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.

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.
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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 dramatically accelerates the onset and progression of diabetic renal disease and proteinuria, and this phenomenon can be slowed or prevented by a combination of treatment modalities, including ACE inhibitors, which dilate efferent glomerular vessels and lower intraglomerular pressure. Despite sodium retention in diabetes patients, single-drug therapy with a diuretic is not indicated because the chronic state of dehydration in such patients may become worse
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Description : In the nutritional support of patients with cancer, which of the following statements is/are true? A. Nutritional support benefits the patient's lean body mass but does not enable ... with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

Last Answer : Answer: B DISCUSSION: The problem with the patient with cancer is a very vexing one. Clearly, one of the metabolic effects of cancer, cachexia, affects patients in the last quartile ... undoubtedly reveal that there are certain nutrients that tumors require, which probably should be best avoided

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Description : 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 ... animal studies that demonstrate a significant improvement in survival with the use of such agents.

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

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

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

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

Which of the following may be responsible for a hypokalaemic hypertension 1) Non-classical congenital adrenal hyperplasia 2) Barter's syndrome 3) Diabetic nephropathy 4) Liddle's syndrome 5) Type IV renal tubular acidosis

Description : Which of the following may be responsible for a hypokalaemic hypertension 1) Non-classical congenital adrenal hyperplasia 2) Barter's syndrome 3) Diabetic nephropathy 4) Liddle's syndrome 5) Type IV renal tubular acidosis

Last Answer : Answers-4 Liddle's syndrome is typically asscoiated with hypokalaemic hypertension and low renin and aldosterone concentrations - the so called pseudo-hyperaldosteronism. Barter's syndrome is associated ... , which may also be produced with diabetic nephropathy. Hence hyperkalaemia is more typical.

Which of the following patients are at the highest risk of suffering from an adverse drug reaction? a) An 8 month year old infant receiving a prescription for an antibiotic. b) A 22 year old patient with asthma receiving prescriptions for inhalers to relieve and prevent their asthma. c) A 48 year old patient who has hypertension and receives a prescription for an ACE Inhibitor. d) A 68 year old patient who has oedema receiving a prescription for a diuretic.

Description : Which of the following patients are at the highest risk of suffering from an adverse drug reaction? a) An 8 month year old infant receiving a prescription for an antibiotic. b) A 22 year old patient ... ACE Inhibitor. d) A 68 year old patient who has oedema receiving a prescription for a diuretic. 

Last Answer : d) A 68 year old patient who has oedema receiving a prescription for a diuretic. 

Which of the following statement(s) is/are true concerning the neuroendocrine responses to shock? a. Sympathetic nerve endings release epinephrine which is responsible for greater than 80% of systemic vascular resistance b. Endogenous epinephrine is the primary contributor to systemic vascular resistance c. Increased pancreatic secretion of glucagon contributes to glucose intolerance associated with injury and sepsis d. The renin-angiotensin axis further augments the sympathetic-mediated vasoconstriction

Description : Which of the following statement(s) is/are true concerning the neuroendocrine responses to shock? a. Sympathetic nerve endings release epinephrine which is responsible for greater than 80% ... injury and sepsis d. The renin-angiotensin axis further augments the sympathetic-mediated vasoconstriction

Last Answer : Answer: c, d The neuroendocrine response to shock attempts to achieve restoration of effective blood volume, mobilization of metabolic substrates, and maintenance of central ... . Angiotensin II is an extremely effective vasoconstrictor that further augments sympathetic-mediated vasoconstriction

Which of the following statement(s) is/are true concerning the diagnosis and management of hypovolemic shock? a. A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock b. The treatment of shock is generic regardless of the etiology c. Pharmacologic intervention to increase myocardial contractility in hypovolemic shock is an important part the early management d. Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock

Description : Which of the following statement(s) is/are true concerning the diagnosis and management of hypovolemic shock? a. A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock b. The ... d. Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock

Last Answer : Answer: d Hypovolemic shock is readily diagnosed when there is an obvious source of volume loss and overt signs of hemodynamic instability and increased adrenergic output are present. ... response systems and consequences of their disseminated, indiscriminate cellular injury can be quite profound

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

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

A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following statements is/are true? A. This formulation is proposed for the use of patients with fulminant hepatitis. B. Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours. C. The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy. D. In some studies of surgical patients, improvements in mortality have been reported.

Description : A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following ... D. In some studies of surgical patients, improvements in mortality have been reported.

Last Answer : Answer: D DISCUSSION: The use of modified amino acid solutions is based on the false neurotransmitter hypothesis of the cause of hepatic coma. According to this hypothesis, the imbalance ... in a group of patients with cirrhosis, decreasing morbidity and showing a trend toward decreased mortality

If a necrotizing soft tissue infection is considered, therapy mandates: a. Empiric administration of antibiotics active against gram-positive, gram-negative, and anaerobic bacteria b. Due to usually resistant species, penicillin is not indicated c. Immediate operative intervention and aggressive resection of all involved tissues is mandatory d. The use of hyperbaric oxygen has been demonstrated to be clearly advantageous

Description : If a necrotizing soft tissue infection is considered, therapy mandates: a. Empiric administration of antibiotics active against gram-positive, gram-negative, and anaerobic bacteria b. Due to usually ... is mandatory d. The use of hyperbaric oxygen has been demonstrated to be clearly advantageous

Last Answer : Answer: a, c Identification of a necrotizing, soft tissue infection mandates immediate operative intervention with aggressive resection of all involved tissues and empiric ... remains without controlled trials demonstrating any additional benefits derived from hyperbaric oxygen therapy