1st.shifting.surgery

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 to schistosomiasis? - 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 ¼ 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 Willebrand’s 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

32. Which of the ff condition is least likely to cause elevation of plasminogen levels in the blood? - 100% O2 saturation of an extremity

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

33. What intrinsic F causes the activation of plasminogen to plasmin? - F2

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

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

45. Findings that are sufficient to make a dx of tension pneumothorax except - ↓ lung sounds - hypertympany of the involved hemithorax on percussion - hypertension - hypotension

38. In a hemorrhaging patient, the loss of how many % circulating volume will produce obvi__ and symptoms (mild tach, anxiety) - 15 – 25%

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 - beck’s triad is always present and readily appreciated

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

47. The ff procedures may relieve cardiac tamponade , except? - pericardiocentesis - tube thoracostomy - pericardial window - pericardiotomy

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

48. Which procedure may relieve tension pneumothorax - needling - pericardiocentesis - corfirm w/ an chest x ray - volume resuscitation

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

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

- 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

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 ulcer 67. 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 env’t? - ↑ 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

59. The cytokine present in wound healing that stimulate epithelial cell and fibroblast prolif and granulation tissue formation - EGF (epidermal growth factor)

72. 1st cll to arrive at injury site? - neutrophil

60. With regards to keloids and hypertrophic scars, the ff statements are true? - hypertrophic scars outgrow their original border

73. At 3 months the tensile wound strenght is what percent of final strenght? - 80%

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

74. TGF-B is involved in - organization of extracellular matrix, scar remodelling and wound contracture

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

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

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? 5 - presence of cellulitis and bacterial count of 10 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 in musculoskeletal tissue - removal of FB 84. Does not predisposed to dev’t of diabetic foot inf? - short term steroid use 85. Most approp tx for abscess w/ cellulitis? - incision + drainage + antibiotic Modified Matching A. B. C. D. E.

Ehlers – Danlos Syndrome Marfan Osteogenesis Imperfecta Epidermolysis Bullosa 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 fibrilin an extracel PRO ASSO WITH ELASTIC FIBERS – b A. B. C. D.

Clean Clean contaminated Contaminated 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. B. C. D.

Hypertrophic scar Keloid Both 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