Which of the following statements concerning monitoring techniques in the intensive care unit are true? A. Pulmonary artery and pulmonary capillary wedge pressure readings should be made at end inspiration, to minimize ventilatory artifacts. B. Continuous SvO 2 monitoring based on the technique of reflectance spectrophotometry has been shown to be accurate and reliable. C. Direct measurement of gastric intramucosal pH can be provided by gastrointestinal tonometry. D. Hyperlactatemia may be seen in a number of clinical conditions not associated with tissue hypoxia, including liver disease and hypermetabolic states.

Which of the following statements concerning monitoring techniques in the intensive care unit are true? A.  Pulmonary artery and pulmonary capillary wedge pressure readings should be made at end inspiration, to minimize ventilatory artifacts. B.  Continuous SvO 2 monitoring based on the technique of reflectance spectrophotometry has been shown to be accurate and reliable. C.  Direct measurement of gastric intramucosal pH can be provided by gastrointestinal tonometry. D.  Hyperlactatemia may be seen in a number of clinical conditions not associated with tissue hypoxia, including liver disease and hypermetabolic states.
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Answer: BD  DISCUSSION: Many different monitoring techniques may be used to assess the adequacy of therapy for shock. The pulmonary artery catheter can provide important hemodynamic and oxygen transport data that are very useful in directing therapy aimed at optimizing cardiac function and oxygen delivery. Pulmonary artery and pulmonary capillary wedge pressure readings should be made at end-expiration to minimize ventilatory artifacts. Continuous SvO 2 monitoring, an accurate, reliable method that combines pulmonary artery catheterization with the technique of reflectance spectrophotometry, may provide early warning signs of hemodynamic compromise or inadequate oxygen delivery. Gastrointestinal tonometry provides information that allows one to infer the adequacy of splanchnic tissue perfusion. In this technique, intramucosal pH is calculated using the Henderson-Hasselbalch equation and measurements of gut intraluminal PCO 2 and arterial bicarbonate concentration. Serum lactate concentration may be monitored in shock to detect metabolic acidosis associated with anaerobic metabolism; however, mild to moderate hyperlactatemia may also be seen with liver disease, toxin ingestion, and hypermetabolic states not associated with shock
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Which of the following statements about septic shock are true? A. A circulating myocardial depressant factor may account for the cardiac dysfunction sometimes seen with shock due to sepsis or SIRS. B. A cardiac index (CI) of 6 liters per minute per square meter of body surface, a pulmonary capillary wedge pressure of 15 mm. Hg, and a systemic vascular resistance index (SVRI) of 800 dynes-sec/(cm 5-m 2) is a hemodynamic profile consistent with septic shock. C. An increase in SvO 2 in septic patients may be explained by the finding of anatomic arteriovenous shunts. D. Results of human trials employing antimediator therapy, such as antiendotoxin antibodies, IL-1 receptor antagonist, and tumor necrosis factor (TNF) antibodies, have confirmed animal studies that demonstrate a significant im

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Glucose overload results in increased CO 2 production. Which of the following statements are true? A. In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated. B. In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose. C. In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding. D. CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support.

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Last Answer : Answer: C DISCUSSION: Few papers have excited as much interest as that by Askanazi, Kinney, and co-workers, which demonstrated that glucose calories given to patients with severe respiratory ... the caloric requirement and glucose for the remainder, without much fear of excessive CO 2 production

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Which of the following statements about continuous cardiac output monitoring are true? A. Continuous cardiac output monitoring may unmask events not detected by intermittent cardiac output measurements. B. Continuous cardiac output monitoring by the thermodilution method requires continuous infusion of fluid injectate at a constant rate and temperature. C. The major advantage of the Fick method over the thermodilution method of calculating cardiac output is that it is noninvasive, requiring only the determination of oxygen consumption by respiratory gas analysis. D. The technique of thoracic electrical bioimpedance utilizes sensors to determine stroke volume by detecting changes in resistance to a small, applied alternating current.

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Last Answer : Answer: AD DISCUSSION: Various techniques are available to measure cardiac output continuously. The advantages of continuous cardiac output monitoring, as compared with intermittent methods, are (1) ... function of the stroke volume, which then can be used to calculate the cardiac output

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A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He is agitated and complains of shortness of breath. Which of the following statement(s) is/ are correct concerning his diagnosis and management? a. Myocardial ischemia secondary to preexisting coronary artery disease is most likely the underlying cause of this problem b. Invasive hemodynamic monitoring with a Swan-Gantz catheter will demonstrate a low cardiac output, a high systemic vascular resistance, and elevated cardiac filling pressures c. The use of morphine sulphate and nitrates should be part of the initial management d. The primary pharmacologic treatment involves the use of moderate doses of inotropic ag

