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ABSITE 9th edition 9.

Which of the following best describes the hemodynamic


SHOCK response to neurogenic shock?
1. The initiating event in shock is A. