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Shifting 16.

What anticoagulant results in the synthesis of dysfunctional


prothrombin, stable factor, antihemophilic factor and stuart power
1. In hemostasis, what is considered as an initial response to injury? factor?
- vasoconstriction - warfarin

2. Which of the ff subs causes vasodilatation? 17. what anticoag catalyzes the action of anti-thrombin III on F2?
- prostacycline - epinephrine - Heparin
- serotonin - Thromboxane 2
18. After cardiopulmonary bypass, what subs is given to reverse the
3. Which of the ff injury is least likely to stop bleeding? action of heparin?
- obliquely incised branchial artery - protamine sulfate
- completely transected radial artery
- avulsed venules in gastrocnemius area 19. What is the treatment for patients with idiopathic
- completely transected popliteal artery thrombocytopenic purpura?
- prednisone
4. What is the normal lifespan of platelets?
- 7 – 10 days 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.
5. What is the main reason why injured veins may remain open and What is most likely dx?
continue to bleed? - consumptive coagulopathy due to dead fetus
- thin muscular layer
21. What is considered as MC abnormality of hemostasis?
6. What is considered initial platelet reaction to injury? - thrombocytopenia
- adhesion
22. What platelet pathology is asso in patient w/ portal hpn due to
7. Which of the ff prevents platelet clump together? schistosomiasis?
- prostaglandin - thrombocytopenia due to ↑ platelet destruction

8. Which of the ff is least likely to be a property of an amorphous 23. What clinical feature distinguishes classic hemophilia from
platelt plug? hemophilia B?
- not affected by heparin - hemarthrosis - pattern of transmission
- fibrinogen is required - age of onset of bledding - none
- irreversible
- stronger platelet plug 24. What complica of classic hemophilia acounts for ¼ of mortality?
- intracranial bleeding
9. What zymogen is activated that starts the cascade in the common
pathway of coagulation? 25. What coomon char orthopedic problem is assoc w/ classic
- Prothrombin hemophilia?
- hemarthrosis
10. What group of factors needs a carboxyl group to their glutamic
acid residues for them to be effective coagulation factors? 26. Which of the ff coagulation defect is autosomal dominant?
- F 2,7, 9, 10 - Von Willebrand’s disease

11. What is the MC manifestation of transfusion reaction 27. Which of the ff situation is streptokinase is least likely beneficial?
- oliguria - thrombolysis of deep v thrombosis in a patient post knee
replacement
12. What is the oldest mechanical method of hemostatis and is also - in situ thrombosis of the L lower ext
considered the least __ hemostat? - myocardial infarction
- Digital pressure - acute pulmonary embolism

13. what surgical procedure is least likely to develop leeding due to 28. Where is Vit K synthesized and absorbed?
release of activated plasminogen? - SI
- modified radical mastectomy
29. What is the end product of coag cascade?
14. A patient with deep vein thrombosis was given regular heparin - fibrin
at 80 units kg bw, ___ was maintained on heparin drip. What test of
coag will you request to determine if the therapeutic level of 30. A patient w/ pancreatic head tumor, w/ acholic stool & tea
heparin is reached? colored urine, will undergo surgery. What can you give this patient
- partial thromboplastin time to minimize the risk of bleeding?
- Vit K
15. A patient who underwent aortic valve replacement was given
coumarin at 5 mg OD, what can you request to monitorthe effects of 31. What plasminogen activator is most efficient and is non
coumadin of the patient? antigenic?
- prothrombin time w/ INR - urokinase
32. Which of the ff condition is least likely to cause elevation of - there is loss of typical reflexive tachycardia that occurs w/
plasminogen levels in the blood? hypovolemia
- 100% O2 saturation of an extremity -all

