Which of the following statements regarding angiogenesis are true? a. Angiogenesis is a seminal biologic event with clinical relevance limited to its effect upon tumor growth b. C-X-C chemokines regulate angiogenesis c. PF-4 has angiogenic properties d. Sites of atherosclerosis demonstrate chronic angiogenic activity

Which of the following statements regarding angiogenesis are true? a. Angiogenesis is a seminal biologic event with clinical relevance limited to its effect upon tumor growth b. C-X-C chemokines regulate angiogenesis c. PF-4 has angiogenic properties d. Sites of atherosclerosis demonstrate chronic angiogenic activity
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Answer: b, d  An important component of tissue repair and wound healing is the process of angiogenesis. This normal, physiologic process is a local, transient event which is regulated strictly. A biological imbalance in the production of angiogenic and angiostatic factors contributes to the pathogenesis of several angiogenesis-dependent disorders. These include both malignant and nonmalignant disorders such as rheumatoid arthritis, scleroderma, psoriasis, atherosclerosis, and idiopathic pulmonary fibrosis. Persistent neovascularization in these benign disorders is a prerequisite for the perpetuation of fibroproliferation. IL-8 and potentially other C-X-C chemokines are involved with the angiogenesis process. IL-8 is a potent angiogenic factor. In contrast, another member of the C-X-C chemokine family, PF-4 has angiostatic properties. This suggests that the C-X-C chemokines may function as either angiostatic or angiogenic factors, and the biologic balance that is maintained between these factors may govern overall angiogenic potential in a variety of physiological and pathophysiological states
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Cytokines with clearly defined actions in acute inflammation and early tissue injury include which of the following? a. Cysteine-X-Cysteine (C-X-C) chemokines b. Tumor Necrosis Factor (TNFa) c. Transforming Growth Factor-b (TGF-b) d. Interleukin-6 (IL-6) e. Platelet Derived Growth Factor (PDGF)

Description : Cytokines with clearly defined actions in acute inflammation and early tissue injury include which of the following? a. Cysteine-X-Cysteine (C-X-C) chemokines b. Tumor Necrosis Factor (TNFa) c. Transforming Growth Factor-b (TGF-b) d. Interleukin-6 (IL-6) e. Platelet Derived Growth Factor (PDGF)

Last Answer : Answer: a, b, c, d, e Polypeptide mediators, such as TNFa and IL-1, are considered early response cytokines and are actively involved in the initiation of the ... of tissue repair. Thus, coagulation and platelet activation provide the initial foundation for subsequent cellular recruitment

Which of the following statements regarding IL-1 are correct? a. While IL-1 and TNFa share many biologic effects, IL-1 appears to be more potent b. IL-1 expression is in part autoregulated c. IL-1 inhibits prostaglandin production d. The ability of IL-1 to upregulate endothelial cell-neutrophil adhesion molecules is relatively limited

Description : Which of the following statements regarding IL-1 are correct? a. While IL-1 and TNFa share many biologic effects, IL-1 appears to be more potent b. IL-1 expression is in part ... production d. The ability of IL-1 to upregulate endothelial cell-neutrophil adhesion molecules is relatively limited

Last Answer : Answer: b IL-1 and TNFa share many biologic properties. In addition, each potentiates the effects of the other one when given concurrently. Overall, IL-1 alone probably has weaker effects than ... IL-1 provides a key step in the extravasation of leukocytes to sites of local inflammation and injury

Which of the following statements about septic shock are true? A. A circulating myocardial depressant factor may account for the cardiac dysfunction sometimes seen with shock due to sepsis or SIRS. B. A cardiac index (CI) of 6 liters per minute per square meter of body surface, a pulmonary capillary wedge pressure of 15 mm. Hg, and a systemic vascular resistance index (SVRI) of 800 dynes-sec/(cm 5-m 2) is a hemodynamic profile consistent with septic shock. C. An increase in SvO 2 in septic patients may be explained by the finding of anatomic arteriovenous shunts. D. Results of human trials employing antimediator therapy, such as antiendotoxin antibodies, IL-1 receptor antagonist, and tumor necrosis factor (TNF) antibodies, have confirmed animal studies that demonstrate a significant im

Description : Which of the following statements about septic shock are true? A. A circulating myocardial depressant factor may account for the cardiac dysfunction sometimes seen with shock due to sepsis or ... animal studies that demonstrate a significant improvement in survival with the use of such agents.

