1. Which of the following is/are cause/s of hypocalcemia?

A. Toxic shock syndrome

B. Necrotizing fasciitis
C. Small bowel fistulas
D. All of the above

Answer: D. All of the above

Rationale: The causes of hypocalcemia include pancreatitis, massive soft tissue
infections such as necrotizing fasciitis, renal failure, pancreatic and small bowel fistulas,
hypoparathyroidism, toxic shock syndrome, abnormalities in magnesium levels, and tumor
lysis syndrome.

2. Which of the following can decrease urinary excretion of phosphorus and thus lead to
hyperphosphatemia?
A. Hyperparathyroidism
B. Hyperthyroidism
C. A & B
D. None of the above

Answer: B. Hyperthyroidism
Rationale: Hypoparathyroidism or hyperthyroidism also can decrease urinary excretion
of phosphorus and thus lead to hyperphosphatemia.

3. Normovolemic hypernatremia can result from which of the following?

A. Mineralocorticoid excess
B. Excess sodium bicarbonate
C. Renal disease
D. Aldosteronism

Answer: C. Renal disease

Rationale: Normovolemic hypernatremia can result from renal causes, including diabetes
insipidus, diuretic use, and renal disease, or from nonrenal water loss from the GI tract or
skin, although the same conditions can result in hypovolemic hypernatremia.

4. Total body water accounts for what percentage of total body weight of a young adult
male?
A. 30%
B. 40%
C. 50%
D. 60%

Answer: D. 60%
Rationale: In an average young adult male, TBW accounts for 60% of total body weight,
whereas in an average young adult female, it is 50%.

5. The principal determinants of osmolality are the concentrations of:

A. Sodium
B. Glucose
C. Urea
D. All of the above
 Answer: D. All of the above
Rationale: The principal determinants of osmolality are the concentrations of sodium,
glucose, and urea (blood urea nitrogen, or BUN):
Calculated serum osmolality = 2 sodium + (glucose/18) + (BUN/2.8)

6. Signs and symptoms of volume deficit.

A. Weight loss
B. Decreased skin turgor
C. Peripheral edema
D. Distended neck veins

Answer: A. Weight loss

Rationale: Acute volume deficit is associated with cardiovascular and central nervous
system signs, whereas chronic deficits display tissue signs, such as a decrease
in skin turgor and sunken eyes, in addition to cardiovascular and central nervous
system signs.

7. At what level of serum Na concentration does symptomatic hypernatremia occur?

A. 100 mEq/L
B. 120 mEq/L
C. 140 mEq/L
D. 160 mEq/L

Answer: D. 160 mEq/L

Rationale: Symptomatic hypernatremia usually occurs only in patients with impaired
thirst or restricted access to fluid. Symptoms are rare until serum Na concentration
exceeds 160mEq/L.

8. Volume control is sensed by osmoreceptors located in the hypothalamus which then

secretes ______.
A. Vasopressin
B. Antidiuretic hormone (ADH)
C. Brain natriuretic peptide (BNP)
D. A and B

Answer: D. A and B
Rationale: The hypothalamus is stimulated to secrete vasopressin, aka ADH, which
increases water reabsorption in the kidneys

9. Extracellular volume excess may be iatrogenic or secondary to:

A. Renal dysfunction
B. Congestive heart failure
C. Cirrhosis
D. All of the Above

Answer: D: All of the Above

Rationale: Extracellular volume excess may be iatrogenic or secondary to renal
dysfunction, congestive heart failure, or cirrhosis. Both plasma and interstitial volumes
usually are increased.
10. What do you call the type of hyponatremia wherein there is an excessive water intake or
iatrogenic IV water excess in the body.
A. Pseudohyponatremia
B. Depletional Hyponatremia
C. Dilutional Hyponatremia
D. None of the Above

Answer: C. Dilutional Hyponatremia

Rationale: Dilutional Hyponatremia is a condition wherein there is an excessive water
intake or iatrogenic IV water excess in the body leading to hyponatremia.

11. Type of hyponatremia where there is a decrease intake or increased loss of sodium
containing fluids
A. Pseudohyponatremia
B. Depletional Hyponatremia
C. Dilutional Hyponatremia
D. None of the Above

Answer: B. Depletional Hyponatremia

Rationale: Depletional Hyponatremia is due to decrease intake or increased loss of
sodium containing fluids

12. This is not a true hyponatremia due to extreme elevations in plasma lipids and proteins
masking the true levels of sodium in the body.
A. Pseudohyponatremia
B. Depletional Hyponatremia
C. Dilutional Hyponatremia
D. None of the Above

Answer: A. Pseudohyponatremia
Rationale: Pseudohyponatremia happens when there is an extreme elevations of
plasma lipids and proteins which causes a false decrease in extracellular sodium
concentration.

13. What is the most common cause of hypercalcemia in hospitalized patients?

A. Diabetes Insipidus
B. Malignancy
C. Malnutrition
D. Acute renal failure

Answer: B: Malignancy
Rationale: Malignancy is the most common cause of hypercalcemia in hospitalized
patients and is due to increased bone resorption or decreased renal excretion.

14. This is a condition which results from loss of fixed acids or the gain of bicarbonate and
worsened by potassium depletion.
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
 Answer: B. Metabolic alkalosis
Rationale: Metabolic alkalosis results from loss of fixed acids or the gain of bicarbonate
and worsened by potassium depletion.

15. The following are causes of respiratory alkalosis except:

A. salicylates
B. fever
C. thyrotoxicosis
D. hyperoxemia

Answer: D. hyperoxemia
Rationale: Salicylates, fever, gram-negative bacteremia, thyrotoxicosis, and hypoxemia
are the causes of respiratory alkalosis.

16. In the absence of preexisting abnormalities, a 55-kg female would receive a total of
______ fluid daily:
A. 2100 mL
B. 2200 mL
C. 2300 mL
D. 2350 mL

Answer: B. 2200 mL
Rationale:
Maintenance Fluid Calculation:
For the first 0–10 kg Give 100 mL/kg per day
For the next 10–20 kg Give an additional 50 mL/kg per day
For weight >20 kg Give an additional 20 mL/kg per day

1000 mL for the first 10 kg of body weight (10 kg × 100 mL/kg per day)
500 mL for the next 20 kg (10 kg × 50 mL/kg per day)
700 mL for the last 40 kg (35 kg × 20 mL/kg per day).
1000 mL + 500 mL + 700 mL = 2200 mL

17. Which of the following is the earliest sign of volume overload?

A. Weight gain
B. Peripheral edema
C. Pulmonary edema
D. Distended neck veins

Answer: A. Weight gain

Rationale: Volume excess is a common disorder in the postoperative period. This may
be due to the overestimation of third-space losses or to ongoing GI losses that are difficult
to measure accurately. The earliest sign of volume overload is weight gain. Peripheral
edema may not necessarily be associated with intravascular volume overload because
overexpansion of total ECF may exist in association with a deficit in the circulating plasma
volume

18. Which of the following is/are cause/s of respiratory acidosis

A. Narcotics
B. Central nervous system injury
C. Atelectasis
 D. All of the above

Answer: D. All of the above

Rationale: Principal causes of respiratory acidosis includes narcotics, central nervous
system injury, pulmonary causes includes secretions, atelectasis, mucus plug, pneumonia
and pleural effusion.

19. The average postoperative patient who is not receiving nutritional support should lose
approximately how many pounds from catabolism.
A. 0.25 to 0.5 lb/d
B. 0.5 to 1lb/d
C. 1 - 2 lb/d
D. 2 -3 lb/d

Answer: A. 0.25 to 0.5 lb/d

Rationale: The average postoperative patient who is not receiving nutritional support
should lose approximately 0.25 to 0.5 lb/d (0.11 to 0.23 kg/d) from catabolism.

20. Which of the following can contribute to hyperkalemia in patients with renal
insufficiency?
A. Loop diuretics
B. Aspirin
C. Calcium channel blockers
D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer: D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Rationale: A number of medications can contribute to hyperkalemia, particularly in the
presence of renal insufficiency, including potassium-sparing diuretics, angiotensin
converting enzyme inhibitors, and NSAIDs. Loop diuretics basing it from its MOA, would
tend to contribute to hypokalemia. While, aspirin and calcium channel blockers have no
significant effect on potassium levels.

21. Which of the following signs and symptoms signifies a volume excess in the
cardiovascular system?
A. Tachycardia
B. Orthostasis/ hypotension
C. Collapsed neck vein
D. Increased cardiac output

Answer: D. Increased cardiac output

Rationale: Tachycardia, orthostasis/ hypotension and collapsed neck veins signifies a
volume deficit in the cardiovascular system, while increased cardiac output signifies a
volume excess.

22. The following are etiology of hyperkalemia, EXCEPT

A. Acidosis
B. Hyperaldosteronism
C. Rhabdomyolysis
D. Hyperglycemia

Answer: B. Hyperaldosteronism
 Rationale: Acidosis, endogenous load/ destruction such as rhabdomyolysis, and rapid
rise of extracellular osmolality such as hyperglycemia or mannitol are all etiology of
hyperkalemia while excessive potassium excretion such as hyperaldosteronism causes
hypokalemia.

