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

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
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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 necrosis with patients both with and without protein C deficiency. This syndrome usually involves full thickness skin slough over fatty areas such as the breasts and buttocks. Warfarin therapy should be monitored using the one stage prothrombin time (PT). The PT should be kept at 1.3 to 1.4  control for effective anticoagulation. At higher levels, there is a five-fold increase in the frequency of bleeding complications. Two major complications of Warfarin therapy include recurrent thrombosis and bleeding. It is recommended that Warfarin be continued four months after an initial episode of deep venous thrombosis. Between ten weeks and four to six months after deep vein thrombosis, there is a recurrent thrombosis rate of 8.3 episodes per 1000 patient months. Between four months and three years, recurrences fall to four episodes per 1000 patient-months. At four months, the risks of bleeding complications matches and exceeds the benefit from anticoagulant therapy and thus is the basis for discontinuing warfarin administration at this time
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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

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

Which of the following statement(s) is/are true concerning hemophilia A? a. Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII b. A positive family history for bleeding disorders present in all patients c. Laboratory tests reveal a prolongation of aPTT, prothrombin time (PT), thrombin clotting time and platelet aggregation d. Spontaneous bleeding is unusual with factor VIII levels greater than 10% of normal

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Which of the following statement(s) is/are true concerning methods of nutritional support? a. Optimal results for enteral feedings are achieved with approximately half of calories supplied as carbohydrate and half as fat b. Diarrhea is the most common complication of enteral feeds and is due to the high osmolarity of the carbohydrate components c. The hyperosmolar nature of parenteral fat solutions requires central venous administration d. Approximately 25–50% of calories should be provided as fat emulsion in patients receiving total parenteral nutrition

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Last Answer : Answer: a, b, d Most formulas for enteral feeding range from 1.0 to 2 cal/ml and include 3 to 7% protein. Most of the calories are supplied as glucose or sucrose, so that the solutions ... up to 25 to 50% of calories each day as fat emulsion may optimize the delivery of this caloric delivery

Blood level of which clotting factor declines most rapidly after the initiation of warfarin therapy: A. Factor VII B. Factor IX C. Factor X D. Prothrombin

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Last Answer : A. Factor VII

Which of the following statement(s) is/are true concerning the results of a National Institute of Health Consensus Conference on venous thrombosis and low-dose heparin prophylaxis? a. The odds of developing deep venous thrombosis with low-dose heparin prophylaxis decreases by 67% b. The risk of pulmonary embolism is decreased by almost 50% c. There is no increase in mortality from other causes found in patients treated with low-dose heparin d. There was no difference in the incidence of bleeding complications

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Which of the following statement(s) concerning intravenous nutritional support is/are true? a. Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis b. A major disadvantage of the peripheral technique is limited caloric delivery c. If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein is the most suitable site d. Venous thrombosis is an uncommon complication for long-term central vein catheterization

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

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Laboratory monitoring of coagulation and anticoagulation includes testing of platelet function. Which of the following statements is/are true concerning tests of platelet function? a. A platelet count of 50,000/µL or more usually ensures hemostasis b. Bleeding time assays assessibility of platelets to perform hemostatic plugs and is determined from a sample of blood drawn in an EDTA coated test tube c. Aspirin therapy can be associated with a bleeding time in the range of 8–15 minutes d. Tests of platelet aggregation should be part of the standard preoperative evaluation of patients using aspirin

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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

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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

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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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Von Willebrand’s disease is a common, congenital bleeding disorder. Which of the following statement(s) is/are true concerning Von Willebrand’s disease? a. As in hemophilia, it is much more common in men b. A history of spontaneous bleeding is common c. Screening laboratory tests will include a prolonged aPTT with a normal prothrombin time d. Pre-treatment for elective surgery require administration of cryoprecipitate to achieve levels of 23–50% of normal

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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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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

