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Shifting

1. In hemostasis, what is considered as an initial response to injury?

- vasoconstriction

2. Which of the ff subs causes vasodilatation?

- prostacycline - epinephrine

- serotonin - Thromboxane 2

3. Which of the ff injury is least likely to stop bleeding?

- obliquely incised branchial artery- completely transected radial artery

- avulsed venules in gastrocnemius area

- completely transected popliteal artery

4. What is the normal lifespan of platelets?

- 7 10 days

5. What is the main reason why injured veins may remain open and

continue to bleed?

- thin muscular layer

6. What is considered initial platelet reaction to injury?

- adhesion

7. Which of the ff prevents platelet clump together?

- prostaglandin

8. Which of the ff is least likely to be a property of an amorphous

platelt plug?

- not affected by heparin

- fibrinogen is required

- irreversible

- stronger platelet plug

9. What zymogen is activated that starts the cascade in the common

pathway of coagulation?

- Prothrombin

10. What group of factors needs a carboxyl group to their glutamic

acid residues for them to be effective coagulation factors?

- F 2,7, 9, 10

11. What is the MC manifestation of transfusion reaction

- oliguria

12. What is the oldest mechanical method of hemostatis and is also

considered the least __ hemostat?

- Digital pressure

13. what surgical procedure is least likely to develop leeding due to

release of activated plasminogen?

- modified radical mastectomy

14. A patient with deep vein thrombosis was given regular heparin

at 80 units kg bw, ___ was maintained on heparin drip. What test of

coag will you request to determine if the therapeutic level of

heparin is reached?

- partial thromboplastin time

15. A patient who underwent aortic valve replacement was given

coumarin at 5 mg OD, what can you request to monitorthe effects of

coumadin of the patient?

- prothrombin time w/ INR

16. What anticoagulant results in the synthesis of dysfunctional

prothrombin, stable factor, antihemophilic factor and stuart power

factor?

- warfarin

17. what anticoag catalyzes the action of anti-thrombin III on F2?

- Heparin

18. After cardiopulmonary bypass, what subs is given to reverse the

action of heparin?

- protamine sulfate

19. What is the treatment for patients with idiopathic

thrombocytopenic purpura?

- prednisone

20. a 24 yo F G1P0 noted absence of fetal movements 1 wk ago, she

was noted to have epistaxis, UGIB platelet count of 40 000/ mm3.

What is most likely dx?

- consumptive coagulopathy due to dead fetus

21. What is considered as MC abnormality of hemostasis?

- thrombocytopenia

22. What platelet pathology is asso in patient w/ portal hpn due toschistosomiasis?

- thrombocytopenia due to platelet destruction

23. What clinical feature distinguishes classic hemophilia from

hemophilia B?

- hemarthrosis - pattern of transmission

- age of onset of bledding - none

24. What complica of classic hemophilia acounts for of mortality?

- intracranial bleeding

25. What coomon char orthopedic problem is assoc w/ classic

hemophilia?

- hemarthrosis

26. Which of the ff coagulation defect is autosomal dominant?

- Von Willebrands disease

27. Which of the ff situation is streptokinase is least likely beneficial?

- thrombolysis of deep v thrombosis in a patient post knee

replacement

- in situ thrombosis of the L lower ext

- myocardial infarction

- acute pulmonary embolism

28. Where is Vit K synthesized and absorbed?

- SI

29. What is the end product of coag cascade?

- fibrin

30. A patient w/ pancreatic head tumor, w/ acholic stool & tea

colored urine, will undergo surgery. What can you give this patient

to minimize the risk of bleeding?

- Vit K

31. What plasminogen activator is most efficient and is non

antigenic?

- urokinase

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32. Which of the ff condition is least likely to cause elevation of

plasminogen levels in the blood?

- 100% O2 saturation of an extremity

33. What intrinsic F causes the activation of plasminogen to

plasmin?

- F2

34. Which of the ff congenital hemostatic defect is char by

platelet destruction?

- Wiscott-aldrich syndrome - bernard-souier syndrome-von willebrand disease - hereditary thrombocytopenia

35. What is the blood component is cheapest and readily avail F8

replacement but has lowest [ ] of F8?

- Fresh frozen plasma

36. The integrity of the cell is compromised. The maintenance of cel

membrane potential and volume is impaired. The main F resp is?

