Which of the following statement(s) is/are true concerning the cell function of phagocytosis? a. Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes b. Lymphocytes are the primary blood cell involved with this process c. The process involves a coating of the cytoplasmic surface known as clathrin d. Phagocytosis is performed only by white blood cells and tissue macrophages

Which of the following statement(s) is/are true concerning the cell function of phagocytosis? a. Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes b. Lymphocytes are the primary blood cell involved with this process c. The process involves a coating of the cytoplasmic surface known as clathrin d. Phagocytosis is performed only by white blood cells and tissue macrophages
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Answer: a  Phagocytosis is a specialized form of endocytosis by which large particles are internalized by specialized cells primarily macrophages and neutrophils. To be phagocytosed, particles must bind to the surface of the phagocytic cell, usually as the result of specific antibody coating the particle. The phagocytic cell then extends pseudopods which engulf the particle. This event is followed by membrane fusion and a pinching off. As opposed to endocytosis, this process does not involve the membrane protein, clathrin, but rather actin. A physiologically relevant site of phagocytosis is the thyroid gland, where thyroid follicular cells phagocytose and digest thyroglobulin from the lumen of the thyroid follicle, thereby releasing the thyroid hormones, thyroxine triiodothyronine
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The initiation of a humoral immune response involves a complex interaction of the antigen, cells and intercellular messengers. Which of the following statement(s) concerning the initiation of the humoral immune response is/are correct? a. Helper T lymphocytes stimulate B lymphocytes through secretion of cytokines such as interleukin 4 and 6 b. A number of cells can aid in presenting the antigen to the helper T cell including B lymphocytes and macrophages c. All antigens require coordinated efforts of the various cellular components of the immune system d. An antigen must be a living microorganism

Description : The initiation of a humoral immune response involves a complex interaction of the antigen, cells and intercellular messengers. Which of the following statement(s) concerning the initiation of the ... various cellular components of the immune system d. An antigen must be a living microorganism

Last Answer : Answer: a, b Stimulation of the immune system occurs after a variety of antigen-presenting cells (B lymphocytes, macrophages, dendritic cells, and Langerhans cells) act to engulf ... polysaccharides), most antigens require coordinated efforts of the various cellular components of the immune system

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

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

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

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

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

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

Which of the following statement(s) is/are true about the role of macrophages in the wound healing process? a. Macrophages are the dominant cell type during the inflammatory phase of wound healing b. Macrophages are not essential for wound healing c. The macrophage role in wound healing is limited to phagocytosis d. Macrophages are a source of a number of humoral factors essential for wound healing

Description : Which of the following statement(s) is/are true about the role of macrophages in the wound healing process? a. Macrophages are the dominant cell type during the inflammatory phase of wound ... phagocytosis d. Macrophages are a source of a number of humoral factors essential for wound healing

Last Answer : Answer: a, d Within three or four days after injury, macrophages become the dominant cell type in the inflammatory phase of wound healing. The role of macrophages is not limited only ... . These studies confirm the dominant role of the macrophage and the inflammatory phase of wound healing

Cytokines are low-molecular-weight polypeptides exerting a wide variety of biologic effects at both local and systemic levels. Which of the following statement(s) is/are true concerning the production and actions of cytokines? a. Cytokines are produced solely by macrophages b. Cytokines act only on other cells within the same local environment c. Cytokines may have both protective and deleterious effects on the host d. Each specific cytokine is produced by a single cell type

Description : Cytokines are low-molecular-weight polypeptides exerting a wide variety of biologic effects at both local and systemic levels. Which of the following statement(s) is/are true concerning the production and ... effects on the host d. Each specific cytokine is produced by a single cell type

Last Answer : Answer: c Macrophages, endothelial cells, lymphocytes, and other cells secrete a large number of different compounds, termed cytokines, that are most probably evolved for the purpose of ... host defenses, exerting both salutatory and deleterious effects on the host, has become increasingly evident

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

Description : Increasing evidence has implicated gram-negative bacterial lipopolysaccharide (LPS endotoxin) as the portion of the gram-negative bacterial cell membrane responsible for many, if not all the ... host, exerting deleterious effects on the host when excessive amounts reach the systemic circulation