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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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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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There are a number of hypercoaguable states which can be associated with arterial or venous thrombosis and embolic phenomenon. These include: a. Heparin-associated thrombocytopenia b. Antithrombin III deficiency c. Von Willebrand disease d. Vitamin C deficiency

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Last Answer : Answer: a, b A number of hypercoaguable states are present. These include heparin-associated thrombocytopenia in which a heparin-dependent platelet antibody causes aggregation of ... soft tissue increasing vascular permeability and fragility resulting in the potential for bleeding disorders

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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Last Answer : Answer: a, d Infections due to fungal pathogens have become increasingly common during the past decade, frequently occurring in patients undergoing prolonged hospitalization in the Surgical ... agents should be discontinued until evidence of infection is absolutely controlled or is eradicated

Which of the following statement(s) is/are true concerning the outcome in patients with acute renal failure? a. Mortality for ischemic acute tubular necrosis without other organ failure is approximately 6% b. Multiple organ failure complicated with acute renal failure is associated with mortality ranging from 50% to 90% c. Recovery of renal function after six weeks is unlikely d. There is no difference in survival between oliguric and nonoliguric renal failure

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The following statements are true of oral anticoagulants except: A. They interfere with an early step in the synthesis of clotting factors B. Irrespective of the dose administered, their anticoagulant effect has a latency of onset of 1-3 days C. Their dose is adjusted by repeated measurement of prothrombin time D. They are contraindicated during pregnancy

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Which of the following statement(s) is/are true concerning protein/amino acid metabolism in man? a. The major source of amino acids is breakdown of circulating proteins b. The recommended daily allowance for protein may triple in critically ill patients c. Urinary nitrogen losses will approach 0 in the face of protein starvation d. Negative nitrogen balance refers to a decrease in nitrogen taken into the body versus the amount of nitrogen lost

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Last Answer : Answer: b, d About 15% of the total body weight is made up of proteins, about half of which are intracellular and half extracellular. In man and other animals, dietary protein is the source of ... is exceeded by the amount of nitrogen lost in the urine, stool, skin, wounds, and fistula drainage

Bleeding complications are frequently associated with fibrinolytic therapy. Which of the following statement(s) concerning complications of fibrinolytic therapy is/are true? a. Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications b. A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding c. Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy d. A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal

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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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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

Vitamin K regulates the synthesis of blood clotting factors. (A) VII (B) IX (C) X (D) All of these

Description : Vitamin K regulates the synthesis of blood clotting factors. (A) VII (B) IX (C) X (D) All of these

Last Answer : Answer : D

Vitamin K regulates the synthesis of blood clotting factors: (A) VII (B) IX (C) X (D) All of these

Description : Vitamin K regulates the synthesis of blood clotting factors: (A) VII (B) IX (C) X (D) All of these

Last Answer : Answer : D

The use of antibiotics can be based on either the clinical course of a patient without the benefit of well-defined microbiologic data (empiric therapy), or targeted at specific identified pathogens once sensitivity reports are available (directed therapy). The following statement(s) is/are true concerning these therapies. a. The issue of toxic side effects of antibiotics is only important in dealing with emperic therapy b. Single agent therapy is generally inferior to specific multi-drug therapy (aminoglycoside plus an antianaerobic agent) for the treatment of secondary bacterial peritonitis due to appendicitis, diverticulitis, penetrating gastrointestinal injury, or anastomotic leak c. With the empiric use of antibiotics, a diligent search for the septic source should be undertaken and co

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Last Answer : Answer: c The use of empiric therapy without the benefit of well-defined microbiologic data is appropriate when there is sufficient clinical evidence to support the diagnosis such that it would ... components of the infection if the body site is such that these microorganisms may be present

Which of the following statement(s) is/are true concerning oxygen delivery? a. The amount of oxygen delivered to peripheral tissues is dependent upon the oxygen content in arterial blood and cardiac output b. Oxygen content is commonly measured in arterial blood c. The normal arterial-venous difference is 4 cc O2/dL d. Normal systemic oxygen delivery for a typical adult is approximately 1000 cc/min

