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

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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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 have a very high osmolarity. Cramps or diarrhea can result when these high osmolar solutions are placed into the stomach or intestine. Diarrhea is the major complication with most tube feeding formulas. Diarrhea can be minimized by the use of starch or fat as an energy source in tube feedings. This can be supplied as part of the commercial preparation or added in the form of medium chain triglycerides or other oils. The best results are usually achieved by supplying approximately half the calories as carbohydrate and half as fat. In patients receiving total parenteral nutrition, energy source is provided as carbohydrate, fat, and amino acid solutions. Parenteral feeding with carbohydrate is limited by the sclerotic effect of hyperosmolar solutions on veins. Fat is a more efficient energy source and can be given through peripheral veins in concentrations of either 10 or 20%. Most intensivists favor supplementing standard total parenteral nutrition solution with intravenous fat to provide at least 100 grams of fat emulsion each week to preclude fatty acid deficiency. Giving up to 25 to 50% of calories each day as fat emulsion may optimize the delivery of this caloric delivery
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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

Description : 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 ... suitable site d. Venous thrombosis is an uncommon complication for long-term central vein catheterization

Last Answer : Answer: b Although peripheral access can be used for intravenous nutrition, the major disadvantage of this technique is limited caloric delivery to meet catabolic demands within tolerated fluid ... studies that use phlebography or radionucleotide venography indicate the incidence is as high as 35%

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 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

Description : 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 ... feeding catheter should be placed at the time of surgery for postoperative enteral feeding

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

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

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

Essential fatty acid deficiency may complicate total parenteral nutrition (TPN). Which of the following statements are true? A. Essential fatty acid deficiency may be prevented by the administration of 1% to 2% of total calories as fat emulsion. B. Fat-free parenteral nutrition results in the appearance of plasma abnormalities, indicating essential fatty acid deficiency, within 7 to 10 days of initiation. C. An abnormal plasma eicosatrienoic-arachidonic acid ratio is always associated with essential fatty acid deficiency. D. Following initiation of fat-free parenteral nutrition, dry, scaly skin associated with a maculopapular rash indicates essential fatty acid deficiency.

Description : Essential fatty acid deficiency may complicate total parenteral nutrition (TPN). Which of the following statements are true? A. Essential fatty acid deficiency may be prevented by the ... , dry, scaly skin associated with a maculopapular rash indicates essential fatty acid deficiency.

Last Answer : Answer: BD DISCUSSION: Biochemical evidence of essential fatty acid deficiency may occur as early as 7 to 10 days following initiation of fat-free parenteral nutrition. The decrease in ... essential to the diagnosis of essential fatty acid deficiency, but this plasma abnormality is often present

A 16-year-old boy suffers a mid-gut volvulus with massive loss of small intestine. Which of the following statement(s) is/are true concerning his nutritional requirements and management? a. If at least 18 inches of residual small intestine survives, the patient may tolerate some form of enteral nutrition b. A nutritional regimen consisting of supplemental glutamine, growth hormone, and a modified high carbohydrate, low fat diet may be beneficial in this patient c. The regimen described above may decrease the cost of care d. TPN needs will increase after discontinuation of growth hormone

Description : A 16-year-old boy suffers a mid-gut volvulus with massive loss of small intestine. Which of the following statement(s) is/are true concerning his nutritional requirements and management? a. If ... above may decrease the cost of care d. TPN needs will increase after discontinuation of growth hormone

Last Answer : Answer: a, b, c Prior to the availability of TPN, most patients developing short bowel syndrome from either surgery or catastrophic event died. In selected patients, however, with ... the growth hormone did not increase TPN needs in patients once they had undergone successful gut rehabilitation

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

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

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

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

Description : 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 ... use of TPN better prepares the patient for surgery if surgical intervention proves necessary

Last Answer : Answer: a, b, d Patients with gastrointestinal-cutaneous fistulas represent the classical indication for TPN. In such patients, oral intake of food almost invariably results in increased ... treated more aggressively surgically after a defined period of nutritional support (unless closure occurs)

Answer: e The role of nutritional support in the cancer patient remains an important component of overall therapy. Preoperative nutritional support should be given only to those patients who do not require an emergency operation and who have severe weight loss (> 15% of pre-illness body weight) and a serum albumen < 2.9 mg%. Preoperative nutrition (enteral or parenteral) should not be given for longer than 7 to 10 days. Enteral nutrition is always the preferred route of feeding cancer patients if the GI tract is functional. There are several benefits of using the bowel lumen for nutrient delivery. The trophic effects of enteral feeding on small bowel mucosa have been well described. The integrity of the mucosal lining is maintained and it may provide an effective barrier to intraluminal

