The pair of substances and special stains which is incorrect:
A. Lipid: Oil Red O (ORO)
B. Hemosiderin: Prussian Blue
C. Glygogen: Periodic Acid Schiff (PAS) without diastase
D. Anthracotic pigment: Alizarin Red
Answer
Multiple clear [unstained] vacuoles are seen in the cytoplasm of hepatocytes on a routinely stained liver biopsy from an alcoholic. A PAS stain fails to show any material in the vacuoles. An Oil Red O stain does stain red in the vacuoles when done on a piece of tissue cut on frozen section. Your conclusion:
A. The material is glycogen; the cytoplasmic vacuoles are normal.
B. The material is amyloid; the cytoplasmic change is irreversible.
C. The material is triglyceride; the change is irreversible.
D. The material is triglyceride; the change is reversible.
E. The material is water; the change is reversible.
Answer
A Prussion blue stain is done on granular pigment found in the liver; the stain is positive. Your findings and the interpretation:
A. The stain is blue; the pigment is hemosiderin
B. The stain is blue; the pigment is lipofuschin
C. The stain is black; the pigment is carbon
D. The stain is red; the pigment is amyloid
E. The stain is red; the pigment is cholesterol
Answer
A tatooed prison inmate is bitten by another inmate in a fight. You examine his healing scar two
weeks later, are concerned about infection, and do a biopsy and a culture to evaluate the wound. Your friendly local pathologist sees some brown pigment in the tissue. You think it is hemosiderin rather than tatoo pigment. To confirm your suspicion, you suggest that she do a:
A. Prussian blue stain
B. Trichrome stain
C. Oil Red O stain
D. Periodic Acid Schiff stain
E. Gram stain
Answer
The tissue not usually associated with hyperplasia:
A. Gastric mucosa
B. Skin
C. Skeletal muscle
D. Smooth muscle
E. Bronchial lining cells
Answer
Which of the following provides an example of concomitant hyperplasia and hypertrophy?
a. left ventricular cardiac hypertrophy
b. enlargement of skeletal muscle in athletics
c uterine growth during pregnancy
d cystic hyperplasia of the endometrium
Answer
Response of cardiac muscle to systemic hypertension
a. coagulation necrosis
b. hyperplasia
c. aplasia
d. hypertrophy
e. atrophy
Answer
Response of adrenocortical cells to a pituitary adenoma producing ACTH
a. coagulation necrosis
b. hyperplasia
c. aplasia
d. hypertrophy
e. atrophy
Answer
Ischemic damage in survivors of shock may result in this renal abnormality:
a oval fat bodies
b acute tubular necrosis
c proteinuria
d ascites
Answer
Ischemia may be the primary injury producing all of the following results in the affected organ except:
A. atrophy
B. apoptosis
C. coagulative necrosis
D. dystrophic calcification
E. anthracosis
Answer
Lipofuschin is:
A. Limited to the liver
B. Pigment from cellular breakdown
C. Microvesicular fatty change in the myocardium
D. Hyaline pigment in striated muscle cells
E. Stained distinctively by Prussian blue
Answer
Which of the following statements regarding slow waves in the stomach is FALSE? A. They consist of upstroke and plateau phases.
B. Their frequency is 3-5/minute.
C. When the plateau phase exceeds a threshold, contraction occurs.
D. Action potentials on top of the slow waves are required for contraction.
E. They determine the frequency of contractions.
Answer
The pathway from the intestinal lumen to the circulating blood for a medium-chain fatty acid is A. enterocytechylomicronlymphatic ductblood
B. enteroctyeVLDLblood
C. enterocyteblood
D. enterocyteLDLlymphatic ductblood
E. enterocytelymphatic ductblood
Answer
Which of the following is responsible for moving fecal material into the rectum? A. segmentation contractions
B. rectosphincteric complex
C. migrating motility complex
D. mass movement
E. peristaltic contractions
Answer
With regard to gastric secretions, A. the higher the flow rate of gastric juice, the higher is its Na+ concentration.
B. H+ is secreted across the apical membrane of the parietal cell in exchange for K+.
C. Cl- is secreted into the lumen via a Cl- active transport protein.
D. K+ concentrations are always lower than in plasma.
E. only small amounts of ATP are required.
Answer
With regard to salivary secretion, A. the major control of secretion is via the enteric nervous system.
B. parasympathetic input stimulates secretion, while sympathetic input inhibits secretion.
C. as flow rate increases, Na+ and Cl- concentrations increase.
D. stimulation of the sympathetic nerves to salivary glands results in prolonged stimulation of salivation.
E. the volume is low relative to the mass of the salivary glands.
Answer
With regard to the small intestine, A. peristaltic contractions are the most common type of contractions.
