Which of the following statements about the coagulation cascade is/are true? A. The intrinsic pathway of coagulation is the predominant pathway in vivo for hemostasis and coagulation. B. The intrinsic pathway beginning with the activation of factor XII is the predominant in vivo mechanism for activation of the coagulation cascade. C. Deficiencies of factor VIII and IX cause highly significant coagulation abnormalities. D. Deficiencies of factor XII cause severe clinical bleeding syndromes.

Which of the following statements about the coagulation cascade is/are true? A.  The intrinsic pathway of coagulation is the predominant pathway in vivo for hemostasis and coagulation. B.  The intrinsic pathway beginning with the activation of factor XII is the predominant in vivo mechanism for activation of the coagulation cascade. C.  Deficiencies of factor VIII and IX cause highly significant coagulation abnormalities. D.  Deficiencies of factor XII cause severe clinical bleeding syndromes.
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Answer: AC  DISCUSSION: Although it was previously held that two somewhat distinct pathways existed for the activation of the coagulation cascade, it is now recognized that the predominant mechanism for coagulation in vivo is the “extrinsic pathway.” Tissue factor is exposed in the subendothelial tissues when endothelial cell injury occurs. Tissue factor then tightly binds factor VII circulating in the plasma and activates the coagulation cascade. Factor VIII and factor IX deficiency cause the clinical syndromes of hemophilia A and hemophilia B, respectively. Both of these disorders involve very severe clinical bleeding disorders, whereas deficiencies of factor XII do not generally cause clinically significant bleeding. This further emphasizes the secondary role that the “intrinsic pathway” plays in coagulation
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Hemostasis and the cessation of bleeding require which of the following processes? A. Adherence of platelets to exposed subendothelial glycoproteins and collagen with subsequent aggregation of platelets and formation of a hemostatic plug. B. Interaction of tissue factor with factor VII circulating in the plasma. C. The production of thrombin via the coagulation cascade with conversion of fibrinogen to fibrin. D. Cross-linking of fibrin by factor XIII.

Description : Hemostasis and the cessation of bleeding require which of the following processes? A. Adherence of platelets to exposed subendothelial glycoproteins and collagen with subsequent aggregation of platelets and ... conversion of fibrinogen to fibrin. D. Cross-linking of fibrin by factor XIII.

Last Answer : Answer: ABCD DISCUSSION: Hemostasis requires the interaction of platelets with the exposed subendothelial structures at the site of injury followed by aggregation of more platelets in that area. ... form a stable clot that incorporates the platelet plug and fibrin thrombus into a stable clot

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

Description : 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 aggregation should be part of the standard preoperative evaluation of patients using aspirin

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

Which of the statements listed below about bleeding disorders is/are correct? A. Acquired bleeding disorders are more common than congenital defects. B. Deficiencies of vitamin K decrease production of factors II, VII, IX, and X, protein C, and protein S. C. Hypothermia below 32؛C rarely causes a bleeding disorder. D. Von Willebrand's disease is a very uncommon congenital bleeding disorder.

Description : Which of the statements listed below about bleeding disorders is/are correct? A. Acquired bleeding disorders are more common than congenital defects. B. Deficiencies of vitamin K decrease production ... disorder. D. Von Willebrand's disease is a very uncommon congenital bleeding disorder.

Last Answer : Answer: AB DISCUSSION: Acquired bleeding disorders are significantly more common than congenital bleeding defects. Vitamin K deficiency may be related to malnutrition or competitive inhibition ... a relatively common disorder of bleeding and is generally undetectable by routine screening methods

Tests of coagulation are used to monitor anticoagulation treatment and detect intrinsic abnormalities in coagulation. Which of the following statement(s) is/are true concerning coagulation tests? a. Prothrombin time (PT) measures both the intrinsic and extrinsic clotting pathways and fibrinogen b. Activated partial thromboplastin time (aPTT) can be used to monitor both oral anticoagulation with Warfarin and intravenous anticoagulation with heparin c. Thrombin clotting time (TCT) is a measurement of the time it takes for exogenously administered thrombin to turn plasma fibrinogen into fibrin clot d. Whole blood activated clotting time (ACT) is a measurement of the ability of whole blood to clot and is used to monitor heparin levels intraoperatively during cardiovascular and peripheral vascu

