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Published by: 2013SecB on Mar 16, 2011
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06/21/2014

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1.
 
A pregnant woman in her 32
nd
wk of gestation is given magnesium sulfate forpre-eclampsia. The earliest clinical indication of hypermagnesemia is:
a.
 
Loss of deep tendonreflexes
b
.
 
Flaccid paralysisc.
 
Respiratory arrestd.
 
Hypotensione.
 
Stupor2.
 
The chief surgical risk to which patients with polycythemiavera are exposed isthat due to:a.
 
Anemic distur
b
ances
b
.
 
Hemorrhage
c.
 
Infectiond.
 
Renal dysfunctione.
 
Cardiopulmonarycomplications3.
 
Signs and symptoms of hemolytic transfusion reactions include:a.
 
Hypothermia
b
.
 
Hypertensionc.
 
Polyuria
d.
 
A
b
normal
b
leeding
e.
 
Hypesthesia at thetransfusion site4.
 
The surgeon should
b
e particularly concerned a
b
out which coagulation functionin patients receiving anti-inflammatory or analgesic medications?a.
 
APTT
b
.
 
PTc.
 
Reptilase time
d.
 
Bleeding time
e.
 
Throm
b
in time5.
 
The su
b
strate depleted earliestin the postoperative period is:a.
 
Branched-chain aminoacids
b
.
 
Non-
b
ranched-chainamino acidsc.
 
Ketone
d.
 
Glycogen
e.
 
Glucose6.
 
Hypocalcemia is associatedwith:a.
 
Acidosis
b
.
 
Shortened QT interval
c.
 
Hypomagnesemia
d.
 
Myocardial irrita
b
ilitye.
 
Hyperproteinemia
 
7
.
 
Which of the following characteristics of this patient mightincrease the risk of awound infection?a.
 
History of colonsurgery
b
.
 
Hypertensionc.
 
Male sexd.
 
Receipt of chemotherapye.
 
Asthma
I
tems 8²10
An in-hospital workup of a
78
- year-old, hypertensive, mildly asthmatic man who isreceiving chemotherapy for colon cancer reveals symptomatic gallstones. Preoperativela
b
oratory results are nota
b
le for a hematocrit of 24% and a urinalysis with 1
25 WBCsand gram-negative
b
acteria. On call to the operating room he receives intravenouspenicillin. His a
b
domen is shaved in the operating room. An open cholecystectomy isperformed and, despite a lack of indications, the common
b
ile duct is explored. Thewound is closed primarily with a Penrose drain exiting a separate sta
b
wound. Onpostoperative day 3 the patient develops a wound infection.
8
.
 
Which of the following changes could make this wound a lessfavora
b
leenvironment for infection?
a.
 
Decreasing the operative time and wound contamination
b
yomitting the common
b
ile duct exploration
b
.
 
Placing a Penrose drain exitingdirectly through the lateral corner of thewoundc.
 
Using oral rather than intravenous penicillin perioperativelyd.
 
Leaving a seroma in the wound to prevent desiccation of the tissuese.
 
Reinforcing the wound closure with a sheet of prostheticpolypropylene mesh.9.
 
Which of the following characteristicsof this patient mightincrease the risk of awound infection?a.
 
History of colon surgery
b
.
 
Hypertensionc.
 
Male sex
d.
 
Receipt of chemotherapy
e.
 
Asthma
 
10.
 
Which of the followingchanges in the care of this patientcould decrease thechance of apostoperative wound infection?a.
 
Increasing the length of the preoperativehospital stay toprophylacticallytreat the asthma with steroids
b
.
 
Treating the urinary infection priorto surgery
c.
 
Shaving the a
b
domen the nightprior to surgeryd.
 
Continuing the prophylactic anti
b
ioticsfor three postoperative dayse.
 
Use of a closed drainage system
b
rought out through theoperativeincision11.
 
Signs and symptoms associatedwith early sepsis include:a.
 
Respiratory acidosis
b
.
 
Decreased cardiac outputc.
 
Hypoglycemiad.
 
Increased arteriovenous oxygen difference
e.
 
Cutaneous vasodilation
12.
 
The most common physiologiccause of hypoxemia is:a.
 
Hypoventilation
b
.
 
Incomplete alveolar oxygen diffusion
c.
 
Ventilation-perfusion inequality
d.
 
Pulmonary shunt flowe.
 
Elevated erythrocyte 2,3-diphosphoglycerate level (2,3-DPT)13.
 
Major alterations in pulmonary function associated with adult respiratorydistress syndrome(ARDS) include:
a.
 
Hypoxemia
b
.
 
Increased pulmonary compliancec.
 
Increased resting lung volumed.
 
Increased functional residual capacitye.
 
Decreased dead space ventilation14.
 
An 1
8
-year-old woman develops urticaria and wheezing after an injection of penicillin. Her
b
lood pressure is 120/60 mm Hg, heart rate is 155
b
eats/min, andrespiratory rate is 30
b
reaths/min. Immediatetherapy should include:

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