Which of the following statements about respiratory acidosis are true? A. Compensation occurs by a shift of chloride out of the red blood cells. B. Renal compensation occurs rapidly. C. Retention of bicarbonate and increased ammonia formation are normal compensatory mechanisms. D. Narcotic administration is an unusual cause of respiratory acidosis. E. The ratio of bicarbonate to carbonic acid is less than 20:1.

Which of the following statements about respiratory acidosis are true? A.  Compensation occurs by a shift of chloride out of the red blood cells. B.  Renal compensation occurs rapidly. C.  Retention of bicarbonate and increased ammonia formation are normal compensatory mechanisms. D.  Narcotic administration is an unusual cause of respiratory acidosis. E.  The ratio of bicarbonate to carbonic acid is less than 20:1.
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Answer: CE  DISCUSSION: Renal compensation for acute hypoventilation is relatively slow. Depression of the respiratory center by morphine can lead to respiratory acidosis. Renal retention of bicarbonate, ammonia formation, and shift of chloride into red cells combine to increase the ratio of bicarbonate to carbonic acid to 20:1
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In patients receiving massive blood transfusion for acute blood loss, which of the following is/are correct? A. Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume. B. Two units of FFP should be given with every 5 units of packed red blood cells in most cases. C. A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases. D. One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis. E. One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.

Description : In patients receiving massive blood transfusion for acute blood loss, which of the following is/are correct? A. Packed red blood cells and crystalloid solution should be infused to restore oxygen ... should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.

Last Answer : Answer: A DISCUSSION: Patients who are suffering from acute blood loss require crystalloid resuscitation as the initial maneuver to restore intravascular volume and re-establish vital signs. If 2 to 3 liters ... when the infusion of blood proceeds at a rate exceeding 1 to 2 units every 5 minutes

Which of the following statements are true of a patient with hyperglycemia and hyponatremia? A. The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose. B. With normal renal function, this patient is likely to be volume overloaded. C. Proper fluid therapy would be unlikely to include potassium administration. D. Insulin administration will increase the potassium content of cells. E. Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.

Description : Which of the following statements are true of a patient with hyperglycemia and hyponatremia? A. The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood ... . E. Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.

Last Answer : Answer: D DISCUSSION: Each 100-mg. per 100 ml. elevation in blood glucose causes a fall in serum sodium concentration of approximately 2 mEq. per liter. Excess serum glucose ... correction of the patient's associated acidosis produce movement of potassium ions into the intracellular compartment

During compensation of respiratory alkalosis, all the following changes occur except (A) Decreased secretion of hydrogen ions by renal tubules (B) Increased excretion of sodium in urine (C) Increased excretion of bicarbonate in urine (D) Increased excretion of ammonia in urine

Description : During compensation of respiratory alkalosis, all the following changes occur except (A) Decreased secretion of hydrogen ions by renal tubules (B) Increased excretion of sodium in urine (C) Increased excretion of bicarbonate in urine (D) Increased excretion of ammonia in urine

Last Answer : Answer : D

Which of the following statements about the preparation and storage of blood components is/are true? A. Solutions containing citrate prevent coagulation by binding calcium. B. The shelf life of packed red blood cells preserved with CPDA-1 is approximately 35 days at 1؛ to 6؛ C. C. There are normal numbers of platelets in packed red blood cells stored at 1؛ to 6؛ C for more than 2 days. D. The storage lesion affecting refrigerated packed red blood cells includes development of acidosis, hyperkalemia, and decreased intracellular 2,3DPG (diphosphoglycerate).

Description : Which of the following statements about the preparation and storage of blood components is/are true? A. Solutions containing citrate prevent coagulation by binding calcium. B. The ... cells includes development of acidosis, hyperkalemia, and decreased intracellular 2,3DPG (diphosphoglycerate).