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Last Answer : Answer: a, b, d Intrinsic cardiogenic shock results from failure of the heart as an effective pump. Coronary artery disease is the most common cause of myocardial ... hemodynamic monitoring. Infusion of afterload-reducing agents can be administered in conjunction with inotropic support

Transfusions of blood products can be associated with a number of complications including immediate and delayed hemolytic reactions; nonhemolytic reactions; infectious disease transmission; and complications of massive transfusions. Which of the following statements are true concerning complications of blood transfusions? a. Immediate hemolytic transfusion reactions are caused by major ABO blood group incompatibility b. Nonhemolytic transfusion reactions are usually due to RH incompatibility and are therefore more common in women of childbearing age c. The most common complication of massive blood transfusion is dilutional thrombocytopenia d. Routine impaired calcium supplementation is necessary during most massive transfusion episodes

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Last Answer : Answer: a, c Immediate hemolytic reactions are usually caused by blood group ABO incompatibility although they may be caused by antigens of other blood group systems ... when associated with massive transfusion during complex intraoperative procedures such as thoracoabdominal aneurysm resection

Phases of multiorgan failure will include: a. Generalized increased capillary permeability b. A hypermetabolic state c. Organ malfunction d. All of the above

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Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema? a. Diuresis and blood transfusion is a valuable step b. Salt-poor albumin leaks through the capillaries and worsens the condition c. Mannitol is contraindicated as a diuretic in this clinical situation d. Isoproterenol is a poor choice as an ionotropic agent

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A 55-year-old renal transplant patient has been hospitalized in a Surgical Intensive Care Unit, receiving a prolonged course of antibiotics following an attack of acute cholecystitis. The following statement(s) is/are true concerning his management. a. Due to the potential risk of Candida infection, prophylaxis with oral nystatin should be instituted early in the patient’s course b. A Candida urinary tract infection should be treated with systemic amphotericin B c. Changes of Candida retinitis are of little significance d. The presence of a virulent Candida bacteremia should suggest a dosage reduction in immunosuppressive agents until the infection can be adequately controlled

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Which of the following statements are true of the multiple organ dysfunction syndrome (MODS)? A. The “two-hit” model proposes that secondary MODS may be produced when even a relatively minor second insult reactivates, in a more amplified form, the systemic inflammatory response that was primed by an initial insult to the host. B. The systemic inflammatory response syndrome (SIRS), shock due to sepsis or SIRS, and MODS may be regarded as a continuum of illness severity. C. Prolonged stimulation or activation of Kupffer cells in the liver is thought to be a critical factor in the sustained, uncontrolled release of inflammatory mediators. D. The incidence of MODS in intensive care units has decreased owing to increased awareness, prevention, and treatment of the syndrome.

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Last Answer : Answer: ABC DISCUSSION: MODS is part of a clinical continuum that begins with the systemic inflammatory response syndrome, which is the host's stress response to any major insult such ... pathogenesis of MODS, the incidence of MODS continues to increase without a significant improvement in outcome

The first line of host defense is the barrier presented to the external environment. Which of the following statement(s) is/are true concerning host barriers? a. Sebaceous glands secrete chemical compounds that maintain a relatively high pH, providing effective bacterial stasis b. Within the respiratory tract, ciliary function serves to extrude microorganisms trapped within the mucus secretion layer c. The low pH within the stomach markedly decreases bacterial content of the upper gastrointestinal tract d. Gut peristalsis serves to prevent microbial adherence and invasion

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Last Answer : Answer: b, c, d The skin, mucus membranes, and epithelial layers of various organs of the body constitute effective physical barriers against microbial invasion. In certain portions of the ... very low pH within the stomach and gut peristalsis both serve to prevent microbial adherence and invasion

Infectious disease transmission during blood transfusions is of clinical significance to surgeons and of major importance to patients contemplating surgery potentially associated with the need for blood administration. Which of the following statement(s) is/are true concerning the transmission of infectious disease during blood transfusions? a. Post-transfusion hepatitis is usually due to hepatitis B b. Hepatitis and HIV transmission is greatest with the administration of pooled plasma products such as serum albumin c. The most important cause of post-transfusion disease in immunosuppressed patients is CMV infection d. The risk of HIV transmission in blood transfusions is significantly less than the risk of hepatitis transmission

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Last Answer : Answer: c, d The most common infectious diseases transmitted during blood transfusions include viral hepatitis, CMV, and HIV infection. Post-transfusion hepatitis in 90% of cases consists of ... infectious disease transmission, the risks of HIV transmission is markedly less than that of hepatitis

When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is measured, the measurement obtained is referred to as the a) pulmonary artery wedge pressure. When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary arty until it can no longer be passed and the pressure is recorded, reflecting left atrial pressure and left ventricular end-diastolic pressure.

