The angiomatiod or plexiform lesion of pulmonary hypertension is most likely to occur in:
A. A 60 year old man with chronic bronchitis
B. A 35 year old male with Wegener's necrotizing granulomatosis and vasculitis
C. A 50 year old female non-smoker with an adenocarcinoma of the lung
D. A 5 year old with congenital cyanotic heart disease
E. A 70 year old person with end stage emphysema
Answer
The disease least likely to produce atelectasis:
A. Squamous cell carcinoma
B. Chronic bronchitis
C. Cystic fibrosis
D. Mycoplasma interstitial pneumonitis
Answer
The patient most likely to develop a pulmonary infraction after a pulmonary embolus:
A. A 25 year old athlete on crutches after a tibial fracture
B. A 65 year old chronic smoker hospitalized in traction after a motor vehicle accident with multiple pelvic fractures
C. A 10 month old boy hospitalized with RSV pneumonitis
D. A 32 year old ascribed health nut hospitalized for one week with pancreatis secondary to a common bile duct stone.
Answer
The major differences between bronchopneumonia and lobar pneumonia:
A. Kind of cells in the inflammatory infiltrate
B. Number of cells in inflammatory infiltrate
C. Degree of fibrovascular granulation tissue repair
D. Distribution of inflammatory infiltrate in the lung
E. Kind of chemical mediators initiating injury
Answer
Ferruginous bodies in the lungs are markers for:
A. Coal dust
B. Quartz exposure
C. Thermophillic actinomycea
D. Asbestos exposure
E. Nocardia
Answer
Chronic bronchitis is defined as:
A. Allergic asthma
B. A cough productive of sputum for 3 months for at least 2 years.
C A productive cough in a smoker
D. Chronic bronchial wall inflammation
E. Mucus plugs in bronchioles
Answer
Major basic protein is a major mediator of injury in:
A. Allergic asthma
B. Centrilobular emphysema
C. Panobular emphysema
D. Chronic bronchitis
E. Lobular pneumonia
Answer
A 42 year old black woman presents with shortness of breath. She is a non-smoker. A diffuse interstitial pattern with small parenchymal nodules is seen on chest radiograph, as well as massively enlarged hilar lymph nodes. Based on your suspected clinical diagnosis, what do you expect to find on transbronchial biopsy of the lung?
A. Loss of alveolar walls with minimal changes in the airways
B. Non caseating granulomata
C. Many neutrophils in alveoli with edema
D. Type II pneumocyte proliferation with chronic interstitial inflammation and intranuclear viral inclusions
E. An increased Reid index
Answer
The cardiomyopathy of alcohol abuse is a/an:
A. Dilated cardiomyopathy
B. Restrictive cardiomyopathy
C. Hypertrophic cardiomyopathy
D. Ischemic cardiomyopathy
Answer
Skeletal muscle breakdown produces predominantly liberation of which two amino acids?
A. Lysine.
B. Tyrosine.
C. Alanine.
D. Glutamine.
E. Arginine.
Answer
In “catabolic” surgical patients, which of the following changes in body composition do not occur?
A. Lean body mass increases.
B. Total body water increases.
C. Adipose tissue decreases.
D. Body weight decreases.
Answer
The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues?
A. Central nervous system.
B. Skeletal muscle.
C. Bone.
D. Kidney.
E. Tissue in the healing wound.
Answer
Cytokines are endogenous signals that stimulate:
A. Local cell proliferation within the wound.
B. The central nervous system to initiate fever.
C. The production of “acute-phase proteins.”
D. Hypoferremia.
E. Septic shock.
Answer
The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
A. Hypermetabolism.
B. Fever.
C. Tachypnea.
D. Hyperphagia.
E. Negative nitrogen balance.
Answer
Shock can best be defined as:
A. Hypotension.
B. Hypoperfusion of tissues.
C. Hypoxemia.
D. All of the above.
Answer
Which of the following statements about continuous cardiac output monitoring are true?
A. Continuous cardiac output monitoring may unmask events not detected by intermittent cardiac output measurements.
B. Continuous cardiac output monitoring by the thermodilution method requires continuous infusion of fluid injectate at a constant rate and temperature.
C. The major advantage of the Fick method over the thermodilution method of calculating cardiac output is that it is noninvasive, requiring only the determination of oxygen consumption by respiratory gas analysis.
D. The technique of thoracic electrical bioimpedance utilizes sensors to determine stroke volume by detecting changes in resistance to a small, applied alternating current.
Answer
Which of the following statements regarding cytokines is incorrect?
A. Cytokines act directly on target cells and may potentiate the actions of one another.
B. Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.
C. Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.
D. Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates.
Answer
True statements concerning hypoadrenal shock include which of the following?