23. Compute for the maintenance fluid of a patient who weighs 75kg
A. 2600 mL
B. 2630 mL
C. 2660 mL
D. 2700 mL

Answer: A. 2600 mL
Rationale: (1st 10kg x 100mL) + (2nd 10kg x 50mL) + (each kg above 20 kg x 20mL)
= 1000 mL/day + 500 mL/day + (55kg x 20 mL/day)
= 1000 mL/day + 500 mL/day + 1100 mL/day
= 2600 mL/day

24. What is the most common fluid disorder in surgical patients?

A. ICF volume deficit
B. ICF volume excess
C. ECF volume deficit
D. ECF volume excess

Answer: C. ECF volume deficit

Rationale: ECF volume deficit is the most common fluid disorder in surgical patients

25. Which of the following signs may be seen in hyperkalemia?

A. Shortened PR interval
B. High peaked T waves
C. Constipation
D. Decreased reflexes

Answer: B. High peaked T waves

Rationale: ECG changes seen in hyperkalemia include high peaked and a prolonged
PR interval. While constipation and Decreased Reflexes are GI symptoms and
neuromuscular symptoms of hypokalemia

26. Which of the following about pseudohyponatremia is true?

A. Caused by excessive water intake or iatrogenic IV excess free water
administration
B. Excess ADH
C. Caused by extreme elevations in plasma and proteins leading to a false
decrease in extra cellular sodium
D. Due to a increased loss of sodium containing fluids.

Answer: C. Caused by extreme elevations in plasma and proteins leading to a

false decrease in extra cellular sodium
Rationale: choices A and B pertains to Dilutional Hyponatremia while D pertains to
depletion hyponatremia. Pseudohyponatremia is caused by an elevation of plasma,
lipids and protein causing a false decrease in sodium.
27. The following are sensible water losses EXCEPT:
A. Urine
B. Lungs
C. Intestinal
D. Sweat

Answer: B. Lungs
Rationale: Sensible water loss are the typical routes of excretion and it includes urine,
intestinal and sweat. On the other hand, insensible water loss is not easily measured
and it includes water loss from skin and lungs.

28. Rapid correction of hypernatremia can lead to the following:

A. Cerebral edema
B. Herniation
C. All of the above
D. None of the above

Answer: C. All of the above

Rationale: Slower correction should be undertaken for chronic hypernatremia because
overly rapid correction can lead to cerebral edema and herniation.

29. Nephrogenic DI occurs in association administration of radiocontrast dye, use of certain

drugs such as aminoglycosides and amphotericin B, and ______.
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypernatremia

Answer: B. Hypokalemia
Rationale: Diabetes insipidus (DI) is a disorder of ADH stimulation and is manifested by
dilute urine in the case of hypernatremia. Central DI is frequently seen in association with
pituitary surgery, closed head injury, and anoxic encephalopathy. Nephrogenic DI occurs
in association with hypokalemia, administration of radiocontrast dye, and use of certain
drugs such as aminoglycosides and amphotericin B.

30. Classic signs of hypovolemic hypernatremia

A. Tachycardia, orthostasis, and hypotension
B. Tachycardia, orthostasis, and hypertension
C. Bradycardia, orthostasis, and hypotension
D. Bradycardia, orthostasis, and hypertension

Answer: A
Rationale: The classic signs of hypovolemic hypernatremia (tachycardia, orthostasis,
and hypotension) may be present, as well as the unique findings of dry, sticky mucous
membranes.
WOUND HEALING
1. The following are the phases of wound healing:
A. hemostasis and inflammation
B. proliferation
C. maturation and remodeling
D. All of the Above

Answer: D. All of the above

Rationale: The following choices are the phases of wound healing (arranged from first
to last step)

2. PMNs peak at what time?

A. 8-12 hours post injury
B. 24-48 hours post injury
C. 48-96 hours post injury
D. One week post injury

Answer: B. 24-48 hours

Rationale:
PMNs peak at 24 to 48 hours.
C is for Macrophages
D is for T lymphocytes

3. The following cells are important to the first phase of wound healing except?
A. PMNs
B. Macrophages
C. T lymphocytes
D. Fibroblasts

Answer: D. Fibroblast
Rationale: While PMNs, macrophages, and T lymphocytes are given much importance
during the first phase, fibroblasts and endothelial cells take the center stage for the
second phase.

4. Marfan’s syndrome is associated with what mutation?

A. FBN1
B. type I collagen
C. COL7A1
D. FBN2

Answer: A. FBN1
Rationale: The genetic defect associated with Marfan’s syndrome is a mutation in the
FBN1 gene, which encodes for fibrillin.
- B is for Osteogenesis Imperfecta
- C is for Epidermolysis Bullosa

5. Which type of Osteogenesis Imperfecta can be Autosomal Recessive?

A. Type I
B. Type II
C. Type III
 D. Type IV

Answer: C. Type III

Rationale:

6. Failure of healing results in, except?

A. Leaks
B. Fistula
C. Stricture formation
D. Dehiscence

Answer: C. Stricture formation

Rationale: Leaks, fistula and dehiscence results due to failure of healing while stricture
formation is a result of excessive healing.

7. Layer that imparts the greatest tensile strength and greatest suture-holding capacity
A. Serosa
B. Submucosa
C. Circular muscle
D. Longitudinal muscle

Answer: B. Submucosa
Rationale: Submucosa is comprised of abundant collagenous and elastic fibers and
supports neural and vascular structures. It is the layer that imparts the greatest tensile
strength and greatest suture-holding capacity.

8. Collagen synthesis in the GI tract is carried out by

A. Collagenase
B. Fibroblast
C. Smooth muscle cells
D. Both B & C

Answer: D. Both B & C

 Rationale: Collagen synthesis in the GI tract is carried out by both fibroblasts and
smooth muscle cells.

9. Symptoms associated with this stage are characteristic of inflammation, with clinical
evidence of swelling and erythema.
A. Soft callus stage
B. Hematoma formation
C. Hard callus stage
D. Remodelling phase

Answer: B. Hematoma Formation

Rationale: In hematoma formation there is liquefaction and degradation of nonviable
products at the fracture site, Revascularization and characteristic of inflammation, with
clinical evidence of swelling and erythema.

10. Interruption of axonal continuity but preservation of basal lamina

A. Axonotmesis
B. Neurapraxia
C. Neurotmesis
D. None of the above

Answer: B. Neurapraxia
Rationale: There are three types of nerve injuries: Neurapraxia: focal demyelination,
Axonotmesis: interruption of axonal continuity but preservation of Schwann cell basal
lamina, Neurotmesis which is complete transection)

11. Which sequence of events is correct regarding the phases of wound healing?
A. Proliferation, maturation, hemostasis
B. Hemostasis, proliferation, maturation
C. Hemostasis, maturation, proliferation
D. Maturation, hemostasis, proliferation

Answer: B. Hemostasis, proliferation, maturation

Rationale: Normal wound healing is divided into phases defined by characteristic cellular
populations and biochemical activities: (a) hemostasis and inflammation, (b) proliferation,
and (c) maturation and remodeling. This sequence of events in most circumstances spans
the time from injury to resolution of acute wounds.

12. Which of the following conditions has phenotypic findings that include thin, friable skin
with prominent veins, easy bruising, poor wound healing, atrophic scar formation,
recurrent hernias, and hyperextensible joints?
A. Marfan’s Syndrome
B. Osteogenesis Imperfecta
C. Ehlers-Danlos Syndrome
D. epidermolysis bullosa

Answer: C. Ehlers-Danlos Syndrome

Rationale: “classic” EDS with phenotypic findings that include thin, friable skin with
prominent veins, easy bruising, poor wound healing, atrophic scar formation, recurrent
hernias, and hyperextensible joints.
13. Which of the following are the major glycosaminoglycans present in wounds?
A. Dermatan
B. Chondroitin sulfate
C. Both A and B
D. None of the above

Answer: C. Both A and B

Rationale: The major glycosaminoglycans present in wounds are dermatan and
chondroitin sulfate. Fibroblasts synthesize these compounds, increasing their
concentration greatly during the first 3 weeks of healing.

14. These are characteristics that may influence the differences between fetal and adult
wounds, except:
A. Wound matrix
B. Inflammation
C. Growth Factors
D. Wound size

Answer: D. Wound size

Rationale: There are a number of characteristics that may influence the differences
between fetal and adult wounds. These include wound environment, inflammatory
responses, differential growth factor profiles, and wound matrix.

15. An acute wound becomes chronic if healing is not achieved after how many weeks of
treatment?
A. 4 weeks of treatment
B. 6 weeks of treatment
C. 8 weeks of treatment
D. 2 weeks of treatment

Answer: A. 4 weeks of treatment

Rationale: By definition, an acute wound becomes chronic if healing is not achieved
after 4 weeks of treatment. Acute wounds heal in a predictable manner and time frame
as previously mentioned.

16. This approach of closure and acute healing of wound involves an incised wound with
that is clean and closed via suturing.
A. Primary Intention
B. Secondary Intention
C. Tertiary Intention
D. Quaternary Intention

Answer: A. Primary Intention

Rationale: Primary intention: an incised wound that is clean and closed by sutures.
Secondary intention: Because of bacterial contamination or tissue loss, a wound will be
left open to heal by granulation tissue formation and contraction Tertiary intention or
delayed primary closure: represents a combination of the first two, consisting of the
placement of sutures, allowing the wound to stay open for a few days, and the subsequent
closure of the sutures

17. Systemic Factors affecting wound healing except

 A. Age
B. Trauma
C. Smoking
D. Low Oxygen Tension

Answer: D. Low Oxygen Tension

Rationale: Please refer to the table below

18. The peak number of fibroblasts in a healing wound occurs?

A. 2 days post injury
B. 6 days post injury
C. 15 days post injury
D. 60 days post injury

Answer: B. 6 days post injury

Rationale: Please refer to the table below. The number of fibroblasts peaks 6 days post
injury
19. The tensile strength of a completely healed wound approaches the strength of uninjured
tissue?
A. 2 weeks after injury
B. 3 months after injury
C. 12 months after injury
D. Never

Answer: D. Never
Ratio: By several weeks post-injury, the amount of collagen in the wound reaches a
plateau, but the tensile strength continues to increase for several more months. Fibril
formation and fibril cross-linking result in decreased.