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Last Answer : a) pulmonary artery wedge pressure. When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary arty until it can no longer be passed and the pressure is recorded, reflecting left atrial pressure and left ventricular end-diastolic pressure.

Laboratory monitoring of coagulation and anticoagulation includes testing of platelet function. Which of the following statements is/are true concerning tests of platelet function? a. A platelet count of 50,000/µL or more usually ensures hemostasis b. Bleeding time assays assessibility of platelets to perform hemostatic plugs and is determined from a sample of blood drawn in an EDTA coated test tube c. Aspirin therapy can be associated with a bleeding time in the range of 8–15 minutes d. Tests of platelet aggregation should be part of the standard preoperative evaluation of patients using aspirin

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Last Answer : Answer: a, c Tests of platelet function include peripheral platelet counts, bleeding times, and platelet aggregation. Usually, a platelet count of 50,000/mL or more ensures adequate hemostasis ... is not available in most laboratories, probably because of the observer-dependent nature of the test

Increasing evidence has implicated gram-negative bacterial lipopolysaccharide (LPS endotoxin) as the portion of the gram-negative bacterial cell membrane responsible for many, if not all the toxic effects that occur during gram-negative bacterial sepsis. The following statement(s) is/are true concerning LPS and the host response. a. The LPS molecule can in itself cause physiologic responses similar to that seen during gram-negative bacterial sepsis b. LPS triggers host macrophages to release a variety of cytokines including TNF-a, IL-1a, and IL-1b, IL-6, and IFN-a c. Excessive cytokine production is not associated with detrimental consequences d. TNFa and IL-1b appear to be the primary mediators within the host, exerting deleterious effects on the host when excessive amounts reach the syst

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Last Answer : Answer: a, b, d The LPS molecule exerts diverse effects on the mammalian host. Immunologic responses to LPS include nonspecific polyclonal B-cell proliferation, macrophage activation and ... deleterious effects on the host only after large amounts are secreted and reach the systemic circulation

Which of the following statement(s) concerning laboratory studies used in monitoring a patient with intravenous heparinization is/are correct? a. The platelet count should be followed because of the risk of heparin-associated thrombocytopenia b. The prothrombin time should be observed if prolonged treatment is necessary c. The activated partial thromboplastin time (aPTT) should be maintained at approximately 1.5 times normal d. The serum creatinine should be measured daily to allow adjustments in dose based on renal function

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Last Answer : Answer: a, c In monitoring the effect of heparin, an activated partial thromboplastin time (aPTT) of 1.5 control or a thrombin clotting time (TCT) of 2 times control reflects adequate ... system. Therefore the dose of heparin need not be adjusted in cases of liver or renal dysfunction

Thrombolytic therapy has become a useful adjunct in the management of peripheral arterial occlusion. In this setting, direct intraarterial administration rather than intravenous has been advocated to decrease the risk of systemic bleeding. Which of the following true statement(s) concerning the use of thrombolytic agents for arterial occlusion is/are true? a. A standard technique involves infusing high-dose urokinase, 4000 units per minute for 1–2 hours, directly into the clot by a catheter embedded in the thrombus b. If progress is made, further fibrinolytic therapy is given at 1000 to 2000 units per minute until clot lysis has occurred c. The usual infusion time by the above-stated technique is usually in excess of 24 hours d. Successful clot lysis occurs more frequently in arterial graf

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Last Answer : Answer: a, b, e The most popular method for intraarterial thrombolytic therapy for arterial occlusion involves passing a guidewire through the thrombus with arteriographic guidance and ... acute arterial occlusion) or when distal vasculative is occluded and precludes appropriate inflow patency

Which of the following statement(s) is/are true concerning oxygen consumption (O2)? a. O2 is normally 100–120 cc2/m2/min b. Resting O2 is controlled by the level of thyroid and catecholamine hormones c. Under steady state conditions the amount of oxygen consumed exceeds the amount of oxygen taken up by the pulmonary capillaries d. O2 is dependent on the status of pulmonary function

Description : Which of the following statement(s) is/are true concerning oxygen consumption (O2)? a. O2 is normally 100-120 cc2/m2/min b. Resting O2 is controlled by the level of thyroid and catecholamine ... of oxygen taken up by the pulmonary capillaries d. O2 is dependent on the status of pulmonary function

Last Answer : Answer: a, b Oxygen consumed in the process of metabolism is expressed as the volume of oxygen per minute (O2). O2 is normally 100-120 cc2/m2/min, or 200 cc/min for a typical adult. ... , so we measure O2 across the lung and assume that it is exactly the amount consumed in the systemic metabolism