B. slow waves trigger contractions.
C. contractions are more frequent in the ileum than in the duodenum.
D. there is no migrating motility/myoelectric complex.
E. motility is mediated by both the extrinsic and intrinsic nervous systems.
Answer
With regard to pancreatic secretion, A. during the intestinal phase, CCK stimulates pancreatic acinar cells to secrete pancreatic enzymes.
B. as flow rate increases, Na+ concentration increases.
C. CCK does not influence the response of ductal cells to secretin.
D. the HCO3- concentration is always lower than that in plasma.
E. HCO3- enters the lumen by through channels.
Answer
Which of the following are determinants of the host response to surgical stress?
a. Gender
b. Age
c. Nutritional status
d. Body composition
Answer
Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition?
a. Glutamine is an essential amino acid
b. Glutamine appears to be of primary benefit in critical illness
c. Glutamine is included in most standard TPN solutions
d. Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon
Answer
In contrast to a patient undergoing an elective operation, which of the following statement(s) is/are true concerning a patient who has suffered a multiple trauma?
a. Basal metabolic rates are similar
b. The patient is highly sensitive to insulin
c. Utilization of the amino acids, glutamine and alanine, is similar to their composition in skeletal muscle
d. Fat and protein stores are rapidly depleted
Answer
A 47-year-old patient undergoing a complicated laparotomy for bowel obstruction develops a postoperative enterocutaneous fistula. Which of the following statement(s) is/are true concerning parenteral nutritional support in the postoperative period?
a. Oral intake can result in severe dehydration, electrolyte abnormalities, and perifistula skin injury
b. Total parenteral nutrition increases the spontaneous closure rate of intestinal fistula
c. Total parenteral nutrition decreases mortality rate in patients with intestinal fistulas
d. The use of TPN better prepares the patient for surgery if surgical intervention proves necessary
Answer
Appropriate guidelines for the use of TPN in cancer patients include:
a. Long-term TPN in patients with rapid progressive tumor growth unresponsive to other therapy
b. Mildly malnourished patients undergoing surgery for a curable cancer
c. Preoperatively administered TPN prior to surgery or other therapy in patients with severe malnutrition
d. Patients in whom treatment toxicity precludes the use of enteral nutrition
Answer
Which of the following statements(s) is/are true concerning human energy requirement?
a. In normal subjects, less than 5% of basal energy requirement is spent on cardiac output and the work of breathing
b. Mechanical ventilation can decrease the energy expenditure for normal respiration
c. For a 70 kg male, average resting energy consumption is almost 1500 kcal/day
d. Similar increases in energy expenditures are associated with elective surgery and trauma or thermal injury
Answer
A 55-year-old male undergoes a total abdominal colectomy. Which of the following statement(s) is/are true concerning the hormonal response to the surgical procedure?
a. Adrenocorticotropic hormone (ACTH) is secreted from the anterior pituitary gland
b. ACTH stimulation results in elevation of serum cortisol levels for up to a week after the operation
c. An increased secretion of aldosterone and ADH may contribute to postoperative fluid retention
d. An increase in serum insulin and a fall in glucagon accelerate hepatic glucose production and maintain gluconeogenesis
Answer
Which of the following complications of TPN are appropriately managed with the listed treatment?
a. Air embolism—place patient in reverse Trendelenburg and the left lateral decubitus position and aspirate venous air
b. Hyperchloremic metabolic acidosis—give sodium and potassium as acetate salts
c. Carbon dioxide retention—decrease glucose calories and replace with fat
d. Line sepsis—intravenous antibiotics
Answer
A number of prospective clinical trials have addressed the role of total parenteral nutrition in the cancer patient. The results have been somewhat conflicting. Which of the following statement(s) have been proven correct by prospective trials?
a. Preoperative TPN is beneficial in surgical patients with severe preoperative nutrition
b. Postoperative TPN is of value following pancreatic resection
c. Routine use of perioperative (including prior to the procedure) TPN is of benefit in patients undergoing hepatectomy for hepatoma
d. TPN is of no benefit in patients undergoing bone marrow transplant
Answer
Which of the following statements concerning perioperative nutrition is true concerning the above-described patient?
a. Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition
b. Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens
c. Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements
d. A jejunal feeding catheter should be placed at the time of surgery for postoperative enteral feeding
Answer
Which of the following tissues contain significant collagen useful for placing sutures to allow the prolonged tension necessary to maintain tissue approximation?