Last Answer : Answer: AB DISCUSSION: Shock due to sepsis or SIRS frequently manifests as a hyperdynamic cardiovascular response, consisting of an elevated CI and a decreased SVR or SVRI. Occasionally, ... been encouraging thus far in human clinical trials, despite the promising results from many animal studies

Which of the following statements regarding fibroblasts and their function in wound healing are true? a. IL-1 has both inhibitory and promotional effects on fibroblast growth b. TNFa stimulates fibroblast collagen synthesis c. IL-1 and TNFa have opposite effects on the healing of bone d. In human clinical trials, EGF (epithelial growth factor) has been demonstrated to accelerate epidermal regeneration in cutaneous wounds

Description : Which of the following statements regarding fibroblasts and their function in wound healing are true? a. IL-1 has both inhibitory and promotional effects on fibroblast growth b. TNFa ... EGF (epithelial growth factor) has been demonstrated to accelerate epidermal regeneration in cutaneous wounds

Last Answer : Answer: a, d IL-1 appears to be important in the process of normal wound repair. IL-1 has been shown to stimulate skin fibroblast and keratinocyte growth, as well as ... that recombinant EGF enhances keratinocyte migration. EGF is also a potent chemoattractant for granulation tissue fibroblasts

Which of the following belong to the family of C-X-C chemokines? a. IL-8 b. IL-10 c. Growth Related Oncogene-a d. Leukotreine B4 e. b Thromboglobulin

Description : Which of the following belong to the family of C-X-C chemokines? a. IL-8 b. IL-10 c. Growth Related Oncogene-a d. Leukotreine B4 e. b Thromboglobulin

Last Answer : Answer: a, c, e A particularly important group of novel chemotactic cytokines has been elucidated over the last decade. Twelve are known and are listed below. C-X-C ... in vivo cytokine networks involving these molecules which regulate chemotaxis, and other fundamental aspects of inflammation

Which of the following statement(s) is/are true concerning pharmacologic agents used to accelerate wound healing? a. A number of these agents are now currently approved for use in this country b. PDGF (platelet-derived growth factor) promotes fibroblast proliferation, chemotaxis, and collagenase synthesis c. PDGF has been demonstrated in a number of clinical trials to promote healing in chronic wounds d. Growth hormone functions by promoting fibroblast proliferation and collagen synthesis

Description : Which of the following statement(s) is/are true concerning pharmacologic agents used to accelerate wound healing? a. A number of these agents are now currently approved for use in ... healing in chronic wounds d. Growth hormone functions by promoting fibroblast proliferation and collagen synthesis

Last Answer : Answer: b, c Currently there are no approved clinical agents that accelerate normal healing. Although a number of clinical trials are in progress, no agents are currently ... hormone administration significantly accelerates donor site healing, presumably due to its effects in minimizing catabolism

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

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

In the nutritional support of patients with cancer, which of the following statements is/are true? A. Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow. B. In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied. C. Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition. D. Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

Description : In the nutritional support of patients with cancer, which of the following statements is/are true? A. Nutritional support benefits the patient's lean body mass but does not enable ... with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

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

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

Which of the following statements regarding neutrophils are true? a. The neutrophil undergoes final maturation after release into the circulation b. Patients with chronic granulomatous disease have a defective neutrophil H-oxidase system c. Neutrophil killing of bacteria is achieved by oxidants, proteinases and cationic proteins d. The normal human neutrophil circulates in the blood for 7–10 days

Description : Which of the following statements regarding neutrophils are true? a. The neutrophil undergoes final maturation after release into the circulation b. Patients with chronic granulomatous disease have a defective ... proteins d. The normal human neutrophil circulates in the blood for 7-10 days

Last Answer : Answer: b, c The neutrophil is a migratory phagocytic cell that defends the host against bacteria and eliminates necrotic tissue. The neutrophil matures in the bone marrow and is ... phagocytose bacteria, they are unable to kill the intracellular microbes and chronic, unresolved infections result

In contrast to adult wound healing with scar formation, which of the following are characteristic of scarless fetal skin repair? A. Matrix rich in hyaluronic acid. B. Increased inflammatory response. C. Increased production of TGF-b. D. No collagen deposition. E. Minimal angiogenesis.