Last Answer : Answer: ABD DISCUSSION: After blood has been collected from a donor, it is anticoagulated with a solution containing citrate, which acts by binding calcium. Blood is then separated into its ... transfusion or produce effects other than those predicted based on the content of the unit of blood

Which of the following statements are true of elevated–anion gap metabolic acidosis? A. Hypoperfusion from the shock state rarely produces an elevated anion gap. B. Retention of sulfuric and phosphoric acids may lead to this form of acidosis. C. Copious diarrhea does not produce this condition. D. Rapid volume expansion may produce this form of acidosis. E. Use of lactated Ringer's solution is inappropriate in the treatment of lactic acidosis.

Description : Which of the following statements are true of elevated-anion gap metabolic acidosis? A. Hypoperfusion from the shock state rarely produces an elevated anion gap. B. Retention of sulfuric and phosphoric ... E. Use of lactated Ringer's solution is inappropriate in the treatment of lactic acidosis.

Last Answer : Answer: BC DISCUSSION: An elevated anion gap may be produced by lactic acidosis from shock or by retention of inorganic acids from uremia. Lactated Ringer's solution rapidly corrects the ... . Bicarbonate loss from diarrhea and dilutional acidosis are non-anion gap types of metabolic acidosis

If the body experiences acidosis the respiratory center located in the medulla gets the information and induces the increase of the respiratory frequency. The increment of the respiratory frequency makes the body eliminate more carbon dioxide and to shift the equilibrium of the formation of bicarbonate towards the spending of more hydrogen ions and thus the blood pH raises.

Description : If the body experiences acidosis the respiratory center located in the medulla gets the information and induces the increase of the respiratory frequency. The increment of the respiratory frequency makes the ... of bicarbonate towards the spending of more hydrogen ions and thus the blood pH raises.

Last Answer : How does the breathing process correct alkalosis?

Respiratory acidosis is caused by (A) Increase in carbonic acid relative to bicarbonate (B) Decrease in bicarbonate fraction (C) Increase in bicarbonate fraction (E) Decrease in the carbonic acid fraction

Description : Respiratory acidosis is caused by (A) Increase in carbonic acid relative to bicarbonate (B) Decrease in bicarbonate fraction (C) Increase in bicarbonate fraction (E) Decrease in the carbonic acid fraction

Last Answer : Answer : A

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.

Description : 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 ... who are supported by respirators in intensive care units and are receiving nutritional support.

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

Blood chemistry shows the following changes in compensated respiratory acidosis: (A) Increased pCO2 (B) Increased bicarbonate (C) Decreased chloride (D) All of these

Description : Blood chemistry shows the following changes in compensated respiratory acidosis: (A) Increased pCO2 (B) Increased bicarbonate (C) Decreased chloride (D) All of these

Last Answer : Answer : D

Essential amino acids have been advocated as standard therapy for renal failure. Which of the following statements are true? A. Increased survival from acute renal failure has been reported with both essential and nonessential amino acid therapy of patients in renal failure. B. Essential amino acids retard the rise of blood urea nitrogen (BUN) secondary to decreased urea appearance. C. Essential amino acids and hypertonic dextrose are a convenient form of therapy for hyperkalemia. D. Essential amino acids decrease BUN and creatinine to the same degree as solutions containing excessive nonessential amino acids.

Description : Essential amino acids have been advocated as standard therapy for renal failure. Which of the following statements are true? A. Increased survival from acute renal failure has been reported ... BUN and creatinine to the same degree as solutions containing excessive nonessential amino acids.

Last Answer : Answer: BC DISCUSSION: Essential amino acids and hypertonic dextrose, as opposed to hypertonic dextrose alone, was reported by Abel and co-workers to be associated with a decreased mortality rate ... renal failure have not been carried out in sufficient numbers to yield answers to this question

Which of the following is true concerning a 68 year old male with type 2 diabetes diagnosed with type IV renal tubal acidosis? 1) Aminoaciduria would be expected. 2) Fludrocortisone treatment is effective 3) Increased Glomerular filtration rate is expected. 4) Increased urinary bicarbonate would be expected. 5) Normal renal handling of K+ and H+

Description : Which of the following is true concerning a 68 year old male with type 2 diabetes diagnosed with type IV renal tubal acidosis? 1) Aminoaciduria would be expected. 2) Fludrocortisone treatment is effective ... 4) Increased urinary bicarbonate would be expected. 5) Normal renal handling of K+ and H+

Last Answer : Answers-2 H+ secretion, sodium reabsorption and ammonia production diminishes. RTA 4 is in effect hyporeninaemic hypoaldosteronism or failure of aldosterone action and thus helped treated with ... particularly. Aminoaciduria and increased urine bicarbonate are features of RTA types 1 and 2.

