actinic keratosis

Breslow Staging measures a. Deepest level of tumor invasion on layer of skin b. Number of mitotic figures c. Tumor thickness d. Lymph node involvement

c. Tumor thickness

Clark’s level measures: a. Penetration of the lesions from the top of the granular layer b. Mitotic rate c. Tumor thickness d. Lymph node involvement

a. Penetration of the lesions from the top of the granular layer

Hemangioma that turned skin colored flat, wrinkled and non distensible is what stage a. Proliferative b. Malignant degeneration c. Expanding d. Involution

d. Involution

26/male with multiple subcutaneous nodules in the face, trunk and extremities, axillary freckling and Lisch nodules has what condition? a. Dermatofibrosarcoma protuberans b. Neurofibromatosis c. Steatocystoma multiplex d. Verruca vulgaris

b. Neurofibromatosis

16/female, with sebum- filled cyst over the face, trunk and extremities and the same condition with her father has what condition? a. Dermatofibrosarcoma protuberans b. Neurofibroma c. Steatocystoma multiplex d. Verruca vulgaris

c. Steatocystoma multiplex

Pressure injury with full thickness and necrosis a. Grade 1 b. Grade 2 c. Grade 3 d. Grade 4

c. Grade 3

Chronic infection of skin, hair follicles, and apocrine sweat glands with sinus tract formation is found in a. Palmoplantar hyperhidrosis b. Cellulitis c. Tuberculous adenitis d. Hidradenitis suppurativa

d. Hidradenitis suppurativa

Treatment for above condition (#46) -- Hidradenitis suppurativa a. Systemic antibiotic b. Anti TB Medication c. Botulinum toxin injection d. Unroofing and excision

a. Systemic antibiotic

Condyloma acuminata is found in a. Genitalia, perineum and perianal region b. Axilla c. Face d. Hands

a. Genitalia, perineum and perianal region

The case above (#48--Condyloma acuminata) is caused by a. Human papillomavirus b. Epstein Barr virus c. Mycoplasma leprae d. Pox virus

a. Human papillomavirus

This is an example of a high flow vascular lesion a. Strawberry angioma b. Arterio-venous malformation c. Lymphangioma d. Cherry angioma

b. Arterio-venous malformation