Surgery - END (Part 2)

Question 1

Water constitutes what percentage of total body weight? *
A. 30-40%.
B. 40-50%
C. 50-60%
D. 60-70%.

Answer 1

C. 50-60%
Rationale: Water typically makes up about 50-60% of an adult’s total body weight. This proportion can vary based on factors such as age, gender, and body fat percentage, but for a healthy adult, around 50-60% is a standard reference range.

Question 2

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%
B. 8-12%
C. 15-18%
D. 22-25%

Answer 2

A. 3-4%

Question 3

A 35-year-old unrestrained driver was involved in a motor-vehicle crash. A computed tomography (CT) of the abdomen revealed a large hematoma in the second portion of duodenum. The rest of the abdomen is normal. The initial management of this duodenal hematoma should be: *
A. Operative evacuation
B. Nasogastric decompression, intravenous fluids, and gradual resumption of oral diet
C. Endoscopic retrograde cholangiopancreatogram (ERCP)
D. Laparotomy, pyloric exclusion, and gastrojejunostomy
E. Octretide

Answer 3

B. Nasogastric decompression, intravenous fluids, and gradual resumption of oral diet
Rationale: The initial management of a duodenal hematoma, especially in the absence of other abdominal injuries, is conservative. This includes nasogastric decompression to relieve gastric distension and prevent vomiting, intravenous fluids to maintain hydration, and a gradual resumption of an oral diet as tolerated. Surgery or other invasive procedures are considered if there is no improvement with conservative management.

Question 4

38-year-old woman is brought to the emergency department after she stepped on a rusty nail and sustained a puncture wound to the foot. The patient has been on a therapeutic dose of steroids for the past 5 years for ulcerative colitis. Her last tetanus toxoid booster was 8 years ago. What should the patient receive? *
A. Tetanus toxoid booster
B. Human immunoglobulin
C. Antibiotics with anaerobic coverage
D. Tetanus toxoid plus human immunoglobulin
E. Tetanus toxoid plus human immunoglobulin and antibiotics with aerobic and anaerobic coverage

Answer 4

E. Tetanus toxoid plus human immunoglobulin and antibiotics with aerobic and anaerobic coverage

Question 5

A 27-year-old man is brought to the emergency room after a house fire. He has burns around his mouth and his voice is hoarse, but breathing is unlabored. What most appropriate next step in management? *
A. Immediate endotracheal intubation
B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available
C. Place on supplemental oxygen
D. Placement of two large-bore intravenous (IV) catheters with fluid resuscitation

Answer 5

B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available
Rationale: The patient’s burns around the mouth and hoarseness suggest possible inhalation injury or airway burns. However, since his breathing is unlabored, immediate endotracheal intubation may not be necessary. A thorough examination of the oral cavity, pharynx, and if possible, the larynx using a fiberoptic laryngoscope is appropriate to assess the extent of injury and determine the need for airway management.

Question 6

Which of the following is NOT one of the four major physiologic events of hemostasis? *
A. Fibrinolysis
B. Vasodilatation
C. Platelet plug formation
D. Fibrin production

Answer 6

B. Vasodilatation
Rationale: Hemostasis involves the arrest of bleeding and includes four main steps: vasoconstriction, platelet plug formation, fibrin production, and finally fibrinolysis. Vasodilatation is not a part of the hemostasis process; in fact, vasoconstriction occurs initially to help reduce blood flow to the injured area.

Question 7

What percentage burn does a patient have who has suffered burns to one leg (circumferential), one arm (circumferential), and the anterior trunk? *
A. 18%
B. 27%
C. 36%
D. 45%.

Answer 7

D. 45%.
According to the Rule of Nines used in calculating body surface area affected by burns, each arm is approximately 9% of the body’s surface area, each leg is approximately 18%, and the entire trunk is approximately 36%. Therefore, burns to one entire leg (18%), one entire arm (9%), and the anterior trunk (half of 36%, so 18%) would total 45%.

Question 8

What is the risk of Hepatitis C and HIV-1 transmission with blood transfusion? *
A. 1:10,000,000
B. 1:1,000,000
C. 1:500,000
D. 1:100,000

Answer 8

B. 1:1,000,000
Rationale: The risk of transmission of Hepatitis C and HIV-1 through blood transfusion has greatly decreased due to rigorous screening processes. While the exact risk can vary, it is generally considered to be around 1 in 1,000,000 for each virus, reflecting the effectiveness of current blood screening methods.

Question 9

A patient who has spasms in the hand when a blood pressure cuff is blown up most likely has *
A. Hypercalcemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypomagnesemia

Answer 9

B. Hypocalcemia
Rationale: The description is indicative of Trousseau’s sign, a medical phenomenon where inflation of a blood pressure cuff to a level above systolic pressure leads to spasms of the hand and wrist. This sign is commonly associated with hypocalcemia, as low calcium levels increase nerve excitability.

Question 10

Allergic reactions do not occur with *
A. Packed RBC’s
B. FFP.
C. Cyroprecipitate
D. None of the above

Answer 10

D. None of the above
Rationale: Allergic reactions can potentially occur with any blood product, including packed red blood cells (RBCs), fresh frozen plasma (FFP), and cryoprecipitate. Therefore, it’s incorrect to say that allergic reactions do not occur with any specific one of these products; all can potentially trigger an allergic response in susceptible individuals.

Question 11

A 53-year-old woman involved in a bus accident suffered a severe blow to the middle upper abdomen. Physical examination revealed diffuse tenderness, but there was no evidence of rebound tenderness or guarding. What test would be performed to rule out traumatic pancreatitis? *
A. Peritoneal lavage
B. Serum amylase
C. CT scan with oral and intravenous contrast
D. Upper GI study
E. ERCP

Answer 11

C. CT scan with oral and intravenous contrast
Rationale: A CT scan with oral and intravenous contrast is the best choice for assessing abdominal trauma and can provide detailed images of the pancreas and surrounding structures to rule out traumatic pancreatitis. It can identify pancreatic injuries, hematomas, and other complications like fluid collections.

Question 12

Patients with a penicillin allergy are LEAST likely to have a cross-reaction with *
A. Synthetic penicillins
B. Carbapenems
C. Cephalosporins
D. Monobactams

Answer 12

D. Monobactams
Rationale: Monobactams, such as aztreonam, have a different chemical structure from penicillins and are less likely to cause cross-reactivity in patients with a penicillin allergy. Unlike penicillins, cephalosporins, and carbapenems, monobactams do not have the beta-lactam ring structure similar to penicillins, making them a safer option for patients with known penicillin allergies

Question 13

A 46-year-old man is struck by a motor vehicle while crossing the street; he arrives in the ED hypotensive, bradycardic, and unable to move his extremities.
What is the most likely cause of his hypotension? *
A. Hypovolemic shock
B. Obstructive shock
C. Neurogenic shock
D. Vasodilatory shock.