a. Dermis
b. Intestinal submucosa
c. Muscular fascia
d. Blood vessel wall
Answer
The neurohormonal arm of the stress response is well defined. Less is known about the inflammatory arm mediated primarily by cytokines. Which of the following statement(s) is/are true concerning this arm of the surgical stress response?
a. Cytokines primarily work locally via direct cell-to-cell communication
b. Cytokines are never detectable in the systemic bloodstream
c. Cytokines are produced only by immune cells attracted to the site of injury
d. Cytokine release may stimulate the release of other cytokines leading to an important cascade of events
Answer
Products of platelet degranulation include:
a. Tumor necrosis factor
b. Interleukin-1
c. Transforming growth factor b
d. Platelet-derived growth factor
Answer
Which of the following factors can be associated with impaired wound healing?
a. Chemotherapy
b. Chronic steroid use
c. Peripheral vascular disease
d. Radiation therapy
e. Diabetes mellitus
Answer
A patient with gross fecal contamination and peritonitis from a ruptured sigmoid diverticulum has his midline wound left open to heal by secondary intention. Which of the following statement(s) describes this healing process?
a. Wounds healing in this fashion have an altered sequence of healing compared to a primarily closed wound
b. A bed of granulation tissue forms over exposed subcutaneous tissue
c. Epithelialization is enhanced in the face of bacterial colonization
d. The ability of a wound to form granulation tissue is dependent on the blood supply of the tissue
Answer
Which of the following cells or blood elements play a role in the initial phases of wound healing?
a. Polymorphonuclear leukocytes (PMNs)
b. Platelets
c. Monocytes
d. Lymphocytes
Answer
Which of the following surgical techniques lead to improved wound healing?
a. Atraumatic handling of tissue
b. Approximation of underlying fatty tissue to obliterate dead space
c. Protecting the wound from water for at least one week
d. Meticulous hemostasis
Answer
Which of the following statement(s) is/are true concerning the clinical management of an open wound?
a. A wet-to-dry dressing is the most optimal form of wound management
b. A moist occlusive dressing promotes epithelialization and reduces pain
c. The protein rich plasma exudate covering the open wound facilitates healing
d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process
Answer
Which of the following statement(s) is/are correct concerning the management of an open wound?
a. Frequent surgical debridement is usually necessary
b. Water irrigation can effectively debride most wounds
c. Hydrogen peroxide is particularly useful in the management of open wounds
d. A number of the newer dressing products have clearly been shown to promote wound healing compared to simple moist occlusive dressing
Answer
Which of the following statement(s) is/are true concerning the proliferative phase of wound healing?
a. The macrophage is the predominant cell type
b. The pink or purple-red appearance of a wound is due to ingrowth and proliferation of endothelial cells
c. Collagen, the dominant structural molecule of the wound matrix, contains two unique amino acids, hydroxyproline and hydroxylysine
d. The predominant collagen type in a scar is type 3
Answer
Which of the following statement(s) is/are true concerning the role of antibiotics in wound care?
a. Systemic antibiotics are indicated for all open wounds
b. Bacterial resistance can occur with systemic but not topical antibiotics
c. An indication for systemic antibiotic administration is a granulation tissue bacterial count in excess of greater than 105 organisms/gram of tissue on quantitative analysis
d. Silver sulfadiazine is useful only for the management of burns
Answer
Which of the following statement(s) is/are true about the role of macrophages in the wound healing process?
a. Macrophages are the dominant cell type during the inflammatory phase of wound healing
b. Macrophages are not essential for wound healing
c. The macrophage role in wound healing is limited to phagocytosis
d. Macrophages are a source of a number of humoral factors essential for wound healing
Answer
Which of the following statement(s) is/are true concerning wound contraction?
a. Wound contraction accounts for similar rates of reduction of wound size regardless of their location
b. The fibroblast, at the cellular level, is the primary force driving wound contraction
c. Excessive wound contraction, when occurring over a joint, may lead to disability
d. Actin microfillaments are found in fibroblasts and may play a role in wound contracture
Answer
There are a multitude of various dressings available. Which of the following statement(s) is/are true concerning options for surgical dressings?
a. Hydrocolloids, such as karaya compounds, offer the primary advantage of increased absorptive ability
b. Films, such as Op-site, provide a water impermeable environment to achieve a dry wound
c. Impregnates are fine gauze impregnated with a variety of substances such as antibiotics or moisturizing agents that adhere tightly to the wound and do not require a secondary dressing
d. Absorptive powders and paste are highly useful in debriding necrotic and fibrous material from wounds and absorbing wound serum
Answer