- activity of the membrane NaK-ATPase pump slows

37. The imperical initial treatment of any patient in any form of

shock are the ff except

- secure airway - maintain circ

- adequate breathing - identify duration and degree of shock state

38. In a hemorrhaging patient, the loss of how many % circulating

volume will produce obvi__ and symptoms (mild tach, anxiety)

- 15 25%

39. In cardiogenic shock, the ff are treatment options for

documented profound cardiac dysfucntion EXCEPT:

- inotrophic support w/ dopamine & dobutamine

- use of mech support (intra, aortic, ballon pump)

- early coronary re vascularization

- liberal use and infusion of fluids to regain volume loss

40. The ff is/are diff factors w/c support diagnosis of septic shock?

- episode severe infection- sevre vasodilatation of vessels due to isoform Nitric Oxide synthase

rendering it resistant to the effects of vasoconstructing agents

- warm extremities despite hypotension

- all of the above

41. The classic description of neurogenic shock consists of the ff

except?

- BP w/ bradycardia

- warm extremities

- motor and sensory deficits

- radiographic evidence of vertebral and lung parenchymal injury

42. Which is true regarding to neurogenic shock?

- admin of vasoconstrictors will improve peripheral vascular tone- admin of vasoconstrictors should only be considered once

hypovolemia is excluded and dx of neurogenic shock established

- it implies loss of vasoconstrictor impulses w/ inc vascular

capacitance, venous return, and CO

-all

43. Neurogenic shock is usually secondary to spinal cord injuries.

The pathophysio involves:

- anatomic disruption of sympa regulation of peripheral vasc tone

- sympa input to the heart is disrupted w/ the loss of heart rate

and cardiac contract

- there is loss of typical reflexive tachycardia that occurs w/

hypovolemia

-all

44. In obstructive shock, the main pathophysio is mech obstruction

of venous return in trauma patients. In tension pneumothorax,

which is not true?

- involved hemithorax has positive pressure due to continous leak of

air from parenchyma or airway

- intrathoracic pressure causes the shift of the mediastinal

structure to the contralateral hemithorax- the mediastinal shift causes the heart to twist in its axix, thereby

causing obstruction of the venous return to the heart

- tension pneumothorax is best diagnosed w/ a chest x ray

45. Findings that are sufficient to make a dx of tension

pneumothorax except

- lung sounds

- hypertympany of the involved hemithorax on percussion

- hypertension

- hypotension

46. True of cardiac tamponade

- accum of fluid in pericardial sac to restrict blood entrance to the R

ventricle- manifestation of cardiac tamponade are always of total circ

collapse

- patient will have flat neck veins

- becks triad is always present and readily appreciated

47. The ff procedures may relieve cardiac tamponade

, except?

- pericardiocentesis

- tube thoracostomy

- pericardial window

- pericardiotomy

48. Which procedure may relieve tension pneumothorax

- needling- pericardiocentesis

- corfirm w/ an chest x ray

- volume resuscitation

49. As cellular ATP is depleted under hypoxic conditions the ff occurs

- Na accumulates intracellularly while K leaks into EC space

- Net gain of IC Na is accompanied by gain in IC water and

development of cellular swelling

- the resulting swelling causes rupture of diff IC organeles leading

to cell death and necrosis

50. Which describes the immune and inflam response

- the immune response to shock encompasses the elaboration of

mediators w/ only proinfla properties- the exagerated immune response is advantagous to restoring

homeostasis

- if excessive, the immune response may promote cellular and organ

repair

- it is responsible for the development of ARDS, MODS and post

traumatic intussuception that can prolong recovery.

51. The ff are features of inflam phase of wound healing, except:

- this phase is marked by loss of fucntion of the wounded area, as

well as pain, redness and swelling

- This phase lasts a finite length of time of approximately 4 days in

primary intention healing

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- this phase is marked by an increased rate of collagen synthesis

from fibroblasts

- In this pahse, neutrophil phagocytosis aids in the removal of clot,

bacteria and other debris from the wound

52. The stages of wound healing in order are:

- proliferative phase, substrate phase, remodeling phase

- fibrin phase, remoeling phase, inflammatory phase

- substrate phase, proliferative phase, remodeling phase

- connective tissue regeneration involves contraction

53. Which of the ff is INCORRECT, regarding stages of wound

healing?

- the 1st phase is inflam or reactive phase

- the most importsant cell in the prolif pahse is neutrophil

- the remodeling phase can take place b/w 6 wks to 2 yrs

- connective tissue regeneration involves contraction

54. Collage most abundant in prolif stage of wound healing?

- Type III

55. Which of the ff statement is false?

- a laceration refers to an intact skin over a crash injury

- a contusion is a bruise without a break in the skin

- an abrasion is a superficial removal of skin- an avulsion refers to a total or partial removal of tissue

56. All of the ff impair wound healing EXCEPT?

- smoking

- immunosupression

- hyperntsion

- vitamin A

57. Maximum tensile strenght of wound is reach on the?

- 40th 50th day

58. Mechanism of wound healing whreby keratocytes migrate abd

then divide to surface partial thickness loss of skin or mucosa?