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

Reconstitution of the epithelial barrier (epithelialization) begins within hours of the initial injury. Which of the following statement(s) is/are true concerning the process of epithelialization? a. Bacteria, protein exudate, and necrotic tissue all will compromise this process b. Epithelial cells exhibit contact proliferation c. Epithelialization occurs only from the margins of the wound d. Visible scarring can occur only when the injury extends deeper than the superficial dermis

Description : Reconstitution of the epithelial barrier (epithelialization) begins within hours of the initial injury. Which of the following statement(s) is/are true concerning the process of epithelialization? a. ... d. Visible scarring can occur only when the injury extends deeper than the superficial dermis

Last Answer : Answer: a, d The initial step of epithelialization involves epithelial cells from the basal layer of the wound edge flattening and migrating across the wound, completing wound coverage within 24- ... abrasions and burns may scar significantly. Whenever the dermis is incised, a scar will form

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

The transport of proteins out of the cell is termed exocytosis. Which of the following statement(s) is/are true concerning this process? a. Secretory vesicles fuse with the plasma membrane b. The process can occur in either a constitutive or regulated process c. A regulated secretion is triggered by a stimulus, most likely a hormone or a neurotransmitter d. A decrease in cytoplasmic calcium occurs as part of the secretion process

Description : The transport of proteins out of the cell is termed exocytosis. Which of the following statement(s) is/are true concerning this process? a. Secretory vesicles fuse with the plasma membrane b. ... or a neurotransmitter d. A decrease in cytoplasmic calcium occurs as part of the secretion process

Last Answer : Answer: a, b, c Transport vesicles that bud off the Golgi network carry both material to be secreted from the cell and protein destined to become components of the plasma ... but may also involve generation of diacylglycerol or production of cyclic AMP which activate kinases or phosphatases

Platelets have a wide array of functions in inflammation. Which of the following are among these? a. Synthesis and release of vasoactive eicosanoids b. Release of chemotactic factors c. Adherence to and coating of bacterial and tumor cells d. Increase of vascular permeability e. Phagocytosis of bacteria

Description : Platelets have a wide array of functions in inflammation. Which of the following are among these? a. Synthesis and release of vasoactive eicosanoids b. Release of chemotactic factors c. ... coating of bacterial and tumor cells d. Increase of vascular permeability e. Phagocytosis of bacteria

Last Answer : Answer: a, b, c, d Platelets are anucleated cells derived from megakaryocytes in the bone marrow. Their central role in hemostasis is well known. Platelets possess a wide ... primitive precursor inflammatory cell. Platelets serve primarily as an amplifier or modulator of the inflammatory response

An important step in protein synthesis is transcription. Which of the following statement(s) is/are true concerning this process? a. The first step in gene transcription involves separating the double helix of DNA by an enzyme known as DNA polymerase b. The initial product of DNA transcription is called heterogeneous nuclear RNA which codes directly for proteins c. After processing is complete, the mRNA is exported from the nucleus to the cytoplasm d. Only one protein can be produced from an initial mRNA strand

Description : An important step in protein synthesis is transcription. Which of the following statement(s) is/are true concerning this process? a. The first step in gene transcription involves separating the double helix ... nucleus to the cytoplasm d. Only one protein can be produced from an initial mRNA strand

Last Answer : Answer: c Transcription of a gene begins at an initiation site associated with a specific DNA sequence, termed a promoter region. After binding to DNA, the RNA polymerase opens up a short ... different proteins from the same gene. mRNA is exported from the nucleus only after processing is complete

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

Description : 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 ... effects d. Platelet-activating factor can be released by both circulating and fixed tissue cells

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 water movement across cell membranes? a. Water moves only actively through cell membrane transport proteins b. For most cells of the body, the transmembrane hydrostatic pressure is 0 c. Water distribution is determined entirely by solute distribution d. Specialized cells such as the glomerulus of the kidney actively transport water to maintain hydrostatic pressure

Description : Which of the following statement(s) is/are true concerning water movement across cell membranes? a. Water moves only actively through cell membrane transport proteins b. For most cells of ... cells such as the glomerulus of the kidney actively transport water to maintain hydrostatic pressure