Description : In contrast to adult wound healing with scar formation, which of the following are characteristic of scarless fetal skin repair? A. Matrix rich in hyaluronic acid. B. Increased inflammatory response. C. Increased production of TGF-b. D. No collagen deposition. E. Minimal angiogenesis.

Last Answer : Answer: AE DISCUSSION: The ability of a fetus to heal without scar formation depends on its gestational age at the time of injury and the size of the wound defect. In ... repair has possible clinical applications in the modulation of adult fibrotic diseases and abnormal scar-forming conditions

Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of the following statement(s) is/are true concerning intracellular receptors? a. The messengers or hormones must by lipophilic b. These intracellular receptors generally regulate protein synthesis c. The intracellular receptors are located entirely in the nucleus of the cell d. A heat-shock protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Description : Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of ... protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Last Answer : Answer: a, d Although most hormone and other messenger receptors are extracellular, intracellular receptors have been identified. The hormone messengers involved for these receptors are primarily ... DNA-binding domain of the receptor. Activation involves the dissociation of the inhibitor protein

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

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

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

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

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

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

A 65-year old patient has colon carcinoma metastatic to the liver and lungs. He has had a weight loss of 10 kg. Cytokine-dependent tumor cachexia is attributable to which of the following? a. Increased glucose uptake and increased glycogen breakdown occur in this circumstance. b. Suppressed activity of lipoprotein lipase results from TNFa c. TNFa stimulates lipolysis d. The differentiation process of pre-adipocytes is impaired e. Partial reversal of differentiated adipocytes to pre-adipocyte morphology and gene expression occurs

Description : A 65-year old patient has colon carcinoma metastatic to the liver and lungs. He has had a weight loss of 10 kg. Cytokine-dependent tumor cachexia is attributable to which of the ... is impaired e. Partial reversal of differentiated adipocytes to pre-adipocyte morphology and gene expression occurs

Last Answer : Answer: a, b, c, d, e Tumor cachexia appears to be mediated by TNFa. Lipopolysaccharide (LPS), as well as other cytokines, activate a variety of inflammatory cells, most ... chronic syndromes of anorexia, weight loss, and cachexia that are associated with both chronic infection and malignancy

Which of the following statements regarding transforming growth factor b (TGF-b) are true? a. TGF-b expression is autoregulated b. TGF-b enhances collagen synthesis c. TGF-b inhibits extracellular matrix production d. TGF-b may inhibit or promote cellular proliferation

Description : Which of the following statements regarding transforming growth factor b (TGF-b) are true? a. TGF-b expression is autoregulated b. TGF-b enhances collagen synthesis c. TGF-b inhibits extracellular matrix production d. TGF-b may inhibit or promote cellular proliferation

Last Answer : Answer: a, b, d TGF-b appears to be one of the key cytokines in control of tissue repair. TGF-b is strongly chemotactic for neutrophils, T cells, monocytes, and fibroblasts. ... TGF-b stimulates the proliferation of densely plated human marrow fibroblasts, but is inhibitory at high concentrations

Platelet activating factor is: a. Generated by the action of phospholipase A2 on membrane phospholipids b. Antiinflammatory in most of its actions c. Synthesized by endothelial and other cells d. Exerts a variety of biologic effects which are platelet-independent

Description : Platelet activating factor is: a. Generated by the action of phospholipase A2 on membrane phospholipids b. Antiinflammatory in most of its actions c. Synthesized by endothelial and other cells d. Exerts a variety of biologic effects which are platelet-independent

Last Answer : Answer: a, c, d Like the eicosanoids, platelet-activating factor (PAF) is not stored in cells but is rapidly produced during inflammation. PAF exerts a variety of biologic effects ... and LTB4. There is considerable overlap and redundancy in the effects produced by PAF and eicosanoids