33. What intrinsic F causes the activation of plasminogen to 44. In obstructive shock, the main pathophysio is mech obstruction
plasmin? of venous return in trauma patients. In tension pneumothorax,
- F2 which is not true?
- involved hemithorax has positive pressure due to continous leak of
34. Which of the ff congenital hemostatic defect is char by ↑ air from parenchyma or airway
platelet destruction? - ↑ intrathoracic pressure causes the shift of the mediastinal
- Wiscott-aldrich syndrome - bernard-souier syndrome structure to the contralateral hemithorax
-von willebrand disease - hereditary thrombocytopenia - the mediastinal shift causes the heart to twist in its axix, thereby
causing obstruction of the venous return to the heart
35. What is the blood component is cheapest and readily avail F8 - tension pneumothorax is best diagnosed w/ a chest x ray
replacement but has lowest [ ] of F8?
- Fresh frozen plasma 45. Findings that are sufficient to make a dx of tension
pneumothorax except
36. The integrity of the cell is compromised. The maintenance of cel - ↓ lung sounds
membrane potential and volume is impaired. The main F resp is? - hypertympany of the involved hemithorax on percussion
- activity of the membrane NaK-ATPase pump slows - hypertension
- hypotension
37. The imperical initial treatment of any patient in any form of
shock are the ff except 46. True of cardiac tamponade
- secure airway - maintain circ - accum of fluid in pericardial sac to restrict blood entrance to the R
- adequate breathing - identify duration and degree of shock state ventricle
- manifestation of cardiac tamponade are always of total circ
38. In a hemorrhaging patient, the loss of how many % circulating collapse
volume will produce obvi__ and symptoms (mild tach, anxiety) - patient will have flat neck veins
- 15 – 25% - beck’s triad is always present and readily appreciated

39. In cardiogenic shock, the ff are treatment options for 47. The ff procedures may relieve cardiac tamponade
documented profound cardiac dysfucntion EXCEPT: , except?
- inotrophic support w/ dopamine & dobutamine - pericardiocentesis
- use of mech support (intra, aortic, ballon pump) - tube thoracostomy
- early coronary re vascularization - pericardial window
- liberal use and infusion of fluids to regain volume loss - pericardiotomy

40. The ff is/are diff factors w/c support diagnosis of septic shock? 48. Which procedure may relieve tension pneumothorax
- episode severe infection - needling
- sevre vasodilatation of vessels due to isoform Nitric Oxide synthase - pericardiocentesis
rendering it resistant to the effects of vasoconstructing agents - corfirm w/ an chest x ray
- warm extremities despite hypotension - volume resuscitation
- all of the above
49. As cellular ATP is depleted under hypoxic conditions the ff occurs
41. The classic description of neurogenic shock consists of the ff - Na accumulates intracellularly while K leaks into EC space
except? - Net gain of IC Na is accompanied by gain in IC water and
- ↓ BP w/ bradycardia development of cellular swelling
- warm extremities - the resulting swelling causes rupture of diff IC organeles leading
- motor and sensory deficits to cell death and necrosis
- radiographic evidence of vertebral and lung parenchymal injury
50. Which describes the immune and inflam response
42. Which is true regarding to neurogenic shock? - the immune response to shock encompasses the elaboration of
- admin of vasoconstrictors will improve peripheral vascular tone mediators w/ only proinfla properties
- admin of vasoconstrictors should only be considered once - the exagerated immune response is advantagous to restoring
hypovolemia is excluded and dx of neurogenic shock established homeostasis
- it implies loss of vasoconstrictor impulses w/ inc vascular - if excessive, the immune response may promote cellular and organ
capacitance, ↓ venous return, and ↓ CO repair
-all - it is responsible for the development of ARDS, MODS and post
traumatic intussuception that can prolong recovery.
43. Neurogenic shock is usually secondary to spinal cord injuries.
The pathophysio involves: 51. The ff are features of inflam phase of wound healing, except:
- anatomic disruption of sympa regulation of peripheral vasc tone - this phase is marked by loss of fucntion of the wounded area, as
- sympa input to the heart is disrupted w/ the loss of ↑ heart rate well as pain, redness and swelling
and cardiac contract - 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 64. Incorrent in tretament of human bites?
from fibroblasts - debride wound, cleanse thoroughly
- In this pahse, neutrophil phagocytosis aids in the removal of clot, - culture the wound
bacteria and other debris from the wound - broad spectrum antibiotics
- suturing the wound
52. The stages of wound healing in order are:
- proliferative phase, substrate phase, remodeling phase 65. Not a component of an ideal ulcer dressing?
- fibrin phase, remoeling phase, inflammatory phase - improved aesthetics
- substrate phase, proliferative phase, remodeling phase - Immobilization
- connective tissue regeneration involves contraction - Absorption
- compression
53. Which of the ff is INCORRECT, regarding stages of wound
healing? 66. A patient has chronic ulcer loc on the lower L leg, over medial
- the 1st phase is inflam or reactive phase malleolus. It is moderately painful with some relief when elevated.
- the most importsant cell in the prolif pahse is neutrophil This ulcer is most likely of which type?
- the remodeling phase can take place b/w 6 wks to 2 yrs - Venous ulcer
- connective tissue regeneration involves contraction
67. Human bite injuries in the hand are treated with irrigation,
54. Collage most abundant in prolif stage of wound healing? exploration and debridement, G +/- culture as well a broad spectrum
- Type III antibiotic coverage. In addition, the ff tretament?
- Tetatnus, if no immunization in the last 10 yrs, Clavulinic acid, 2ry
55. Which of the ff statement is false? closure
- a laceration refers to an intact skin over a crash injury
- a contusion is a bruise without a break in the skin 68. A 19 yo man went to emergency room after a fist fight, early
- an abrasion is a superficial removal of skin sunday AM bec of laceration over his knuckles. Most approp tx?
- an avulsion refers to a total or partial removal of tissue - clean, do not suture, give antibitics and tetanus booster

