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.

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.
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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 effects; however, ketorolac, like all NSAIDs, can enhance surgical bleeding and cause renal and platelet dysfunction. Additionally, it is recommended that ketorolac should not be used for more than 5 consecutive days
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Which of the following statements concerning perioperative nutrition is true concerning the above-described patient? a. Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition b. Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens c. Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements d. A jejunal feeding catheter should be placed at the time of surgery for postoperative enteral feeding

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

The use of prophylactic antibiotics has become commonplace. Which of the following statement(s) is/are true concerning the prophylactic use of antibiotics? a. The appropriate use of prophylactic antibiotics must include the initiation of the agent prior to the surgical procedure b. Continuing the antibiotic into the postoperative period has led to improved results in antibiotic prophylaxis c. The prophylactic administration of broad-spectrum agents (third-generation cephalosporins) has been shown to be particularly advantageous d. The topical use of antimicrobial agents is of no advantage in the prophylactic setting

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Last Answer : Answer: a Intravenous administration of an antibiotic is clearly indicated for patients undergoing clean contaminated operations. These antibiotics should be administered prior to surgery ... of antimicrobial agents is equivalent to the administration of intravenous antimicrobial agent antibiotics

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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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.

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11. Which route of drug administration is most likely to lead to the first-pass effect? a) Sublingual b) Oral c) Intravenous d) Intramuscular

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Last Answer : b) Oral

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

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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

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

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

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

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

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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

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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.

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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.

Description : 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 ... of respiratory acidosis. E. The ratio of bicarbonate to carbonic acid is less than 20:1.

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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

Description : 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 ... is used to monitor heparin levels intraoperatively during cardiovascular and peripheral vascular operations

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

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

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

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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

The preferred drug for suppressing febrile convulsions is: A. Intramuscular phenobarbitone B. Intravenous phenytoin C. Rectal diazepam D. Oral sodium valproate

Description : The preferred drug for suppressing febrile convulsions is: A. Intramuscular phenobarbitone B. Intravenous phenytoin C. Rectal diazepam D. Oral sodium valproate

Last Answer : C. Rectal diazepam

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

Description : Which of the following statement(s) concerning laboratory studies used in monitoring a patient with intravenous heparinization is/are correct? a. The platelet count should be followed because of the ... serum creatinine should be measured daily to allow adjustments in dose based on renal function

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

Budesonide is a (a) Nonsteroidal anti-inflammatory drug (b) High ceiling diuretic (c) Inhaled corticosteroid for asthma (d) Contraceptive

Description : Budesonide is a (a) Nonsteroidal anti-inflammatory drug (b) High ceiling diuretic (c) Inhaled corticosteroid for asthma (d) Contraceptive

Last Answer : Ans: C

A 45-year-old surgeon has developed symmetric early morning stiffness in her hands. She wishes to take a nonsteroidal anti-inflammatory drug to relieve these symptoms and wants to avoid gastrointestinal side effects. Which one of the following drugs is most appropriate? (a) Aspirin (b) Celecoxib (c) Ibuprofen (d) Indomethacin (e) Piroxicam

Description : A 45-year-old surgeon has developed symmetric early morning stiffness in her hands. She wishes to take a nonsteroidal anti-inflammatory drug to relieve these symptoms and wants to avoid gastrointestinal side ... appropriate? (a) Aspirin (b) Celecoxib (c) Ibuprofen (d) Indomethacin (e) Piroxicam

Last Answer : Ans: B

Mini-dose heparin has been shown to be useful in the prophylaxis of postoperative venous thrombosis. Mechanism(s) by which low-dose heparin is/are thought to protect against venous thrombosis include: a. Enhancement of antithrombin III activity b. A decrease in thrombin availability c. Inhibition of platelet aggregation and subsequent platelet release action d. A mild prolongation of activated partial thromboplastin time

Description : Mini-dose heparin has been shown to be useful in the prophylaxis of postoperative venous thrombosis. Mechanism(s) by which low-dose heparin is/are thought to protect against venous ... aggregation and subsequent platelet release action d. A mild prolongation of activated partial thromboplastin time

Last Answer : Answer: a, b, c Low-dose heparin is thought to protect against venous thrombosis through three different mechanisms. First, antithrombin III activity with its inhibition of activated Factor X is ... release reaction. The standard doses of heparin administered (5000 units bid) does not affect aPTT

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

All of the following facts are true about non-steroidal anti-inflammatory drugs (NSAIDs) except (a) They are antipyretic (b) There is a celling effect to their analgesia (c) They can cause tolerance (d) They do not cause dependence (e) They are anti-inflammatory

Description : All of the following facts are true about non-steroidal anti-inflammatory drugs (NSAIDs) except (a) They are antipyretic (b) There is a celling effect to their analgesia (c) They can cause tolerance (d) They do not cause dependence (e) They are anti-inflammatory

Last Answer : Ans: C

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

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External pneumatic compression has been advocated for the prevention of deep venous thrombosis during operative procedures. Which of the following statement(s) concerning the use of external pneumatic compression devices is/are true? a. Intermittent pneumatic compression is as effective as low-dose heparin in prevention of venous thrombosis b. These devices function by compressing the lower extremities therefore augmenting venous return c. Pneumatic compression devices may also exhibit their antithrombotic effect through stimulating local and systemic fibrinolysis d. The length of time that intermittent pneumatic compression should be used includes through the operation and for at least several days in the postoperative period

Description : External pneumatic compression has been advocated for the prevention of deep venous thrombosis during operative procedures. Which of the following statement(s) concerning the use of external pneumatic ... includes through the operation and for at least several days in the postoperative period

Last Answer : Answer: b, c, d In many well-controlled studies of venous prophylaxis, intermittent pneumatic compression has been found to be as effective as low-dose heparin therapy. In addition to augmentation ... be used through the operation and for at least five days in the face or prolonged immobilization

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

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

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.

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A number of changes in trace mineral metabolism are noted during sepsis. Which of the following change(s) may be observed in a septic or trauma patient? a. Plasma iron levels are noted to decrease b. Plasma copper levels are noted to decrease c. Plasma serum zinc levels may decrease d. Administration of iron is appropriate

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Last Answer : Answer: a, c Changes in the balance of magnesium, inorganic phosphate, zinc, and potassium generally follow alterations in nitrogen balance. Although the iron-binding capacity of transferrin ... concentrations can be ascribed almost entirely to the levels of the ceruloplasmin produced by the liver

The treatment of the following patient should include: a. Initial empiric therapy directed against both aerobes and anaerobes b. The addition of anti-fungal therapy in an elderly patient c. A minimum of two weeks of antibiotic therapy is indicated d. The addition of appropriate antibiotic therapy has made surgical therapy unnecessary in such cases e. Either a single agent or combination therapy is appropriate if the agents selected possess activity against both aerobic and anaerobic bacteria

Description : The treatment of the following patient should include: a. Initial empiric therapy directed against both aerobes and anaerobes b. The addition of anti-fungal therapy in an elderly patient ... therapy is appropriate if the agents selected possess activity against both aerobic and anaerobic bacteria

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The primary route of administration of insulin is: A. Intradermal B. Subcutaneous C. Intramuscular D. Intravenous

Description : The primary route of administration of insulin is: A. Intradermal B. Subcutaneous C. Intramuscular D. Intravenous

Last Answer : B. Subcutaneous

The most appropriate route of administration for adrenaline in a case of anaphylactic shock is: A. Intracardiac B. Intravenous C. Intramuscular D. Subcutaneous

Description : The most appropriate route of administration for adrenaline in a case of anaphylactic shock is: A. Intracardiac B. Intravenous C. Intramuscular D. Subcutaneous

Last Answer : A. Intracardiac

Select the route of administration which carries the highest risk of adversely affecting vital functions: A. Intra arterial injection B. Intrathecal injection C. Intravenous injection D. Intramuscular injection

Description : Select the route of administration which carries the highest risk of adversely affecting vital functions: A. Intra arterial injection B. Intrathecal injection C. Intravenous injection D. Intramuscular injection

Last Answer : C. Intravenous injection

Select the route of administration which carries the highest risk of adversely affecting vital functions: A. Intra arterial injection B. Intrathecal injection C. Intravenous injection D. Intramuscular injection

Description : Select the route of administration which carries the highest risk of adversely affecting vital functions: A. Intra arterial injection B. Intrathecal injection C. Intravenous injection D. Intramuscular injection

Last Answer : C. Intravenous injection

Glyceryl trinitrate is administratered by all of the following routes except (a) Oral (b) Sublingual (c) Intramuscular (d) Intravenous

Description : Glyceryl trinitrate is administratered by all of the following routes except (a) Oral (b) Sublingual (c) Intramuscular (d) Intravenous

Last Answer : Ans: C

Glyceryl trinitrate is administered by the following routes except: A. Oral B. Sublingual C. Intramuscular D. Intravenous

Description : Glyceryl trinitrate is administered by the following routes except: A. Oral B. Sublingual C. Intramuscular D. Intravenous

Last Answer : C. Intramuscular

The following regimen is preferred for nonsurgical termination of pregnancy in the first 7 weeks: A. Intravenous oxytocin infusion B. Intramuscular carboprost C. Intravaginal mifepristone followed by intraamniotic dinoprost D. Oral mifepristone followed by oral misoprostol

Description : The following regimen is preferred for nonsurgical termination of pregnancy in the first 7 weeks: A. Intravenous oxytocin infusion B. Intramuscular carboprost C. Intravaginal mifepristone followed by intraamniotic dinoprost D. Oral mifepristone followed by oral misoprostol

Last Answer : D. Oral mifepristone followed by oral misoprosto

___________ absorption in infants and children is noticeably faster than in neonatal period. a) Oral. b) Topical c) Intravenous. d) Intramuscular.