20. Re-epithelization for an approximated incised wound is completed when?

A. 12 hours
B. 24 hours
C. 36 hours
D. 48 hours

Answer: D. 48 hours
Rationale: Re-epithelialization is complete in less than 48 hours in the case of
approximated incised wounds, but may take longer in case of larger wounds, in which
there is a significant epidermal/dermal defect

21. What type of nerve injury involves disruption of axonal continuity with preserved
Schwann cell basal lamina?
A. Neuropraxia
B. Neurotmesis
C. Axonotemesis
 D. Axonopraxia

Answer: C. Axonotemesis
Rationale: There are three types of nerve injuries: neurapraxia (focal demyelination),
axonotmesis interruption of axonal continuity but preservation of Schwann cell basal
lamina), and neurotmesis (complete transection).

22. What is the major cause of impaired wound healing?

A. Malnutrition
B. Local tissue infection
C. Anemia
D. Hemostasis

Answer: Local tissue infection

Rationale: All the factors listed impair wound healing, but local infection is the major
problem.

23. Which is the most important type of collagen in wound healing?

A. Type III
B. Type IV
C. Type V
D. Type II

Answer: Type III

Rationale: Type III collagen is normally present in skin and becomes more prominent
and important during the repair process

24. What supplementation would benefit wound healing in patients without micronutrient
deficiency?
A. Vitamin A
B. Vitamin C
C. Zinc
D. Vitamin K

Answer: Vitamin A
Rationale: Vitamin A deficiency impairs wound healing, while supplemental vitamin A
bene its wound healing in nondeficient humans and animals.

25. Steroids impair wound healing by?

 A. Inhibit Hemostasis
B. Increasing fibrinolysis
C. Inhibit inflammatory phase of wound healing
D. Promote hemolysis

Answer: C. Inhibit inflammatory phase of wound healing

Rationale: The major effect of steroids is to inhibit the inflammatory phase of wound
healing (angiogenesis, neutrophil and macrophage migration, and fibroblast proliferation)
and the release of lysosomal enzymes.

26. Which type of collagen is important for wound healing?

A. I and III
B. IV
C. X
D. XI

Answer: A. I and III

Rationale: Collagen is the most abundant protein in the body which plays a critical role in
the successful completion of adult wound healing. The deposition, maturation, and
subsequent remodeling of the collagen, are essential to the functional integrity of the
wound. There are at least 18 types of collagen described, and the important types to
wound repair are types I and III

27. What is the strongest chemotactic factor for fibroblast?

A. Epidermal Growth Factor
B. Fibroblast Growth Factor
C. Interleukin – 6
D. Platelet Derived Growth Factor

Answer: D. Platelet Derived Growth Factor

Rationale: Fibroblast is a connective tissue which main role is to produce collagen.
Collagen is the major component of extracellular matrix in the soft tissue, bones,
ligaments, and tendons. Platelet-derived growth factor (PDGF) is the most important
chemotactic factor that attracts fibroblasts.

28. What is the major cell responsible for wound contraction?

A. Endothelial Cells
B. Fibroblast
C. Myofibroblast
D. Actin fiber

Answer: C. Myofibroblast
Rationale: The myofibroblast has been postulated as the major cell responsible for
contraction. This cell contains α-smooth muscle actin in thick bundles called stress fibers,
that gives myofibroblasts contractile function.

29. Presence of these cells bridges the transition from inflammatory to the proliferative
phase of healing:
A. PMN’s
B. Macrophages
C. T lymphocytes
 D. B lymphocytes

Answer: C. T lymphocytes
Rationale: T lymphocytes are the third group of cells that appears to the wound site. Less
numerous than macrophages, T-lymphocyte numbers peak at about 1 week post injury
and truly bridge the transition from the inflammatory to the proliferative phase of healing

30. What is the first cells that infiltrate the wound site?
A. PMNs
B. Macrophages
C. T lymphocyte
D. B lymphocytes

Answer: A. PMNs
Rationale: PMNs are the first infiltrating cells to enter the wound site, peaking at 24 to 48
hours.

31. Type of skin graft that is taken from another species

A. Autologous
B. Allogenic
C. Xenogeneic
D. Homologous

Answer: C. Xenogeneic
Rationale:
Choice A: from one site on the body to another
Choice B: from a living nonidentical donor or cadaver to the host

32. Type of dressing that is impregnated with paraffin, petroleum jelly or water-soluble jelly
A. Absorbent dressing
B. Nonadherent dressing
C. Medicated dressing
D. Hydrophilic dressing

Answer: B. Nonadherent dressing

Rationale:
Choice A: helps control exudate without soaking through the dressing
Choice C: used as a drug-delivery system
Choice D: components of a composite dressing; aids in absorption

33. Irrigation to visualize all areas of the wound and remove foreign material is best
accomplished with _____.
A. Normal saline
B. Iodine
C. Hydrogen peroxide
D. Povidone-iodine

Answer: A. Normal saline

Rationale: Iodine, povidone-iodine, hydrogen peroxide and organically based
antibacterial preparations should not be used since all have been shown to impair wound
healing due to injury to wound neutrophils and macrophages.
34. Which of the following is NOT a characteristic of a keloid?
A. Contracture is rare
B. Has no predilection
C. Incidence is rare
D. No regression

Answer: B. Has no predilection

Rationale:

35. Wound is left open to heal spontaneously through granulation tissue formation and
contraction
A. Primary intention
B. Secondary intention
C. Tertiary intention
D. Quaternary intention

Answer: B. Secondary intention

Rationale:
Choice A: incised wound that is clean and is approximated without tension
Choice C: combination of the first two wherein the wound is allowed to stay open for a few
days to be cleaned and observed to ensure no infection is apparent, and then it is
surgically closed
SHOCK
1. Cardiac tamponade is one of the causes of obstructive shock. What are the three classic
signs of cardiac tamponade?
A. Hypotension, muffled heart sounds, Kussmaul’s sign
B. Hypotension, muffled heart sounds, friction rub
C. Hypertension, muffled heart sounds, jugular vein distention
D. Hypotension, muffled heart sounds, jugular vein distention

Answer: D. Hypotension, muffled heart sounds, jugular vein distention

Rationale: The three classic signs of cardiac tamponade can be described by Beck’s triad
which consist of hypotension, muffled heart sounds and neck vein distention (jugular).

2. Tension pneumothorax is the most common cause of obstructive shock in trauma patients.
In performing tube thoracostomy, what is the most recommended placement of the chest
tube?
A. Fourth intercostal space at the anterior axillary line
B. Third intercostal space at the anterior axillary line
C. Second intercostal space at the midaxillary line
D. Eight intercostal space at the midaxillary line

Answer: A. Fourth intercostal space at the anterior axillary line

Rationale: Chest tube should be inserted rapidly but carefully. According to Schwartz 11th
ed, the most recommended placement is in the fourth intercostal space (nipple level) at
the anterior axillary line.

3. Patient had an injury above T6. What is the most probable form of shock that may happen?
A. Septic Shock
B. Obstructive Shock
C. Neurogenic Shock
D. Hemorrhagic Shock

Answer: C. Neurogenic Shock

Rationale: Neurogenic shock is usually secondary to spinal cord injuries from vertebral
body fractures of the cervical or high thoracic region. Example is an injury above T6.

4. This refers to a pathophysiologic response wherein the body is able to compensate for the
initial loss of blood volume through neuroendocrine response to maintain hemodynamics.
A. Compensated Phase of Shock
B. Ischemia/Reperfusion Injury
C. Decompensation Phase of Shock
D. Irreversible Phase of Shock

Answer: A. Compensated Phase of Shock

Rationale: In hemorrhagic shock, the body can compensate for the initial loss of blood
volume through neuroendocrine response to maintain hemodynamics. This represents the
compensated phase of shock.

5. Stimuli that can produce neuroendocrine response.

A. Emotional arousal
B. Loss of circulating blood volume
 C. Infection
D. All of the above

Answer: D. All of the above

Rationale: Afferent impulses transmitted from the periphery are processed within the
central nervous system (CNS) and activate the reflexive effector responses or efferent
impulse. The initial inciting event usually is loss of circulating blood volume. Other stimuli
that can produce the neuroendocrine response include pain, hypoxemia, hypercarbia,
acidosis, infection, change in temperature, emotional arousal or hypoglycemia

6. In shock, stimulation of chemoreceptors leads to the following except:

A. Vasodilation of the coronary arteries
B. Tachycardia
C. Vasoconstriction of the splanchnic circulation
D. Vasoconstriction of the skeletal circulation

Answer: B. Tachycardia
Rationale: Stimulation of the chemoreceptors results in vasodilation of the coronary
arteries, slowing of the heart rate, and vasoconstriction of the splanchnic and skeletal
circulation.

7. The following are clinical signs of shock, EXCEPT:

A. Agitation
B. Cool, clammy extremities
C. Bradycardia
D. Hypotension

Answer: C. Bradycardia
Rationale: The clinical signs of shock include agitation, cool clammy extremities,
tachycardia, weak or absent peripheral pulses, and hypotension.

7. You assisted in the operating room and heard that the patient lost up to 20% of his blood
during the operation. The resident in charge then asked you to classify the hemorrhage.
What would be your answer?
A. Class I
B. Class II
C. Class III
D. Class IV

Answer: B. Class II
Rationale: Loss of up to 15% falls under Class I. Class II refers to blood loss of up to
30% of the circulating volume, loss of 40% falls under Class III, and anything greater
than 40% is considered as Class IV.