Answer 13

C. Neurogenic shock
Rationale: Neurogenic shock can occur following a severe spinal cord injury, which may be inferred from the inability to move extremities and the presence of bradycardia combined with hypotension. This type of shock results from the loss of sympathetic tone, leading to vasodilation and decreased cardiac output.

Question 14

A 68-year-old woman is hit by a car and injures her midabdomen. The best way to rule out a rupture of the second part of the duodenum is by which mode? *
A. Repeated physical examinations
B. Ultrasound
C. Repeated amylase levels
D. CT with oral and intravenous contrast
E. Peritoneal lavage

Answer 14

D. CT with oral and intravenous contrast
Rationale: A CT scan with oral and intravenous contrast is the most effective method to evaluate for injuries such as a rupture of the duodenum. It provides detailed images of the abdominal organs, allowing for the identification of any ruptures, hematomas, or other injuries.

Question 15

Which factor does NOT influence the development of surgical site infections (SSls)? *
A. Duration of procedure
B. Degree of microbial contamination of the wound
C. Malnutrition
D. General anesthesia

Answer 15

D. General anesthesia
Rationale: While factors like the duration of the procedure, the degree of microbial contamination of the wound, and the nutritional status of the patient (malnutrition) can influence the risk of SSIs, general anesthesia itself does not directly affect the development of surgical site infections.

Question 16

A 55-year-old male with a known history of alcoholism is admitted with acute pancreatitis. His serum calcium is 7 mg/dL. Management is based upon which of the following *
A. One-fourth of calcium in serum is ionized
B. Alkalosis increases the ionized calcium component
C. Hypocalcemia may cause polyuria and polydipsia
D. Determination of serum albumin is necessary
E. Treatment should involve intravenous administration of calcium chloride

Answer 16

D. Determination of serum albumin is necessary
Rationale: In the context of hypocalcemia and acute pancreatitis, it is important to determine the serum albumin level because calcium is often bound to albumin in the blood. Hypoalbuminemia, which can occur in the setting of alcoholism and acute illness, may cause a decrease in total serum calcium while the ionized (biologically active) calcium may be normal. Therefore, it’s crucial to assess the albumin level to correctly interpret the calcium level and guide management.

Question 17

A 46-year-old man has multiple intra-abdominal injuries after a gunshot wound.
Celiotomy reveals multiple injuries to small and large bowel and major bleeding from the liver. After repair of the bowel injuries, the abdomen is closed with towel clips, leaving a large pack in the injured liver. Within 12 hours, there is massive abdominal swelling with edema fluid, and intra-abdominal pressure exceeds 35 mm Hg. The immediate step in managing this problem is to *
A. Administer albumin intercavernously
B. Give an IV diuretic.
C. Limit IV fluid administration
D. Open the incision to decompress the abdomen

Answer 17

D. Open the incision to decompress the abdomen
Rationale: This scenario describes abdominal compartment syndrome, where intra-abdominal pressure is critically high, threatening organ function. The immediate treatment is to relieve the pressure, typically by opening the abdominal incision to decompress the abdomen. This can prevent further organ damage and improve blood flow.

Question 18

All the following treatments for hyperkalemia reduce serum potassium EXCEPT *
A. Bicarbonate
B. Kayexalate
C. Glucose infusion with insulin
D. Calcium

Answer 18

D. Calcium
Rationale: Calcium is used in the treatment of hyperkalemia to stabilize the heart muscle cells’ membranes, reducing the risk of arrhythmias. However, it does not lower the serum potassium level; it merely protects against its cardiac effects. Bicarbonate, Kayexalate, and glucose infusion with insulin help to actually lower the potassium levels in the blood.

Question 19

The most abundant amino acid in the human body is *
A. Carnitine.
B. Arginine
C. Glutamine
D. Methionine

Answer 19

C. Glutamine
Rationale: Glutamine is the most abundant amino acid in the human body and plays a key role in many biological processes, including protein synthesis, energy production, and as a nitrogen transporter.

Question 20

A 65-year-old man is brought into the emergency department following his injury as a passenger in a car crash. He complains of right side chest pain.
Physical examination reveals a respiratory rate of 42 breaths per minute and multiple broken ribs of a segment of the chest wall that moves paradoxically with respiration. What should the next step be? *
A. Tube thoracostomy
B. Tracheostomy
C. Thoracentesis
D. Endotracheal intubation
E. Intercostal nerve blocks

Answer 20

C. Thoracentesis

Question 21

Successful antibiotic penetration of a burn eschar can be achieved with *
A. Mafenide acetate
B. Neomycin
C. Silver nitrate
D. Silver sulfadiazine

Answer 21

A. Mafenide acetate
Rationale: Mafenide acetate is known for its ability to penetrate burn eschar effectively. It has broad-spectrum antimicrobial activity and is used topically to prevent and treat infections in burn wounds. Unlike other agents, which may have limited penetration through eschar, mafenide acetate can reach deeper tissues.

Question 22

A 22-year-old man is shot with a handgun and found to have a through-and-through injury to the right transverse colon. There is little fecal contamination and no bowel devascularization. At operation, what does he require? *
A. Right hemicolectomy with ileotransverse colon anastomosis
B. Right hemicolectomy with ileostomy and mucous fistula
C. Debridement and closure of wounds with exteriorization of colon
D. Debridement and closure of wounds
E. Segmental resection with primary anastomosis

Answer 22

D. Debridement and closure of wounds

Question 23

A 54-year-old man underwent major abdominal surgery to remove a ruptured aortic aneurysm. Four days after the operation, an attempt was made to wean him off the ventilator. ABG analysis reveals pH, 7.54; PCO2, 30 mm Hg; PO2, 110 mm Hg; HCO3,30 mEq/L; and Sa02, 99%. Blood gas analysis reveals which of the following? *
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Compensated respiratory acidosis
E. Combined respiratory and metabolic alkalosis

Answer 23

B. Metabolic alkalosis… E sabi ni chatgpt

Question 24

A 35-year-old woman presents to the emergency department with a stab wound to the neck above the angle of the mandible. The patient’s blood pressure is 110/80 mm Hg, pulse rate is 100 bpm, and respiration rate is 24 breaths per minute. Between initial presentation and insertion of intravenous lines, the hematoma in the upper neck enlarges significantly. What should be the next step in the patient’s management? *
A. Barium swallow
B. Flexible endoscopy
C. Operative exploration
D. Doppler ultrasound
E. Angiography

Answer 24

E. Angiography… C. sabi ni chatgpt

Question 25

A 55 year-old restrained driver was involved in a motor-vehicle crash. He is hemodynamically stable and has a large seat belt sign on the abdomen. His abdomen is tender to palpation. In this patient one should be most concerned about: * A. Liver and spleen injury B. Transection of the head of the pancreas C. Renal pedicle avulsion D. Hollow-viscus injuries E. Pelvic fracture

Answer 25

D. Hollow-viscus injuries Rationale: The presence of a seat belt sign (ecchymosis across the abdomen from the seat belt) and abdominal tenderness in a patient involved in a motor-vehicle crash is particularly concerning for hollow-viscus injuries (injury to the bowel or other hollow abdominal organs). These injuries may not be immediately apparent but can lead to significant morbidity if not promptly identified and treated.