Last Answer : Answer: b, c The energetics of water transport across cell membranes is simplified by the fact that water moves only passively due to gradients of hydrostatic pressure or water ... water is distributed at equilibrium. Water distribution is determined entirely by solute to solute distribution

The following statement(s) is/are true concerning necrotizing fascitis. a. Mortality rates as high as 40% can be expected b. The infection involves only the superficial fascia, sparing the deep muscular fascia c. An impaired immune system is a common factor predisposing to this condition d. The infection is usually polymicrobial e. Necrotizing fascitis is most likely to develop in the face of impaired fascial blood supply

Description : The following statement(s) is/are true concerning necrotizing fascitis. a. Mortality rates as high as 40% can be expected b. The infection involves only the superficial fascia, sparing the deep ... e. Necrotizing fascitis is most likely to develop in the face of impaired fascial blood supply

Last Answer : Answer: a, c, d, e Necrotizing fascitis is an uncommon infection of the deep and superficial fascia that is associated with mortality as high as 40% in many series. ... fulminant and is frequently associated with cellulitis, myositis, fascitis, and bacteremia with attendant high mortality

Which of the following statement(s) is/are true concerning pharmacologic agents used in the treatment of shock? a. The primary difference between dopamine and dobutamine is the absence of significant a adrenergic activity b. The renal and mesenteric vasoconstrictive effects of norepinephrine complicate and sometimes restrict its use c. The apparent paradoxical use of vasodilators, such as nitroprusside, in shock is indicated as a means to augment cardiac function d. Isoproterenol with its potent b-adrenergic effect, is a particularly useful agent in the treatment of all forms of shock

Description : Which of the following statement(s) is/are true concerning pharmacologic agents used in the treatment of shock? a. The primary difference between dopamine and dobutamine is the absence of significant a ... b-adrenergic effect, is a particularly useful agent in the treatment of all forms of shock

Last Answer : Answer: a, b, c Therapeutic adjustments of intravascular volume (preload) and systemic vascular resistance (afterload) form the basis of the treatment strategies for all ... careful constant monitoring of arterial pressure and repeated hemodynamic measurements with a pulmonary artery catheter

Antithrombin III deficiency is a commonly observed hypercoaguable state. Which of the following statement(s) is/are true concerning this condition? a. A patient with this deficiency usually presents with thrombosis while on heparin or exhibits an inability to become adequately anticoagulated with heparin b. This deficiency may be either congenital or acquired c. Thrombotic episodes are related to predisposing events such as operations, childbirth, and infections d. Treatment involves acutely the administration of fresh frozen plasma followed by long-term treatment with Coumadin

Description : Antithrombin III deficiency is a commonly observed hypercoaguable state. Which of the following statement(s) is/are true concerning this condition? a. A patient with this deficiency usually ... involves acutely the administration of fresh frozen plasma followed by long-term treatment with Coumadin

Last Answer : Answer: a, b, c, d Antithrombin III deficiency accounts for about 2% of venous thrombotic event. This deficiency has been described in patients with pulmonary embolism, mesenteric venous ... is established, fresh frozen plasma should be administered followed by long-term treatment with Coumadin

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

Description : A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He ... use of moderate doses of inotropic agents e. Afterload reduction with nitroprusside is absolutely contraindicated

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

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

There are two properties of the cell necessary to maintain nonequilibrium cellular composition; the first is selectivity and the second is energy conversion. Which of the following statement(s) is/are true concerning energy converting transport? a. The site of energy conversion and transport in the plasma membrane involves the phospholipid component b. The Na+-K++-ATPase derives energy from hydrolysis of extracellular ATP c. In some systems, energy inherent in the transmembrane ion gradient can be used to drive transport of a second species d. Examples of species transported via secondary active transport include hydrogen ions, calcium, amino acids and glucose

Description : There are two properties of the cell necessary to maintain nonequilibrium cellular composition; the first is selectivity and the second is energy conversion. Which of the following statement(s ... transported via secondary active transport include hydrogen ions, calcium, amino acids and glucose