Description : Answer: e The role of nutritional support in the cancer patient remains an important component of overall therapy. Preoperative nutritional support should be given only to those patients who ... of bowel rest; this atrophy is not reversed by currently available total parenteral nutrition solutions

Last Answer : Which of the following hormones can be expected to be released as part of the stress response? a. Antidiuretic hormone (ADH) b. Aldosterone c. Insulin d. Epinephrine nswer: a, b, d ... This hormone has the exact opposite effect of insulin, which promotes glucose storage and uptake by the cells

It is stated that enteral nutrition is safer than parenteral nutrition. Which of the following may be complications of enteral nutrition? A. Hyperosmolar, nonketotic coma. B. Vomiting and aspiration. C. Pneumatosis cystoides intestinalis. D. Perforation and peritonitis.

Description : It is stated that enteral nutrition is safer than parenteral nutrition. Which of the following may be complications of enteral nutrition? A. Hyperosmolar, nonketotic coma. B. Vomiting and aspiration. C. Pneumatosis cystoides intestinalis. D. Perforation and peritonitis.

Last Answer : Answer: ABCD DISCUSSION: It is not necessarily true that enteral nutrition is safer than parenteral nutrition, and it may in fact be associated with a higher risk of death than parenteral ... be prevented by judicious use of enteral nutrition with the same care one uses for parenteral nutrition

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

Glucose overload results in increased CO 2 production. Which of the following statements are true? A. In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated. B. In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose. C. In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding. D. CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support.

Description : Glucose overload results in increased CO 2 production. Which of the following statements are true? A. In patients with respiratory insufficiency, administration of glucose as a principal calorie ... who are supported by respirators in intensive care units and are receiving nutritional support.

Last Answer : Answer: C DISCUSSION: Few papers have excited as much interest as that by Askanazi, Kinney, and co-workers, which demonstrated that glucose calories given to patients with severe respiratory ... the caloric requirement and glucose for the remainder, without much fear of excessive CO 2 production

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

Description : 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 ... treated with low-dose heparin d. There was no difference in the incidence of bleeding complications

Last Answer : Answer: a, b, c In a metaanalysis of 70 randomized trials in 16,000 patients comparing low-dose heparin prophylaxis with standard therapy, the odds of developing deep venous thrombosis ... Similarly, the effectiveness of prophylaxis was not influenced by either two or three times daily dosage

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

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

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

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

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

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

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

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 the role of the gut in shock and sepsis are true? A. Selective decontamination of the digestive tract with the use of oral antibiotics has been shown to reduce nosocomial pneumonias and to improve mortality rates. B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus architecture of the gut. C. Gut dysfunction may be an effect of shock, but it may also contribute to the development of MODS by the mechanism of bacterial translocation. D. As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.

Description : Which of the following statements about the role of the gut in shock and sepsis are true? A. Selective decontamination of the digestive tract with the use of oral antibiotics has been ... As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.

Last Answer : Answer: BCD DISCUSSION: The gut has a vital role in the pathophysiology of shock. The splanchnic circulation is very vulnerable to the circulatory redistribution that occurs in shock, thus, gut ... , enteral feeding is more cost effective and is associated with a lower rate of septic morbidity

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

Description : 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 ... is unlikely d. There is no difference in survival between oliguric and nonoliguric renal failure

Last Answer : Answer: a, b, c Survival of patients with acute renal failure is a function of the successful treatment of the primary disease from which the renal failure was derived. The mortality ... is unlikely. Nonoliguric renal failure is usually limited in its extent and is almost always reversible

Answer: b Metabolic response to injury results in increased energy expenditure. If energy intake is less than expenditure, oxidation of body fat stores and erosion of lean body mass will occur with resultant loss of weight. When weight loss exceeds 10–15% of body weight, the complications of malnutrition interact with disease processes, with increased morbidity and mortality rates. The goal of nutritional support is maintenance of body cell mass and limitation of weight loss to less than 10% preinjury. The major impact of nutritional support in the trauma patient is to aid host defense. Under-nutrition may compromise the available host defense mechanism and may thus increase the likelihood of invasive sepsis, multiple organ system failure, and death. Resuscitation, oxygenation and arrest