8. Cardiogenic shock is the most common cause of death in patients with acute myocardial
infarction. When do most patients develop signs of cardiogenic shock?
A. Within 24 hours after onset of infarction
B. Within 36 hours after onset of infarction
C. Within 2 days after onset of infarction
D. Within 4 days after onset of infarction
 Answer: A. Within 24 hours after onset of infarction
Rationale: 75% of patients who have cardiogenic shock brought about by complicating
acute myocardial infarction develop signs of shock within 24 hours after onset of
infarction.

9. The following statements are true about cellular hypoperfusion in shock, except?
A. The oxygen debt is the deficit in tissue oxygenation over time that occurs during
shock.
B. Hypoperfused cells and tissues experience what has been termed oxygen debt.
C. When oxygen delivery is limited, oxygen consumption can be adequate to match
the metabolic needs of cellular respiration, thus no deficit in oxygen requirements
at the cellular level.
D. The measurement of oxygen deficit uses calculation of the difference between the
estimated oxygen demand and the actual value obtained for O2 consumption.

Answer: C. When oxygen delivery is limited, oxygen consumption can be adequate

to match the metabolic needs of cellular respiration, thus no deficit in oxygen
requirements at the cellular level.
Rationale: Letter C is an incorrect statement. The correct statement is: When oxygen
delivery is limited, oxygen consumption can be inadequate to match the metabolic needs
of cellular respiration, creating a deficit in O2 requirements at the cellular level.

10. What is cellular dysoxia?

A. It is a state in which oxygen is not available in sufficient amounts at the tissue level
to maintain adequate homeostasis.
B. It occurs when levels of oxygen in the blood are lower than normal.
C. It is a deficit in tissue oxygenation over time that occurs during shock.
D. It occurs when oxygen delivery is so severely impaired such that oxidative
phosphorylation cannot be sustained.

Answer: D. It occurs when oxygen delivery is so severely impaired such that

oxidative phosphorylation cannot be sustained.
Rationale:
Choice A is hypoxia
Choice B is hypoxemia
Choice C is oxygen debt

11. These drugs have proven to have profound effects on cellular metabolism during shock.
They play a role in your body's natural fight-or-flight response to stress.
A. Epinephrine
B. Norepinephrine
C. Both a and b
D. None of the above

Answer: C. Both a and b

Rationale: Epinephrine and norepinephrine have a profound impact on cellular
metabolism. Hepatic glycogenolysis, gluconeogenesis, ketogenesis, skeletal muscle
protein breakdown, and adipose tissue lipolysis are increased by catecholamines.

12. Which is the first leukocyte to be recruited to the site of injury?

A. Monocyte
 B. Lymphocyte
C. Neutrophil
D. Basophil

Answer: C. Neutrophil
Rationale: In the inflammatory response, neutrophil activation is one of the earliest events
and thus they are immediately activated and recruited to the site of injury.

13. What is the cytokine which is responsible for producing a febrile response by activating
prostaglandins in the posterior hypothalamus?
A. Interleukin-1
B. Interleukin-2
C. Interleukin-3
D. Interleukin-4

Answer: A. Interleukin-1
Rationale: IL-1 is responsible for the production of a febrile response to injury. IL-2 is
responsible for T cell maturation. IL-3 is a bone marrow stimulator while IL-4 helps in B
cell maturation.

14. Which of the following cytokines is considered as an anti-inflammatory mediator?

A. Interleukin-6
B. Interleukin-8
C. Interleukin-10
D. Tumor necrosis factor

Answer: C. Interleukin-10
Rationale: IL-10 is considered as an anti-inflammatory cytokine. Even though it is
increased after shock and trauma, it functions as an immunosuppressive cytokine which
may lead to depressed immune function clinically. It is therefore considered as an anti-
inflammatory cytokine along with IL-4, IL-13, PGE2 and TGFB. Other choices listed
include cytokines such as IL-2, IL-6, and IL-8, all of which function in different inflammatory
cascades.

15. The following are known as proinflammatory mediators of shock, except.

A. Interleukin-2
B. Interleukin-8
C. Interleukin-13
D. Interferon

Answer: C. Interleukin-13
Rationale: Proinflammatory mediators of shock include Interleukin-1α/β, Interleukin-2,
Interleukin-6, Interleukin-8, Interferon, TNF and PAF. Anti-inflammatory mediators of
shock include Interleukin-4, Interleukin-10, Interleukin-13, Prostaglandin E2 and TGFβ.

16. Which of the following is true regarding TNF-a?

A. It can produce peripheral vasoconstriction
B. It has an anticoagulant activity
C. It contributes to muscle protein breakdown and cachexia
D. It cannot activate release of other cytokines
 Answer: C. It contributes to muscle protein breakdown and cachexia
Rationale: TNF-a can produce peripheral vasodilation, activate the release of other
cytokines, induce procoagulant activity and stimulate a wide array of cellular metabolic
responses. During stress, it contributes to muscle protein breakdown and cachexia.

17. Complement cascade can be activated by?

A. Injury
B. Shock
C. Severe Infection
D. All of the above
E. None of the above

Answer: D
Rationale: Complement cascade can be activated by injury, shock and severe Infection.
It contributes to host defense and proinflammatory activation. Significant complement
consumption occurs after hemorrhagic shock.

18. Tissue specific endpoint in resuscitation

A. Lactate
B. Base Deficit
C. Gastric tonometry
D. Membrane potential

Answer: C. Gastric tonometry

Rationale: Tissue specific endpoints: Gastric tonometry, tissue pH, oxygen, carbon
dioxide levels, near infrared spectroscopy

19. Accounts for approximately 50% of whole body lactate uptake

A. Liver
B. Kidneys
C. Both
D. None

Answer: A. Liver
Rationale: Lactate is released into the circulation and is predominantly taken up and
metabolized by the liver and the kidneys. Liver accounts for approximately 50% and the
kidney for about 30% of whole body lactate uptake

20. Mild base deficit

A. 3 to 5 mmol/L
B. 6-14 mmol/L
C. 15 mmol/L
D. 13 mmol/L

Answer: A. 3 to 5 mmol/L
Rationale: Mild: 3-5 mmol/L, Moderate: 6-14 mmol/L, Severe: 15 mmol/L

21. The state when O2 delivery is so severely impaired such that oxidative phosphorylation
cannot be sustained.
A. Dyspnea
B. Dysphagia
 C. Dysoxia
D. Dystocia

Answer: C. Dysoxia
Rationale: When O2 delivery is so severely impaired such that the oxidative
phosphorylation cannot be sustained, the state is termed dysoxia. When oxidative
phosphorylation is insufficient, the cells shift to anaerobic metabolism and glycolysis to
generate ATP. This occurs via the breakdown of cellular glycogen stores to pyruvate.

22. Cellular metabolism is based primarily on the hydrolysis of:

A. Adenosine Triphosphate (ATP)
B. Adenosine Diphosphate (ADP)
C. Both
D. None

Answer: A. Adenosine Triphosphate (ATP)

Rationale: Cellular metabolism is based primarily on the hydrolysis of adenosine
triphosphate (ATP). The splitting of the phosphoanhydride bond of the terminal or y-
phosphate from ATP is the source energy for most processes within the cell under
normal conditions.

23. This/these contribute/s to the catabolism during shock.

A. Cortisol
B. Glucagon
C. ADH
D. All of the above

Answer: D. All of the above

Rationale: Epinephrine and norepinephrine have a profound impact on cellular
metabolism. Hepatic glycogenolysis, gluconeogenesis, ketogenesis, skeletal muscle
protein breakdown, and adipose tissue lipolysis are increased by catecholamines.
Cortisol, glucagon, and ADH also contribute to the catabolism during shock.

24. The following are global endpoints in resuscitation EXCEPT

A. Cardiac Output
B. Lactate
C. Membrane potential
D. Base deficit

Answer: C. Membrane potential

Rationale: Global/Systemic deficits include CO, lactate, base deficit and oxygen delivery
and consumption. Membrane potential is a cellular parameter along with ATP.

25. Indirect parameters used to measure O2 debt:

A. Serum lactate and base deficit
B. Heart rate and urine output
C. ABG and CVP
D. Electrolytes

Answer: A. Serum lactate and base deficit

 Rationale: In shock, Inability to repay O2 debt is a predictor of mortality and organ failure.
But direct measurement of O2 debt is difficult therefore surrogate parameters, Serum
lactate and base deficit, are measured instead and correlates with O2 debt. HR, UO,
ABG and CVP are poor indicators of adequacy of tissue perfusion.

26. This type of shock is clinically defined as circulatory pump failure leading to diminished
forward flow and subsequent tissue hypoxia, in the setting of adequate intravascular
volume
A. Cardiogenic shock
B. Traumatic shock
C. Obstructive shock
D. All of the above

Answer: A. Cardiogenic shock

Rationale: Cardiogenic shock is defined clinically as circulatory pump failure leading to
diminished forward flow and subsequent tis- sue hypoxia, in the setting of adequate
intravascular volume.

27. What is the most common cause of cardiogenic shock

A. Acute extensive MI
B. Acute mitral regurgitation
C. Arrhythmia
D. Myocarditis

Answer: A. Acute extensive MI

Rationale: Acute extensive MI is the most common cause of cardiogenic shock; a
smaller infarction in a patient with existing left ventricular dysfunction also may
precipitate shock.