Question 26

The proliferative phase of wound healing occurs how long after the injury? * A. 1 day B. 2 days C. 7 days. D. 14 days

Answer 26

C. 7 days. B. daw sabi ni chatgpt

Question 27

A 16-year-old girl had an injury to the right retroperitoneum with duodenal contusion. What is the test required to exclude a rupture of the duodenum? * A. Serum amylase B. Dimethyliminodiacetic acid (HIDA) scan C. Gastrografin study D. Upper Gl with barium E. ERCP

Answer 27

C. Gastrografin study Rationale: A Gastrografin (or water-soluble contrast) study is the preferred initial test to evaluate for duodenal rupture. Gastrografin is a contrast agent that can be used in imaging to highlight the gastrointestinal tract and identify leaks or ruptures, particularly in the duodenum.

Question 28

A 18-year-old girl presents to the emergency department with a stab wound to the abdomen and a blow to the head that left her groggy. Her blood pressure is 80/0 mm Hg, pulse is120 bpm, and respiration rate is 28 breaths per minute. Her abdomen has a stab wound in the anterior axillary line at the right costal margin. Two large-bore intravenous lines, a nasogastric tube, and a Foley catheter are inserted. The blood pressure rises to 85 mm Hg after 2 L of Ringer's lactate. The appropriate management is which of the following? * A. Peritoneal lavage B. Ultrasound of the abdomen C. Laparoscopic assessment of the peritoneal cavity D. Exploratory laparotomy E. CT of the head

Answer 28

D. Exploratory laparotomy Rationale: Given the patient's stab wound in a critical area, hemodynamic instability despite fluid resuscitation, and the potential for significant intra-abdominal injuries, immediate exploratory laparotomy is indicated. This allows for direct visualization and treatment of any internal injuries. The urgency of the abdominal findings supersedes the need for head imaging at this critical juncture.

Question 29

Which is required for platelet adherence to injured endothelium? * A. Thromboxane A2. B. Glycoprotein (GP) IIb/Illa C. Adenosine diphosphate (ADP) D. Von Willebrand factor (vWF)

Answer 29

D. Von Willebrand factor (vWF) Rationale: Von Willebrand factor (vWF) plays a crucial role in the initial stages of blood clot formation by mediating the adhesion of platelets to the site of endothelial injury. vWF binds to specific receptors on the platelet surface (like glycoprotein Ib), anchoring the platelets to the damaged vessel wall.

Question 30

A 63-year-old man sustains numerous injuries involving the abdomen and lower extremities. During the intra- and postoperative periods, he is resuscitated with 10 L of Ringer's lactate and 2 U of packed red blood cells (RBC). After initial improvement, he has severe dyspnea on the second postoperative day. The most useful initial diagnostic test is which of the following? * A. Electrocardiogram B. Analysis of arterial blood gas C. Insertion of a central venous line D. Ventilation-perfusion scan E. Computed tomography (CT) scan of abdomen

Answer 30

B. Analysis of arterial blood gas (ABG) Rationale: Given the sudden onset of severe dyspnea postoperatively, especially after significant fluid resuscitation, an ABG analysis would be very informative. It can help assess the oxygenation status, ventilation, and acid-base balance, providing crucial information to diagnose potential issues such as acute respiratory distress syndrome (ARDS), fluid overload, or pulmonary embolism.

Question 31

Hypocalcemia may cause which of the following? * A. Congestive heart failure B. Atrial fibrillation C. Pancreatitis D. Hypoparathyroidism

Answer 31

A. Congestive heart failure

Question 32

Which of the following is true about antidiuretic hormone (ADH) production in injured patients? * A. ADH acts as a potent mesenteric vasoconstrictor. B. ADH levels all to normal within 2 to 3 days o the initial insult C. ADH decreases hepatic gluconeogenesis. D. ADH secretion is mediated by the renin-angiotensin system.

Answer 32

A. ADH acts as a potent mesenteric vasoconstrictor.

Question 33

Fluid resuscitation using albumin * A. Is associated with coagulopathy B. Is available as 1% or 5% solutions C. Can lead to pulmonary edema D. Decreased factor XIII

Answer 33

C. Can lead to pulmonary edema Rationale: Albumin is used in fluid resuscitation to expand blood volume. However, if administered excessively or in patients with compromised cardiac or renal function, it can lead to fluid overload and pulmonary edema, where fluid accumulates in the lungs, making it difficult to breathe.

Question 34

A 54-year-old man skidded from the road at high speed and hit a tree. Examples of deceleration injuries in this patient include: * A. Aortic valve rupture B. Kidney injury C. Posterior dislocation of shoulder D. Mesenteric avulsion E. Stomach rupture

Answer 34

D. Mesenteric avulsion D. Mesenteric avulsion is the most prototypical example of a deceleration injury among the options provided. This type of injury aligns with the mechanics of deceleration where the fixed point (attachment of the mesentery to the posterior abdominal wall) and the moving organ (small intestine) are subjected to forces that lead to avulsion injuries. This selection best fits the described injury mechanisms in deceleration scenarios detailed in surgical literature and textbooks such as "Schwartz's Principles of Surgery".

Question 35

A trauma patient arrives following a stab wound to the left chest with systolic blood pressure (SBP) 85 mm Hg, which improves slightly with intravenous (IV) fluid resuscitation. Chest X-ray demonstrates clear lung fields. What is the most appropriate next step? * A. Computed tomography (CT) scan of the chest B. Pelvic X-ray C. Focused abdominal sonography for trauma (FAST) examination D. Tube thoracostomy of the left chest

Answer 35

C. Focused abdominal sonography for trauma (FAST) examination

Question 36

Which is NOT a component of systemic inflammatory response syndrome (SIRS)? A. Temperature B. White blood cell (WBC) count C. Blood pressure D. Heart rate

Answer 36

C. Blood pressure Rationale: SIRS criteria include body temperature abnormalities, heart rate, respiratory rate, and white blood cell count. While blood pressure changes can be a consequence of severe SIRS leading to shock, it is not one of the primary diagnostic criteria for defining SIRS.

Question 37

Less than 0.5% of transfusions result in a serious transfusion-related complication. What is the leading cause of transfusion-related deaths? * A. Transfusion-related acute lung injury B. ABO hemolytic transfusion reactions C. Bacterial contamination of platelets D. latrogenic hepatitis C infection

Answer 37

A. Transfusion-related acute lung injury (TRALI) Rationale: TRALI has become one of the leading causes of transfusion-related mortality. It typically occurs within hours of transfusion, leading to acute respiratory distress and pulmonary edema not related to cardiac overload or volume excess.