Description : Answer: b Metabolic response to injury results in increased energy expenditure. If energy intake is less than expenditure, oxidation of body fat stores and erosion of lean body mass will occur ... requirements, caloric requirements should be distributed at a ratio of 70% as glucose and 30% as fat

Last Answer : Which of the following statement(s) is/are true concerning body fuel reserves? a. The largest fuel reserve in the body is skeletal muscle b. Fat provides about 9 calories/gram c. Free glucose and glycogen stores are a trivial fuel reserve d. Body protein is a valuable storage form of energy

Which of the following statement(s) is/are true concerning O2 venous saturation monitoring? a. The normal saturation of mixed venous blood is 50% b. Mixed venous blood obtained for saturation monitoring can be obtained from any peripheral vein c. If arterial blood is fully saturated, the saturation of mixed venous blood is 80% d. In less than fully saturated blood, the difference between arterial and venous saturation corresponds to oxygen extraction

Description : Which of the following statement(s) is/are true concerning O2 venous saturation monitoring? a. The normal saturation of mixed venous blood is 50% b. Mixed venous blood obtained ... than fully saturated blood, the difference between arterial and venous saturation corresponds to oxygen extraction

Last Answer : Answer: c, d The relationship between oxygen delivery and oxygen consumption is reflected in the amount of oxygen in venous blood. Under normal circumstances, oxygen delivery is 1000 ... and venous saturation corresponds to the oxygen extraction, hence the oxygen delivery/oxygen consumption ratio

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

Description : 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 ... -treatment for elective surgery require administration of cryoprecipitate to achieve levels of 23-50% of normal

Last Answer : Answer: c, d Von Willebrand's factor is an adhesive protein that mediates platelet adhesion to collagen. In addition, it protects and prevents the rapid removal of factor VIII ... platelet aggregation responses to ristocetin. The most reliable source of Von Willebrand's factor is cryoprecipitate

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

Description : 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 ... suggest a dosage reduction in immunosuppressive agents until the infection can be adequately controlled

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 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

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

Altering the amino acid profile in total parenteral nutrition solutions can be of benefit in certain conditions. Which of the following conditions are associated with a benefit by supplementation with the amino acid type listed? a. Acute renal failure and essential amino acids b. Hepatic failure and aromatic amino acids c. Short gut syndrome and glutamine d. Chronic renal failure and essential amino acids

Description : Altering the amino acid profile in total parenteral nutrition solutions can be of benefit in certain conditions. Which of the following conditions are associated with a benefit by supplementation with the ... c. Short gut syndrome and glutamine d. Chronic renal failure and essential amino acids

Last Answer : Answer: a, c In a number of conditions, altering the amino acid profile of the total parenteral nutrition solution can be of benefit. TPN with amino acids of high biologic value ... Glutamine-enriched TPN partially attenuates villous atrophy and may be useful in treatment of short gut syndrome

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

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

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

Although TPN has major beneficial effects to the patient and specific organ systems, TPN has a downside which is related to intestinal disuse. Which of the following statement(s) is/are true concerning the effects of TPN on the GI tract? a. Patients receiving TPN have an accentuated systemic response to endotoxin challenge compared to enterally fed volunteers b. TPN can result in disruption of intestinal microflora c. In experimental models, bacterial translocation from the gut is increased d. Effects of TPN on the gut may lead to multiple organ failure

Description : Although TPN has major beneficial effects to the patient and specific organ systems, TPN has a downside which is related to intestinal disuse. Which of the following statement(s) is/are true concerning the ... from the gut is increased d. Effects of TPN on the gut may lead to multiple organ failure

Last Answer : Answer: a, b, c, d A number of studies have examined the effects of TPN on intestinal function and immunity. Although most of these studies have been done in animal models, ... the release of bacteria and/or cytokines leading to pronounced systemic responses and possibly multiple organ failure

Transfusions of blood products can be associated with a number of complications including immediate and delayed hemolytic reactions; nonhemolytic reactions; infectious disease transmission; and complications of massive transfusions. Which of the following statements are true concerning complications of blood transfusions? a. Immediate hemolytic transfusion reactions are caused by major ABO blood group incompatibility b. Nonhemolytic transfusion reactions are usually due to RH incompatibility and are therefore more common in women of childbearing age c. The most common complication of massive blood transfusion is dilutional thrombocytopenia d. Routine impaired calcium supplementation is necessary during most massive transfusion episodes