28. What are the causes of septic and vasodilatory shock?

A. Systemic response to infection
B. Systemic inflammatory response - noninfectious
C. Anaphylaxis
D. All of the above

Answer: All of the above

 Rationale:

29. During the operation, you noticed that the patient’s parameters are as follows: blood loss
of 600 mL, heart rate of 90 bpm, and normal or no other CNS symptoms. Under what
classification of hemorrhage is this patient?
A. I
B. II
C. III
D. IV

Answer: A. I
Rationale: Classification I is composed of the following parameters: Blood loss of <750
ml or <15%, heart rate of <100 bpm, normal blood pressure and CNS symptoms

30. Which of the following is not the cause of septic and vasodilatory shock?
A. Anaphylaxis
B. Acute adrenal insufficiency
C. Arrhythmia
D. Burns

Answer: C. Arrhythmia
Rationale: Anaphylaxis, Acute adrenal insufficiency and Burns are causes of septic and
vasodilatory shock. Arrhythmia is a cause of cardiogenic shock

31. Hemodynamic criteria of cardiogenic shock include:

A. Hypertension
B. Increased cardiac index
C. Elevated pulmonary artery wedge pressure
D. SBP of >90 mmhg for at least 30 minutes
 Answer: C. Elevated pulmonary artery wedge pressure
Rationale: Hypotension (SBP <90 mmHg for at least 30 minutes), reduced cardiac index
(<2.2 L/min) per square meter) and elevated pulmonary artery wedge pressure (>15
mmHg)

32. The initiating event in shock is

A. Hypotension
B. Decreased cardiac output
C. Decreased oxygen delivery
D. Cellular energy deficit

Answer: D. Cellular energy deficit

Rationale: Regardless of the etiology, the initial physiologic responses in shock are driven
by tissue hypoperfusion and the developing cellular energy deficit. This imbalance
between cellular supply and demand leads to neuroendocrine and inflammatory
responses, the magnitude of which is usually proportional to the degree and duration of
shock.

33. Vasoconstriction is one of the initial physiologic responses to hypovolemic shock. This is
mediated by
A. Downregulation of alpha adrenergic receptors on the arterioles
B. Activation of alpha adrenergic receptors on the arterioles
C. Downregulation of beta adrenergic receptors on the arterioles
D. Activation of beta adrenergic receptors on the arterioles

Answer: B. Activation of alpha adrenergic receptors on the arterioles

Rationale: Direct sympathetic stimulation of the peripheral circulation via the activation of
the alpha1-adrenergic receptors on arterioles induces vasoconstriction and causes a
compensatory increase in systemic vascular resistance and blood pressure.

34. Antidiuretic hormone (ADH) is secreted in response to shock and remains elevated for
approximately one week. Which of the following is seen as a result of this increased level
of ADH?
A. Mesenteric vasoconstriction
B. Decreased water permeability in the distal tubule
C. Mesenteric vasodilation
D. Increased sodium loss in the distal tube

Answer: A. Mesenteric vasoconstriction

Rationale: The pituitary also releases vasopressin or ADH in response to hypovolemia,
changes in circulating blood volume sensed by baroreceptors and left atrial stretch
receptors, and increased plasma osmolality detected by hypothalamic osmoreceptors.
ADH levels remain elevated for about 1 week after the initial insult, depending on the
severity and persistence of the hemodynamic abnormalities. ADH acts as a potent
mesenteric vasoconstrictor, shunting circulating blood away from the splanchnic organs
during hypovolemia. This may contribute to intestinal ischemia and predispose to intestinal
mucosal barrier dysfunction in shock states.

35. The following are poor indicators of tissue perfusion EXCEPT:

A. Central venous pressure
B. Pulmonary artery occlusion
 C. Base deficit
D. Urine output

Answer: C. Base deficit

Rationale: Base deficit is the amount of base in millimoles that is required to titrate 1 L of
whole blood to a pH of 7.40 with the sample fully saturated with O 2 at 37°C (98.6°F) and
a partial pressure of CO 2of 40 mmHg. The mortality of trauma patients can be stratified
according to the magnitude of base deficit measured in the first 24 hours after admission.
In a retrospective study of over 3000 trauma admissions, patients with a base deficit worse
than 15 mmol/L had a mortality of 70%.

36. Compared to patients with mild acidosis, what is the required volume of blood
transfusion of trauma patients admitted with a base deficit greater than 15 mmol/L in the
first 24 hours?
A. twice the volume of fluid infusion & 5x more blood transfusion
B. twice the volume of fluid infusion & 6x more blood transfusion
C. thrice the volume of fluid infusion & 5x more blood transfusion
D. thrice the volume of fluid infusion & 6x more blood transfusion

Answer: B. twice the volume of fluid infusion & 6x more blood transfusion
Rationale: Transfusion requirements increased as base deficit worsened and ICU and
hospital lengths of stay increased.

37. Which of the following statements is INCORRECT?

A. The goal in the treatment of shock is restoration of adequate organ perfusion and
tissue oxygenation.
B. Compensated shock exists when inadequate tissue perfusion persists despite
normalization of blood pressure and heart rate.
C. Attempts to stabilize an actively bleeding patient anywhere in the hospital is
appropriate.
D. None of the above

Answer: C. Attempts to stabilize an actively bleeding patient anywhere in the

hospital is appropriate.
Rationale: The important concept of operating room resuscitation of the critically injured
patient should be noted as any intervention that delays the patient’s arrival in the operating
room for control of hemorrhage increases mortality.
PHYSIOLOGIC MONITORING
1. What is the IAP for intra-abdominal hypertension?
A. >10 mmHg
B. >11 mmHg
C. >12mmHg
D. >13mmHg

Answer: D. >12mmHg
Rationale: IAP of >12mmHg is recorded on three standard measurements conducted 4
to 6 hours apart and is separated into several grades.

2. Placement of Pulmonary Artery Catheter (PAC), requires access to the central venous
circulation. Which placement carries the lowest risk of complications?
A. RIght antecubital vein
B. Right femoral vein
C. Right internal jugular vein
D. Right subclavian vein

Answer: C. Right internal jugular vein

Rationale: Percutaneous placement through either the jugular or subclavian vein
generally is preferred. Right internal jugular vein cannulation carries the lowest risk of
complications, and the path of the catheter from this site into the right atrium is straight.

3. It is the determinants of cardiac performance which refer to the inotropic state of the
myocardium?
A. Preload
B. Afterload
C. Contractility
D. Heart rate

Answer: C. Contractility
Rationale: Contractility is defined as the inotropic state of the myocardium. Contractility
is said to increase when the force of ventricular contraction increases at constant preload
and afterload. Clinically, contractility is difficult to quantify because virtually all of the
available measures are dependent to a certain degree on preload and afterload.

4. This is used as an alternative to detect brain activity that cannot be detected by EEG?
A. Electroencephalogram
B. Transcranial Doppler Ultrasonography
C. Transcranial Near-Infrared Spectroscopy
D. None of the above

Answer: A. Electroencephalogram
Rationale: Electroencephalography offers the capacity to monitor global neurologic
electrical activity, while evoked potential monitoring can assess pathways not detected by
the conventional EEG. Continuous EEG (CEEG) monitoring in the intensive care unit
permits ongoing evaluation of cerebral cortical activity. It is especially useful in obtunded
and comatose patients.
5. What are the 2 wavelengths that are employed in a pulse oximetry to properly analyze
blood components?
A. 250nm and 660nm
B. 550nm and 800nm
C. 100nm and 200nm
D. 660nm and 940nm

Answer: A. 660nm and 940nm

Rationale: Pulse oximetry employs two wavelengths of light (i.e., 660 nm and 940 nm) to
analyze the pulsatile component of blood flow between the light source and sensor.
Because oxyhemoglobin and deoxyhemoglobin have different absorption spectra,
differential absorption of light at these two wavelengths can be used to calculate the
fraction of oxygen saturation of hemoglobin.

6. This is the main scoring system used in monitoring patients in the ICU that is based on 5
bedside parameters: Systolic Blood Pressure, heart rate, respiratory rate, Temperature
and level of consciousness?
A. APACHE II (Acute Physiologic AND Chronic Health Evaluation II)
B. Modified Early Warning Score (MEWS)
C. All of the above
D. None of the above

Answer: B. Modified Early warning score

Rationale: APACHE II includes the following as a basis of scoring: AaDO2 or PaO2
(depending on FiO2), Temperature (rectal), Mean arterial pressure, pH arterial, Heart rate,
Respiratory rate, Sodium (serum), Potassium (serum), Creatinine, Hematocrit, White
blood cell and Glasgow coma scale while MEWS basis of scoring are Systolic Blood
Pressure, Heart Rate, Respiratory Rate, Temperature and Level of consciousness.

7. The following are indications for ICP monitoring EXCEPT:

A. 45 y/o Female, with GCS score of less than or equal to 10 with an abnormal CT
scan
B. 42 y/o Male, with neurologic deterioration following acute subarachnoid
hemorrhage
C. 40 y/o Female, with evidence of brain swelling
D. 43 y/o Male, diagnosed with ischemic middle cerebral artery stroke

Answer: A. 45 y/o Female, with GCS score of less than or equal to 10 with an
abnormal CT scan
Rationale: Monitoring of ICP is currently recommended to patients with severe traumatic
brain injury (TBI), defined as GCS score less than 8 with an abnormal CT scan, and in
patients with severe TBI and a normal CT scan if two or more of the following are present:
age greater than 40 years, unilateral or bilateral motor posturing, systolic blood pressure
less than 90 mmHg.
Reference: Schwartz’s Principles of Surgery 10th ed.

8. Which of the following instances provides useful blood gas information results?
A. Respiratory failure
B. Sepsis
C. Altered mental status
D. All of the above
 Answer: D. All of the above
Rationale: Blood gas analysis may provide useful information when caring for patients
with respiratory failure, however absence of respiratory failure or the need for
mechanical ventilation, blood gas determination also can be valuable to detect
alterations in acid-base balance due to low QT, sepsis, renal failure, severe trauma,
medication or drug overdose, or altered mental status.
Reference: Schwartz’s Principles of Surgery 10th ed.