Which of the following statements regarding hypercalcemia are true? A. The symptoms of hypercalcemia may mimic some symptoms of hyperglycemia. B. Metastatic breast cancer is an unusual cause of hypercalcemia. C. Calcitonin is a satisfactory long-term therapy for hypercalcemia. D. Severely hypercalcemic patients exhibit the signs of extracellular fluid volume deficit. E. Urinary calcium excretion may be increased by vigorous volume repletion.

Description : Which of the following statements regarding hypercalcemia are true? A. The symptoms of hypercalcemia may mimic some symptoms of hyperglycemia. B. Metastatic breast cancer is an unusual cause of ... fluid volume deficit. E. Urinary calcium excretion may be increased by vigorous volume repletion.

Last Answer : Answer: ADE DISCUSSION: Markedly elevated serum calcium levels produce polydipsia, polyuria, and thirst. Vigorous volume repletion and saline diuresis correct the extracellular fluid volume ... , from bony metastasis. The calcitonin effect on calcium is diminished with repeat administrations

Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose metabolism lead to the development of efficient substrate utilization b. A progressive rise in serum triglyceride levels result from less efficient clearance and increased hepatic lipogenesis c. A net negative nitrogen balance occurs due to the oxidative metabolism of proteins to meet energy needs d. The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Description : Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose ... The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Last Answer : Answer: b, c A broad spectrum of metabolic abnormalities become apparent in sepsis and the systemic inflammatory response syndrome following shock. Disruption of the normal cycles of carbohydrate, ... acetyl coenzyme A. This results in reduced serum level of leucine, isoleucine and valine

All the following statements about renal tubular acidosis are correct except (A) Renal tubules may be unable to reabsorb bicarbonate (B) Renal tubules may be unable to secrete hydrogen ions (C) Plasma chloride is elevated (D) Anion gap is decreased

Description : All the following statements about renal tubular acidosis are correct except (A) Renal tubules may be unable to reabsorb bicarbonate (B) Renal tubules may be unable to secrete hydrogen ions (C) Plasma chloride is elevated (D) Anion gap is decreased

Last Answer : Answer : D

Following acute haemorrhage, the following compensatory mechanisms occur: a. increased chemoreceptor discharge b. increased level of circulating angiotensin II c. vasoconstriction of renal efferent arterioles d. all above

Description : Following acute haemorrhage, the following compensatory mechanisms occur: a. increased chemoreceptor discharge b. increased level of circulating angiotensin II c. vasoconstriction of renal efferent arterioles d. all above

Last Answer : all above

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

Respiratory acidosis results from (A) Retention of carbon dioxide (B) Excessive elimination of carbon dioxide (C) Retention of bicarbonate (D) Excessive elimination of bicarbonate

Description : Respiratory acidosis results from (A) Retention of carbon dioxide (B) Excessive elimination of carbon dioxide (C) Retention of bicarbonate (D) Excessive elimination of bicarbonate

Last Answer : Answer : A

Ketorolac: A. Is a nonsteroidal anti-inflammatory drug (NSAID) approved for intravenous, intramuscular, and oral administration. B. Can be used indefinitely for postoperative analgesia. C. Can cause renal dysfunction. D. May decrease surgical blood loss.

Description : Ketorolac: A. Is a nonsteroidal anti-inflammatory drug (NSAID) approved for intravenous, intramuscular, and oral administration. B. Can be used indefinitely for postoperative analgesia. C. Can cause renal dysfunction. D. May decrease surgical blood loss.