A. Adrenocortical insufficiency may manifest itself as severe shock refractory to volume and pressor therapy.
B. The presence of hyperglycemia and hypotension may suggest the diagnosis of shock due to adrenocortical insufficiency.
C. Hydrocortisone does not interfere with the serum cortisol assay and should be given to hemodynamically unstable patients suspected of having hypoadrenal shock.
D. The rapid adrenocorticotropic hormone (ACTH) stimulation test should be performed to help establish the diagnosis of acute adrenocortical insufficiency.
Answer
All of the following are true about neurogenic shock except:
A. There is a decrease in systemic vascular resistance and an increase in venous capacitance.
B. Tachycardia or bradycardia may be observed, along with hypotension.
C. The use of an alpha agonist such as phenylephrine is the mainstay of treatment.
D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.
Answer
True statements regarding eicosanoids include which of the following?
A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway.
B. The vasoconstricting, platelet-aggregating, and bronchoconstricting effects of thromboxane A 2 are balanced by the actions of prostacyclin, which produces the opposite effects.
C. Leukotriene synthesis is inhibited by the action of nonsteroidal anti-inflammatory drugs (NSAIDs).
D. The principal prostaglandins have a short circulation half-life and exert most of their effects locally.
Answer
Which of the following statements about delivery-dependent oxygen consumption are true?
A. Below the critical oxygen delivery (DO2crit), one would expect to see a decrease in the lactate-pyruvate ratio.
B. D(overdot)O 2crit may be increased in patients with sepsis.
C. A desirable goal in the treatment of shock is to achieve delivery-independent oxygen consumption.
D. The oxygen extraction ratio remains constant as long as oxygen delivery remains above D(overdot)O 2crit.
Answer
All of the following may be useful in the treatment of cardiogenic shock except:
A. Dobutamine.
B. Sodium nitroprusside.
C. Pneumatic antishock garment.
D. Intra-aortic balloon pump.
Answer
An 18-year-old man shot once in the left chest has a blood pressure of 80/50 mm. Hg, a heart rate of 130 beats per minute, and distended neck veins. Immediate treatment might include:
A. Administration of one liter of Ringer's lactate solution.
B. Subxiphoid pericardiotomy.
C. Needle decompression of the left chest in the second intercostal space.
D. Emergency thoracotomy to cross-clamp the aorta.
Answer
Which of the following statements concerning monitoring techniques in the intensive care unit are true?
A. Pulmonary artery and pulmonary capillary wedge pressure readings should be made at end inspiration, to minimize ventilatory artifacts.
B. Continuous SvO 2 monitoring based on the technique of reflectance spectrophotometry has been shown to be accurate and reliable.
C. Direct measurement of gastric intramucosal pH can be provided by gastrointestinal tonometry.
D. Hyperlactatemia may be seen in a number of clinical conditions not associated with tissue hypoxia, including liver disease and hypermetabolic states.
Answer
Which of the following statements are true of the multiple organ dysfunction syndrome (MODS)?
A. The “two-hit” model proposes that secondary MODS may be produced when even a relatively minor second insult reactivates, in a more amplified form, the systemic inflammatory response that was primed by an initial insult to the host.
B. The systemic inflammatory response syndrome (SIRS), shock due to sepsis or SIRS, and MODS may be regarded as a continuum of illness severity.
C. Prolonged stimulation or activation of Kupffer cells in the liver is thought to be a critical factor in the sustained, uncontrolled release of inflammatory mediators.
D. The incidence of MODS in intensive care units has decreased owing to increased awareness, prevention, and treatment of the syndrome.
Answer
All of the following statements about hemorrhagic shock are true except:
A. Following hemorrhagic shock, there is an initial interstitial fluid volume contraction.
B. Dopamine, or a similar inotropic agent, should be given immediately for resuscitation from hemorrhagic shock, to increase cardiac output and improve oxygen delivery to hypoperfused tissues.
C. The use of colloid solutions or hypertonic saline solutions is contraindicated for treatment of hemorrhagic shock.
D. In hemorrhagic shock, a narrowed pulse pressure is commonly seen before a fall in systolic blood pressure.
Answer
Which of the following statements are true of oxidants?
A. In addition to their pathophysiologic roles in inflammation, injury, and infection, oxidants also have physiologic roles.
B. Oxidants may be generated from activated neutrophils and during reperfusion following a period of ischemia.
C. The deleterious effects of oxidants include lipid peroxidation and cell membrane damage, oxidative damage to DNA, and inhibition of adenosine triphosphate (ATP) synthesis.
D. The mechanism of ischemia-reperfusion injury involved the catalytic production of superoxide anion (O 2•) by the enzyme xanthine oxidase.
Answer
Which of the following statements about septic shock are true?
A. A circulating myocardial depressant factor may account for the cardiac dysfunction sometimes seen with shock due to sepsis or SIRS.
B. A cardiac index (CI) of 6 liters per minute per square meter of body surface, a pulmonary capillary wedge pressure of 15 mm. Hg, and a systemic vascular resistance index (SVRI) of 800 dynes-sec/(cm 5-m 2) is a hemodynamic profile consistent with septic shock.