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Last Answer : Answer: a, c, d Coagulation tests include prothrombin time (PT), which measures the intrinsic and extrinsic pathways of fibrinogen production and is the most common method for ... more while for peripheral vascular applications, values of 250 seconds or greater are considered appropriate

Which of the following statement(s) is/are correct concerning the immunoinflammatory response to shock? a. The anaphylactoxins, C3a and C5a, are products of activation of only the classical pathway of the compliment cascade b. Eicosanoids, such as prostaglandins are stored in platelets and endothelial cells and released in response to inflammatory stimuli c. Thromboxane and PGI2 have similar effects d. Platelet-activating factor can be released by both circulating and fixed tissue cells

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Last Answer : Answer: d Inflammatory mediators have recently been recognized as playing a significant role in the clinical manifestations and progression of shock and the development ... increased pulmonary vascular resistance, bronchoconstriction, peripheral vasodilatation, and increased vascular permeability

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

The complement system consists of a series of serum proteins that exist in a quiescent or very low-level state of activation in the uninfected host. Which of the following statement(s) is/are true concerning complement activation? a. The alternate (properdin) pathway of complement activation can occur directly through contact with fungal or bacterial cell wall compounds b. Complement component fragments may serve to decrease vascular permeability c. Excessive complement activation can produce deleterious effects d. Fragments of certain complement components serve as chemoattractants to additional cellular components of the host defense mechanism

Description : The complement system consists of a series of serum proteins that exist in a quiescent or very low-level state of activation in the uninfected host. Which of the following ... certain complement components serve as chemoattractants to additional cellular components of the host defense mechanism

Last Answer : Answer: a, c, d Complement activation can occur through either classic or alternate (properdin) pathways, both of which eventuate in deposition of terminal complement pathway components on the ... and release of lysosomal enzymes that can directly damage certain target tissues, such as the lung

The evaluation of a patient scheduled for elective surgery should always include the following as tests of hemostasis and coagulation: A. History and physical examination. B. Complete blood count (CBC), including platelet count. C. Prothrombin time (PT) and activated partial thromboplastin time (APTT). D. Studies of platelet aggregation with adenosine diphosphate (ADP) and epinephrine.

Description : The evaluation of a patient scheduled for elective surgery should always include the following as tests of hemostasis and coagulation: A. History and physical examination. B. Complete blood count ( ... (APTT). D. Studies of platelet aggregation with adenosine diphosphate (ADP) and epinephrine.

Last Answer : Answer: A DISCUSSION: The evaluation of most patients scheduled for elective surgery who do not have a history of significant bleeding disorders is somewhat controversial. An adequate history and ... suspected of having qualitative defects of platelet function (e.g., von Willebrand's disease)

he primary mechanism by which heparin prevents coagulation of blood is: A. Direct inhibition of prothrombin to thrombin conversion B. Facilitation of antithrombin III mediated inhibition of factor Xa and thrombin C. Activation of antithrombin III to inhibit factors IX and XI D. Inhibition of factors XIIa and XIIIa

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Last Answer : B. Facilitation of antithrombin III mediated inhibition of factor Xa and thrombi

Hepatic abnormalities have been noted in adults since the beginning of hyperalimentation. Which of the following statements are true? A. Hepatic steatosis appears to be associated with an overload of glucose. B. Hepatic steatosis is usually associated with abnormalities in hepatic enzymes. C. Hyperbilirubinemia is inevitably associated with hepatic steatosis. D. Abnormalities in the portal insulin-glucagon ratio are thought to be causative of hepatic steatosis in experimental animals.

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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

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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

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A 47-year-old patient undergoing a complicated laparotomy for bowel obstruction develops a postoperative enterocutaneous fistula. Which of the following statement(s) is/are true concerning parenteral nutritional support in the postoperative period? a. Oral intake can result in severe dehydration, electrolyte abnormalities, and perifistula skin injury b. Total parenteral nutrition increases the spontaneous closure rate of intestinal fistula c. Total parenteral nutrition decreases mortality rate in patients with intestinal fistulas d. The use of TPN better prepares the patient for surgery if surgical intervention proves necessary

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Last Answer : Answer: a, b, d Patients with gastrointestinal-cutaneous fistulas represent the classical indication for TPN. In such patients, oral intake of food almost invariably results in increased ... treated more aggressively surgically after a defined period of nutritional support (unless closure occurs)