Last Answer : Answer: AC DISCUSSION: Ketorolac tromethamine, an NSAID, is approved by the FDA for intravenous, intramuscular, and oral administration. The agent is an effective analgesic with minimal side ... Additionally, it is recommended that ketorolac should not be used for more than 5 consecutive days

Which of the following complications of TPN are appropriately managed with the listed treatment? a. Air embolism—place patient in reverse Trendelenburg and the left lateral decubitus position and aspirate venous air b. Hyperchloremic metabolic acidosis—give sodium and potassium as acetate salts c. Carbon dioxide retention—decrease glucose calories and replace with fat d. Line sepsis—intravenous antibiotics

Description : Which of the following complications of TPN are appropriately managed with the listed treatment? a. Air embolism-place patient in reverse Trendelenburg and the left lateral decubitus position ... dioxide retention-decrease glucose calories and replace with fat d. Line sepsis-intravenous antibiotics

Last Answer : Answer: b, c A number of complications of TPN can occur which can be divided into three types: mechanical, metabolic, and infectious

Which of the following statement(s) is/are true concerning the pulmonary response to shock? a. The acute pulmonary vascular response to shock differs markedly from that of systemic vasculature b. The pulmonary edema of ARDS occurs in the face of elevated left heart pressures c. The initial physiologic changes of ARDS involve the capillary endothelial cells and the type I pneumocyte d. Mechanisms proposed in the pathogenesis of ARDS include injury from mediators of inflammation elsewhere and from activated cellular elements e. A decrease in lung compliance may result from the loss of type I pneumocytes

Description : Which of the following statement(s) is/are true concerning the pulmonary response to shock? a. The acute pulmonary vascular response to shock differs markedly from that of systemic vasculature b. The ... elements e. A decrease in lung compliance may result from the loss of type I pneumocytes

Last Answer : Answer: c, d, e Contributing pathophysiologic processes to the pulmonary manifestations of shock include the pulmonary component of the cardiovascular response, disruption of the normal ... injury from mediators of inflammation elaborated elsewhere, and from activated cellular blood elements

Chloride shift is (A) H ions leaving the RBC in exchange of Cl- (B) Cl– leaving the RBC in exchange of bicarbonate (C) Bicarbonate ion returns to plasma and exchanged with chloride which shifts into the cell (D) Carbonic acid to the plasma

Description : Chloride shift is (A) H ions leaving the RBC in exchange of Cl- (B) Cl– leaving the RBC in exchange of bicarbonate (C) Bicarbonate ion returns to plasma and exchanged with chloride which shifts into the cell (D) Carbonic acid to the plasma

Last Answer : Answer : C

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 statements about head injury and concomitant hyponatremia are true? A. There are no primary alterations in cardiovascular signs. B. Signs of increased intracranial pressure may be masked by the hyponatremia. C. Oliguric renal failure is an unlikely complication. D. Rapid correction of the hyponatremia may prevent central pontine injury. E. This patient is best treated by restriction of water intake.

Description : Which of the following statements about head injury and concomitant hyponatremia are true? A. There are no primary alterations in cardiovascular signs. B. Signs of increased intracranial pressure may be ... central pontine injury. E. This patient is best treated by restriction of water intake.

Last Answer : Answer: A DISCUSSION: Acute symptomatic hyponatremia is characterized by central nervous system signs of increased intracranial pressure. Changes in blood pressure and pulse are secondary to ... lead to central pontine myelinolysis. Oliguric renal failure may rapidly develop in severe hyponatremia

Which of the following statement(s) is/are true concerning the relationship between cardiac function and effective blood volume? a. A pulmonary capillary wedge pressure of 5–10 rules out fluid overload as a cause of pulmonary edema b. A shift to the right in the Frank-Starling curve is associated with compromised cardiac function c. Dilutional anemia may contribute to tachycardia even though blood volume and filling pressures are normal d. The sole purpose of a pulmonary artery catheter is to measure pulmonary artery pressure and cardiac output

Description : Which of the following statement(s) is/are true concerning the relationship between cardiac function and effective blood volume? a. A pulmonary capillary wedge pressure of 5-10 rules out ... sole purpose of a pulmonary artery catheter is to measure pulmonary artery pressure and cardiac output

Last Answer : Answer: b, c Although physical findings are often adequate to establish a diagnosis and institute management of cardiac failure, direct measurement of filling pressures of the right heart ( ... blood volume is normal, filling pressures are normal, and total body extracellular fluid is excessive

Essential fatty acid deficiency may complicate total parenteral nutrition (TPN). Which of the following statements are true? A. Essential fatty acid deficiency may be prevented by the administration of 1% to 2% of total calories as fat emulsion. B. Fat-free parenteral nutrition results in the appearance of plasma abnormalities, indicating essential fatty acid deficiency, within 7 to 10 days of initiation. C. An abnormal plasma eicosatrienoic-arachidonic acid ratio is always associated with essential fatty acid deficiency. D. Following initiation of fat-free parenteral nutrition, dry, scaly skin associated with a maculopapular rash indicates essential fatty acid deficiency.

Description : Essential fatty acid deficiency may complicate total parenteral nutrition (TPN). Which of the following statements are true? A. Essential fatty acid deficiency may be prevented by the ... , dry, scaly skin associated with a maculopapular rash indicates essential fatty acid deficiency.

Last Answer : Answer: BD DISCUSSION: Biochemical evidence of essential fatty acid deficiency may occur as early as 7 to 10 days following initiation of fat-free parenteral nutrition. The decrease in ... essential to the diagnosis of essential fatty acid deficiency, but this plasma abnormality is often present

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

Description : 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 ... transmission in blood transfusions is significantly less than the risk of hepatitis transmission

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

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

Description : 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 ... mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

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

Respiratory acidosis occurs in (A) Any disease which impairs respiration like emphysema (B) Renal disease (C) Poisoning by an acid (D) Pyloric stenosis

Description : Respiratory acidosis occurs in (A) Any disease which impairs respiration like emphysema (B) Renal disease (C) Poisoning by an acid (D) Pyloric stenosis

Last Answer : Answer : A

A 55-year-old male undergoes a total abdominal colectomy. Which of the following statement(s) is/are true concerning the hormonal response to the surgical procedure? a. Adrenocorticotropic hormone (ACTH) is secreted from the anterior pituitary gland b. ACTH stimulation results in elevation of serum cortisol levels for up to a week after the operation c. An increased secretion of aldosterone and ADH may contribute to postoperative fluid retention d. An increase in serum insulin and a fall in glucagon accelerate hepatic glucose production and maintain gluconeogenesis

Description : A 55-year-old male undergoes a total abdominal colectomy. Which of the following statement(s) is/are true concerning the hormonal response to the surgical procedure? a. Adrenocorticotropic ... in serum insulin and a fall in glucagon accelerate hepatic glucose production and maintain gluconeogenesis

Last Answer : Answer: a, c One of the earliest consequence of a surgical procedure is the rise in levels of circulating cortisol that occur in response to a sudden outpouring of ACTH ... hepatic glucose production, and, with other hormones (epinephrine and glucocorticoids), gluconeogenesis is maintained

Plasma bicarbonate is increased in (A) Respiratory alkalosis (B) Metabolic alkalosis (C) Respiratory acidosis (D) Metabolic acidosis

Description : Plasma bicarbonate is increased in (A) Respiratory alkalosis (B) Metabolic alkalosis (C) Respiratory acidosis (D) Metabolic acidosis

Last Answer : Answer : B

Which of the following statement(s) is/are true concerning oxygen kinetics in a critically ill, febrile patient? a. Oxygen consumption will likely exceed three times normal b. The high cardiac output and pulse rate are designed to increase oxygen delivery c. The hyperdynamic response may actually increase oxygen delivery to exceed the increase in oxygen consumption d. The patient can maintain adequate compensation as long as the oxygen delivery/oxygen consumption rate is greater than 2:1