Description : Transfusions of blood products can be associated with a number of complications including immediate and delayed hemolytic reactions; nonhemolytic reactions; infectious disease transmission; and ... d. Routine impaired calcium supplementation is necessary during most massive transfusion episodes

Last Answer : Answer: a, c Immediate hemolytic reactions are usually caused by blood group ABO incompatibility although they may be caused by antigens of other blood group systems ... when associated with massive transfusion during complex intraoperative procedures such as thoracoabdominal aneurysm resection

The most important intervention in the nutritional support of a patient with a burn injury is to provide adequate nutrition and calories to: a) decrease catabolism. The most important intervention in the nutritional support of a patient with a burn injury is to provide adequate nutrition and calories to decrease catabolism. Nutritional support with optimized protein intake can decrease the protein losses by approximately 50%.

Description : The most important intervention in the nutritional support of a patient with a burn injury is to provide adequate nutrition and calories to: a) decrease catabolism. The most important intervention ... the energy source is seen after a burn injury; interventions are instituted to decrease catabolism.

Last Answer : a) decrease catabolism. The most important intervention in the nutritional support of a patient with a burn injury is to provide adequate nutrition and calories to decrease catabolism. Nutritional support with optimized protein intake can decrease the protein losses by approximately 50%.

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

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

Description : The use of prophylactic antibiotics has become commonplace. Which of the following statement(s) is/are true concerning the prophylactic use of antibiotics? a. The appropriate use of prophylactic ... d. The topical use of antimicrobial agents is of no advantage in the prophylactic setting

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

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

Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock c. Arterial vasoconstriction affects all vascular beds equally d. The total circulating blood volume is equally split between the arterial and venous system

Description : Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. ... d. The total circulating blood volume is equally split between the arterial and venous system

Last Answer : Answer: a Central in the general cardiovascular response to shock is the action of the heart itself. The principle determinants of cardiac function in the normal heart are the volume of blood ... Blood flow to the skin is sacrificed early, followed by that to the kidneys and splanchnic viscera

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

Sepsis causes a marked metabolic response. Which of the following statement(s) is/are true concerning the metabolic response to sepsis? a. Oxygen consumption is increased in the face of infection b. In a patient with a maximal metabolic rate secondary to trauma, the presence of infection will increase the rate further c. Metabolic rate increases at a rate of approximately 10% for each increase of 1°C in central temperature d. The extent of increase in oxygen consumption relates to the severity of the infection

Description : Sepsis causes a marked metabolic response. Which of the following statement(s) is/are true concerning the metabolic response to sepsis? a. Oxygen consumption is increased in the face of infection ... d. The extent of increase in oxygen consumption relates to the severity of the infection

Last Answer : Answer: a, c, d Oxygen consumption is usually elevated in the infected patient. The extent of this increase is related to the severity of the infection, with peak elevations reaching 50% ... suggest that the metabolic rate increases 10% to 13% for each elevation of 1°C in central temperature

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

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

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

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

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

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

Which of the following venous access devices can be used for no more than 30 days in patients requiring parenteral nutrition? a) Non-tunneled catheter The subclavian vein is the most common vessel used because the subclavian area provides a stable insertion site to which the catheter can be anchored, allows the patient freedom of movement, and provides easy access to the dressing site.

Description : Which of the following venous access devices can be used for no more than 30 days in patients requiring parenteral nutrition? a) Non-tunneled catheter The subclavian vein is the most common vessel used because the ... term home IV therapy (eg, Port A Cath, Mediport, Hickman Port, P.A.S. Port).

Last Answer : a) Non-tunneled catheter The subclavian vein is the most common vessel used because the subclavian area provides a stable insertion site to which the catheter can be anchored, allows the patient freedom of movement, and provides easy access to the dressing site.

A 67-year-old male presents with an intraabdominal abscess secondary to perforated sigmoid diverticulitis. The following statement(s) is/are true concerning his intraabdominal abscess. a. Culture will likely reveal a solitary organism b. Both aerobic and anaerobic islets are encountered in 50% of specimens c. The most common aerobic islet will be likely E. coli and other gram-negative enteric bacilli d. The most common anaerobic islet will be a Bacteroides species

Description : A 67-year-old male presents with an intraabdominal abscess secondary to perforated sigmoid diverticulitis. The following statement(s) is/are true concerning his intraabdominal abscess. a. Culture will ... gram-negative enteric bacilli d. The most common anaerobic islet will be a Bacteroides species

Last Answer : Answer: b, c, d Typically an intraabdominal infection results in perforation of a hollow viscus and the ensuing contamination of a normally sterile peritoneal cavity. The normal ... Bacteroides species (especially B. fragilis, Clostridium), and anaerobic cocci are most consistently isolated

A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following statements is/are true? A. This formulation is proposed for the use of patients with fulminant hepatitis. B. Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours. C. The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy. D. In some studies of surgical patients, improvements in mortality have been reported.

