In contrast to a patient undergoing an elective operation, which of the following statement(s) is/are true concerning a patient who has suffered a multiple trauma? a. Basal metabolic rates are similar b. The patient is highly sensitive to insulin c. Utilization of the amino acids, glutamine and alanine, is similar to their composition in skeletal muscle d. Fat and protein stores are rapidly depleted

In contrast to a patient undergoing an elective operation, which of the following statement(s) is/are true concerning a patient who has suffered a multiple trauma? a. Basal metabolic rates are similar b. The patient is highly sensitive to insulin c. Utilization of the amino acids, glutamine and alanine, is similar to their composition in skeletal muscle d. Fat and protein stores are rapidly depleted
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Answer: b, d  The degree of hypermetabolism is generally related to the severity of injury. Patients with long-bone fractures have a 15–25% increase in metabolic rate, whereas metabolic rates in patients with multiple injuries increases by 50%. These metabolic rates in trauma patients are contrasted with those in postoperative patients, who rarely increase their BMR by more than 10–15% following operation. Studies have shown that uninjured volunteers are able to dispose of exogenous glucose load much more readily than injured patients. Other studies have demonstrated a failure to suppress hepatic glucose production in trauma patients during glucose loading or insulin infusion. Thus, profound insulin resistance occurs in injured patients. Skeletal muscle is the major source of nitrogen that is lost in the urine following extensive injury. Although it is recognized that amino acids are released by muscle in increased quantities following injuries, it has only been recently appreciated that the composition of amino acid reflux does not reflect the composition of muscle protein. The release is skewed towards glutamine and alanine, each of which comprise about one-third of the total amino acids released by skeletal muscle. To support hypermetabolism, stored triglyceride is mobilized at an accelerated rate. Although mobilization and use of free fatty acids are accelerated in injured subjects, if unfed, severely injured patients rapidly deplete their fat and protein stores
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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

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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

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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

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

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Increased serum alanine during fasting is due to (A) Breakdown of muscle proteins (B) Decreased utilization of non essential amino acids (C) Leakage of aminoacids to plasma (D) Impaired renal function

Description : Increased serum alanine during fasting is due to (A) Breakdown of muscle proteins (B) Decreased utilization of non essential amino acids (C) Leakage of aminoacids to plasma (D) Impaired renal function

Last Answer : Answer : A

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

Description : 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) ... hepatectomy for hepatoma d. TPN is of no benefit in patients undergoing bone marrow transplant

Last Answer : Answer: a, c Numerous clinical trials have failed to yield a consensus with regard to the efficacy of TPN in cancer patients. In 1991, a multicenter VA cooperative trial demonstrated ... patients receiving bone marrow transplantation has also been shown to be a valuable component of overall care

It has been suggested that enterocyte-specific fuels be utilized for all patients receiving parenteral nutrition. Theoretically, the benefits of such fuels include: A. Glutamine increases gut mucosal protein content and wall thickness. B. Butyrate increases jejunal mucosal protein content and wall thickness. C. The short-chain fatty acids—butyrate, propionate, and acetate—are useful in supporting ileal mucosal protein content and thickness. D. The use of glutamine-enriched solutions for parenteral nutrition for patients with chemotherapy toxicity or radiation enteritis is without hazards.

Description : It has been suggested that enterocyte-specific fuels be utilized for all patients receiving parenteral nutrition. Theoretically, the benefits of such fuels include: A. Glutamine increases ... parenteral nutrition for patients with chemotherapy toxicity or radiation enteritis is without hazards.