9. The following are determinants of oxygen delivery except:

A. Oxygen saturation of Hgb in arterial blood (SaO2)
B. Partial pressure of oxygen in arterial blood (PaO2)
C. QT (Cardiac output)
D. None of the above

Answer: D. None of the above

Rationale: The determinants of oxygen delivery are: oxygen saturation of Hgb in arterial
blood (SaO2), partial pressure of oxygen in arterial blood (PaO2), QT (Cardiac output)
and hemoglobin.

10. It is the stretch of ventricular myocardial tissue just prior to the next contraction.
A. Afterload
B. Preload
C. End-systolic volume
D. End-diastolic volume

Answer: B. Preload
Rationale: Preload is the stretch of ventricular myocardial tissue just prior to the next
contraction. It is determined by end-diastolic volume (EDV).

11. The following statements are true regarding the determinants of cardiac performance
EXCEPT:
A. Starling’s law of the heart states that the force of muscle contraction depends on
the initial length of the cardiac fibers.
B. Cardiac preload is determined by end-diastolic volume (EDV)
C. Afterload is commonly approximated by calculating systemic vascular resistance,
defined as mean arterial pressure (MAP) divided by the central venous pressure
(CVP).
D. Contractility is increased when the force of ventricular contraction increases at
constant preload and afterload
.
Answer: C. Afterload is commonly approximated by calculating systemic vascular
resistance, defined as mean arterial pressure (MAP) divided by the central venous
pressure (CVP).
Rationale: Afterload is commonly approximated by calculating systemic vascular
resistance, defined as mean arterial pressure (MAP) divided by cardiac output.

12. The change in frequency when ultrasonic sound waves are reflected by moving
erythrocytes in the bloodstream, depending on whether the cells are moving toward or
away from the ultrasonic source.
A. Bioimpedance
 B. Photoplethysmography
C. Doppler Shift
D. Flow time

Answer: C. Doppler shift

Rationale: When ultrasonic sound waves are reflected by moving erythrocytes in the
bloodstream, the frequency of the reflected signal is increased or decreased, depend- ing
on whether the cells are moving toward or away from the ultrasonic source. This change
in frequency is called the Doppler shift, and its magnitude is determined by the velocity of
the moving red blood cells. Therefore, measurements of the Doppler shift can be used to
calculate red blood cell velocity.

13. It is NOT important to check for Arterial blood gas in patients who are not having
respiratory failure.
A. True
B. False

Answer: B. False
Rationale: even in the absence of respiratory failure or the need for mechanical
ventilation, blood gas determinations also can be valuable to detect alterations in
acid-base balance due to low QT, sepsis, renal failure, severe trauma, medication or
drug overdose, or altered mental status.

14. The problem is a decrease in the compliance in the lung/chest wall unit
A. both Ppeak and Pplateau are increased
B. Peak is increased but Pplateau is relatively normal
C. low Ppeak
D. both Ppeak and Pplateau are decreased

Answer: A both Ppeak and Pplateu are increased

Rationale: If both Ppeak and Pplateau are increased (and tidal volume is not excessive),
then the problem is a decrease in the compliance in the lung/chest wall unit. Common
causes of this problem include pneumothorax, hemothorax, lobar atelectasis, pulmonary
edema, pneumonia, acute respiratory distress syndrome (ARDS), etc. When Ppeak is
increased but Pplateau is relatively normal, the primary problem is an increase in
airway resistance, such as occurs with bronchospasm low Ppeak also should trigger an
alarm, as it suggests a discontinuity in the airway circuit.

15. Generally accepted normal urine output in adults

A. 1 ml/k/hr
B. 1.5 ml/kg/hr
C. 0.5 ml/kg/hr
D. 2 ml/kg/hr

Answer: C 0.5 ml/kg/hr

Rationale: The generally accepted normal urine output is 0.5 mL/kg per hour for adults
and 1 to 2 mL/kg per hour for neonates and infants

16. Pulse Oximetry works by

A. CO2 absorption of infrared light at a peak wavelength of approximately 4.27 μm
 B. Absorption at two wavelengths of light (i.e., 660 nm and 940 nm) of both oxy- and
deoxy hemoglobin
C. measured at the end of inspiration
D. Counting how many inspiration seen in a minute

Answer: B Absorption at two wavelengths of light (i.e., 660 nm and 940 nm) of
both oxy- and deoxy hemoglobin
Rationale: Pulse oximetry employs two wavelengths of light (i.e., 660 nm and 940 nm) to
analyze the pulsatile component of blood flow between the light source and sensor.
Because oxyhemoglobin and deoxyhemoglobin have different absorption spectra,
differential absorption of light at these two wavelengths can be used to calculate the
fraction of oxygen saturation of hemoglobin

17. The following are possible serious complications of pulmonary artery catheterization
EXCEPT:
A. Pulmonary arterial perforation
B. Catheter-related sepsis
C. Ventricular arrhythmias
D. Congestive heart failure

Answer: D. Congestive heart failure

Rationale: Even though bedside pulmonary artery catheterization is quite safe, the
procedure is associated with a finite incidence of serious complications, including
ventricular arrhythmias, catheter-related sepsis, central venous thrombosis, pulmonary
arterial perforation, and pulmonary embolism. (P.442 Schwartz)

18. Which of the following minimally invasive alternatives to the pulmonary artery catheter
uses changes in electrical impedance to generate a waveform that is dependent upon
the volume and velocity of blood in the aorta.
A. Doppler ultrasonography
B. Transpulmonary thermodilution
C. Impedance cardiography
D. Pulse contour analysis

Answer: C Impedance cardiography

Rationale: The impedance to flow of alternating electrical current in regions of the body
is commonly called bioimpedance. In the thorax, changes in the volume and velocity of
blood in the thoracic aorta lead to detectable changes in bioimpedance. P.443 schwartz

19. Triad of Oliguria, elevated intra-abdominal pressure and __ is known as abdominal

compartment syndrome (ACS)
A. Elevated peak airway pressures
B. Elevated BP
C. Elevated HR
D. Elevated RR

Answer: A. Elevated peak airway pressures

Rationale: The triad of oliguria, elevated peak airway pressures, and elevated intra-
abdominal pressure is known as abdominal compartment syndrome (ACS). This
syndrome, first described in patients after repair of ruptured abdominal aortic aneurysm,
is associated with interstitial edema of the abdominal organs, resulting in elevated intra-
 abdominal pressure (IAP). When IAP exceeds venous or capillary pressures, perfusion of
the kidneys and other intra-abdominal viscera is impaired. Oliguria is a cardinal sign. While
the diagnosis of ACS is a clinical one, measuring IAP is useful to confirm the diagnosis.

20. This ICP measuring device consists of a fluid-filled catheter inserted into a cerebral
ventricle and connected to an external pressure transducer.
A. Ventriculostomy catheter
B. Foley Catheter
C. Doppler ultrasound
D. Jugular venous oximetry

Answer: A. Ventriculostomy catheter

Rationale: One type of ICP measuring device, the ventriculostomy catheter, consists of
a fluid-filled catheter inserted into a cerebral ventricle and connected to an external
pressure transducer. This device permits measurement of ICP but also allows drainage of
cerebrospinal fluid (CSF) as a means to lower ICP and sample CSF for laboratory studies.

21. What is the normal value for brain tissue oxygen tension (PbtO2)?
A. 8-10 mmHg
B. 20-40 mmHg
C. 5-7 mmHg
D. 6-12 mmHg

Answer: B. 20-40 mmHg

Rationale: Normal value of Brain tissue oxygen tension are 20-40mmHg while its critical
levels are 8-10 mmHg. 5-7 mmHg is the normal value for bladder pressure and 6-12 mmHg
is the normal value of Pulmonary artery occlusion pressure
Reference: Schwartz’s Principles of Surgery 11th ed. Chapter 13

22. The ff is TRUE regarding Continuous Electroencephalogram monitoring EXCEPT.

A. It permits ongoing evaluation of cerebral cortical activity
B. Useful in obtunded and comatose patients
C. Useful for monitoring therapy for status epilepticus
D. Useful in detecting late changes associated with cerebral ischemia

Answer: D. Useful in detecting late changes associated with cerebral ischemia

Rationale: Continuous Electroencephalogram (CEEG) monitoring in the intensive care
unit permits ongoing evaluation of cerebral cortical activity. It is useful in obtunded and
comatose patients, for monitoring therapy for status epilepticus and in detecting EARLY
changes associated with cerebral ischemia
Reference: Schwartz’s Principles of Surgery 11th ed. Chapter 13, P. 448

23. Oliguria may reflect inadequate renal artery perfusion due to:
A. Hypotension
B. Hypovolemia
C. Both A & B
D. None of the above

Answer: C. Both A & B

Rationale: Inadequate renal artery perfusion may be due to hypovolemia, hypotension,
or low Qt.
24. The cardinal sign of abdominal compartment syndrome (ACS):
A. Oliguria
B. Elevated peak airway pressure
C. Elevated intraabdominal pressure
D. Interstitial edema of the abdominal organs

Answer: A. Oliguria
Rationale: Oliguria, elevated peak airway pressure, and elevated intraabdominal
pressure are the triad of ACS but oliguria is the cardinal sign.

25. Which is the preferred access because of its lowest risk of complication, for placement of
Pulmonary Artery Catheter (PAC)?
A. Right internal jugular vein
B. Left internal jugular vein
C. Right subclavian vein
D. Left subclavian vein

Answer: A. Right internal jugular vein

Rationale: Percutaneous placement through either the jugular vein or subclavian vein is
generally preferred. Right internal jugular vein cannulation carries the lowest risk of
complications, and the path of the catheter from the site into the right atrium is straight.