Description : Which of the following statement(s) is/are true concerning oxygen kinetics in a critically ill, febrile patient? a. Oxygen consumption will likely exceed three times normal b. The high cardiac ... adequate compensation as long as the oxygen delivery/oxygen consumption rate is greater than 2:1

Last Answer : Answer: b, d In critically ill patients oxygen consumption may be elevated or depressed, but slight to moderate elevations in oxygen consumption is the most common abnormality in critically ill patients. ... however, and the patient will remain stable as long as the ratio is greater than 2:1

The following statement(s) is/are true concerning host defense mechanisms to intraabdominal infection. a. Bacterial clearance can occur via translymphatic absorption b. Phagocytic activity and bacterial killing can occur via resident phagocytic cells and an influx of PMNs c. A fibrinogen-rich inflammatory exudate is released into the peritoneal cavity, trapping large numbers of bacteria and other particulate matter d. Perforations of a bowel may be walled off but are seldom sealed by the omentum and other mobile viscera

Description : The following statement(s) is/are true concerning host defense mechanisms to intraabdominal infection. a. Bacterial clearance can occur via translymphatic absorption b. Phagocytic activity and bacterial killing can ... may be walled off but are seldom sealed by the omentum and other mobile viscera

Last Answer : Answer: a, b, c The introduction of microorganisms into the normally sterile peritoneal environment invoke several potent specialized host antimicrobial defense mechanisms. Bacterial clearance, ... the contaminated enteric contents walled off, preventing continued soilage of the peritoneal cavity

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

A striking feature of living cells is a marked difference between the composition of the cytosol and the extracellular milieu. Which of the following statement(s) concerning the mechanisms of maintenance of these differences is/are true? a. The cell membrane is able to maintain a 10,000 fold gradient between the extracellular concentration of ionized calcium and the intracellular concentration b. The key to these differences is the fact that the plasma membrane is normally impermeable to sodium, potassium and calcium c. The selectivity of biologic membranes is highly consistent and seldom changes d. The selectivity of cell membranes relates only to ions and not organic compounds

Description : A striking feature of living cells is a marked difference between the composition of the cytosol and the extracellular milieu. Which of the following statement(s) concerning the mechanisms of maintenance ... d. The selectivity of cell membranes relates only to ions and not organic compounds

Last Answer : Answer: a The survival of the cell requires that cytosolic composition be maintained within narrow limits, despite the constant influx of nutrients and the simultaneous outflow of waste. A ... be altered drastically as a result of regulatory or signaling processes that occur within the cell

If the body undergoes alkalosis the respiratory center located in the medulla gets the information and induces the lowering of the respiratory frequency. The reduction of the respiratory frequency makes the body retain more carbon dioxide and to shift the equilibrium of the formation of bicarbonate towards the production of more hydrogen ions and thus the blood pH lowers.

Description : If the body undergoes alkalosis the respiratory center located in the medulla gets the information and induces the lowering of the respiratory frequency. The reduction of the respiratory frequency makes ... of bicarbonate towards the production of more hydrogen ions and thus the blood pH lowers.

Last Answer : What is the difference between respiratory acidosis and metabolic acidosis and what is the difference between respiratory alkalosis and metabolic alkalosis?

At the pH of blood 7.4, the ratio between the carbonic acid and bicarbonate fractions is (A) 1 : 10 (B) 1 : 20 (C) 1 : 30 (D) 1 : 40

Description : At the pH of blood 7.4, the ratio between the carbonic acid and bicarbonate fractions is (A) 1 : 10 (B) 1 : 20 (C) 1 : 30 (D) 1 : 40

Last Answer : Answer : B

Under certain circumstances, the gut may become a source of sepsis and serve as the motor of systemic inflammatory response syndrome. Microbial translocation is the process by which microorganisms migrate across the mucosal barrier to invade the host. Which of the following mechanisms can promote bacterial translocation? a. An increased number of gut bacteria b. Altered intestinal mucosal permeability c. Decreased host defense mechanisms d. Lack of enteral feeding