Products of platelet degranulation include: a. Tumor necrosis factor b. Interleukin-1 c. Transforming growth factor b d. Platelet-derived growth factor

Description : Products of platelet degranulation include: a. Tumor necrosis factor b. Interleukin-1 c. Transforming growth factor b d. Platelet-derived growth factor

Last Answer : Answer: c, d The initial response to injury and disruption of a blood vessel is bleeding. The hemostatic response to this is clot formation to stop hemorrhage. Platelet plug ... . Tumor necrosis factor and interleukin-1 also stimulate fibroblast proliferation, however are produced by macrophages

Appropriate guidelines for the use of TPN in cancer patients include: a. Long-term TPN in patients with rapid progressive tumor growth unresponsive to other therapy b. Mildly malnourished patients undergoing surgery for a curable cancer c. Preoperatively administered TPN prior to surgery or other therapy in patients with severe malnutrition d. Patients in whom treatment toxicity precludes the use of enteral nutrition

Description : Appropriate guidelines for the use of TPN in cancer patients include: a. Long-term TPN in patients with rapid progressive tumor growth unresponsive to other therapy b. Mildly malnourished ... with severe malnutrition d. Patients in whom treatment toxicity precludes the use of enteral nutrition

Last Answer : Answer: c, d As a general rule, the most important factor to consider when making decisions about the use of TPN in patients with cancer is the response of the tumor to antineoplastic ... . Long-term TPN is not indicated with rapidly progressive tumor growth which is unresponsive to such therapy

Which of the following statements about the coagulation cascade is/are true? A. The intrinsic pathway of coagulation is the predominant pathway in vivo for hemostasis and coagulation. B. The intrinsic pathway beginning with the activation of factor XII is the predominant in vivo mechanism for activation of the coagulation cascade. C. Deficiencies of factor VIII and IX cause highly significant coagulation abnormalities. D. Deficiencies of factor XII cause severe clinical bleeding syndromes.

Description : Which of the following statements about the coagulation cascade is/are true? A. The intrinsic pathway of coagulation is the predominant pathway in vivo for hemostasis and coagulation. ... coagulation abnormalities. D. Deficiencies of factor XII cause severe clinical bleeding syndromes.

Last Answer : Answer: AC DISCUSSION: Although it was previously held that two somewhat distinct pathways existed for the activation of the coagulation cascade, it is now recognized that the predominant ... bleeding. This further emphasizes the secondary role that the intrinsic pathway plays in coagulation

Which of the following statements concerning monitoring techniques in the intensive care unit are true? A. Pulmonary artery and pulmonary capillary wedge pressure readings should be made at end inspiration, to minimize ventilatory artifacts. B. Continuous SvO 2 monitoring based on the technique of reflectance spectrophotometry has been shown to be accurate and reliable. C. Direct measurement of gastric intramucosal pH can be provided by gastrointestinal tonometry. D. Hyperlactatemia may be seen in a number of clinical conditions not associated with tissue hypoxia, including liver disease and hypermetabolic states.

Description : Which of the following statements concerning monitoring techniques in the intensive care unit are true? A. Pulmonary artery and pulmonary capillary wedge pressure readings should be made ... clinical conditions not associated with tissue hypoxia, including liver disease and hypermetabolic states.

Last Answer : Answer: BD DISCUSSION: Many different monitoring techniques may be used to assess the adequacy of therapy for shock. The pulmonary artery catheter can provide important hemodynamic and oxygen ... also be seen with liver disease, toxin ingestion, and hypermetabolic states not associated with shock

Which of the following statements regarding TNFa are true? a. TNFa has a marked procoagulant effect b. Passive immunization of patients with neutralizing antibodies to TNFa improves survival from multi-organ system failure c. TNFa upregulates E-selectin expression d. The most potent known stimulus for TNFa production and release is IL-1

Description : Which of the following statements regarding TNFa are true? a. TNFa has a marked procoagulant effect b. Passive immunization of patients with neutralizing antibodies to TNFa improves survival from multi-organ ... expression d. The most potent known stimulus for TNFa production and release is IL-1

Last Answer : Answer: a, c TNFa has a marked procoagulant effect on endothelial cells, precipitating intravascular thrombosis. TNFa causes endothelial cells to release procoagulant activity (tissue factor), ... to produce TNFa, however the most potent stimulus for TNFa production and release is endotoxin

Intensive insulin therapy: A. Prevents the aggressive development of atherosclerosis in diabetic patients. B. Is not associated with unawareness of hypoglycemia. C. Improves peripheral neuropathy. D. Improves established retinopathy and nephropathy. E. Is indicated in all patients with non–insulin-dependent diabetes mellitus (NIDDM).