26. In measuring the arterial blood pressure, the width of the cuff must be proportional to
arm circumference. If the cuff used is too narrow, which of the following would be the
effect to the result of the blood pressure reading?
A. Elevated
B. Low
C. No change
D. None of the above

Answer: A. Elevated
Rationale: The accuracy of these devices is variable and often dependent on the size
mismatch between the circumference and the cuff size. If the cuff is too narrow, the
measured pressure will artifactually elevated.

27. In a 12-lead ECG, lead ___ is the most sensitive for detecting perioperative ischemia
and infarction.
A. V1
B. V4
C. V6
D. V5

Answer: B. V4
Rationale: The precordial lead V4, which is not routinely monitored on a standard 3-lead
ECG, is the most sensitive for detecting perioperative ischemia and infarction. To detect
95% of the ischemic episodes, two or more precordial leads were necessary.

28. Intra-abdominal hypertension (IAH)

A. IAP ≤12 mmHg recorded on three standard measurements conducted 4 to 6
hours apart and is separated into several grades.
 B. IAP ≤20 mmHg recorded by three measurements 1 to 6 hours apart, along with
new onset of organ dysfunction.
C. IAP ≥12 mmHg recorded on three standard measurements conducted 4 to 6
hours apart and is separated into several grades.
D. IAP ≥20 mmHg recorded by three measurements 1 to 6 hours apart, along with
new onset of organ dysfunction.

Answer: C. IAP ≥12 mmHg recorded on three standard measurements conducted 4

to 6 hours apart and is separated into several grades.
Rationale: Intra-abdominal hypertension is defined as an IAP ≥12 mmHg recorded on
three standard measurements conducted 4 to 6 hours apart and is separated into several
grades. The diagnosis of ACS is the presence of an IAP ≥20 mmHg recorded by three
measurements 1 to 6 hours apart, along with new onset of organ dysfunction.

29. Amount of pressure that the heart needs to exert to eject the blood during ventricular
contraction
A. Afterload
B. Preload
C. End-systolic volume
D. End-diastolic volume

Answer: A. Afterload
Rationale: afterload is the resistance to the expulsion of blood from the heart chamber
of interest, usually the left ventricle

30. Point of critical oxygen delivery (DO2crit)

A. Represents the transition from supply-independent to supply-dependent oxygen
uptake and is decreased in sepsis.
B. Represents the transition from supply-independent to supply-dependent oxygen
uptake and is increased in sepsis
C. Represents the minimal rate of oxygen delivery needed for aerobic metabolism
and is decreased in sepsis.
D. Represents the minimal rate of oxygen delivery needed for aerobic metabolism
and is increased in sepsis.

Answer: B. Represents the transition from supply-independent to supply-

dependent oxygen uptake and is increased in sepsis
Rationale: In pathologic circumstances when oxygen availability is inadequate, oxygen
utilization (VO2) becomes dependent upon oxygen delivery (DO2). The relationship of
VO2 to DO2 over a broad range of DO2 values is commonly represented as two
intersecting straight lines. In the region of higher DO2 values, the slope of the line is
approximately zero, indicating that VO2 is largely independent of DO2. In contrast, in the
region of low DO2 values, the slope of the line is nonzero and positive, indicating that VO2
is supply-dependent. The region where the two lines intersect is called the point of critical
oxygen delivery (DO2crit), and represents the transition from supply-independent to
supply-dependent oxygen uptake. Microcirculatory derangements, such as those seen in
sepsis, will shift this point higher.
SURGICAL INFECTIONS
1. This occurs subsequent to contamination of the peritoneal cavity due to perforation or
severe inflammation and infection of an intra-abdominal organ
A. Primary microbial peritonitis
B. Secondary microbial peritonitis
C. Tertiary peritonitis
D. Persistent peritonitis

Answer: B. Secondary microbial peritonitis

Rationale:
Primary microbial infection occurs when microbes invade normally sterile confines of the
peritoneal cavity via hematogenous dissemination from a distant source of infection or
direct inoculation.
Tertiary (persistent) infection that happens more commonly in immunocompromised
patients whose peritoneal host defenses do not effectively clear or sequester the initial
secondary microbial peritoneal infection. (Reference: page 171)

2. At what level of platelet count is prophylactic transfusion of platelets done in the absence
of bleeding?
A. <10,000/mL
B. <20,000mL
C. <50,000/mL
D. 150,000/mL

Answer: A. <10,000/mL
Rationale:
Prophylactic transfusion of platelets is done when counts are <20,000/mL if there is risk
of bleeding, <50,000/mL in the setting of active bleeding or need for procedure.
150,000/mL platelet count is within the normal range (Reference: page 176)

3. How many days should a patient with endocarditis be given antibiotics?

A. 4-8 days
B. 6-12 days
C. 4-8 weeks
D. 6-12 weeks

Answer: D. 6-12 weeks

Rationale: Antibiotic therapy for osteomyelitis, endocarditis, or prosthetic infections in
which it is hazardous to remove the device consists of prolonged courses of treatment for
6 to 12 weeks. (Schwartz’s Principles of Surgery 11th edition, p.164)

4. Which of the following is NOT included in resuscitation endpoints in Surviving Sepsis

Campaign guidelines?
A. Urine output >0.5mL/kg/hr
B. Mean arterial pressure >55mmHg
C. Mixed venous oxygen saturation >65%
D. Normalization of lactate

Answer: B. Mean arterial pressure >55mmHg

 Rationale: Resuscitation goals include mean arterial pressure >65 mmHg, urine output
>0.5 mL/kg per h, and mixed venous oxygen saturation >65%. Target resuscitation to
normalize lactate in patients with elevated lactate levels. (Schwartz’s Principles of Surgery
11th edition, p.176)

5. What is the Mechanism of action of Clindamycin?

A. Inhibits cell wall synthesis
B. Inhibits protein synthesis by binding to 50s ribosomal unit
C. Inhibits protein synthesis by binding to 30s ribosomal unit
D. Inhibits topoisomerase II and IV

Answer: Inhibits protein synthesis by binding to 50s ribosomal unit

Rationale:

6. Risk factor under local factors for development of surgical site infections
A. Malnutrition
B. Prolonged hospitalization
C. Poor skin preparation
D. Toxin secretion

Answer: Poor skin preparation

Rationale:
7. The following are 2nd-generation cephalosporins except:
A. Cefoxitin
B. Cefotetan
C. Cefotaxime
D. Cefuroxime

Answer: Cefotaxime
Rationale:

8. Which among the bacteria that are known to commonly cause surgical infections is gram-
positive?
A. Escherichia coli
B. Klebsiella pneumoniae
C. Staphylococcus aureus
D. Pseudomonas aeruginosa

Answer: C. Staphylococcus aureus

Rationale: The Gram stain is an important evaluation that allows rapid classification of
bacteria by color. This color is related to the staining characteristics of the bacterial cell
wall: gram-positive bacteria stain blue. This includes aerobic skin commensals such as
Staphylococcus aureus and epidermidis and Streptococcus pyogenes and enteric
organisms such as E. faecalis and faecium.

9. During skin preparation, which is the preferred instrument used to remove hair prior to
operation?
A. Razor
B. Clippers
C. Scissors
D. Knife

Answer: B. Clippers
Rationale: Hair removal from an operative site should be performed in the operating room
with clippers rather than with a razor, to avoid creating nicks in the skin that could foster
bacterial growth.

10. Which of the following is considered as a Class II wound?

A. Breast biopsy
B. Penetrating abdominal trauma
C. Perforated diverticulitis
D. Cholecystectomy

Answer: D. Cholecystectomy
 Rationale: Clean/contaminated wounds (class II) include those in which a hollow viscus
such as the respiratory, alimentary, or genitourinary tracts with indigenous bacterial flora
is opened under controlled circumstances without significant spillage of contents. This
includes the following: cholecystectomy, elective gastrointestinal surgery (not colon), and
elective colorectal surgery.

11. Which of the following is not a patient risk factor for developing surgical site infections.
A. Obesity
B. Infancy
C. Malnutrition
D. Anemia

Answer: B. Infancy
Rationale: Infancy is not a risk factor for developing SSIs (surgical site infections).

12. Secondary microbial peritonitis occurs subsequent to the following conditions, EXCEPT:
A. Appendicitis
B. Diverticulitis
C. Ascites
D. Perforation of any of the GIT

Answer: C. Ascites
Rationale: Secondary microbial peritonitis occurs subsequent to contamination of the
peritoneal cavity due to perforation or severe inflammation and infection of an intra-
abdominal organ. Examples include appendicitis, perforation of any portion of the
gastrointestinal tract, or diverticulitis. Meanwhile, Primary microbial peritonitis
occurs when microbes invade the normally sterile confines of the peritoneal cavity via
hematogenous dissemination from a distant source of infection or direct inoculation. This
process is more common among patients who retain large amounts of peritoneal fluid due
to ascites, and among those individuals who are being treated for renal failure via
peritoneal dialysis.

13. The development of SSIs is related to…

A. The degree of microbial contamination of the wound during surgery
B. The duration of the procedure
C. Host factors such as diabetes, malnutrition, obesity, immune suppression
 D. All of the above

Answer: C. Blood transfusion

Rationale: All 3 are factors related to the development of SSIs

14. The following are possible signs of surgical site infections, EXCEPT:
A. Heat
B. Pain
C. Redness
D. All of the above

Answer: D. All of the above

Rationale: Heat, Pain, Redness are all possible signs of surgical infections including
Swelling, and Discharge.

15. Control of source of infection is of utmost importance in the management of surgical

infections. Measures undertaken to control surgical infections includes:
A. Drainage of purulent material
B. Debridement of infected and devitalized tissue and debris
C. Removal of foreign bodies at the site of infection
D. All of the above.