C. An increase in SvO 2 in septic patients may be explained by the finding of anatomic arteriovenous shunts.
D. Results of human trials employing antimediator therapy, such as antiendotoxin antibodies, IL-1 receptor antagonist, and tumor necrosis factor (TNF) antibodies, have confirmed animal studies that demonstrate a significant improvement in survival with the use of such agents.
Answer
Which of the following statements about the role of the gut in shock and sepsis are true?
A. Selective decontamination of the digestive tract with the use of oral antibiotics has been shown to reduce nosocomial pneumonias and to improve mortality rates.
B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus architecture of the gut.
C. Gut dysfunction may be an effect of shock, but it may also contribute to the development of MODS by the mechanism of bacterial translocation.
D. As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.
Answer
The Correct answer is
B
The middle ear (tympanic) cavity is derived from the first pharyngeal pouch and the ossicles are from the first and second arch cartilages .
First Pharyngeal Pouch
- forms the auditory tube (narrow proximal part) & tympanic cavity (distal sac-like structure)
- tympanic membrane—forms from lining of tympanic cav.
- later comes into contact with epithelial lining of 1st pharyngeal cleft (future EAM)
Ossicles—(malleus, incus, & stapes) embedded in mesenchyme during most of development; in 8th month it degenerates & endoderm envelops them & connects them to wall of cavity
- malleus—1st pharyngeal arch (tensor tympanin = accompanying m. inn by CN V)
- incus—1st pharyngeal arch
- stapes—2nd pharyngeal arch (stapedius m = accompanying m. inn by CN VII)
The Correct Option is
E
Auditory receptors are located in the cochlea
- Hearing is best developed in tetrapods, specifically mammals and birds
- The cochlea is a spiral-shaped tube consisting of two connected canals; the upper vestibular canal and the lower tympanic canal that are continuous at the apex of the cochlea
- These two canals are filled with perilymph
- The middle canal is the cochlear duct, and is filled with endolymph
- The organ of Corti is located in the cochlear duct, and is composed of hair cells resting on a basilar membrane
- The basilar membrane separates the cochlear duct from the tympanic canal
- The tectorial membrane lies above the hair cells
- In humans, sound waves cause the tympanic membrane to vibrate; the three middle ear bones (malleus, incus, and stapes) transmit and amplify the vibration to the oval window, which transmits the vibration to the perilymph in the vestibular canal
- The pressure wave is transmitted through the vestibular canal to the tympanic canal, and ultimately causes the basilar membrane to vibrate
- The tectorial membrane stimulates the hair cells of the organ of Corti, which send impulses to the brain via the cochlear nerve
- Sounds of different frequencies resonate and stimulate the basilar membrane in different ways and in different areas
- Loudness is based on a greater number of hair cells being stimulated
- The human ear typically responds to sounds between 20 and 20,000 cycles per second (Hz), which is much more sensitive than the human eye
Cells considered to be usually in the G0 of the cell cycle would include the following:
A. Columnar epithelium of the gastrointestinal tract
B. Hematopoietic tissues
C. Hepatocytes
D. A and B
E. All of the above
Answer
Both the aPTT and PT would be expected to be prolonged with:
A. Deficiency of factors X, V, II or I
B. Deficiency of factors X, V, II or XIII
C. Deficiency of factors XII, XI, IX, VIII, or IV
D. Deficiency of factors III or VII
E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein
Answer
Which of the following would be increased with deficiency(ies) of factors XI, IX, or VIII:
A. aPTT (activated partial thromboplastin time)
B. PT (prothrombin time)
C. Ivey bleeding time
D. Platelet count
Answer
Both the aPTT and PT would be expected to be prolonged with:
A. Deficiency of factors X, V, II or I
B. Deficiency of factors X, V, II or XIII
C. Deficiency of factors XII, XI, IX, VIII, or IV
D. Deficiency of factors III or VII
E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein
Answer
Which of the following would be increased with deficiency(ies) of factors XI, IX, or VIII:
A. aPTT (activated partial thromboplastin time)
B. PT (prothrombin time)
C. Ivey bleeding time
D. Platelet count
Answer
Fibrin/Fibrinogen split products may cause prolongation of the aPTT due to:
A. Inhibition of platelet aggregation
B. Inhibition of fibrin crosslinking by factors XIIIa
C. Inhibition of thrombin mediated conversion of fibrinogen to fibrin
D. Conversion of plasminogen to plasmin
Answer
Fibrin/Fibrinogen split products may cause prolongation of the aPTT due to:
A. Inhibition of platelet aggregation
B. Inhibition of fibrin crosslinking by factors XIIIa
C. Inhibition of thrombin mediated conversion of fibrinogen to fibrin
D. Conversion of plasminogen to plasmin
Answer