Question 38

Normal saline is * A. 135 mEq NaCI/L B. 145 mEq NaCl/L C. 148 mEq NaCI/L D. 154 mEq NaCI/L

Answer 38

D. 154 mEq NaCl/L Rationale: Normal saline (0.9% sodium chloride) contains 154 mEq of sodium and 154 mEq of chloride per liter.

Question 39

A 50-year-old man who weighs 65 kg is being observed in the ICU. Twenty-four hours postoperatively, he develops convulsions. His serum sodium is 118 mEq/L. Appropriate management includes which of the following? * A. Administration of normal saline (0.9%) B. Administration of hypertonic saline (3%) C. Emergency hemodialysis D. Administration of vasopressin E. Administration of Lasix, 40 mg intravenously (IV)

Answer 39

B. Administration of hypertonic saline (3%) Rationale: Convulsions due to severe hyponatremia (serum sodium 118 mEq/L) require prompt treatment with hypertonic saline (3%) to raise the serum sodium concentration quickly and safely to prevent further neurological complications.

Question 40

Cardiogenic shock* A. Is most commonly caused by exacerbation of congestive heart failure B. Cardiogenic shock following an acute myocardial infarction is typically present on admission. C. Cardiogenic shock occurs in 5 to 10% of acute MIs. D. Is characterized by hypotension, reduced cardiac index, and reduced pulmonary artery wedge pressure.

Answer 40

C. Cardiogenic shock occurs in 5 to 10% of acute MIs. Rationale: Cardiogenic shock is a serious condition that occurs in 5 to 10% of patients with acute myocardial infarction (MI) and is characterized by reduced cardiac output leading to inadequate tissue perfusion. It is associated with high mortality and typically presents with hypotension, a reduced cardiac index, and increased pulmonary artery wedge pressure (not reduced).

Question 41

A 24-year-old man is stabbed in the right intercostal space in the midclavicular line and presents to the emergency department. On examination, subcutaneous emphysema of the right chest wall, absent breath sounds, and a trachea shifted to the left are noted. What is the most likely serious diagnosis? * A. Pneumothorax B. Tension pneumothorax. C. Massive hemothorax D. Hemopneumothorax E. Chest wall laceration

Answer 41

B. Tension pneumothorax Rationale: The clinical presentation of subcutaneous emphysema, absent breath sounds on one side, and tracheal deviation to the opposite side strongly suggests a tension pneumothorax. This is a life-threatening condition where air enters the pleural space and cannot escape, leading to increased intrathoracic pressure, collapse of the lung on the affected side, and shift of the mediastinum towards the unaffected side, which can compromise cardiac output and requires immediate decompression.

Question 42

In hemorrhage, larger arterioles vasoconstrict in response to the sympathetic nervous system. Which categories of shock are associated with vasodilation of larger arterioles? * A. Septic shock B. Cardiogenic shock C. Neurogenic shock D. A&C

Answer 42

D. A&C (Septic shock and Neurogenic shock) Rationale: Both septic and neurogenic shock are associated with vasodilation of larger arterioles. In septic shock, inflammatory mediators cause widespread vasodilation, leading to hypotension. In neurogenic shock, loss of sympathetic tone due to spinal cord injury results in vasodilation.

Question 43

What is the actual potassium of a patient with pH of 7.8 and serum potassium of 2.2* A. 2.2. B. 2.8 C. 3.2 D. 3.4

Answer 43

A. 2.2. C daw

Question 44

Which of the following is a common sequelae of electrical injury? * A. Cardiac arrhythmias B. Paralysis C. Brain damage D. Cataracts

Answer 44

D. Cataracts... A daw sabi ni gpt.

Question 45

The first step in the management of acute hypercalcemia should be * A. Correction of deficit of extracellular fluid volume B. Hemodialysis C. Administration of furosemide D. Administration of mithramycin

Answer 45

A. Correction of deficit of extracellular fluid volume Rationale: The initial management of acute hypercalcemia typically involves intravenous hydration to correct the volume deficit that often accompanies hypercalcemia. This helps to increase renal calcium excretion and dilute serum calcium concentration. Hydration is usually followed by other treatments like diuretics, bisphosphonates, or calcitonin to further reduce calcium levels.

Question 46

Supplementation of which of the following micronutrients improves wound healing in patients without micronutrient deficiency? * A. Vitamin C. B. Vitamin A C. Selenium D. Zinc

Answer 46

B. Vitamin A

Question 47

What is the best determinant of whether a patient has a metabolic acidosis versus alkalosis? * A. Arterial pH B. Serum bicarbonate C. PCO2. D. Serum CO2 level

Answer 47

A. Arterial pH

Question 48

Which cytokine is anti-inflammatory and increases after shock and trauma? * A. Interleukin (IL)-1 B. IL-2 C. IL-6 D. IL-10

Answer 48

D. IL-10 Rationale: Interleukin-10 (IL-10) is an anti-inflammatory cytokine that typically increases after shock and trauma. It plays a role in limiting and terminating inflammatory responses, promoting the healing process.

Question 49

What congenital factor deficiency is associated with delayed bleeding after initial hemostasis? * A. Factor VIII B. Factor IX C. Factor XI D. Factor XIII

Answer 49

D. Factor XIII Rationale: Factor XIII deficiency is associated with delayed bleeding after initial hemostasis because it is responsible for stabilizing the clot formed during the coagulation process. A deficiency in Factor XIII can lead to normal initial clotting followed by later rebleeding as the clot is not adequately stabilized.

Question 50

A 50-year-old man is hit by a pickup truck and brought to the emergency department with a blood pressure of 70/0 mm Hg. Peritoneal lavage showed no blood in the abdomen. The blood pressure is elevated to 85 systolic following the administration of 2 L of Ringer's lactate. An x-ray showed a pelvic fracture. What is the next step in management? * A. Exploratory laparotomy with packing of the pelvis B. CT scan of the pelvis C. External fixation of the pelvis D. Open reduction and internal fixation (ORIF) of the pelvis E. Exploratory laparotomy with bilateral ligation of the internal iliac arteries

Answer 50

C. External fixation of the pelvis Rationale: Given the presence of a pelvic fracture and the hypotension that has partially responded to fluid resuscitation, external fixation of the pelvis is a common next step. This helps stabilize the fracture, reduce bleeding by limiting the pelvic volume, and allow for better control of the hemodynamic status. Although angiographic embolization (not listed in the options) is also a consideration for ongoing bleeding, external pelvic fixation is a critical immediate step in the stabilization process.

Question 51

You are called to the emergency department to evaluate a 55-year-old woman following motor vehicle crash with associated head trauma. She withdraws to pain and is intubated for airway protection. In order to calculate the Glasgow Coma Scale score, which of the following components of the neurologic examination are necessary? * A. Motor response, verbal response, corneal reflexes B. Motor response, eye opening, verbal response C. Eye opening, pupillary light reflexes, motor response D. Pupillary light reflexes, motor response, verbal response E. Corneal reflexes, pupillary light reflexes, motor response

Answer 51

B. Motor response, eye opening, verbal response Rationale: The Glasgow Coma Scale (GCS) score is calculated based on three components: motor response, eye opening, and verbal response. These components assess the level of consciousness and neurological function.