Description : Intensive insulin therapy: A. Prevents the aggressive development of atherosclerosis in diabetic patients. B. Is not associated with unawareness of hypoglycemia. C. Improves peripheral neuropathy. D. ... . E. Is indicated in all patients with non-insulin-dependent diabetes mellitus (NIDDM).

Last Answer : Answer: C DISCUSSION: Intensive insulin therapy is indicated in patients with IDDM who can actively participate in their own management and the attainment of the goals set for ... or prevents progression of these complications; however, better glucose control may improve peripheral neuropathy

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

Which of the following statements about the presence of gallstones in diabetes patients is/are correct? A. Gallstones occur with the same frequency in diabetes patients as in the healthy population. B. The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient. C. Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk. D. The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer. E. Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and g

Description : Which of the following statements about the presence of gallstones in diabetes patients is/are correct? A. Gallstones occur with the same frequency in diabetes patients as in the ... have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.

Last Answer : Answer: E DISCUSSION: Gallstones have been found to be very prevalent in patients with type II (non-insulin-dependent) diabetes mellitus, perhaps related to the dyslipoproteinemia in ... added mortality associated with it. There is no causal relationship between diabetes and pancreatic cancer

The standard management oral anticoagulant therapy for chronic treatment of venous thromboembolism is with the drug warfarin. Which of the following statement(s) is/are true concerning the administration of warfarin? a. An important complication of warfarin therapy is skin necrosis in patients with protein C deficiency b. Warfarin interferes with vitamin K dependent clotting factors II, VII, IX, X c. For effective anticoagulation the prothrombin time (PT) should be kept at 2 control d. It is recommended that warfarin be continued for at least one year after initial episode of deep venous thrombosis

Description : The standard management oral anticoagulant therapy for chronic treatment of venous thromboembolism is with the drug warfarin. Which of the following statement(s) is/are true concerning the administration ... warfarin be continued for at least one year after initial episode of deep venous thrombosis

Last Answer : Answer: a, b Warfarin interferes with the vitamin K dependent clotting factors II, VII, IX and X, protein C, and protein S. An important complication of warfarin is skin ... the benefit from anticoagulant therapy and thus is the basis for discontinuing warfarin administration at this time

Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema? a. Diuresis and blood transfusion is a valuable step b. Salt-poor albumin leaks through the capillaries and worsens the condition c. Mannitol is contraindicated as a diuretic in this clinical situation d. Isoproterenol is a poor choice as an ionotropic agent

Description : Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema? a. Diuresis and blood transfusion is a valuable step b. Salt-poor albumin leaks through the ... a diuretic in this clinical situation d. Isoproterenol is a poor choice as an ionotropic agent

Last Answer : Answer: a Treatment of pulmonary edema has two important goals, the first is to improve oxygenation if it is impaired, and the second is to minimize fibrosis and bacterial infection, which often ... leaks out , the short term effects of expanding blood volume and decrease in edema will appear

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

Which of the following statement(s) is/are true concerning septic shock? a. The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents b. The circulatory derangements of septic shock precede the development of metabolic abnormalities c. Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance d. Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

Description : Which of the following statement(s) is/are true concerning septic shock? a. The clinical picture of gram negative septic shock is specifically different than shock associated with ... mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

Last Answer : Answer: d The clinical findings in sepsis and septic shock represent the host response to infection. Gram-positive and gram-negative bacteria, viruses, fungi, rickettsiae, and ... intravascular volume, exogenous volume resuscitation must be provided to restore venous return and ventricular filling