56. All of the ff impair wound healing EXCEPT? 69. Bacterial toxin present in local wound env’t?
- smoking - ↑ host cell pdxn of matrix metalloproteases
- immunosupression
- hyperntsion 70. An ICU pt presented w/ infection w/c lead to gangrene of subcu
- vitamin A tissue and subsequent necrois of more superficial layers. He was dx
w/ necrotizing fascitis?
57. Maximum tensile strenght of wound is reach on the? - beta hemolytic strep
- 40th – 50th day
71. All of the ff are true of cellulitis except?
58. Mechanism of wound healing whreby keratocytes migrate abd - MC org are staph aureus and BH strep
then divide to surface partial thickness loss of skin or mucosa? - erythema w/ sharply demarcated borders are present
- epithelialization - 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 72. 1st cll to arrive at injury site?
- EGF (epidermal growth factor) - neutrophil

60. With regards to keloids and hypertrophic scars, the ff statements 73. At 3 months the tensile wound strenght is what percent of final
are true? strenght?
- hypertrophic scars outgrow their original border - 80%

61. All of the ff are contraindications to primary wound closure 74. TGF-B is involved in
except? - organization of extracellular matrix, scar remodelling and wound
- too much tension on the wound contracture
- animal/ human bites
- < 6 hrs post injury 75. All of the ff are char of aminoglycosides, except?
- Infection - active against broad spectrum of G – aerobves
- emergence of resistant bacterial strain does not occur
62. Which of the ff is true regarding leg ulcers - narrow margin b/w therapeutic and toxic levels
- venous ulcer are common over the medial malleolus - nephrotoxic

63. Which of the ff is not indicated for the management of 76. antibiotic that disrups membrane barrier fxn?
chronologically contaminated wounds? - Amphoterecin B
- freq dressing change
- systemic antibiotics 77. Antibiotics that disrupts ribosomal PRO synthesis
- debridement - aminoglycosides
- final closure w/ skin graft or flap
78. A 30 yo M pt has an elective herniorrhaphy. On 2nd post op day 96. inc in net collagen synthesis – C
he develops excruciating pain over the wound and a thin, brown, 97. common in burns, may subside and cause contractures – A
foul smelling discharge. He is tachycardic w/ high fever. G strain of 98. intralesional tx of steroids – C
exudate shows G + drumstick 99. growth beyond the borders of original wound – B
- clostridium welchii 100. sometimes preventable - A

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. Ehlers – Danlos Syndrome


B. Marfan
C. Osteogenesis Imperfecta
D. Epidermolysis Bullosa
E. 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. Clean
B. Clean contaminated
C. Contaminated
D. 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 scar
B. Keloid
C. Both
D. Neither