Question 52

The major cause of impaired wound healing is * A. Anemia B. Diabetes mellitus C. Local tissue infection D. Malnutrition

Answer 52

C. Local tissue infection Rationale: While all the listed factors can impair wound healing, local tissue infection is a major cause because it can lead to chronic inflammation, further tissue damage, and interruption of the normal stages of wound healing. Malnutrition, anemia, and diabetes mellitus also significantly affect wound healing but in terms of direct and immediate impact, local infection is often the most critical to address.

Question 53

A 40-year-old woman involved in a car crash is brought into the emergency department. Her blood pressure is 90/60 mm Hg, pulse rate is 120 bpm, and respiration rate is 18 breaths per minute. On peritoneal lavage, she is noted to have free blood in the peritoneal cavity. At the time of exploratory laparotomy, a liver laceration is noted, and there is a 2.5-cm-diameter contusion to an area of small bowel. How should the small-bowel contusion be treated? * A. Transillumination evaluation of hematoma with meticulous hemostasis B. Resection of the bowel with single-layer anastomosis C. Inversion of the area of contusion with a row of fine nonabsorbable mattress sutures D. Resection of the bowel and ileostomy E. Observation (no surgical therapy)

Answer 53

E) Observation (no surgical therapy) Rationalization: In the case of a small bowel contusion noted during surgery without evidence of perforation or extensive damage, conservative management (observation) is often sufficient. The 2.5-cm contusion, if not compromising the integrity of the bowel or associated with signs of perforation or ischemia, does not necessarily require surgical intervention. Continuous monitoring and follow-up assessments are crucial to ensure that the contusion heals without complications such as necrosis or perforation. Surgical options like resection or suturing are reserved for more severe injuries or if the contusion worsens.

Question 54

What is true regarding the evaluation of blunt abdominal trauma? * A. Patients with abdominal wall rigidity and negative abdominal CT should undergo diagnostic peritoneal lavage (DPL) to rule out small bowel injury B. If FAST examination is negative in a hemodynamically unstable patient then DPL is indicated to rule out abdominal bleeding C. FAST examination cannot detect intraperitoneal fluid if the total volume is <1000 mL D. Bowel injury can be ruled out in hemodynamically stable patients with abdominal CT

Answer 54

B. If FAST examination is negative in a hemodynamically unstable patient then DPL is indicated to rule out abdominal bleeding

Question 55

The most appropriate treatment for a duodenal hematoma that occurs from blunt trauma is * A. Exploratory laparotomy and bypass of the duodenum B. Exploratory laparotomy and evacuation of the hematoma C. Exploratory laparotomy to rule out associated injuries D. Observation

Answer 55

D. Observation Rationale: Duodenal hematomas, especially if they are not obstructing the bowel, can often be managed conservatively. Observation involves monitoring the patient for signs of bowel obstruction or ischemia, with surgery reserved for those who fail to improve or worsen.

Question 56

Which of the following is a cause of cardiogenic shock in a trauma patient? * A. Hemothorax B. Penetrating injury to the aorta C. Air embolism D. latrogenic increased afterload due to pressors

Answer 56

C. Air embolism

Question 57

A patient has a blood pressure o 70/50 mm Hg and a serum lactate level of 30 mg/100 mL (normal: 6-16). His cardiac output is 1.9 L/min, and his central venous pressure is 2 cm H2O. The most likely diagnosis is * A. Congestive heart failure B. Cardiac tamponade C. Hypovolemic shock D. Septic shock

Answer 57

C. Hypovolemic shock Rationale: The presentation of low blood pressure, high lactate levels (indicating poor tissue perfusion), low cardiac output, and low central venous pressure suggests hypovolemic shock, which is characterized by a significant reduction in intravascular volume leading to decreased cardiac output and hypoperfusion.

Question 58

The best method for hair removal from an operative field is * A. Shaving the night before B. Depilating the night before surgery C. Shaving in the operating room D. Using hair clippers in the operating room

Answer 58

D. Using hair clippers in the operating room Rationale: Using hair clippers in the operating room just before surgery is recommended to minimize the risk of skin injury and subsequent infection. Shaving can cause microscopic cuts and increase the risk of surgical site infections.

Question 59

A 70-year-old man, who weighs 70 kg, is admitted with acute cholecystitis. His calculated daily fluid requirement for maintenance is approximately which of the following?* A. 1 L B. 2L C. 2.5 L D. 3 L E. 4 L

Answer 59

C. 2.5 L C. 2.5 L is the most appropriate choice for the daily fluid requirement of a 70-year-old man weighing 70 kg with acute cholecystitis. This volume meets the calculated needs based on standard fluid management principles, ensuring adequate hydration while avoiding the risks associated with both underhydration and fluid overload in a patient without specific complicating factors.

Question 60

What type of nerve injury involves disruption of axonal continuity with preserved Schwann cell basal lamina?* A. Neurapraxia B. Axonotemesis C. Neurotmesis D. Axonolysis

Answer 60

B. Axonotemesis Rationale: Axonotemesis is a nerve injury where the axons are damaged but the connective tissue structures (Schwann cell basal lamina, endoneurium) remain intact. This type of injury allows for potential regeneration of the axons over time.

Question 61

A 41-year-old woman is brought to the emergency department following a car crash in which she was the driver. In the emergency department, her blood pressure is 80/60 mm Hg, pulse is 128 bpm, and respiratory rate is 32 breaths per minute. She complains of right lower chest wall and severe right upper quadrant (RUQ) tenderness. Her breath sounds are questionably diminished. The immediate priority is to perform which of the following? * A. Peritoneal lavage B. Chest x-ray C. CT scan of chest and abdomen D. Thoracentesis with an 18-gauge needle E. Endotracheal intubation

Answer 61

E. Endotracheal intubation

Question 62

A 40-year-old man is brought to the emergency department following a high-speed car accident. He was the driver, and the windshield of the car was broken. On examination, he is alert, awake, oriented, and in no respiratory distress. He is unable to move any of his four extremities; however, his extremities are warm and pink. His vital signs on admission are HR 54 bpm and BP70/40 mm Hg. What is the diagnosis? * A. Hemorrhagic shock B. Cardiogenic shock C. Neurogenic shock D. Septic shock E. Irreversible shock

Answer 62

C. Neurogenic shock Rationale: The patient’s presentation with bradycardia, hypotension, and warm, pink extremities, along with the inability to move all four extremities, is indicative of neurogenic shock. This condition results from spinal cord injury leading to loss of sympathetic tone, causing vasodilation and decreased cardiac output.