Description : Under certain circumstances, the gut may become a source of sepsis and serve as the motor of systemic inflammatory response syndrome. Microbial translocation is the process by which microorganisms ... intestinal mucosal permeability c. Decreased host defense mechanisms d. Lack of enteral feeding

Last Answer : Answer: a, b, c, d 99 Translocation is promoted in three general ways: 1) altered permeability of the intestinal mucosa as caused by shock, sepsis, distant injury, or cell toxins; 2) ... trauma patient d. Fifty percent of non-nitrogen caloric requirements should be provided in the form of fat

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

Description : 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 ... may be indicated for situations where complete clot evacuation cannot be accomplished surgically

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

Select the diuretic which is orally active, efficacious in acidosis as well as alkalosis, causes diuresis even in renal failure and has additional carbonic anhydrase inhibitory action: A. Mannitol B. Benzthiazide C. Indapamide D. Furosemide

Description : Select the diuretic which is orally active, efficacious in acidosis as well as alkalosis, causes diuresis even in renal failure and has additional carbonic anhydrase inhibitory action: A. Mannitol B. Benzthiazide C. Indapamide D. Furosemide

Last Answer : D. Furosemide

Which of the following statements about hypertension in diabetes patients is/are correct? A. Hypertension worsens the macrovascular disease of diabetes patients. B. Hypertension accelerates the progression of diabetic nephropathy. C. Hypertension is associated with sodium retention in diabetes patients. D. Angiotensin-converting enzyme (ACE) inhibitors should be used in all patients with chronic hyperglycemia, regardless of the presence of hypertension. E. Diuretics, as single-drug therapy, are not indicated in the treatment of hypertension in diabetes patients.

Description : Which of the following statements about hypertension in diabetes patients is/are correct? A. Hypertension worsens the macrovascular disease of diabetes patients. B. Hypertension accelerates the ... single-drug therapy, are not indicated in the treatment of hypertension in diabetes patients.

Last Answer : Answer: ABCDE DISCUSSION: All of the answers listed are correct. By damaging endothelial cells, hypertension worsens macrovascular disease in all patients but especially in diabetics. Hypertension ... is not indicated because the chronic state of dehydration in such patients may become worse

Which of the following statement(s) is/are true concerning hemophilia A? a. Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII b. A positive family history for bleeding disorders present in all patients c. Laboratory tests reveal a prolongation of aPTT, prothrombin time (PT), thrombin clotting time and platelet aggregation d. Spontaneous bleeding is unusual with factor VIII levels greater than 10% of normal

Description : Which of the following statement(s) is/are true concerning hemophilia A? a. Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII b. A positive family history for ... platelet aggregation d. Spontaneous bleeding is unusual with factor VIII levels greater than 10% of normal

Last Answer : Answer: a, d Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII although 0% of cases are secondary to spontaneous mutation. The incidence of this abnormality is ... factor levels as low as 1% have been noted and patients are at risk for spontaneous bleeding

Which of the following statement(s) is/are true concerning translation of the mRNA message to protein synthesis? a. An adaptor molecule, tRNA, recognizes specific nucleic acid bases and unites them with specific amino acids b. Covalent attachment of tRNA to amino acids is energy dependent c. The formation of a peptide bond between the growing peptide chain and the free amino acid occurs in the free cytoplasm d. Complete protein synthesis takes hours

Description : Which of the following statement(s) is/are true concerning translation of the mRNA message to protein synthesis? a. An adaptor molecule, tRNA, recognizes specific nucleic acid bases and unites them ... and the free amino acid occurs in the free cytoplasm d. Complete protein synthesis takes hours

Last Answer : Answer: a, b The synthesis of protein involves conversion from a four-letter nucleotide language to one of 20 chemically distinct amino acids. This process is referred to as ... translation and be moving down the mRNA molecules simultaneously, thus increasing the rate of protein synthesis

Salicylate poisoning can cause (A) Respiratory acidosis (B) Metabolic acidosis with normal anion gap (C) Metabolic acidosis with increased anion gap (D) Metabolic alkalosis