Which of the following statement(s) is/are true concerning hypoadrenal shock? a. In the United States, idiopathic adrenal atrophy (Addison’s disease) is the most common cause b. Laboratory abnormalities include hyponatremia, hypochloremia, and hyperkalemia c. Fever may be seen with hypoadrenal shock d. ACTH stimulation test is the diagnostic test of choice to confirm hypoadrenal shock

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Last Answer : Answer: b, c, d Shock of a dramatic nature, poorly responsive to resuscitation, may develop as a consequence of adrenal insufficiency. In this country, adrenal insufficiency most ... of an ACTH stimulation test. A significant major cortisol response should be elicited by ACTH administration

Which of the following statement(s) is/are true concerning septic shock? a. The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents b. The circulatory derangements of septic shock precede the development of metabolic abnormalities c. Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance d. Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

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Last Answer : Answer: d The clinical findings in sepsis and septic shock represent the host response to infection. Gram-positive and gram-negative bacteria, viruses, fungi, rickettsiae, and ... intravascular volume, exogenous volume resuscitation must be provided to restore venous return and ventricular filling

Bleeding complications are frequently associated with fibrinolytic therapy. Which of the following statement(s) concerning complications of fibrinolytic therapy is/are true? a. Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications b. A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding c. Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy d. A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal

Description : Bleeding complications are frequently associated with fibrinolytic therapy. Which of the following statement(s) concerning complications of fibrinolytic therapy is/are true? a. Careful monitoring of prothrombin time ... months ago can be treated with fibrinolytic therapy if head CT scan is normal

Last Answer : Answer: b Fibrinolytic therapy induces a hemostatic defect through a combination of factors. Hypofibrinogenemia and fibrin degradation products inhibit fibrin polymerization and, in combination ... is considered a major relative contraindication to either regional or systemic thrombolytic therapy

Which of the following statements concerning perioperative nutrition is true concerning the above-described patient? a. Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition b. Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens c. Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements d. A jejunal feeding catheter should be placed at the time of surgery for postoperative enteral feeding

Description : Which of the following statements concerning perioperative nutrition is true concerning the above-described patient? a. Since the patient's weight had been stable with no preoperative nutritional deficit ... feeding catheter should be placed at the time of surgery for postoperative enteral feeding

Last Answer : Answer: a Most patients undergoing elective operations are adequately nourished. Unless the patient has suffered significant preoperative malnutrition, characterized by weight loss greater than ... gastrointestinal surgery, this technique would not appear indicated in the patient described above

Rank the clinical scenarios in order of greatest likelihood of serious postoperative pulmonary complications. A. Transabdominal hysterectomy in an obese woman that requires 3 hours of anesthesia time. B. Right middle lobectomy for bronchogenic cancer in a 65-year-old smoker. C. Vagotomy and pyloroplasty for chronic duodenal ulcer disease in a 50-year-old who had chest film findings of old, healed tuberculosis. D. Right hemicolectomy in an obese 60-year-old smoker. E. Modified radical mastectomy in a 58-year-old woman who is obese.

Description : Rank the clinical scenarios in order of greatest likelihood of serious postoperative pulmonary complications. A. Transabdominal hysterectomy in an obese woman that requires 3 hours of anesthesia time. B. Right ... smoker. E. Modified radical mastectomy in a 58-year-old woman who is obese.

Last Answer : Answer: BDCAE DISCUSSION: If one considers the constellation of risk factors for pulmonary complications that is provided in tabular form in the accompanying chapter, one should ... is associated with relatively little postoperative pain, and provides free and unrestricted respiratory function

Which of the following statement(s) is/are true concerning the effects of MOFS? a. Pulmonary dysfunction tends to arise early and may resolve within 7 to 10 days b. Unless the precipitating insult has prompted oliguric acute tubular necrosis, renal function tends to be maintained early in the course of MOFS c. Although hepatic dysfunction is common with MOFS, the GI tract plays little role in this process d. Intercurrent nosocomial infection, most commonly pulmonary, is a common complication providing a “second hit” to the patient

Description : Which of the following statement(s) is/are true concerning the effects of MOFS? a. Pulmonary dysfunction tends to arise early and may resolve within 7 to 10 days b. Unless the precipitating ... infection, most commonly pulmonary, is a common complication providing a second hit to the patient

Last Answer : Answer: a, b, d Pulmonary dysfunction typically arises early in the development of systemic inflammation and may represent mild relatively localized acute lung injury or it may be a prelude ... is marked by progressive rise in serum bilirubin levels after a latent period of several days

Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. Severe thrombocytopenia (platelet count less than 100,000) is seen in less than 10% of patients treated with heparin c. Heparin-associated thrombocytopenia is due to the aggregation of platelets and may result in thrombosis or embolic episodes d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Description : Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. ... d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Last Answer : Answer: b, c Heparin-associated thrombocytopenia occurs in 0.6% to 30% of patients who receive heparin, although severe thrombocytopenia (platelet counts less than 100,000) is seen in ... as coating on pulmonary artery catheters or low rate infusion into arterial catheters may cause this syndrome

Which of the following statement(s) is/are true concerning pharmacologic agents used to accelerate wound healing? a. A number of these agents are now currently approved for use in this country b. PDGF (platelet-derived growth factor) promotes fibroblast proliferation, chemotaxis, and collagenase synthesis c. PDGF has been demonstrated in a number of clinical trials to promote healing in chronic wounds d. Growth hormone functions by promoting fibroblast proliferation and collagen synthesis

Description : Which of the following statement(s) is/are true concerning pharmacologic agents used to accelerate wound healing? a. A number of these agents are now currently approved for use in ... healing in chronic wounds d. Growth hormone functions by promoting fibroblast proliferation and collagen synthesis

Last Answer : Answer: b, c Currently there are no approved clinical agents that accelerate normal healing. Although a number of clinical trials are in progress, no agents are currently ... hormone administration significantly accelerates donor site healing, presumably due to its effects in minimizing catabolism

Which of the following statement(s) is/are true concerning the treatment of MOFS? a. Prevention and therapy of MOFS requires control of the infectious or inflammatory source b. Restoration of normal clinical parameters such as blood pressure, pulse rate, and urine output ensures optimal resuscitation in most patients c. Branch chain amino acids play and important role in the nutritional support of the patient d. Because of the nature of gut injury, total parenteral nutrition is preferred for most patients with MOFS

Description : Which of the following statement(s) is/are true concerning the treatment of MOFS? a. Prevention and therapy of MOFS requires control of the infectious or inflammatory source b. Restoration of normal ... of the nature of gut injury, total parenteral nutrition is preferred for most patients with MOFS

Last Answer : Answer: a, c The therapy of MOFS is directed towards interrupting the involving pathophysiologic process and providing an optimal physiologic environment for healing and recovery. ... Enteral absorption and processing of nutrients appears superior to TPN and lessens overall complications

Which of the following is true of loss of gastrointestinal secretions? A. Gastric losses are best replaced with a balanced salt solution. B. Potassium supplementation is unnecessary in replacement of gastric secretions. C. Bicarbonate wasting is an unusual complication of a high-volume pancreatic fistula. D. Balanced salt solution is a reasonable replacement fluid for a small bowel fistula. E. A patient with persistent vomiting usually requires hyperchloremic replacement fluids.

Description : Which of the following is true of loss of gastrointestinal secretions? A. Gastric losses are best replaced with a balanced salt solution. B. Potassium supplementation is unnecessary in ... bowel fistula. E. A patient with persistent vomiting usually requires hyperchloremic replacement fluids.

Last Answer : Answer: DE DISCUSSION: Gastric secretions are relatively high in chloride and potassium. Other than an isolated pancreatic fistula, gastrointestinal tract losses below the pylorus ... Although potassium concentrations are low, copious losses require potassium supplementation to prevent hypokalemia

Which of the following statement(s) is/are true concerning CO2 transfer in the lung? a. Carbon dioxide excretion is a direct function of alveolar ventilation b. Normally end tidal CO2 should be identical to PaCO2 c. The gradient between end tidal and arterial CO2 can be an indirect measure of nonperfused alveoli d. Positive pressure ventilation under normal airway pressures creates a significant end tidal PaCO2 gradient

Description : Which of the following statement(s) is/are true concerning CO2 transfer in the lung? a. Carbon dioxide excretion is a direct function of alveolar ventilation b. Normally end tidal ... d. Positive pressure ventilation under normal airway pressures creates a significant end tidal PaCO2 gradient

Last Answer : Answer: a, b, c The amount of carbon dioxide excretion is directly related to alveolar ventilation. While oxygenation is a function of matching blood flow to alveoli, carbon dioxide excretion is ... high (over 30 cm H2O) and the compression volume is a significant component of each exhaled breath

The following statement(s) is/are true concerning gram-negative bacterial sepsis. a. Mortality due to this condition has almost been eliminated due to therapeutic intervention with antibiotics, aggressive hemodynamic monitoring and fluid resuscitation b. Recent series have noted a decrease in the incidence of this condition c. Predisposing factors include old age, malnutrition, and immunosuppression d. Pseudomonas bacteremia is the most common cause of gram-negative sepsis e. Polymicrobial sepsis is generally considered a more serious problem than sepsis due to a single organism