Question 63

A 28-year-old man is admitted to the ED shortly after being involved in an automobile accident. He is in a coma (GCS = 7). His pulse is barely palpable at a rate of 140 beats per minute, and BP is 60/0. Breathing is rapid and shallow, aerating both lung fields. His abdomen is moderately distended with no audible peristalsis. There are closed fractures of the right forearm and the left lower leg. After rapid IV administration of 2 L lactated Ringer solution in the upper extremities, his pulse is 130 and BP 70/0. The next immediate step should be to * A. Obtain cross-table lateral X-rays of the cervical spine B. Obtain head and abdominal CT scans C. Obtain supine and lateral decubitus X-rays of the abdomen D. Obtain an arch aortogram E. Explore the abdomen

Answer 63

E. Explore the abdomen Rationale: Given the patient’s continued hypotension and tachycardia after fluid resuscitation, along with a distended abdomen and lack of peristalsis, there is a high suspicion of intra-abdominal bleeding. This scenario necessitates immediate exploratory laparotomy to identify and control the source of bleeding.

Question 64

A 34-year-old woman is scheduled for an elective cholecystectomy. The best method of identifying a potential bleeder is which of the following? * A. Platelet count B. A complete history and physical examination C. Bleeding time D. Lee-White clotting time E. Prothrombin time (PT)

Answer 64

B. A complete history and physical examination Rationale: A comprehensive history and physical examination are essential to identify potential bleeding risks. This approach includes reviewing the patient's medical history, medication use (including anticoagulants and non-steroidal anti-inflammatory drugs), family history of bleeding disorders, and previous experiences with surgery or bleeding. Laboratory tests like platelet count, PT, and bleeding time can provide additional information but are not as broadly informative as the clinical history and examination.

Question 65

A patient with spontaneous eye opening, who is confused and localizes pain has a Glasgow Coma Score (GCS) of * A. 9 B. 11 C. 13 D. 5

Answer 65

C. 13 Rationale: For GCS scoring: spontaneous eye opening scores 4, confusion (verbal response) scores 4, and localizing pain (motor response) scores 5. Adding these together gives a total GCS of 13.

Question 66

Calculate the daily maintenance fluids needed for a 60-kg female * A. 2060. B. 2100. C. 2160. D. 2400.

Answer 66

B. 2100.

Question 67

After an automobile accident, a 45-year-old woman is discovered to have a posterior pelvic fracture. Hypotension and tachycardia respond marginally to volume replacement. Once it is evident that her major problem is free intraperitoneal bleeding and a pelvic hematoma in association with the fracture, appropriate management would be * A. Application of medical antishock trousers with inflation of the extremity and abdominal sections B. Arterial embolization of the pelvic vessels C. Celiotomy and ligation of the internal iliac arteries bilaterally D. Celiotomy and pelvic packing E. External fixation application to stabilize the pelvis

Answer 67

E. External fixation application to stabilize the pelvis

Question 68

A patient with necrotizing pancreatitis undergoes computed tomography (CT)-guided aspiration, which results in growth of Escherichia coli on culture. The most appropriate treatment is * A. Culture-appropriate antibiotic therapy B. Endoscopic retrograde cholangiopancreatography with sphincterotomy C. CT-guided placement of drains(s) D. Exploratory laparotomy

Answer 68

D. Exploratory laparotomy

Question 69

What type of bacterial sepsis can lead to thrombocytopenia and hemorrhagic disorder? * A. Gram-negative B. Gram-positive C. Both Gram-negative & Gram-positive D. Encapsulated bacteria

Answer 69

A. Gram-negative

Question 70

Excessive administration of normal saline for fluid resuscitation can lead to what metabolic derangement? * A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory alkalosis D. Respiratory acidosis

Answer 70

B. Metabolic acidosis Rationale: Excessive administration of normal saline, which is a high-chloride solution, can lead to a condition known as hyperchloremic metabolic acidosis. This is due to the dilution of bicarbonate in the blood and the increased chloride content.

Question 71

A 70-year-old man is a front-seat passenger in a car crash. He is found to have three fractured ribs on the right, rupture of the liver, pelvic fracture, right femoral fracture, and a left tibial fracture. The patient is given broad-spectrum antibiotics, and his injuries are managed by surgery, requiring 12 U of blood. The patient improves initially, but on the third postoperative day, he develops hypoxia (PaO2, 55 mm Hg), with confusion, tachypnea, and petechia. What is the most likely diagnosis? * A. Recurrent intra-abdominal hemorrhage from dilutional thrombocytopenia B. Transfusion reaction C. Antibiotic allergy D. Fat embolus E. Disseminated intravascular clotting

Answer 71

D. Fat embolus Rationale: The combination of hypoxia, neurological symptoms (confusion), respiratory distress (tachypnea), and petechiae after fractures and surgery are characteristic of a fat embolus syndrome, which can occur when fat globules enter the bloodstream following long bone fractures or orthopedic surgery.

Question 72

A 60-year-old man with carcinoma of the esophagus is admitted with severe malnutrition. Nutritional support is to be initiated. What should be his daily caloric intake? * A. 1 kcal/kg body weight/day B. 5 kcal/kg body weight/day C. 15 kcal/kg body weight/day D. 30 kcal/kg body weight/day E. 100 kcal/kg body weight/day

Answer 72

D. 30 kcal/kg body weight/day Rationale: Severely malnourished patients, especially those with cancer, often require a higher caloric intake to meet their nutritional needs and support recovery. A common recommendation is around 25-35 kcal/kg body weight/day, with 30 kcal/kg being a typical target in such clinical situations.

Question 73

A 56-year-old man underwent prostatectomy. He bled excessively and urgently required blood over and above what had been requested before surgery. In deciding on an appropriate blood transfusion protocol, what should be kept in mind? * A. Group AB is the universal donor. B. Serum from the recipient stored for 1 week is suitable for testing. C. Hypothermia is indicated if cryoglobulin is found. D. Cross-matching should be done before dextran administration. E. Fresh-frozen plasma can be given instead of 4 U of packed cells

Answer 73

D. Cross-matching should be done before dextran administration. Rationale: Cross-matching is essential before transfusion to ensure compatibility between the donor blood and the recipient's blood. Administering blood without proper cross-matching can lead to serious transfusion reactions. Dextran administration can interfere with blood typing and cross-matching procedures, hence it should be done beforehand.

Question 74

A patient with penetrating injury to the chest should undergo thoracotomy if* A. There is more than 500 mL of blood which drains from the chest tube when placed B. There is more than 200 mL/h of blood for 3 hours from the chest tube C. There is an air leak that persists for >48 hours D. There is documented lung injury on CT scan

Answer 74

B. There is more than 200 mL/h of blood for 3 hours from the chest tube Rationale: Indications for thoracotomy following a penetrating chest injury include ongoing blood loss of more than 200 mL/hour for 2-4 hours. This suggests a significant ongoing hemorrhage that is not being adequately controlled by chest tube drainage alone.