Description : Which of the following statement(s) is/are true concerning oxygen delivery? a. The amount of oxygen delivered to peripheral tissues is dependent upon the oxygen content in arterial blood and cardiac ... O2/dL d. Normal systemic oxygen delivery for a typical adult is approximately 1000 cc/min

Last Answer : Answer: a, c, d The amount of oxygen that is delivered to peripheral tissues is the product of the oxygen content in arterial blood times the cardiac output. Normally, oxygen content of arterial blood is ... of venous blood is 16 cc/dL. Hence, the normal arterial-venous difference is 4 cc O2/dL

The following statement(s) is/are true concerning HIV infection. a. Initial screening with ELISA is highly sensitive but can be associated with a false positive rate of 25% b. Treatment with azidothymidine (AZD) appears to prolong survival when administered early in the disease c. Predisposition to infection in HIV infection is primarily due to reduction in the number of helper T cells d. Common infections in patients with AIDS are Pneumocystis, carinii pneumonia, CMV pneumonitis, Cryptococcus meningitis, and disseminated infection due to atypical mycobacteria

Description : The following statement(s) is/are true concerning HIV infection. a. Initial screening with ELISA is highly sensitive but can be associated with a false positive rate of 25% b. ... , carinii pneumonia, CMV pneumonitis, Cryptococcus meningitis, and disseminated infection due to atypical mycobacteria

Last Answer : Answer: b, c, d Acquired immunodeficiency syndrome (AIDS) is a syndrome caused by the human retrovirus (HIV-1) that infects T lymphocytes and causes severe immunosuppression. Individuals who ... to prolong survival when administered early in the course of disease and is considered routine therapy

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

A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ failure. Which of the following statement(s) is/are true concerning necessary changes to be made in his nutritional management? a. Carbohydrate load should be reduced in the face of respiratory failure b. In patients with renal failure, protein intake should be diminished c. During hemodialysis protein intake should be limited to the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Description : A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ ... the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Last Answer : Answer: a, b The most severe complication of sepsis is multiple system organ dysfunction syndrome, which may result in death. The development of organ failure requires changes in the ... should be provided as fat emulsion. If encephalopathy develops, protein load should also be reduced0

Which of the following statements about hypertension in diabetes patients is/are correct? A. Hypertension worsens the macrovascular disease of diabetes patients. B. Hypertension accelerates the progression of diabetic nephropathy. C. Hypertension is associated with sodium retention in diabetes patients. D. Angiotensin-converting enzyme (ACE) inhibitors should be used in all patients with chronic hyperglycemia, regardless of the presence of hypertension. E. Diuretics, as single-drug therapy, are not indicated in the treatment of hypertension in diabetes patients.

Description : Which of the following statements about hypertension in diabetes patients is/are correct? A. Hypertension worsens the macrovascular disease of diabetes patients. B. Hypertension accelerates the ... single-drug therapy, are not indicated in the treatment of hypertension in diabetes patients.

Last Answer : Answer: ABCDE DISCUSSION: All of the answers listed are correct. By damaging endothelial cells, hypertension worsens macrovascular disease in all patients but especially in diabetics. Hypertension ... is not indicated because the chronic state of dehydration in such patients may become worse

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

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

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

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

You are treating a patient of deep vein thrombosis with warfarin. What value of International normalized ratio (INR) will you attempt by adjusting dose of the anticoagulant for an adequate therapeutic effect: A. 1.2 – 1.5 B. 1.3 – 1.7 C. 1.5 – 2.0 D. 2.0 – 3.0

Description : You are treating a patient of deep vein thrombosis with warfarin. What value of International normalized ratio (INR) will you attempt by adjusting dose of the anticoagulant for an adequate therapeutic effect: A. 1.2 – 1.5 B. 1.3 – 1.7 C. 1.5 – 2.0 D. 2.0 – 3.0