Description : The following statement(s) is/are true concerning gram-negative bacterial sepsis. a. Mortality due to this condition has almost been eliminated due to therapeutic intervention with antibiotics, aggressive ... sepsis is generally considered a more serious problem than sepsis due to a single organism

Last Answer : Answer: c, e Gram-negative bacterial sepsis is a serious disease process that produces substantial morbidity and mortality in both normal and immunocompromised patients (10% to 20% and ... and most investigators agree that polymicrobial sepsis is more lethal than infection with a single organism

Which of the following statements about the role of the gut in shock and sepsis are true? A. Selective decontamination of the digestive tract with the use of oral antibiotics has been shown to reduce nosocomial pneumonias and to improve mortality rates. B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus architecture of the gut. C. Gut dysfunction may be an effect of shock, but it may also contribute to the development of MODS by the mechanism of bacterial translocation. D. As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.

Description : Which of the following statements about the role of the gut in shock and sepsis are true? A. Selective decontamination of the digestive tract with the use of oral antibiotics has been ... As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.

Last Answer : Answer: BCD DISCUSSION: The gut has a vital role in the pathophysiology of shock. The splanchnic circulation is very vulnerable to the circulatory redistribution that occurs in shock, thus, gut ... , enteral feeding is more cost effective and is associated with a lower rate of septic morbidity

A number of prospective clinical trials have addressed the role of total parenteral nutrition in the cancer patient. The results have been somewhat conflicting. Which of the following statement(s) have been proven correct by prospective trials? a. Preoperative TPN is beneficial in surgical patients with severe preoperative nutrition b. Postoperative TPN is of value following pancreatic resection c. Routine use of perioperative (including prior to the procedure) TPN is of benefit in patients undergoing hepatectomy for hepatoma d. TPN is of no benefit in patients undergoing bone marrow transplant

Description : A number of prospective clinical trials have addressed the role of total parenteral nutrition in the cancer patient. The results have been somewhat conflicting. Which of the following statement(s) ... hepatectomy for hepatoma d. TPN is of no benefit in patients undergoing bone marrow transplant

Last Answer : Answer: a, c Numerous clinical trials have failed to yield a consensus with regard to the efficacy of TPN in cancer patients. In 1991, a multicenter VA cooperative trial demonstrated ... patients receiving bone marrow transplantation has also been shown to be a valuable component of overall care

Which of the following statement(s) is/are true concerning the physiology of the microvascular system? a. Filtration of capillary fluid into the interstitial and the subsequent reabsorption is influenced by Starling’s law of ultrafiltration b. The most important variable controlling blood to a capillary bed is the length of the vessel c. Most of the resistance to systemic blood flow occurs at the arteriolar level d. Adrenergic vasoconstriction can arrest blood flow to an entire capillary bed

Description : Which of the following statement(s) is/are true concerning the physiology of the microvascular system? a. Filtration of capillary fluid into the interstitial and the subsequent reabsorption is ... the arteriolar level d. Adrenergic vasoconstriction can arrest blood flow to an entire capillary bed

Last Answer : Answer: a, c, d Exchange of material between the vascular space and the cell of various tissues via the interstitial space is essential for organ viability and occurs at the ... contractions are potent enough that blood flow to entire capillary beds can be arrested by adrenergic vasoconstriction

Which of the following statement(s) is/are true concerning ischemia reperfusion injury? a. During ischemia, ATP degradation results in increased plasma and intracellular levels of hypoxanthine and xanthene b. Oxygen free radicals such as the superoxide radical are involved in the expression of the proinflammatory phenotype of endothelial cells, macrophages and neutrophils c. The intracellular adhesion molecule-1 (ICAN-1) contributes to injury and disruption of the endothelial lining, with extensive capillary leak and resultant interstitial edema d. Animal models have demonstrated that passive immunization with antibodies to neutrophil adhesive complex lessen the ischemic/reperfusion microvascular injury

Description : Which of the following statement(s) is/are true concerning ischemia reperfusion injury? a. During ischemia, ATP degradation results in increased plasma and intracellular levels of ... immunization with antibodies to neutrophil adhesive complex lessen the ischemic/reperfusion microvascular injury

Last Answer : Answer: a, b, c, d During the ischemia and hypoperfusion phase, degradation of ATP stores essential to maintain cell integrity and significant loss of diffusible ... either the neutrophil adhesive complex or the endothelial selectins dramatically lessens ischemia/reperfusion microvascular injury