Question 75

A patient with a localized wound infection after surgery should be treated with * A. Antibiotics and warm soaks to the wound B. Antibiotics alone C. Antibiotics and opening the wound D. Incision and drainage alone

Answer 75

D. Incision and drainage alone

Question 76

Tumor necrosis factor-alpha (TNF-a) * A. Can be released as a response to bacteria or endotoxin B. Increased more in trauma than septic patients C. Induces procoagulant activity and peripheral vasoconstriction D. Contributes to anemia or chronic illness

Answer 76

A. Can be released as a response to bacteria or endotoxin Rationale: TNF-α is a cytokine involved in systemic inflammation and is one of the cytokines that make up the acute phase reaction. It can be released in response to bacterial endotoxins and is a key mediator in the inflammatory process.

Question 77

A 70-kg male patient presents to ED following a stab wound to the abdomen. He is hypotensive, markedly tachycardic, and appears confused. What percent of blood volume has he lost? * A. 5% B. 15% C. 35% D. 55%

Answer 77

D. 55%

Question 78

Which constellation of clinical findings is suggestive of cardiac tamponade? * A. Hypotension, wide pulse pressure, tachycardia B. Tachycardia, hypotension, jugular venous distension C. Hypotension, wide pulse pressure, jugular venous distension D. Hypotension, muffled heart tones, jugular venous distention

Answer 78

D. Hypotension, muffled heart tones, jugular venous distention Rationale: The classic triad of findings in cardiac tamponade, known as Beck's triad, includes hypotension, muffled (distant) heart tones, and jugular venous distention. These signs indicate impaired cardiac filling due to the accumulation of fluid in the pericardial space.

Question 79

Which of the following is an early sign of hyperkalemia? * A. Peaked T waves B. Peaked P waves C. Peaked (shortened) QRS complex D. Peaked U waves

Answer 79

A. Peaked T waves Rationale: One of the earliest electrocardiogram (ECG) changes seen in hyperkalemia is peaked T waves. As hyperkalemia progresses, other ECG changes may occur, including widening of the QRS complex, PR interval prolongation, and eventual development of a sine wave pattern in severe cases.

Question 80

A 69-year-old man has undergone anterior resection for carcinoma of the rectum. He is extubated in the operating room (OR). In the recovery room, he is found to be restless with an HR of 136 bpm and a BP of 144/80 mm Hg. ABG analysis on room air reveals pH, 7.24; PCO2, 60 mm Hg; PO2, 54 mm Hg; HCO3,25 mEq/L; and SaO2, 90%. The physiologic status can best be described as which of the following? * A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosis E. Combined respiratory and metabolic acidosis

Answer 80

B. Respiratory acidosis Rationale: The ABG values show a decreased pH (7.24), indicating acidosis. The elevated PCO2 (60 mm Hg) suggests that this is due to respiratory causes, hence respiratory acidosis. The normal HCO3 level (25 mEq/L) suggests there is no significant metabolic compensation or contribution.

Question 81

During a laparoscopic appendectomy, a large bowel injury was caused during trochar placement with spillage of bowel contents into the abdomen. What class of surgical wound is this? * A. Class I (clean) B. Class II (clean/contaminated) C. Class III (contaminated) D. Class IV (dirty)

Answer 81

C. Class III (contaminated) Rationale: Class III surgical wounds are contaminated wounds, which include open, accidental wounds or surgical wounds with a major break in sterile technique or gross spillage from the gastrointestinal tract. This situation describes a contaminated procedure due to spillage of bowel contents.

Question 82

Frozen plasma prepared from freshly donated blood is necessary when a patient requires * A. Fibrinogen B. Prothrombin C. Antihemophilic factor D. Christmas factor E. Hageman factor

Answer 82

C. Antihemophilic factor

Question 83

The most appropriate treatment of a 4-cm hepatic abscess is * A. Antibiotic therapy alone B. Aspiration for culture and antibiotic therapy C. Percutaneous drainage and antibiotic therapy D. Operative exploration, open drainage of the abscess, and antibiotic therapy

Answer 83

C. Percutaneous drainage and antibiotic therapy Rationale: For a hepatic abscess, especially one that is 4 cm in size, the standard treatment would include percutaneous drainage under imaging guidance along with antibiotic therapy. This approach is less invasive than surgery and is often effective in managing hepatic abscesses.

Question 84

A 50-year-old man is hit by a car and sustains an injury to the pelvis. Which of the following is most indicative of a urethral injury? * A. Hematuria B. Scrotal ecchymosis. C. Oliguria. D. High-riding prostate on rectal examination E. Intravenous pyelography (IVP) showing dye extravasation in the pelvis

Answer 84

D. High-riding prostate on rectal examination Rationale: A high-riding or 'ballotable' prostate on rectal examination is a classic sign of a posterior urethral injury, often associated with pelvic fractures. This sign indicates the possibility of urethral disruption or injury.

Question 85

Steroids impair wound healing by * A. Decreasing angiogenesis and macrophage migration B. Decreasing platelet plug integrity C. Increasing release of lysosomal enzymes. D. Increasing fibrinolysis

Answer 85

A. Decreasing angiogenesis and macrophage migration Rationale: Steroids impair wound healing primarily by decreasing angiogenesis (the growth of new blood vessels) and inhibiting the migration and function of macrophages, which are essential for inflammation, a critical phase of the healing process.

Question 86

A 32-year-old woman presents to the emergency department with a chief complaint of severe left upper quadrant (LUQ) pain after being punched by her husband. Her blood pressure is 110/70 mm Hg, pulse is 100 bpm, and respiration rate is 24 breaths per minute. The best means to establish a diagnosis is which of the following?* A. FAST B. Physical examination C. CT of the abdomen. D. Peritoneal lavage E. Upper gastrointestinal (GI) series

Answer 86

C. CT of the abdomen. Rationale: A CT scan of the abdomen is the most effective and comprehensive method to evaluate internal injuries, including organ rupture, internal bleeding, or other intra-abdominal pathologies in cases of trauma.

Question 87

A 45-year-old man is shot in the left lateral chest. In the emergency department, his blood pressure is 120/90 mm Hg, pulse rate is 104beats per minute (bpm), and respiration rate is36 breaths per minute. Chest x-ray shows air and fluid in the left pleural cavity. Nasogastric aspiration reveals blood-stained fluid. What is the best step to rule out esophageal injury? * A. Insertion of chest tube B. Insertion of nasogastric tube C. Esophagogram with gastrografin D. Esophagoscopy E. Peritoneal lavage

Answer 87

C. Esophagogram with gastrografin Rationale: An esophagogram with gastrografin, a water-soluble contrast agent, is a sensitive method for detecting esophageal injuries, such as perforations or leaks. It is less invasive than esophagoscopy and can effectively identify the presence and location of an esophageal injury.