Last Answer : D. 2.0 – 3.0

A patient has an episode of hematemesis following streptokinase infused for the treatment of deep vein thrombosis. Which of the following drugs would be most effective in controlling the bleeding episode: A. Vitamin K B. Noradrenaline C. Epsilon aminocaproic acid D. Rutin

Description : A patient has an episode of hematemesis following streptokinase infused for the treatment of deep vein thrombosis. Which of the following drugs would be most effective in controlling the bleeding episode: A. Vitamin K B. Noradrenaline C. Epsilon aminocaproic acid D. Rutin

Last Answer : C. Epsilon aminocaproic acid

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

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

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 statement(s) is/are true concerning the management of a patient with hemophilia A undergoing an elective surgical operation? a. Concentrates of factor VIII should be given several days prior to elective surgery b. The half-life of factor VIII concentrates is less than 24 hours c. A dose of 40–50 IU/kg of factor VIII concentrate should be given prior to the planned surgical procedure d. Factor VIII concentration administration should be given for the first 24 hours after surgery but may then be stopped if no abnormal bleeding has been observed e. A new recombinant preparation of factor VIII offers the advantage of being virus-free

Description : Which of the following statement(s) is/are true concerning the management of a patient with hemophilia A undergoing an elective surgical operation? a. Concentrates of factor VIII should be given ... observed e. A new recombinant preparation of factor VIII offers the advantage of being virus-free

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

Combined therapy with dipyridamole and warfarin is recommended in subjects with the following: A. Risk factors for coronary artery disease B. Prosthetic heart valves C. Cerebral thrombosis D. Buerger's disease

Description : Combined therapy with dipyridamole and warfarin is recommended in subjects with the following: A. Risk factors for coronary artery disease B. Prosthetic heart valves C. Cerebral thrombosis D. Buerger's disease

Last Answer : B. Prosthetic heart valves

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

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

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

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

Which of the following statement(s) is/are true concerning translation of the mRNA message to protein synthesis? a. An adaptor molecule, tRNA, recognizes specific nucleic acid bases and unites them with specific amino acids b. Covalent attachment of tRNA to amino acids is energy dependent c. The formation of a peptide bond between the growing peptide chain and the free amino acid occurs in the free cytoplasm d. Complete protein synthesis takes hours

Description : Which of the following statement(s) is/are true concerning translation of the mRNA message to protein synthesis? a. An adaptor molecule, tRNA, recognizes specific nucleic acid bases and unites them ... and the free amino acid occurs in the free cytoplasm d. Complete protein synthesis takes hours

Last Answer : Answer: a, b The synthesis of protein involves conversion from a four-letter nucleotide language to one of 20 chemically distinct amino acids. This process is referred to as ... translation and be moving down the mRNA molecules simultaneously, thus increasing the rate of protein synthesis

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

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 statement(s) is/are true concerning the antibody response to an invading antigen? a. All antibodies are composed of one type of heavy and one type of light protein chain b. The carboxyl terminus of the heavy chain is the antigen binding site c. Antibody of the immunoglobulin G class is the initial antibody produced in response to an antigenic stimulus d. Immunoglobulins A, D, and E play an active role in the circulating humoral response

Description : Which of the following statement(s) is/are true concerning the antibody response to an invading antigen? a. All antibodies are composed of one type of heavy and one type of light protein chain b. ... stimulus d. Immunoglobulins A, D, and E play an active role in the circulating humoral response

Last Answer : Answer: a Humoral defenses consist of antibody (immunoglobulin; Ig) and complement. All Ig classes (IgM, IgG, IgA, IgE, IgD) and IgG subclasses are composed of one type (M, G, A, E, D ... exist in smaller amounts in the circulation and do not appear to play a major role as host defense components

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