The following statement(s) is/are true concerning viral infections. a. The most common post-transplantation viral infections are caused by herpes viruses and include CMV and herpes simplex virus b. Viral infections occur at equal frequency anytime during the post-transplantation period c. CMV infection in the post-transplant patient is most likely a pulmonary process d. Herpes simplex virus (HSV) infection primarily presents with a mononucleosis-type syndrome with fever, lethargy, and cough

Description : The following statement(s) is/are true concerning viral infections. a. The most common post-transplantation viral infections are caused by herpes viruses and include CMV and herpes simplex virus ... HSV) infection primarily presents with a mononucleosis-type syndrome with fever, lethargy, and cough

Last Answer : Answer: a, c, Solid organ transplant patients are prone to develop viral infection by virtue of exogenous immunosuppression. The most common post-transplantation viral infections are those ... transplant patient or as painful herpes zoster in patients who have previously developed chicken pox

Which of the following statement(s) is/are true concerning the results of a National Institute of Health Consensus Conference on venous thrombosis and low-dose heparin prophylaxis? a. The odds of developing deep venous thrombosis with low-dose heparin prophylaxis decreases by 67% b. The risk of pulmonary embolism is decreased by almost 50% c. There is no increase in mortality from other causes found in patients treated with low-dose heparin d. There was no difference in the incidence of bleeding complications

Description : Which of the following statement(s) is/are true concerning the results of a National Institute of Health Consensus Conference on venous thrombosis and low-dose heparin prophylaxis? a. The odds of ... treated with low-dose heparin d. There was no difference in the incidence of bleeding complications

Last Answer : Answer: a, b, c In a metaanalysis of 70 randomized trials in 16,000 patients comparing low-dose heparin prophylaxis with standard therapy, the odds of developing deep venous thrombosis ... Similarly, the effectiveness of prophylaxis was not influenced by either two or three times daily dosage

A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ failure. Which of the following statement(s) is/are true concerning necessary changes to be made in his nutritional management? a. Carbohydrate load should be reduced in the face of respiratory failure b. In patients with renal failure, protein intake should be diminished c. During hemodialysis protein intake should be limited to the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Description : A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ ... the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Last Answer : Answer: a, b The most severe complication of sepsis is multiple system organ dysfunction syndrome, which may result in death. The development of organ failure requires changes in the ... should be provided as fat emulsion. If encephalopathy develops, protein load should also be reduced0

Which of the following statement(s) is/are true concerning the clinical management of an open wound? a. A wet-to-dry dressing is the most optimal form of wound management b. A moist occlusive dressing promotes epithelialization and reduces pain c. The protein rich plasma exudate covering the open wound facilitates healing d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

Description : Which of the following statement(s) is/are true concerning the clinical management of an open wound? a. A wet-to-dry dressing is the most optimal form of wound management ... wound facilitates healing d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

Last Answer : Answer: b Epithelialization is more rapid under moist conditions than dry conditions. Without dressings, a superficial wound, or one with minimal devitalized tissue forms a scab or ... dysfunction, increases the distance for diffusion from oxygen and nutrient sources to their metabolic targets

Which of the following statement(s) is/are true concerning the role of antibiotics in wound care? a. Systemic antibiotics are indicated for all open wounds b. Bacterial resistance can occur with systemic but not topical antibiotics c. An indication for systemic antibiotic administration is a granulation tissue bacterial count in excess of greater than 105 organisms/gram of tissue on quantitative analysis d. Silver sulfadiazine is useful only for the management of burns

Description : Which of the following statement(s) is/are true concerning the role of antibiotics in wound care? a. Systemic antibiotics are indicated for all open wounds b. Bacterial resistance can occur with ... of tissue on quantitative analysis d. Silver sulfadiazine is useful only for the management of burns

Last Answer : Answer: c The role of antibiotics in wound care is controversial. All open wounds are colonized with bacteria. Only when surrounding tissue is invaded (cellulitis) are systemic antibiotics clearly ... of relevant drug-resistant plasmids in bacteria, and its low cost make it a good choice

Fibrinolytic therapy is based on activation of plasminogen, the inactive proteolytic enzyme of plasma that binds to fibrin during the formation of thrombosis. Activation of plasminogen to plasmin results in selective thrombolysis at the fibrin clot surface. Which of the following statement(s) is/are true concerning agents used in thrombolytic therapy? a. Streptokinase is a bacterial protein which is antigenic in humans, resulting in allergic reactions in up to l5% of cases b. Tissue plasminogen activator acts directly on plasmin without an intermediate drug–plasmin complex c. The half-life of urokinase, streptokinase, and TPA all exceed 30 minutes d. Streptokinase is significantly cheaper than urokinase or TPA