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

Description : 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 ... which polymicrobial infection is identified, specifically-directed treatment for the predominant organism is satisfactory

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

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 clinical management of an open wound? a. A wet-to-dry dressing is the most optimal form of wound management b. A moist occlusive dressing promotes epithelialization and reduces pain c. The protein rich plasma exudate covering the open wound facilitates healing d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

Description : Which of the following statement(s) is/are true concerning the clinical management of an open wound? a. A wet-to-dry dressing is the most optimal form of wound management ... wound facilitates healing d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

Last Answer : Answer: b Epithelialization is more rapid under moist conditions than dry conditions. Without dressings, a superficial wound, or one with minimal devitalized tissue forms a scab or ... dysfunction, increases the distance for diffusion from oxygen and nutrient sources to their metabolic targets

Which of the following statements regarding the alternative complement pathway are true? a. C1, C4 and C2 are involved b. NH3 apparently activates complement via this pathway c. Factors B and D are involved d. Endotoxin activates complement via the alternative pathway

Description : Which of the following statements regarding the alternative complement pathway are true? a. C1, C4 and C2 are involved b. NH3 apparently activates complement via this pathway c. Factors B and D are involved d. Endotoxin activates complement via the alternative pathway

Last Answer : Answer: b, c, d The alternative pathway differs from the classic pathway in that the first steps involving C1, C4 and C2 are bypassed. (See Figure 6-3 previously reproduced.) ... been correlated with impaired renal function and the presence of complement components at the sites of renal injury

Which of the following statements regarding the complement system are true? a. Complement activation yields products which are directly cytotoxic as well as products which act indirectly via activated leukocytes b. Complement products referred to as anaphylatoxins include C1, C3a, C4a, and C5a c. The principal role of C5a is in bacterial opsonization d. The alternative and classical pathways converge proximal to generating the membrane attack complex (C5b-9)

Description : Which of the following statements regarding the complement system are true? a. Complement activation yields products which are directly cytotoxic as well as products which act indirectly via activated ... and classical pathways converge proximal to generating the membrane attack complex (C5b-9)

Last Answer : Answer: a, d The complement system is composed of two different but linked sequences, the classic and alternative pathways. The pathways involve serum proteins that act to amplify the inflammatory-immune ... the C5 level proximal to generating the membrane attack complex (C5b-9) (Figure 6-3)

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

Which of the following statements regarding hypercalcemia are true? A. The symptoms of hypercalcemia may mimic some symptoms of hyperglycemia. B. Metastatic breast cancer is an unusual cause of hypercalcemia. C. Calcitonin is a satisfactory long-term therapy for hypercalcemia. D. Severely hypercalcemic patients exhibit the signs of extracellular fluid volume deficit. E. Urinary calcium excretion may be increased by vigorous volume repletion.

Description : Which of the following statements regarding hypercalcemia are true? A. The symptoms of hypercalcemia may mimic some symptoms of hyperglycemia. B. Metastatic breast cancer is an unusual cause of ... fluid volume deficit. E. Urinary calcium excretion may be increased by vigorous volume repletion.

Last Answer : Answer: ADE DISCUSSION: Markedly elevated serum calcium levels produce polydipsia, polyuria, and thirst. Vigorous volume repletion and saline diuresis correct the extracellular fluid volume ... , from bony metastasis. The calcitonin effect on calcium is diminished with repeat administrations

True statements regarding eicosanoids include which of the following? A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway. B. The vasoconstricting, platelet-aggregating, and bronchoconstricting effects of thromboxane A 2 are balanced by the actions of prostacyclin, which produces the opposite effects. C. Leukotriene synthesis is inhibited by the action of nonsteroidal anti-inflammatory drugs (NSAIDs). D. The principal prostaglandins have a short circulation half-life and exert most of their effects locally.

Description : True statements regarding eicosanoids include which of the following? A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway. B. The vasoconstricting, platelet-aggregating, ... prostaglandins have a short circulation half-life and exert most of their effects locally.