I have some matchsticks set up like this: I + XI = X. If you do not know Roman numerals, here is a quick starter: I=1 II=2 III=3 IV=4 V=5 VI=6 VII=7 VIII=8 IX=9 X=10 XI=11 XII=12 XIII=13 XIV=14 XV=15...... Of course, I + XI = X is wrong. You are told to move the minimum number of matchsticks to make the question correct. So, how many do you have to move? -Riddles

Description : I have some matchsticks set up like this: I + XI = X. If you do not know Roman numerals, here is a quick starter: I=1 II=2 III=3 IV=4 V=5 VI=6 VII=7 VIII=8 IX=9 X=10 XI=11 ... are told to move the minimum number of matchsticks to make the question correct. So, how many do you have to move? -Riddles

Last Answer : Most people would get to one move at the least, but the real answer is zero moves. If you rotate the whole question around 180 degrees, it will display this: X = IX + I

A company has to choose between two projects whose cash flows are as indicated below; Project 1: i. Investment – Rs. 15 Lakhs ii. Annual cost savings – Rs. 4 lakhs. iii. Bi-annual maintenance cost – Rs. 50,000/- iv. Reconditioning and overhaul during 5th year: 6 lakhs v. Life of the project – 8 years vi. Salvage value – Rs. 5 lakhs Project 2: vii. Investment – Rs. 14 Lakhs viii. Annual cost savings – Rs. 3.5 lakhs. ix. Annual Maintenance cost – Rs. 20,000/- x. Reconditioning and overhaul during 4th year: 5 lakhs xi. Life of the project – 8 years xii. Salvage Value- 2 lakhs Which project should the company choose? The annual discount rate is 12

Description :  A company has to choose between two projects whose cash flows are as indicated  below; Project 1:  i. Investment - Rs. 15 Lakhs ii. Annual cost savings - Rs. 4 lakhs. iii. Bi-annual ... years xii. Salvage Value- 2 lakhs Which project should the company choose? The annual discount rate is 12

Last Answer : Year Project 1 Project 2 Outgo Saving NPV Outgo Saving NPV 0 15.0 0 =-15.0 14.0 0 = -14 1 0 4.0 = (4 / (1+.12)1 = 3.571 0.2 3.5 = (3.3 / (1+.12)1 = 2.95 2 0.5 4.0 = (3.5 / (1+.12)2 = 2.79 0.2 3.5 ... (1+.12)8 = 3.43 0.2 5.5  (3.5+2) = (5.3 / (1+.12)8 = 2.14 NPV = + 2.301 @12% = + 0.15

Which of the following statements regarding fibroblasts and their function in wound healing are true? a. IL-1 has both inhibitory and promotional effects on fibroblast growth b. TNFa stimulates fibroblast collagen synthesis c. IL-1 and TNFa have opposite effects on the healing of bone d. In human clinical trials, EGF (epithelial growth factor) has been demonstrated to accelerate epidermal regeneration in cutaneous wounds

Description : Which of the following statements regarding fibroblasts and their function in wound healing are true? a. IL-1 has both inhibitory and promotional effects on fibroblast growth b. TNFa ... EGF (epithelial growth factor) has been demonstrated to accelerate epidermal regeneration in cutaneous wounds

Last Answer : Answer: a, d IL-1 appears to be important in the process of normal wound repair. IL-1 has been shown to stimulate skin fibroblast and keratinocyte growth, as well as ... that recombinant EGF enhances keratinocyte migration. EGF is also a potent chemoattractant for granulation tissue fibroblasts

A 67-year-old male with advanced cholangiocarcinoma develops gram-negative sepsis. Excessive bleeding is noted around vascular catheters and from needle puncture sites. The diagnosis of disseminated intervascular coagulation (DIC) is considered. Which of the following laboratory test(s) is/are indicative of DIC? a. Decreased platelet count b. Decreased fibrinogen level c. Normal prothrombin time d. Elevated fibrin split products

Description : A 67-year-old male with advanced cholangiocarcinoma develops gram-negative sepsis. Excessive bleeding is noted around vascular catheters and from needle puncture sites. The diagnosis of disseminated ... b. Decreased fibrinogen level c. Normal prothrombin time d. Elevated fibrin split products

Last Answer : Answer: a, b, d Disseminated intravascular coagulation (DIC) is the primary form of acute thrombosis. Causes of this syndrome include abruptio placenta, gram-positive and gram-negative sepsis, ... decline in the platelet count and fibrinogen level, along with an elevation of fibrin split products

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

The patient whom you are about to treat states that he has Von Willebrand’s disease. Which one of the following preoperative haematological analyses may reflect this disease: A. Bleeding time and factor VIII level ptt also prolonged decreased platelet count. B. Bleeding time and factor IX level C. Bleeding time and factor X level D. Platelet count E. Thromboplastin generation time

Description : The patient whom you are about to treat states that he has Von Willebrand's disease. Which one of the following preoperative haematological analyses may reflect this disease: A. Bleeding time and ... C. Bleeding time and factor X level D. Platelet count E. Thromboplastin generation time

Last Answer : A. Bleeding time and factor VIII level ptt also prolonged decreased platelet count

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 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

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

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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 surgical techniques lead to improved wound healing? a. Atraumatic handling of tissue b. Approximation of underlying fatty tissue to obliterate dead space c. Protecting the wound from water for at least one week d. Meticulous hemostasis

Description : Which of the following surgical techniques lead to improved wound healing? a. Atraumatic handling of tissue b. Approximation of underlying fatty tissue to obliterate dead space c. Protecting the wound from water for at least one week d. Meticulous hemostasis

Last Answer : Answer: a, d There are numerous practical implications for the care of wounds and surgical incisions. Meticulous hemostasis reduces the inflammation of phagocytosis necessary to clear the wound of ... or shower one or two days after surgery actually serves useful purpose in debriding the wound

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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Last Answer : Answer: AB DISCUSSION: Shock due to sepsis or SIRS frequently manifests as a hyperdynamic cardiovascular response, consisting of an elevated CI and a decreased SVR or SVRI. Occasionally, ... been encouraging thus far in human clinical trials, despite the promising results from many animal studies

The prothrombin time a. assess the extrinsic pathway of the blood coagulation cascade b. is prolonged in patients with fat absorption c. is increased by warfarin d. all above

Description : The prothrombin time a. assess the extrinsic pathway of the blood coagulation cascade b. is prolonged in patients with fat absorption c. is increased by warfarin d. all above

Last Answer : all above

The prothrombin time a. assess the extrinsic pathway of the blood coagulation cascade b. is prolonged in patients with fat absorption c. is increased by warfarin d. is increased by heparin

Description : The prothrombin time a. assess the extrinsic pathway of the blood coagulation cascade b. is prolonged in patients with fat absorption c. is increased by warfarin d. is increased by heparin

Last Answer : assess the extrinsic pathway of the blood coagulation cascade

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 statement(s) is/are true concerning tumor necrosis factor (TNF)? a. TNF is a product of activated macrophages secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or inflammatory stimuli b. The liver and gut appear to be a major source of TNF following hypoperfusion c. Circulating levels of TNF correlate well with severity of tissue injury in shock d. Recently completed clinical trials of anti-TNF antibody in septic patients shows a marked improvement in survival

Description : Which of the following statement(s) is/are true concerning tumor necrosis factor (TNF)? a. TNF is a product of activated macrophages secreted in response to contact with endotoxin or ... completed clinical trials of anti-TNF antibody in septic patients shows a marked improvement in survival

Last Answer : Answer: a, b Tumor necrosis factor (TNF), a protein product of activated macrophages, is secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or ... patients utilizing infusion of monoclonal antibodies to the TNF molecule have shown no overall survival benefit

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

The neurohormonal arm of the stress response is well defined. Less is known about the inflammatory arm mediated primarily by cytokines. Which of the following statement(s) is/are true concerning this arm of the surgical stress response? a. Cytokines primarily work locally via direct cell-to-cell communication b. Cytokines are never detectable in the systemic bloodstream c. Cytokines are produced only by immune cells attracted to the site of injury d. Cytokine release may stimulate the release of other cytokines leading to an important cascade of events

Description : The neurohormonal arm of the stress response is well defined. Less is known about the inflammatory arm mediated primarily by cytokines. Which of the following statement(s) is/are true ... Cytokine release may stimulate the release of other cytokines leading to an important cascade of events

Last Answer : Answer: a, d Cytokines, which are produced at the site of injury by endothelial cells and by diverse immune cells throughout the body, also occupy a pivotal position in the stress response ... act as hormones and spill over into the systemic circulation and become detectable in the bloodstream

Which of the following statements regarding angiogenesis are true? a. Angiogenesis is a seminal biologic event with clinical relevance limited to its effect upon tumor growth b. C-X-C chemokines regulate angiogenesis c. PF-4 has angiogenic properties d. Sites of atherosclerosis demonstrate chronic angiogenic activity

Description : Which of the following statements regarding angiogenesis are true? a. Angiogenesis is a seminal biologic event with clinical relevance limited to its effect upon tumor growth b. C-X-C ... c. PF-4 has angiogenic properties d. Sites of atherosclerosis demonstrate chronic angiogenic activity

Last Answer : Answer: b, d An important component of tissue repair and wound healing is the process of angiogenesis. This normal, physiologic process is a local, transient event which is ... between these factors may govern overall angiogenic potential in a variety of physiological and pathophysiological 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.

Description : 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 ... clinical conditions not associated with tissue hypoxia, including liver disease and hypermetabolic states.

Last Answer : 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 ... also be seen with liver disease, toxin ingestion, and hypermetabolic states not associated with shock

Which of the following statements regarding the alternative complement pathway are true? a. C1, C4 and C2 are involved b. NH3 apparently activates complement via this pathway c. Factors B and D are involved d. Endotoxin activates complement via the alternative pathway

Description : Which of the following statements regarding the alternative complement pathway are true? a. C1, C4 and C2 are involved b. NH3 apparently activates complement via this pathway c. Factors B and D are involved d. Endotoxin activates complement via the alternative pathway

Last Answer : Answer: b, c, d The alternative pathway differs from the classic pathway in that the first steps involving C1, C4 and C2 are bypassed. (See Figure 6-3 previously reproduced.) ... been correlated with impaired renal function and the presence of complement components at the sites of renal injury

True statements regarding eicosanoids include which of the following? A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway. B. The vasoconstricting, platelet-aggregating, and bronchoconstricting effects of thromboxane A 2 are balanced by the actions of prostacyclin, which produces the opposite effects. C. Leukotriene synthesis is inhibited by the action of nonsteroidal anti-inflammatory drugs (NSAIDs). D. The principal prostaglandins have a short circulation half-life and exert most of their effects locally.

Description : True statements regarding eicosanoids include which of the following? A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway. B. The vasoconstricting, platelet-aggregating, ... prostaglandins have a short circulation half-life and exert most of their effects locally.

Last Answer : Answer: ABD DISCUSSION: The eicosanoids are a group of compounds arising from the metabolism of arachidonic acid. The prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase ... effects and may be involved in the physiologic responses associated with anaphylactic and septic shock

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 statements regarding the complement system are true? a. Complement activation yields products which are directly cytotoxic as well as products which act indirectly via activated leukocytes b. Complement products referred to as anaphylatoxins include C1, C3a, C4a, and C5a c. The principal role of C5a is in bacterial opsonization d. The alternative and classical pathways converge proximal to generating the membrane attack complex (C5b-9)

Description : Which of the following statements regarding the complement system are true? a. Complement activation yields products which are directly cytotoxic as well as products which act indirectly via activated ... and classical pathways converge proximal to generating the membrane attack complex (C5b-9)

Last Answer : Answer: a, d The complement system is composed of two different but linked sequences, the classic and alternative pathways. The pathways involve serum proteins that act to amplify the inflammatory-immune ... the C5 level proximal to generating the membrane attack complex (C5b-9) (Figure 6-3)

The transfusion of fresh frozen plasma (FFP) is indicated for which of the following reasons? A. Volume replacement. B. As a nutritional supplement. C. Specific coagulation factor deficiency with an abnormal prothrombin time (PT) and/or an abnormal activated partial thromboplastin time (APTT). D. For the correction of abnormal PT secondary to warfarin therapy, vitamin K deficiency, or liver disease.

Description : The transfusion of fresh frozen plasma (FFP) is indicated for which of the following reasons? A. Volume replacement. B. As a nutritional supplement. C. Specific coagulation factor deficiency ... the correction of abnormal PT secondary to warfarin therapy, vitamin K deficiency, or liver disease.

Last Answer : Answer: CD DISCUSSION: The use of FFP as a volume expander is not indicated. There are currently several preparations (both crystalloid and colloid) that are equally effective and do not carry the infectious and ... vitamin K-dependent factors II, VII, IX, and X, as well as protein C and protein S

Which of the following statement(s) is/are true concerning the proliferative phase of wound healing? a. The macrophage is the predominant cell type b. The pink or purple-red appearance of a wound is due to ingrowth and proliferation of endothelial cells c. Collagen, the dominant structural molecule of the wound matrix, contains two unique amino acids, hydroxyproline and hydroxylysine d. The predominant collagen type in a scar is type 3

Description : Which of the following statement(s) is/are true concerning the proliferative phase of wound healing? a. The macrophage is the predominant cell type b. The pink or purple-red appearance of a wound ... amino acids, hydroxyproline and hydroxylysine d. The predominant collagen type in a scar is type 3

Last Answer : Answer: b, c The proliferative phase of wound healing begins with the formation of a provisional matrix of fibrin and fibronectin as part of the initial clot formation. Initially, the provisional ... The principal collagen type scar is type 1, with lesser amounts of type 3 collagen also present

Which of the following statements regarding cytokines is incorrect? A. Cytokines act directly on target cells and may potentiate the actions of one another. B. Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury. C. Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability. D. Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates.

Description : Which of the following statements regarding cytokines is incorrect? A. Cytokines act directly on target cells and may potentiate the actions of one another. B. Interleukin 1 (IL-1) ... organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates.

Last Answer : Answer: C DISCUSSION: Cytokines are soluble peptide molecules that are synthesized and secreted by a number of cell types in response to injury, inflammation, and infection. Cytokines, which ... is thought to play a central role in the stress response, particularly in response to endotoxemia

The standard management oral anticoagulant therapy for chronic treatment of venous thromboembolism is with the drug warfarin. Which of the following statement(s) is/are true concerning the administration of warfarin? a. An important complication of warfarin therapy is skin necrosis in patients with protein C deficiency b. Warfarin interferes with vitamin K dependent clotting factors II, VII, IX, X c. For effective anticoagulation the prothrombin time (PT) should be kept at 2 control d. It is recommended that warfarin be continued for at least one year after initial episode of deep venous thrombosis

Description : The standard management oral anticoagulant therapy for chronic treatment of venous thromboembolism is with the drug warfarin. Which of the following statement(s) is/are true concerning the administration ... warfarin be continued for at least one year after initial episode of deep venous thrombosis

Last Answer : Answer: a, b Warfarin interferes with the vitamin K dependent clotting factors II, VII, IX and X, protein C, and protein S. An important complication of warfarin is skin ... the benefit from anticoagulant therapy and thus is the basis for discontinuing warfarin administration at this time

Low concentrations of heparin selectively interfere with the following coagulation pathway(s): A. Intrinsic pathway B. Extrinsic pathway C. Common pathway D. Both ‘A’ and ‘C’

Description : Low concentrations of heparin selectively interfere with the following coagulation pathway(s): A. Intrinsic pathway B. Extrinsic pathway C. Common pathway D. Both ‘A’ and ‘C’

Last Answer : A. Intrinsic pathway

True statements concerning hypoadrenal shock include which of the following? A. Adrenocortical insufficiency may manifest itself as severe shock refractory to volume and pressor therapy. B. The presence of hyperglycemia and hypotension may suggest the diagnosis of shock due to adrenocortical insufficiency. C. Hydrocortisone does not interfere with the serum cortisol assay and should be given to hemodynamically unstable patients suspected of having hypoadrenal shock. D. The rapid adrenocorticotropic hormone (ACTH) stimulation test should be performed to help establish the diagnosis of acute adrenocortical insufficiency.

Description : True statements concerning hypoadrenal shock include which of the following? A. Adrenocortical insufficiency may manifest itself as severe shock refractory to volume and pressor therapy. B. ... test should be performed to help establish the diagnosis of acute adrenocortical insufficiency.

Last Answer : Answer: AD DISCUSSION: Shock due to acute adrenocortical insufficiency is relatively uncommon but must be considered when shock refractory to volume replacement and pressor therapy is present. ... and it is the corticosteroid of choice while the ACTH stimulation test is being performed

All of the following are true about neurogenic shock except: A. There is a decrease in systemic vascular resistance and an increase in venous capacitance. B. Tachycardia or bradycardia may be observed, along with hypotension. C. The use of an alpha agonist such as phenylephrine is the mainstay of treatment. D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

Description : All of the following are true about neurogenic shock except: A. There is a decrease in systemic vascular resistance and an increase in venous capacitance. B. Tachycardia or bradycardia may be ... Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

Last Answer : Answer: C DISCUSSION: Neurogenic shock occurs when severe head injury, spinal cord injury, or pharmacologic sympathetic blockade leads to sympathetic denervation and loss of vasomotor tone. ... of treatment. The use of alpha-adrenergic agonist is infrequently necessary to treat neurogenic shock

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

Which of the following statements are true of oxidants? A. In addition to their pathophysiologic roles in inflammation, injury, and infection, oxidants also have physiologic roles. B. Oxidants may be generated from activated neutrophils and during reperfusion following a period of ischemia. C. The deleterious effects of oxidants include lipid peroxidation and cell membrane damage, oxidative damage to DNA, and inhibition of adenosine triphosphate (ATP) synthesis. D. The mechanism of ischemia-reperfusion injury involved the catalytic production of superoxide anion (O 2•) by the enzyme xanthine oxidase.

Description : Which of the following statements are true of oxidants? A. In addition to their pathophysiologic roles in inflammation, injury, and infection, oxidants also have physiologic roles. B. Oxidants may ... involved the catalytic production of superoxide anion (O 2 ) by the enzyme xanthine oxidase.

Last Answer : Answer: ABCD DISCUSSION: Oxidants are reactive oxygen metabolites that have both physiologic and pathophysiologic roles. As potent oxidizing agents, oxidants are involved in cytochrome P ... leukocyte infiltration and activation, causing further tissue damage by the release of cytotoxic proteases

Which of the following statements about normal salt and water balance are true? A. The products of catabolism may be excreted by as little as 300 ml. of urine per day. B. The lungs represent the primary source of insensible water loss. C. The normal daily insensible water loss is 600 to 900 ml. D. Excessive cell catabolism causes significant loss of total body water. E. In normal humans, urine represents the greatest source of daily water loss.

Description : Which of the following statements about normal salt and water balance are true? A. The products of catabolism may be excreted by as little as 300 ml. of urine per day. B. The lungs represent ... of total body water. E. In normal humans, urine represents the greatest source of daily water loss.

Last Answer : Answer: CE DISCUSSION: The skin is the primary source of insensible water loss. Including losses from the lungs, this averages 600 to 900 ml. per day. Catabolism liberates water of solution. In ... still excrete a minimum of 500 to 800 ml. of urine per day to expel the products of catabolism

A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his diagnosis and management? a. The low blood pressure can be assumed to be due to neurogenic shock b. The sole cause of hypotension is the loss of sympathetic input to the venous system c. Despite significant hypotension, secondary organ injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Description : A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/ ... injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Last Answer : Answer: c Neurogenic shock results from interruption of sympathetic vasomotor input and develops after spinal cord injury, spinal anesthesia, and severe head injury. Under normal conditions, baseline ... the cause is not neurogenic and search for occult blood loss or cardiogenic causes of shock

Which of the following statement(s) is/are true concerning the various types of shock? a. Traumatic shock is more commonly associated with subsequent organ injury and multiorgan failure syndrome than hemorrhagic shock b. Cardiogenic shock can be of either an intrinsic or compressive nature c. Hypodynamic septic shock is associated with a decreased mortality risk when compared with hyperdynamic septic shock d. Hypoadrenal shock usually responds quickly to resuscitation e. Neurogenic shock occurs with the absence of sympathetic activity

Description : Which of the following statement(s) is/are true concerning the various types of shock? a. Traumatic shock is more commonly associated with subsequent organ injury and multiorgan failure ... responds quickly to resuscitation e. Neurogenic shock occurs with the absence of sympathetic activity

Last Answer : Answer: a, b, d, e Classification schemes of shock based on cause have been developed for the seemingly dissimilar processes leading to circulatory collapse and the shock state. ... and pressor agents. The response to exogenous corticosteroids is usually dramatic and potentially life-saving

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

Description : 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 ... a diuretic in this clinical situation d. Isoproterenol is a poor choice as an ionotropic agent

Last Answer : Answer: a Treatment of pulmonary edema has two important goals, the first is to improve oxygenation if it is impaired, and the second is to minimize fibrosis and bacterial infection, which often ... leaks out , the short term effects of expanding blood volume and decrease in edema will appear

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