Last Answer : Answer: NONE IS ENTIRELY TRUE DISCUSSION: The use of enterocyte-specific fuels is part of a new and potentially exciting phase of nutritional pharmacology in parenteral nutrition; ... the maintenance of colonocyte-specific nutrition and, in the case of butyrate, ileal enterocyte nutrition

The following statement(s) is/are true concerning newer detection methods of systemic infection. a. Enzyme-linked immunosorbent assay (ELISA) is a rapid immunologic assay used for both antigen and antibody detection b. Southern, northern, and western immunoblot techniques are used to detect DNA, RNA, or proteins, respectively c. Polymerase chain reaction (PCR) is a sensitive assay used to detect small amounts of microbial DNA, thus detecting infection at its early stages d. Infectious agents currently detected using advanced molecular techniques include cytomegalovirus (CMV) and human immunodeficiency virus (HIV)

Description : The following statement(s) is/are true concerning newer detection methods of systemic infection. a. Enzyme-linked immunosorbent assay (ELISA) is a rapid immunologic assay used for ... detected using advanced molecular techniques include cytomegalovirus (CMV) and human immunodeficiency virus (HIV)

Last Answer : Answer: a, b, c, d Although the classic detection of infection based on clinical signs of infection and bacterial culture remain the most common clinical tools, increasing ... including CMV and HIV. Furthermore, preliminary investigations into possible detection of fungal pathogens are underway

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

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

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

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

The 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 metabolic effects may be observed in patients with sepsis? a. Increased gluconeogenesis b. Accelerated proteolysis c. Increased lipolysis d. Impaired gut metabolism of glutamine

Description : Which of the following metabolic effects may be observed in patients with sepsis? a. Increased gluconeogenesis b. Accelerated proteolysis c. Increased lipolysis d. Impaired gut metabolism of glutamine

Last Answer : Answer: a, b, c, d A number of metabolic responses to sepsis have been defined. Glucose production is increased in infected patients which appears to be additive to the ... metabolism of lipids from peripheral fat stores is especially prominent during a period of inadequate nutritional support

The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues? A. Central nervous system. B. Skeletal muscle. C. Bone. D. Kidney. E. Tissue in the healing wound.

Description : The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues? A. Central nervous system. B. Skeletal muscle. C. Bone. D. Kidney. E. Tissue in the healing wound.

Last Answer : Answer: ADE DISCUSSION: Glucose is produced in increased amounts to satisfy the fuel requirements of the healing wound. In addition, nerve tissue and the renal medulla also utilize this substrate. Skeletal muscle primarily utilizes fatty acids, and bone utilizes mineral substrate

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

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

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

Which of the following statements regarding the transmission of infectious agents through blood transfusions is/are true? A. The transmission rates for human immunodeficiency virus (HIV) have been decreasing progressively since the early 1980s. B. The transmission rates of hepatitis have been decreasing steadily since the 1980s. C. Cytomegalovirus (CMV) is the infectious agent most commonly transmitted in blood. D. Severely immunocompromised patients (such as patients undergoing transplantation) should receive specially screened blood products.

Description : Which of the following statements regarding the transmission of infectious agents through blood transfusions is/are true? A. The transmission rates for human immunodeficiency virus (HIV) ... patients (such as patients undergoing transplantation) should receive specially screened blood products.

Last Answer : Answer: ABCD DISCUSSION: The incidence of both HIV and hepatitis transmitted via blood transfusions has been steadily decreasing since the 1980s. This is related to improved ... , severely compromised patients such as those undergoing transplantation should receive CMV-negative blood products

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

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

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

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

The following statement(s) is/are true concerning viral infections. a. The most common post-transplantation viral infections are caused by herpes viruses and include CMV and herpes simplex virus b. Viral infections occur at equal frequency anytime during the post-transplantation period c. CMV infection in the post-transplant patient is most likely a pulmonary process d. Herpes simplex virus (HSV) infection primarily presents with a mononucleosis-type syndrome with fever, lethargy, and cough

Description : The following statement(s) is/are true concerning viral infections. a. The most common post-transplantation viral infections are caused by herpes viruses and include CMV and herpes simplex virus ... HSV) infection primarily presents with a mononucleosis-type syndrome with fever, lethargy, and cough

Last Answer : Answer: a, c, Solid organ transplant patients are prone to develop viral infection by virtue of exogenous immunosuppression. The most common post-transplantation viral infections are those ... transplant patient or as painful herpes zoster in patients who have previously developed chicken pox