Description : Salicylate poisoning can cause (A) Respiratory acidosis (B) Metabolic acidosis with normal anion gap (C) Metabolic acidosis with increased anion gap (D) Metabolic alkalosis

Last Answer : Answer : C

Respiratory alkalosis is caused by (A) An increase in carbonic acid fraction (B) A decrease in bicarbonic fraction (C) A decrease in the carbonic acid fraction (D) An increase in bicarbonate fraction

Description : Respiratory alkalosis is caused by (A) An increase in carbonic acid fraction (B) A decrease in bicarbonic fraction (C) A decrease in the carbonic acid fraction (D) An increase in bicarbonate fraction

Last Answer : Answer : C

A young child presents with respiratory distress, worsening over 2 days. Blood gases show a pH of 7.25, a PCO2 of 7.5kPa, a PO2 of 8.5kPa, and a base excess of -4. Which of the following interpretations is correct? 1) Results are consistent with bronchopulmonary dysplasia. 2) Blood gases suggest type 1 respiratory failure. 3) Immediate intubation is required. 4) Results are consistent with late severe asthma. 5) Bicarbonate may be necessary to correct the acidosis.

Description : A young child presents with respiratory distress, worsening over 2 days. Blood gases show a pH of 7.25, a PCO2 of 7.5kPa, a PO2 of 8.5kPa, and a base excess of -4. Which of the ... required. 4) Results are consistent with late severe asthma. 5) Bicarbonate may be necessary to correct the acidosis.

Last Answer : Answers-4 In interpreting blood gas results, the following sequence may be useful: Inspect the pH: Is it low, normal or high? Inspect the CO2: Is it low, normal or high? Inspect the PO2: Is ... excess and normal pH. Bicarbonate is usually only considered if the base deficit exceeds about -8 or 00.

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.

Description : 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 ... intensive care units has decreased owing to increased awareness, prevention, and treatment of the syndrome.

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

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 statement(s) is/are true concerning the management of a patient with hemophilia A undergoing an elective surgical operation? a. Concentrates of factor VIII should be given several days prior to elective surgery b. The half-life of factor VIII concentrates is less than 24 hours c. A dose of 40–50 IU/kg of factor VIII concentrate should be given prior to the planned surgical procedure d. Factor VIII concentration administration should be given for the first 24 hours after surgery but may then be stopped if no abnormal bleeding has been observed e. A new recombinant preparation of factor VIII offers the advantage of being virus-free

Description : Which of the following statement(s) is/are true concerning the management of a patient with hemophilia A undergoing an elective surgical operation? a. Concentrates of factor VIII should be given ... observed e. A new recombinant preparation of factor VIII offers the advantage of being virus-free

Last Answer : Answer: b, c, e Although the half-life of factor VIII is 2.9 days in normal individuals, the half-life of factor VIII concentrates is 9 to l8 hours. Levels of 80% to ... infection in the hemophilia population. A new recombinant preparation of factor VIII offers the advantage of being virus-free

Which of the following statement(s) is/are true concerning carbon dioxide kinetics? a. The amount of carbon dioxide produced is equivalent to the amount of oxygen consumed b. Carbon dioxide levels in blood, present mostly as a bicarbonate ion, can quickly change c. Normally the amount of carbon dioxide excreted through the lung is exactly equal to the amount of carbon dioxide produced in peripheral tissues d. The amount of carbon dioxide excreted is a function of ventilation of perfused alveoli

Description : Which of the following statement(s) is/are true concerning carbon dioxide kinetics? a. The amount of carbon dioxide produced is equivalent to the amount of oxygen consumed b. Carbon dioxide levels ... tissues d. The amount of carbon dioxide excreted is a function of ventilation of perfused alveoli

Last Answer : Answer: a, c, d The total amount of carbon dioxide produced by systemic metabolism is roughly equivalent to the amount of oxygen consumed (100-120 cc/m2/min, 200 cc/min in a typical ... carbon dioxide excreted is a function of ventilation of perfused alveoli (i.e. the alveolar ventilation/min).