Last Answer : Answer: ABD DISCUSSION: The eicosanoids are a group of compounds arising from the metabolism of arachidonic acid. The prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase ... effects and may be involved in the physiologic responses associated with anaphylactic and septic shock

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

A diabetic develops a severe perineal infection with skin necrosis, subcutaneous crepitance, and drainage of a thin, watery, grayish and foul-smelling fluid. Management should consist of: a. Gram stain of the fluid, which will likely demonstrate multiple bacteria including predominantly gram-positive rods b. A CT scan is indicated in a stable patient to define the extent of the disease c. Broad spectrum antibiotics followed with prompt extensive debridement is indicated d. A safe guideline is to resect infected necrotic tissue so that a several centimeter margin of grossly normal, healthy tissue can be achieved e. A colostomy is of little benefit in this situation

Description : A diabetic develops a severe perineal infection with skin necrosis, subcutaneous crepitance, and drainage of a thin, watery, grayish and foul-smelling fluid. Management should consist of: a. Gram stain ... normal, healthy tissue can be achieved e. A colostomy is of little benefit in this situation

Last Answer : Answer: a, b, c, d The presence of severe perineal infection (referred to as Fournier gangrene when this process involves the perineum and scrotum in males) is associated with a ... often provides improved wound care and patient management, although it is not invariably a positive outcome

Which of the following statement(s) describe the effects of aging on wound healing? a. A finer, more cosmetic scar might be expected b. In vitro studies demonstrate decreased proliferative potential of fibroblasts and epithelial cells c. Skin sutures should be left in for a longer period of time d. Wound infection occurs more frequently in elderly patients due to diminished ability to fight infection

Description : Which of the following statement(s) describe the effects of aging on wound healing? a. A finer, more cosmetic scar might be expected b. In vitro studies demonstrate decreased proliferative ... . Wound infection occurs more frequently in elderly patients due to diminished ability to fight infection

Last Answer : Answer: a, b, c There are important age-dependent aspects of wound healing. The elderly heal more slowly and with less scarring. There is a gradual attenuation of the inflammatory ... the sutures. There is no evidence to suggest that wound infections occur more commonly in elderly patients

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

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

Cytokines which play an important role in the metabolic response to injury include: a. Tumor necrosis factor—a (TNF) b. Interleukin-1 (IL-1) c. Interleukin-6 (IL-6) d. Interferon-g

Description : Cytokines which play an important role in the metabolic response to injury include: a. Tumor necrosis factor—a (TNF) b. Interleukin-1 (IL-1) c. Interleukin-6 (IL-6) d. Interferon-g

Last Answer : Answer: a, b, c, d TNF or cachetin is considered the primary mediator of the systemic effects of endotoxin, producing anorexia, fever, tachypnea, and tachycardia at low doses and hypotension, ... infected sells. IFN-g has the ability to upregulate the number of TNF receptors on various cell types

A malignant tumor a) gains access to the blood and lymphatic channels. By this mechanism, the tumor metastasizes to other areas of the body. b) demonstrates cells that are well-differentiated. Cells of malignant tumors are undifferentiated. c) is usually slow growing. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. d) grows by expansion. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

Description : A malignant tumor a) gains access to the blood and lymphatic channels. By this mechanism, the tumor metastasizes to other areas of the body. b) demonstrates cells that are well- ... malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

Last Answer : a) gains access to the blood and lymphatic channels. By this mechanism, the tumor metastasizes to other areas of the body.

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

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

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

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

Which of the following statements regarding whole blood transfusion is/are correct? A. Whole blood is the most commonly used red cell preparation for transfusion in the United States. B. Whole blood is effective in the replacement of acute blood loss. C. Most blood banks in the United States have large supplies of whole blood available. D. The use of whole blood produces higher rates of disease transmission than the use of individual component therapies.

Description : Which of the following statements regarding whole blood transfusion is/are correct? A. Whole blood is the most commonly used red cell preparation for transfusion in the United States. B. ... whole blood produces higher rates of disease transmission than the use of individual component therapies.

Last Answer : Answer: B DISCUSSION: Whole blood is effective as a replacement fluid for acute blood loss because it provides both volume and oxygen-carrying capacity (red blood cells). It is rarely used in the ... the use of packed red blood cells, fresh frozen plasma, and platelets, each from a different donor