Last Answer : Answer: c, d The selectivity of the plasma membrane, although impressive, cannot account for the nonequilibrium composition of living cells. A cell can be maintained in a nonequilibrium state only by ... to drive the transport of a second species such as protons, calcium, amino acids, or glucose

Cell regulation can be thought of as the effector side of cell communication. Most commonly cell regulation occurs by means of extracellular chemical messengers. Which of the following statement(s) is/are true concerning these messengers? a. Paracrine regulation involves a messenger which is produced and acts systemically b. The extracellular signal or stimulus is received by a receptor on or in the target cell c. Neurocrine regulation depends on a physical connection between the neuron and the target cell d. Most hormones, local mediators, and neurotransmitters readily cross the cell plasma membrane

Description : Cell regulation can be thought of as the effector side of cell communication. Most commonly cell regulation occurs by means of extracellular chemical messengers. Which of the following statement(s ... d. Most hormones, local mediators, and neurotransmitters readily cross the cell plasma membrane

Last Answer : Answer: b, c Depending on how the extracellular messenger arrives, cell regulation can be classified as paracrine, endocrine, or neurocrine. In paracrine regulation, a chemical messenger ... , local mediators, and neurotransmitters are water-soluble and cannot readily cross the plasma membrane

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

Interleukin-6 is recognized as the cytokine primarily responsible for the alteration in hepatic protein synthesis recognized as the acute phase response. Which of the following statement(s) is/are true concerning acute phase protein response to surgical stress? a. Glucocorticoid hormones inhibit this response b. Proteins such as albumin and transferrin which serve in serum transport are generally increased in this response c. Examples of acute phase proteins include fibrinogen and C-reactive protein d. In general, the physiologic role of acute phase proteins are to reduce the systemic effects of tissue damage

Description : Interleukin-6 is recognized as the cytokine primarily responsible for the alteration in hepatic protein synthesis recognized as the acute phase response. Which of the following statement(s) is/are true ... physiologic role of acute phase proteins are to reduce the systemic effects of tissue damage

Last Answer : Answer: c, d IL-6 is now recognized at the cytokine primarily responsible for the alteration in hepatic synthesis recognized as the acute phase response. Glucocorticoid hormones augment ... that generally inhibit the tissue destruction that is associated with the local initiation of inflammation

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

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

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

Which of the following statements regarding endothelial cells in acute inflammation are true? a. Endothelial cells are characterized by phenotypic homogeneity b. Specific patterns of receptor expression regulate leukocyte adherence c. Endothelial cell nitric oxide generation regulates regional blood flow and leukocyte adhesion d. Endothelial cells may be capable of phagocytosis

Description : Which of the following statements regarding endothelial cells in acute inflammation are true? a. Endothelial cells are characterized by phenotypic homogeneity b. Specific patterns of receptor expression ... blood flow and leukocyte adhesion d. Endothelial cells may be capable of phagocytosis

Last Answer : Answer: b, c, d Endothelial cells are increasingly recognized to be phenotypically heterogeneous. Specific receptor molecules are expressed at various sites where they help to direct lymphocytes and ... rather, they possess the ability to direct and focus many aspects of an inflammatory event

There are a multitude of various dressings available. Which of the following statement(s) is/are true concerning options for surgical dressings? a. Hydrocolloids, such as karaya compounds, offer the primary advantage of increased absorptive ability b. Films, such as Op-site, provide a water impermeable environment to achieve a dry wound c. Impregnates are fine gauze impregnated with a variety of substances such as antibiotics or moisturizing agents that adhere tightly to the wound and do not require a secondary dressing d. Absorptive powders and paste are highly useful in debriding necrotic and fibrous material from wounds and absorbing wound serum

Description : There are a multitude of various dressings available. Which of the following statement(s) is/are true concerning options for surgical dressings? a. Hydrocolloids, such as karaya compounds, offer ... are highly useful in debriding necrotic and fibrous material from wounds and absorbing wound serum

Last Answer : Answer: a, d Although the simplest dressing of gauze and tape combined with the use of antibacterial ointment can achieve moist wound healing in most patients. A multitude of other ... agents have high absorbency for tissue wound fluid and debride necrotic and fibrous material from the wound

Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition? a. Glutamine is an essential amino acid b. Glutamine appears to be of primary benefit in critical illness c. Glutamine is included in most standard TPN solutions d. Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

Description : Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition? a. Glutamine is an essential amino acid b. Glutamine appears to be of primary ... . Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

Last Answer : Answer: b Glutamine is the most studied gut-specific nutrient. Glutamine has been classified as a nonessential or nutritionally dispensable amino acid since glutamine can be synthesized in adequate ... . In contrast to glutamine, short chain fatty acids are primary energy source for colonocytes

Which of the following statement(s) is/are true concerning the multiorgan failure syndrome (MOFS)? a. Changes in the splanchnic and pulmonary microcirculation are critical to the development of MOFS b. Tissue fixed microphages, including the liver Kupffer cell, have little role in the development of MOFS c. MOFS represents systemic consequences of loss of homeostatic control of local inflammation and microcirculatory hypoperfusion d. The nature of MOFS is highly dependent upon the etiology of the underlying problem

Description : Which of the following statement(s) is/are true concerning the multiorgan failure syndrome (MOFS)? a. Changes in the splanchnic and pulmonary microcirculation are critical to the development of MOFS ... d. The nature of MOFS is highly dependent upon the etiology of the underlying problem

Last Answer : Answer: a, c The nature of multiorgan failure syndrome (MOFS) is that of a diffuse cellular injury, developing systemically as a consequence of losing homeostatic control of local ... of microorganism. In noninfectious cases, the response also appears independent of the specific underlying cause

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

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

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

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

Description : Thrombolytic therapy has become a useful adjunct in the management of peripheral arterial occlusion. In this setting, direct intraarterial administration rather than intravenous has been advocated ... may be indicated for situations where complete clot evacuation cannot be accomplished surgically

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

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

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

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

Fatty acids are a major energy source for the body. Which of the following statement(s) is/are true concerning the use of fatty acids as an energy source? a. Fatty acids are stored in adipocytes as triglycerides b. Hormone-sensitive lipase is present only in adipose tissue c. Fatty acids are released into the circulation traveling freely in plasma d. Approximately 25% of total nonprotein caloric needs supplied via total parenteral nutrition should be in the form of fat

Description : Fatty acids are a major energy source for the body. Which of the following statement(s) is/are true concerning the use of fatty acids as an energy source? a. Fatty acids are stored in ... 25% of total nonprotein caloric needs supplied via total parenteral nutrition should be in the form of fat

Last Answer : Answer: a, b, d In most tissues, fatty acids are readily oxidized for energy. They are especially important energy sources for the heart, liver and skeletal muscle. In ... administered to patients receiving total parenteral nutrition should comprise about 5-30% of total nonprotein caloric needs

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 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

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

Description : Infectious disease transmission during blood transfusions is of clinical significance to surgeons and of major importance to patients contemplating surgery potentially associated with the need for ... transmission in blood transfusions is significantly less than the risk of hepatitis transmission

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

Which of the following statement(s) is/are true concerning 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 statement(s) is/are true concerning the cell plasma membrane? a. The plasma membrane is composed of amphipathic molecules b. The hydrophobic core of the lipid bilayer of the cell membrane contains specialized transport proteins which maintain the intracellular ionic milieu different from the extracellular fluid c. Plasma membrane proteins extend externally and bear phospholipid moieties which contribute to the cell coat d. The membrane proteins of nerve cells are highly voltage-dependent

Description : Which of the following statement(s) is/are true concerning the cell plasma membrane? a. The plasma membrane is composed of amphipathic molecules b. The hydrophobic core of the lipid bilayer of the ... contribute to the cell coat d. The membrane proteins of nerve cells are highly voltage-dependent

Last Answer : Answer: a, b, d The plasma membrane defines the boundary of the cell and serves to contain and concentrate enzymes and other macromolecule constituents. The plasma membrane is ... and bear carbohydrate moieties primarily as oligosaccharide chains that contribute to the cell coat or glycocalyx