Answer: D. All of the above

Rationale: The primary precept of surgical infectious disease therapy consists of drainage
of all purulent material, debridement of all infected, devitalized tissue and debris, and/or
removal of foreign bodies at the site of infection, plus remediation of the underlying cause
of infection. (Schwartz 10th ed, p 163)

16. The magnitude of the response of host defense mechanism and eventual outcome is
greatly influenced of the following EXCEPT:
A. Initial number of microbes
B. Microbial pathogenicity
C. The rate of microbial proliferation in relation to containment and killing of host
defenses
D. Potency of host defenses

Answer: B. Microbial pathogenicity

Rationale: The magnitude of the response and eventual outcome is generally related to
several factors: (a) the initial number of microbes, (b) the rate of microbial proliferation in
relation to containment and killing by host defenses, (c) microbial virulence, and (d) the
potency of host defenses. In regard to the latter, drugs or disease states that diminish any
or multiple components of host defenses are associated with higher rates and potentially
more grave infections. (Schwartz 10th ed, p 160)

17. Risk factors for the development of surgical site infections include the ff except:
A. Younger age
B. Prolonged procedure
C. Smoking
D. Recent operation
 Answer: A. Younger age
Rationale:

18. This wound class includes those in which a hollow viscus such as the respiratory,
alimentary, or genitourinary tracts with indigenous bacterial flora is opened under
controlled circumstances without significant spillage of contents.
A. Class I
B. Class III
C. Class II
D. Class V

Answer: C. Class II
Rationale:
● Clean wounds (class I) include those in which no infection is present; only skin
microflora potentially contaminate the wound, and no hollow viscus that contains
microbes is entered.
● Clean/contaminated wounds (class II) include those in which a hollow viscus
such as the respiratory, alimentary, or genitourinary tracts with indigenous
bacterial flora is opened under controlled circumstances without significant spillage
of contents.
● Contaminated wounds (class III) include open accidental wounds encountered
early after injury, those with extensive introduction of bacteria into a normally sterile
area of the body due to major breaks in sterile technique (e.g., open cardiac
massage), gross spillage of viscus contents such as from the intestine, or incision
through inflamed, albeit nonpurulent tissue.
● Dirty wounds (class IV) include traumatic wounds in which a significant delay in
treatment has occurred and in which necrotic tissue is present, those created in
the presence of overt infection as evidenced by the presence of purulent material,
and those created to access a perforated viscus accompanied by a high degree of
contamination.

19. An elective cholecystectomy is classified under which wound class?

A. Class V
B. Class III
C. Class II
D. Class IV
 Answer: C. Class II
Rationale:

20. The best method or hair removal roman operative field is

A. Shaving the night before
B. Depilating the night before surgery
C. Shaving in the operating room
D. Using hair clippers in the operating room

Answer: D. Using hair clippers in the operating room

Rationale: Hair removal should take place using a clipper rather than a razor; the latter
promotes overgrowth of skin microbes in small nicks and cuts. Dedicated use of these
modalities clearly has been shown to diminish the quantity of skin micro lora. (See
Schwartz 10th ed., p. 141.)

21. Postoperative urinary tract infections (UTIs)

A. Are usually treated with a 7- to 10-day course of antibiotics.
B. Initial therapy should be directed by results on urine culture.
C. Are established by >104 CFU/mL of bacteria in urine culture in asymptomatic
patients.
D. Can be reduced by irrigating indwelling Foley catheters daily

Answer: B. Initial therapy should be directed by results on urine culture.

Rationale: The presence of a postoperative UTI should be considered based on
urinalysis demonstrating WBCs or bacteria, a positive test or leukocyte esterase, or a
combination of these elements. he diagnosis is established after >10 4 CFU/mL o
microbes are identified by culture techniques in symptomatic patients, or >105 CFU/mL in
asymptomatic individuals. Treatment for 3 to 5 days with a single antibiotic directed
against the most common organisms (eg, E. Coli, K. pneumoniae) that achieves high
levels in the urine is appropriate. Initial therapy is directed by Gram’s stain results and is
refined as culture results become available. Postoperative surgical patients should have
indwelling urinary catheters removed as quickly as possible, typically within 1 to 2 days,
 as long as they are mobile, to avoid the development of a UTI. (See Schwartz 10th ed., p.
152.)

22. A patient with a localized wound infection after surgery should be treated with
A. Antibiotics and warm soaks to the wound
B. Antibiotics alone
C. Antibiotics and opening the wound
D. Incision and drainage alone

Answer: D. Incision and drainage alone

Rationale: Effective therapy or incisional SSIs consists solely of incision and drainage
without the addition of antibiotics. Antibiotic therapy is reserved for patients in whom
evidence of severe cellulitis is present, or who manifest concurrent sepsis syndrome. The
open wound often is allowed to heal by secondary intention, with dressings being changed
twice a day. The use of topical antibiotics and antiseptics, to further wound healing,
remains unproven, although anecdotal studies indicate their potential utility in complex
wounds that do not heal with routine measures. (See Schwartz 10th ed., p. 149.)

23. Question: The following are inflammatory variables for SIRS (systemic inflammatory
response syndrome) EXCEPT:
A. Leukocytosis (WBC > 12,000)
B. Leukopenia (WBC <4,000)
C. Plasma C-reactive protein <2 s.d.)
D. >10% band forms

Answer: C. Plasma C-reactive protein <2 s.d.)

Rationale: Inflammatory variables for SIRS are Leukocytosis (WBC >12,000),
Leukopenia (WBC <4,000), Bandemia (>10% band forms), Plasma C-reactive protein >2
s.d. above normal value and Plasma procalcitonin >2 s.d. above normal value

24. Question: Which of the following is the causative agent of plague?

A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Staphylococcus epidermidis
D. Yersinia pestis

Answer: D. Yersinia pestis

Rationale: Plague is caused by the gram-negative organism Yersinia pestis. The naturally
occurring disease in humans is transmitted via flea bites from rodents. It was the first
biological warfare agent, and was used in the Crimean city of Caffa by the Tartar army,
whose soldiers catapulted bodies of plague victims at the Genoese. When plague is used
as a biological warfare agent, clinical manifestations include epidemic pneumonia with
blood-tinged sputum if aerosolized bacteria are used, or bubonic plague if fleas are used
as carriers.

25. Question: Laparoscopic Cholecystectomy falls under what classification of wound?

A. Class I
B. Class II
C. Class III
D. Class IV
 Answer: B. Class II
Rationale:

26. Surgical wounds are classified based on the presumed magnitude of the bacterial load at
the time of surgery. This type of wound includes those in which a hollow viscus such as
the respiratory, alimentary, or genitourinary tracts with indigenous bacterial flora is opened
under controlled circumstances without significant spillage of contents.
A. Clean/contaminated wounds (type II)
B. Clean wounds (class I)
C. Contaminated (class III)
D. Dirty (IV)

Answer: A. Clean/contaminated wounds (type II)

Rationale: Clean wounds (class I) include those in which no infection is present; only skin
microflora potentially contaminate the wound, and no hollow viscus that contains microbes
is entered. While Contaminated wounds (class III) include open accidental wounds early
after injury, and lastly, Dirty wounds (class IV) include traumatic wounds in which a
significant delay in treatment has occurred and in which necrotic tissue is present.

27. What is/are the prophylactic antibiotic/s to be given to patients who underwent
Cardiovascular surgery?
A. Cefoxitin
B. Cefazolin, Cefuroxime
C. Cefazolin + Metronidazole
D. Ampicillin-sulbactam
 Answer: B. Cefazolin, Cefuroxime
Rationale:

28. Which of the following is not a Criteria for systemic inflammatory response syndrome
(SIRS)?
A. Fever with core temp >38.3°C
B. Heart rate >90 bpm
C. Leukopenia of WBC <2000
D. Ileus

Answer: C. Leukopenia of WBC <2000

Rationale:

29. Whom of the following is NOT at risk of developing surgical site infections?
A. 32 y/o male with a BMI of 31 kg/m2
B. 52y/o female 20-pack years smoker
C. 72 y/o male with CKD
D. 57 y/o female who had undergone cholecystectomy 10 years ago

Answer: D. 57 y/o female who had undergone cholecystectomy 10 years ago

 Rationale:

30. Which of the following antifungal agents is associated with decreased cardiac contractility?
A. Voriconazole
B. Liposomal amphotericin B
C. Itraconazole
D. Anidulafungin

Answer: C. Itraconazole
Rationale: Itraconazole is associated with decreased cardiac contractility. Voriconazole
can cause visual disturbances. Liposomal amphotericin B primarily has renal toxicity.
Anidulafungin is associated with poor CNS penetration. (Table 6-3). (See Schwartz 10th
ed., p. 141.)

31. The typical chest roentgenographic finding in anthrax is:

A. Bilateral fluffy infiltrates
B. Cavitating lesions, primarily in the upper lobes
C. Pneumothorax
D. Widened mediastinum and pleural effusions

Answer: D. Widened mediastinum and pleural effusions

Rationale: Inhalational anthrax develops after a 1- to 6-day incubation period, with
nonspecific symptoms, including malaise, myalgia, and fever. Over a short period of time,
these symptoms worsen, with development of respiratory distress, chest pain, and
diaphoresis. Characteristic chest roentgenographic findings include a widened
mediastinum and pleural effusions. A key aspect in establishing the diagnosis is eliciting
an exposure history. Rapid antigen tests are currently under development for identification
of this gram-positive rod. Postexposure prophylaxis consists of administration of either
ciprofloxacin or doxycycline. (See Schwartz 10th ed., p. 156-157.)