Description : Fibrinolytic therapy is based on activation of plasminogen, the inactive proteolytic enzyme of plasma that binds to fibrin during the formation of thrombosis. Activation of plasminogen to plasmin results ... TPA all exceed 30 minutes d. Streptokinase is significantly cheaper than urokinase or TPA

Last Answer : Answer: a, b, d Streptokinase is a bacterial protein produced by group C b-hemolytic streptococci. It is therefore antigenic in humans and can be associated with allergic reaction in ... one agent over the other. Streptokinase however, is markedly less expensive than either urokinase or TPA

A 45-year-old solicitor had an onset of severe, crushing, substernal chest pain while attending a football match. He collapsed on his way to the car. Bystander Cardiorespiratory Resuscitation was begun immediately and continued until arrival in Casualty where an endotracheal tube was inserted and ventilation was maintained on 100% oxygen. Investigations revealed: pH 7.13 PaO2 560 mmHg PaCO2 18 mmHg Bicarbonate 5.8 SaO2 98% Based on these laboratory values, which of the following statements best describes his current pathophysiology? 1) He is demonstrating a primary respiratory alkalosis 2) He probably developed a large right to left intracardiac shunt 3) His anion gap is probably normal 4) His oxyhemoglobin curve is shifted to the left 5) His pulmonary artery pressure is probably elevated

Description : A 45-year-old solicitor had an onset of severe, crushing, substernal chest pain while attending a football match. He collapsed on his way to the car. Bystander Cardiorespiratory Resuscitation ... His oxyhemoglobin curve is shifted to the left 5) His pulmonary artery pressure is probably elevated

Last Answer : Answers-5 This young patient with severe central chest pain has probably arrested due to myocardial infarction and arrhythmia. His gases reveal high PO2 following 100% O2 but severe acidosis ... no left to right shunting and high pulmonary pressures would be expected after this arrest scenario.

The following statement(s) is/are true concerning HIV infection. a. Initial screening with ELISA is highly sensitive but can be associated with a false positive rate of 25% b. Treatment with azidothymidine (AZD) appears to prolong survival when administered early in the disease c. Predisposition to infection in HIV infection is primarily due to reduction in the number of helper T cells d. Common infections in patients with AIDS are Pneumocystis, carinii pneumonia, CMV pneumonitis, Cryptococcus meningitis, and disseminated infection due to atypical mycobacteria

Description : The following statement(s) is/are true concerning HIV infection. a. Initial screening with ELISA is highly sensitive but can be associated with a false positive rate of 25% b. ... , carinii pneumonia, CMV pneumonitis, Cryptococcus meningitis, and disseminated infection due to atypical mycobacteria

Last Answer : Answer: b, c, d Acquired immunodeficiency syndrome (AIDS) is a syndrome caused by the human retrovirus (HIV-1) that infects T lymphocytes and causes severe immunosuppression. Individuals who ... to prolong survival when administered early in the course of disease and is considered routine therapy

Which of the following statement(s) is/are true concerning O2 venous saturation monitoring? a. The normal saturation of mixed venous blood is 50% b. Mixed venous blood obtained for saturation monitoring can be obtained from any peripheral vein c. If arterial blood is fully saturated, the saturation of mixed venous blood is 80% d. In less than fully saturated blood, the difference between arterial and venous saturation corresponds to oxygen extraction

Description : Which of the following statement(s) is/are true concerning O2 venous saturation monitoring? a. The normal saturation of mixed venous blood is 50% b. Mixed venous blood obtained ... than fully saturated blood, the difference between arterial and venous saturation corresponds to oxygen extraction

Last Answer : Answer: c, d The relationship between oxygen delivery and oxygen consumption is reflected in the amount of oxygen in venous blood. Under normal circumstances, oxygen delivery is 1000 ... and venous saturation corresponds to the oxygen extraction, hence the oxygen delivery/oxygen consumption ratio

The following statement(s) is/are true concerning cellular defense mechanisms. a. Macrophages function solely as antigen processing cells in the initial reaction to exposure to an antigen b. Macrophages may become activated and secrete cytokines c. Macrophages serve as phagocytic cells in the tissues but not within the bloodstream d. Polymorphonucleocytes (PMNS) are normally present in only small numbers within the tissue and enter an area of infection through diapedesis

Description : The following statement(s) is/are true concerning cellular defense mechanisms. a. Macrophages function solely as antigen processing cells in the initial reaction to exposure to an antigen b. Macrophages ... in only small numbers within the tissue and enter an area of infection through diapedesis

Last Answer : Answer: b, d A wide variety of cell types serve to provide host defense at several levels. Macrophages act as the initial antigen processing cell that serves to ... through diapedesis after chemotactic stimuli are excluded by macrophages, bacterial breakdown products, and complement activation