Which of the following statement(s) is/are true concerning cell membrane receptors? a. The largest family of cell surface receptors are the G-protein-linked receptors b. Activities of the G-protein involve binding and hydrolysis of ATP c. The G protein receptor generates an intracellular messenger commonly through the use adenylate cyclase d. Tyrosine kinase receptors are considered G-protein-linked receptors

Description : Which of the following statement(s) is/are true concerning cell membrane receptors? a. The largest family of cell surface receptors are the G-protein-linked receptors b. Activities of the ... through the use adenylate cyclase d. Tyrosine kinase receptors are considered G-protein-linked receptors

Last Answer : Answer: a, c All water-soluble regulatory molecules bind to the cell surface receptor proteins. Binding of the appropriate ligand evokes an intracellular signal which usually regulates ... are adenylate cyclase, which converts ATP to cAMP, and the polyphosphoinositide-specific phospholipase C

A 17-year-old patient involved in an automobile accident is paralyzed with multiple peripheral extremity injuries. Nutritional support is instituted with a transnasal feeding catheter. Which of the following statement(s) is/are true concerning the patient’s management? a. Feeding into the stomach results in stimulation of the biliary/pancreatic axis which is probably trophic for small bowel b. Gastric secretions will dilute the feedings increasing the risk of diarrhea c. The major risk in this patient is tracheobronchial aspiration d. Placement of the feeding catheter through the pylorus into the first portion of the duodenum reduces the risk of regurgitation and aspiration

Description : A 17-year-old patient involved in an automobile accident is paralyzed with multiple peripheral extremity injuries. Nutritional support is instituted with a transnasal feeding catheter. Which of the ... pylorus into the first portion of the duodenum reduces the risk of regurgitation and aspiration

Last Answer : Answer: a, c, d The use of transnasal feeding catheters for intragastric feeding or for duodenal intubation are popular adjuncts for providing nutritional support by the enteral route. The ... the fourth portion of the duodenum reduces the risk of regurgitation and aspiration of feeding formulas

The following statement(s) is/are true concerning initial microbiologic diagnostic techniques. a. Appropriate expeditious transport of specimens to the microbiology laboratory is essential for obtaining accurate clinical information b. The use of potassium hydroxide in preparing a specimen slide for light microscopy will be useful in identification of anaerobic bacteria c. Antibiotic sensitivity is determined by exposing the specific microorganism to varying amounts of antibiotic with the concentration of the antibiotic inhibiting growth referred to as the MIC (minimal inhibitory concentration) d. Serum levels of antimicrobial agents should achieve in excess of a 4-to 8-fold increase over the MIC to be considered clinically efficacious.

Description : The following statement(s) is/are true concerning initial microbiologic diagnostic techniques. a. Appropriate expeditious transport of specimens to the microbiology laboratory is essential for obtaining accurate ... a 4-to 8-fold increase over the MIC to be considered clinically efficacious.

Last Answer : Answer: a, c, d Because most surgical infections are polymicrobial, specimens should be cultured for aerobic and anaerobic bacteria, as well as fungi. Although aerobic and aerotolerant ... fold increase over MIC during the peak serum level have been demonstrated to be clinically efficacious

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

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

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

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

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

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

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

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

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

Which of the following statement(s) is/are true concerning 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 wound contraction? a. Wound contraction accounts for similar rates of reduction of wound size regardless of their location b. The fibroblast, at the cellular level, is the primary force driving wound contraction c. Excessive wound contraction, when occurring over a joint, may lead to disability d. Actin microfillaments are found in fibroblasts and may play a role in wound contracture

Description : Which of the following statement(s) is/are true concerning wound contraction? a. Wound contraction accounts for similar rates of reduction of wound size regardless of their location b. The fibroblast ... d. Actin microfillaments are found in fibroblasts and may play a role in wound contracture

Last Answer : Answer: b, c, d Wound contraction is an important event which contrasts healing open wounds and closed incisions. When open wounds contract, the surrounding skin is pulled over the open wound ... number in contracting wounds and are felt to play an active role in the process of wound contraction

Which of the following statement(s) is/are correct concerning cell junctions? a. The major occluding junction is the tight junction or zonula occludens b. Tight junctions are usually located near the basal pole of the cell c. Desmosomes are button-like points of attachment which serve to weld together adjacent cells d. Gap junctions are a type of cell junction specialized for cell communication