- epithelialization

59. The cytokine present in wound healing that stimulate epithelial

cell and fibroblast prolif and granulation tissue formation

- EGF (epidermal growth factor)

60. With regards to keloids and hypertrophic scars, the ff statements

are true?

- hypertrophic scars outgrow their original border

61. All of the ff are contraindications to primary wound closure

except?

- too much tension on the wound

- animal/ human bites

- < 6 hrs post injury- Infection

62. Which of the ff is true regarding leg ulcers

- venous ulcer are common over the medial malleolus

63. Which of the ff is not indicated for the management of

chronologically contaminated wounds?

- freq dressing change

- systemic antibiotics

- debridement

- final closure w/ skin graft or flap

64. Incorrent in tretament of human bites?

- debride wound, cleanse thoroughly

- culture the wound

- broad spectrum antibiotics

- suturing the wound

65. Not a component of an ideal ulcer dressing?

- improved aesthetics

- Immobilization

- Absorption

- compression

66. A patient has chronic ulcer loc on the lower L leg, over medial

malleolus. It is moderately painful with some relief when elevated.

This ulcer is most likely of which type?

- Venous ulcer67. Human bite injuries in the hand are treated with irrigation,

exploration and debridement, G +/- culture as well a broad spectrum

antibiotic coverage. In addition, the ff tretament?

- Tetatnus, if no immunization in the last 10 yrs, Clavulinic acid, 2ry

closure

68. A 19 yo man went to emergency room after a fist fight, early

sunday AM bec of laceration over his knuckles. Most approp tx?- clean, do not suture, give antibitics and tetanus booster

69. Bacterial toxin present in local wound envt?

- host cell pdxn of matrix metalloproteases

70. An ICU pt presented w/ infection w/c lead to gangrene of subcu

tissue and subsequent necrois of more superficial layers. He was dx

w/ necrotizing fascitis?

- beta hemolytic strep

71. All of the ff are true of cellulitis except?

- MC org are staph aureus and BH strep

- erythema w/ sharply demarcated borders are present

- Can lead to ascending lymphagitis- Often occurs secondary to trauma

72. 1st cll to arrive at injury site?

- neutrophil

73. At 3 months the tensile wound strenght is what percent of final

strenght?

- 80%

74. TGF-B is involved in

- organization of extracellular matrix, scar remodelling and wound

contracture

75. All of the ff are char of aminoglycosides, except?- active against broad spectrum of G aerobves

- emergence of resistant bacterial strain does not occur

- narrow margin b/w therapeutic and toxic levels

- nephrotoxic

76. antibiotic that disrups membrane barrier fxn?

- Amphoterecin B

77. Antibiotics that disrupts ribosomal PRO synthesis

- aminoglycosides

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78. A 30 yo M pt has an elective herniorrhaphy. On 2nd post op day

he develops excruciating pain over the wound and a thin, brown,

foul smelling discharge. He is tachycardic w/ high fever. G strain of

exudate shows G + drumstick

- clostridium welchii

79. The ff decribe the effects of advanced aging in wound healing,

except?

- the scar appears to be finer

- the fibroblasts have lost their proliferative potential in vitro studies

- skin suture should be removed early to avoid stich abscess- infection rate is higher compared to ypunger indiv

80. Statement that is tru concerning use of antibiotics in wound

care?

- presence of cellulitis and bacterial count of 105

81. Ideal time to admin prophylactic antibiotics for patients

undergoing surgery?

- 1 hr prior to OR

82. Surgical wound carries 10-15% risk of developing wound infect?

- contaminated wound

83. prefered treatment of an infected FB inplanted inmusculoskeletal tissue

- removal of FB

84. Does not predisposed to devt of diabetic foot inf?

- short term steroid use

85. Most approp tx for abscess w/ cellulitis?

- incision + drainage + antibiotic

Modified Matching

A. Ehlers Danlos SyndromeB. MarfanC. Osteogenesis ImperfectaD. Epidermolysis BullosaE. Acrodermatiis Enterohepatica

86. result of mutation of type I collagen C

87. Impair tissue adhession w/in dermis, epidermis or basement

membrane resulting in blistering and ulceration D

88. Inability to absorb zinc from breast milk or food E

89. group of 10 disorder that present as defect in colagen formtionA

90. defect in fibril in an extracel PRO ASSO WITH ELASTIC FIBERS b

A. CleanB. Clean contaminatedC. ContaminatedD. Dirty

91. open surgical removal of gallbladder B

92. emrgency operation to remove ruptured appendicits- D

93. elective repair of indirect inguinal hernia A

94. debridement of diabetic foot D

95 excision of breast mass A

A. Hypertrophic scarB. KeloidC. BothD. Neither

96. inc in net collagen synthesis C

97. common in burns, may subside and cause contractures A

98. intralesional tx of steroids C

99. growth beyond the borders of original wound B

100. sometimes preventable - A