Question 88

Which of the following is true regarding the fibroblastic phase of wound healing? A. Early during wound healing, the predominant composition of the matrix is fibronectin and type II collagen B. After complete replacement of the scar with type Ill collagen, the mechanical strength will equal that of uninjured tissue approximately 6 to 12 months postinjury C. Even though the tensile strength of a wound reaches a plateau after several weeks, the tensile strength will increase over another 6 to 12 months due to fibril formation and cross-linking D. As the scar matures, matrix metalloproteinases (MMPs) break down type l collagen and replace it with type Ill collagen

Answer 88

C. Even though the tensile strength of a wound reaches a plateau after several weeks, the tensile strength will increase over another 6 to 12 months due to fibril formation and cross-linking Rationale: In the fibroblastic phase of wound healing, collagen synthesis and deposition occur, with type III collagen initially laid down, which is later replaced by the stronger type I collagen. Tensile strength increases over time, mainly due to collagen fibril formation and cross-linking, not to the complete replacement of type III with type I collagen.

Question 89

Which of the following statements is correct regarding traumatic spleen injury? * A. An elevation in WBC to 20,000/mm3 and platelets to 300,000/mm3 on postoperative day 7 is a common benign finding in postsplenectomy patients B. Delayed rebleeding or rupture will typically occur within 48 hours of injury C. Common complications after splenectomy include subdiaphragmatic abscess, pancreatic tail injury, and gastric perforation D. Postsplenectomy vaccines against encapsulated bacteria is optimally administered preoperatively or immediately postoperative

Answer 89

C. Common complications after splenectomy include subdiaphragmatic abscess, pancreatic tail injury, and gastric perforation Rationale: Complications following splenectomy can include injury to adjacent structures like the pancreatic tail, subdiaphragmatic abscess, and gastric perforation due to the spleen's proximity to these organs.

Question 90

Bank blood is appropriate for replacing each of the following EXCEPT * A. Factor I (fibrinogen) B. Factor II (prothrombin), C. Factor VII (proconvertin) D. Factor VIII (antihemophilic factor)

Answer 90

D. Factor VIII (antihemophilic factor) Rationale: Stored bank blood does have some coagulation factors, but the levels of factor VIII can be significantly reduced due to the storage process. Factor VIII is better replaced with specific preparations like fresh frozen plasma or factor concentrates.

Question 91

Following a recent abdominal surgery, your patient is in the ICU with septic shock. Below what level of hemoglobin would a blood transfusion be indicated? * A. <12 g/dL B. <10 g/dL. C. <8 g/dL D. <7 g/dL

Answer 91

D. <7 g/dL Rationale: Current guidelines suggest that a more restrictive transfusion threshold (e.g., hemoglobin <7 g/dL) is appropriate in critically ill but stable patients, including those with septic shock, unless there are symptoms of anemia or ongoing significant blood loss.

Question 92

After sustaining a gunshot wound to the right upper quadrant of the abdomen, the patient has no signs of peritonitis. Her vital signs are stable, and CT scan shows a grade Ill liver injury. What is the next step in management? * A. Exploratory laparotomy with control of hepatic parenchymal hemorrhage B. Admission to SICU with serial complete blood count C. Admission to SICU with repeat CT in 24 hours D. Hepatic angiography

Answer 92

B. Admission to SICU with serial complete blood count Rationale: In the absence of peritonitis and with stable vital signs, a non-operative management approach can be considered for grade III liver injuries. This involves close monitoring in the Surgical Intensive Care Unit (SICU) with serial blood counts and clinical assessments to watch for signs of worsening condition or hemorrhage.

Question 93

A 29-year-old man fell down from his bicycle and hit a concrete wall on his left side. An ultrasound examination showed free fluid in the abdomen. A CT scan confirmed a grade Ill splenic injury. The most important contraindication for a nonoperative management of the splenic injury is: * A. Hemodynamic instability B. Active bleeding on CT scan C. Adult patient D. Lack of availability of blood for transfusion E. Extensive associated injuries

Answer 93

A. Hemodynamic instability Rationale: Hemodynamic instability is a major contraindication to nonoperative management of splenic injuries. If the patient cannot maintain stable vital signs, it indicates ongoing bleeding or other complications that require urgent surgical intervention.

Question 94

The most common cause for a transfusion reaction is * A. Air embolism B. Contaminated blood C. Human error D. Unusual circulating antibodies.

Answer 94

C. Human error Rationale: Human error, such as incorrect blood type being transfused, is the most common cause of transfusion reactions. This emphasizes the importance of strict protocols for blood type matching and cross-matching before transfusions.

Question 95

The most common clinical manifestation of a hemolytic transfusion reaction is * A. Flank pain B. Jaundice C. Oliguria D. A shaking chill

Answer 95

C. Oliguria. D. sabi ni gpt

Question 96

Which of the following is true regarding the inflammatory response following traumatic injury? * A. There is an acute proinflammatory response caused by stimulation of the adaptive immune system. B. There is an anti inflammatory response that leads to a return to homeostasis accompanied suppression of the innate immune system. C. The degree of inflammation is proportional to injury severity. D. Systemic inflammation following trauma is related to the immune response to

Answer 96

C. The degree of inflammation is proportional to injury severity. Rationale: The degree of the inflammatory response after trauma is typically proportional to the severity of the injury. More severe injuries tend to induce a more intense inflammatory response.

Question 97

The metabolic derangement most commonly seen in patients with profuse vomiting * A. Hypochloremic, hypokalemic metabolic alkalosis B. Hypochloremic. hypokalemic metabolic acidosis C. Hypochloremic, hyperkalemic metabolic alkalosis D. Hypochloremic, hyperkalemic metabolic acidosis

Answer 97

B. Hypochloremic. hypokalemic metabolic acidosis. A daw sabi ni got

Question 98

Which of the following clotting factors is the first factor common to both intrinsic and extrinsic pathways? * A. Factor I (fibrinogen) B. Factor IX (Christmas factor) C. Factor X (Stuart-Prower factor) D. Factor XI (plasma thromboplasma antecedent)

Answer 98

C. Factor X (Stuart-Prower factor) Rationale: Factor X, also known as the Stuart-Prower factor, is the first factor in the common pathway of coagulation, activated by both the intrinsic and extrinsic pathways.

Question 99

Patients with severe, necrotizing pancreatitis should be treated with * A. No antibiotics unless CT-guided aspiration of the area yields positive cultures B. Empiric cefoxitin or cefotetan C. Empiric cefuroxime plus gentamicin D. Empiric carbapenems or fluoroquinolones

Answer 99

D. Empiric carbapenems or fluoroquinolones

Question 100

An 7-year-old boy is brought to the emergency room after accidentally touching a hot iron with his forearm. On examination, the burned area has weeping blisters and is very tender to the touch. What is the burn depth? * A. First degree B. Second degree C. Third degree D. Fourth degree

Answer 100

B. Second degree Rationale: Second-degree burns (partial-thickness burns) are characterized by the presence of blisters, moist appearance, and tenderness, fitting the description provided.