Description : Which of the following statement(s) is/are correct concerning cell junctions? a. The major occluding junction is the tight junction or zonula occludens b. Tight junctions are usually located near ... adjacent cells d. Gap junctions are a type of cell junction specialized for cell communication

Last Answer : Answer: a, c, d Cell junctions are classified as occluding, anchoring, and communicating. The major occluding junction is the tight junction or zonula occludens which connects ... gap junction which is specialized for communication. This junction mediates both electrical and chemical coupling

Which of the following statement(s) is/are true concerning DNA? a. DNA is contained only in the nucleus of the cell b. DNA strands are encoded by the sequence of four bases—adenine, guanine, cytosine and uridine c. The basic unit of information of DNA is the intron, a sequence of three bases d. There are an infinite number of possible codons

Description : Which of the following statement(s) is/are true concerning DNA? a. DNA is contained only in the nucleus of the cell b. DNA strands are encoded by the sequence of four bases-adenine, guanine, cytosine ... DNA is the intron, a sequence of three bases d. There are an infinite number of possible codons

Last Answer : Answer: a The genetic blueprint of an organism is carried in the nucleus of every cell, encoded by the sequence of four bases-adenine, guanine, cytosine and thymine, which together make up ... codons. Sixty-one of these code for amino acids and three are termination signals called stop codons

Which of the following statement(s) is/are true concerning the assessment of protein reserve? a. Conventional serum proteins such as albumin and globulin are early indicators of malnutrition b. The total lymphocyte count reflects immune status and not nutrition c. Antigen skin testing reflects patient immunity and not nutrition d. Measurement of urea excretion in urine can be used as a measurement of protein breakdown

Description : Which of the following statement(s) is/are true concerning the assessment of protein reserve? a. Conventional serum proteins such as albumin and globulin are early indicators of malnutrition b. The ... d. Measurement of urea excretion in urine can be used as a measurement of protein breakdown

Last Answer : Answer: d Since protein is the functional and structural chemical of the body, most nutritional assessment techniques are estimates of protein reserves. The actual nitrogen balance can ... patients convert from reactive to anergic, and reactivity can be restored by nutritional repletion

Antibacterial agents can be classified with regard to their structure, mechanism of action, and activity pattern against various types of bacterial pathogens. Which of the following statement(s) is/are true concerning antimicrobial classes? a. Penicillins and cephalosporins share the compound structure of a b-lactam ring which binds to bacterial division plate proteins b. Tetracyclines and macrolides such as erythromycin inhibit bacterial ribosomal activity and therefore protein synthesis c. Aminoglycosides act in a similar fashion to tetracyclines and therefore are both bacteriostatic d. Sulfonamides and trimethoprim act synergistically to inhibit purine synthesis

Description : Antibacterial agents can be classified with regard to their structure, mechanism of action, and activity pattern against various types of bacterial pathogens. Which of the following ... are both bacteriostatic d. Sulfonamides and trimethoprim act synergistically to inhibit purine synthesis

Last Answer : Answer: a, b, d Penicillins, cephalosporins, and monobactams possess a b-lactam ring of some type and act to bind bacterial division plate proteins, thus inhibiting cell wall ... act in different mechanisms to inhibit protein synthesis, therefore two agents in combination act synergistically

Which of the following statement(s) is/are true concerning excessive scarring processes? a. Keloids occur randomly regardless of gender or race b. Hypertrophic scars and keloid are histologically different c. Keloids tend to develop early and hypertrophic scars late after the surgical injury d. Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound closed by secondary intention

Description : Which of the following statement(s) is/are true concerning excessive scarring processes? a. Keloids occur randomly regardless of gender or race b. Hypertrophic scars and keloid are histologically different ... scar can be useful in certain situations such as a wound closed by secondary intention

Last Answer : Answer: d True keloids are uncommon and occur predominantly in dark skinned people with a genetic predisposition for keloid formation. In most cases, the gene appears to be ... subside. Hypertrophic scars usually develop within the first month after wounding and often subside gradually

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

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

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