Description : A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following ... D. In some studies of surgical patients, improvements in mortality have been reported.

Last Answer : Answer: D DISCUSSION: The use of modified amino acid solutions is based on the false neurotransmitter hypothesis of the cause of hepatic coma. According to this hypothesis, the imbalance ... in a group of patients with cirrhosis, decreasing morbidity and showing a trend toward decreased mortality

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

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

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

Which of the following statement(s) is/are true concerning the remodeling phase of wound healing? a. Total collagen content increases steadily through this phase b. The normal adult ratio of collagen is approximately 4:1 of type I to type III collagen. c. Eventually a scar will achieve the strength of unwounded skin d. The proteoglycans are responsible for the ground substance of the extracellular matrix

Description : Which of the following statement(s) is/are true concerning the remodeling phase of wound healing? a. Total collagen content increases steadily through this phase b. The normal adult ratio ... unwounded skin d. The proteoglycans are responsible for the ground substance of the extracellular matrix

Last Answer : Answer: b, d The transition from the proliferative phase to the remodeling phase of wound healing is defined by reaching collagen equilibrium. Collagen accumulation within the wound becomes maximal by ... in strength for six months or more, eventually reaching 70% of the strength of unwounded skin

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

Fibrinolytic therapy is based on activation of plasminogen, the inactive proteolytic enzyme of plasma that binds to fibrin during the formation of thrombosis. Activation of plasminogen to plasmin results in selective thrombolysis at the fibrin clot surface. Which of the following statement(s) is/are true concerning agents used in thrombolytic therapy? a. Streptokinase is a bacterial protein which is antigenic in humans, resulting in allergic reactions in up to l5% of cases b. Tissue plasminogen activator acts directly on plasmin without an intermediate drug–plasmin complex c. The half-life of urokinase, streptokinase, and TPA all exceed 30 minutes d. Streptokinase is significantly cheaper than urokinase or TPA

Description : Fibrinolytic therapy is based on activation of plasminogen, the inactive proteolytic enzyme of plasma that binds to fibrin during the formation of thrombosis. Activation of plasminogen to plasmin results ... TPA all exceed 30 minutes d. Streptokinase is significantly cheaper than urokinase or TPA

Last Answer : Answer: a, b, d Streptokinase is a bacterial protein produced by group C b-hemolytic streptococci. It is therefore antigenic in humans and can be associated with allergic reaction in ... one agent over the other. Streptokinase however, is markedly less expensive than either urokinase or TPA

Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. Severe thrombocytopenia (platelet count less than 100,000) is seen in less than 10% of patients treated with heparin c. Heparin-associated thrombocytopenia is due to the aggregation of platelets and may result in thrombosis or embolic episodes d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Description : Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. ... d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Last Answer : Answer: b, c Heparin-associated thrombocytopenia occurs in 0.6% to 30% of patients who receive heparin, although severe thrombocytopenia (platelet counts less than 100,000) is seen in ... as coating on pulmonary artery catheters or low rate infusion into arterial catheters may cause this syndrome

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

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

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

Which of the following is true of loss of gastrointestinal secretions? A. Gastric losses are best replaced with a balanced salt solution. B. Potassium supplementation is unnecessary in replacement of gastric secretions. C. Bicarbonate wasting is an unusual complication of a high-volume pancreatic fistula. D. Balanced salt solution is a reasonable replacement fluid for a small bowel fistula. E. A patient with persistent vomiting usually requires hyperchloremic replacement fluids.

Description : Which of the following is true of loss of gastrointestinal secretions? A. Gastric losses are best replaced with a balanced salt solution. B. Potassium supplementation is unnecessary in ... bowel fistula. E. A patient with persistent vomiting usually requires hyperchloremic replacement fluids.

Last Answer : Answer: DE DISCUSSION: Gastric secretions are relatively high in chloride and potassium. Other than an isolated pancreatic fistula, gastrointestinal tract losses below the pylorus ... Although potassium concentrations are low, copious losses require potassium supplementation to prevent hypokalemia