Description : ___________ absorption in infants and children is noticeably faster than in neonatal period. a) Oral. b) Topical c) Intravenous. d) Intramuscular.

Last Answer : a) Oral. 

A drug (200 mg dose) administered in tablet form and as intravenous injection (50 mg dose) showed AUG of 100 and 200 microgram hr/mL, respectively. The absolute availability of the drug through oral administration is : (A) 125% (B) 250 % (C) 12.5% (D) 1.25%

Description : A drug (200 mg dose) administered in tablet form and as intravenous injection (50 mg dose) showed AUG of 100 and 200 microgram hr/mL, respectively. The absolute availability of the drug through oral administration is : (A) 125% (B) 250 % (C) 12.5% (D) 1.25%

Last Answer : (C) 12.5%

Which of the following statement(s) is/are true concerning the microvascular and cellular response to shock? a. Osmodically induced mobilization of intracellular fluid is the initial response to restore intravascular volume b. With larger volume hemorrhagic shock deterioration of normal cellular transmembrane potential occurs resulting in an increase in extracellular sodium and water c. The accumulation of anaerobic metabolites override normal homeostatic vasomotor tone and contribute to the maladaptive vasodilatation d. Abnormal intracellular calcium homeostasis may contribute to the cellular dysfunction of shock

Description : Which of the following statement(s) is/are true concerning the microvascular and cellular response to shock? a. Osmodically induced mobilization of intracellular fluid is the initial ... d. Abnormal intracellular calcium homeostasis may contribute to the cellular dysfunction of shock

Last Answer : Answer: c, d Moderate hypovolemia results in a relatively rapid spontaneous restitution of intravascular volume through expansion of the plasma space. This plasma expansion by ... potassium pump. Cellular dysfunction also appears to be related to abnormal intracellular calcium homeostasis

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

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

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

Determinants of cerebral blood flow include: A. Preoperative neurologic dysfunction. B. Arterial CO 2 tension. C. Arterial O 2 tension. D. Systemic arterial pressure. E. All of the above.

Description : Determinants of cerebral blood flow include: A. Preoperative neurologic dysfunction. B. Arterial CO 2 tension. C. Arterial O 2 tension. D. Systemic arterial pressure. E. All of the above.

Last Answer : Answer: BCD DISCUSSION: Determinants of cerebral blood flow include arterial CO 2 and O 2 tensions, systemic arterial pressure, and temperature. Other factors that may affect cerebral ... and intracranial pressure are head position, jugular venous obstruction, and positive end-expiratory pressure

All of the following medications should not be used routinely in pregnant patients during the third trimester except (a) Acetaminophen (b) Nonsteroidal anti-inflammatory drugs (c) Warfarin (d) Lithium (e) Aspirin

Description : All of the following medications should not be used routinely in pregnant patients during the third trimester except (a) Acetaminophen (b) Nonsteroidal anti-inflammatory drugs (c) Warfarin (d) Lithium (e) Aspirin

Last Answer : Ans: A

Patients taking chronic doses of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) should periodically be screened for which of the following toxicities? (a) Nephrotoxicity (b) Peripheral neuropathy (c) Cardiotoxicity (d) All of the above (e) None of the above

Description : Patients taking chronic doses of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) should periodically be screened for which of the following toxicities? (a) Nephrotoxicity (b) Peripheral neuropathy (c) Cardiotoxicity (d) All of the above (e) None of the above

Last Answer : Ans: A

Of the following classifications of medications, which is known to inhibit prostaglandin synthesis or release? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses NSAIDs include aspirin and ibuprofen.

Description : Of the following classifications of medications, which is known to inhibit prostaglandin synthesis or release? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses NSAIDs ... to cause immunosuppression. d) Antineoplastic agents Antineoplastic agents are known to cause immunosuppression.

Last Answer : a) Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses NSAIDs include aspirin and ibuprofen.

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

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

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

Which of the following are not determinants of a postoperative cardiac complication? A. Myocardial infarct 4 months previously. B. Clinical evidence of congestive heart failure in a patient with 8.5 gm. per dl. hemoglobin. C. Premature atrial or ventricular contractions on electrocardiogram. D. A harsh aortic systolic murmur. E. Age over 70 years.

Description : Which of the following are not determinants of a postoperative cardiac complication? A. Myocardial infarct 4 months previously. B. Clinical evidence of congestive heart failure in a patient with 8.5 gm ... on electrocardiogram. D. A harsh aortic systolic murmur. E. Age over 70 years.

Last Answer : Answer: B DISCUSSION: Clinical evidence of congestive heart failure in a patient with 8.5 gm. per dl. hemoglobin concentration is a misleading sign. Evidence of congestive ... or ventricular contractions on the electrocardiogram are less strong determinants of a postoperative cardiac complication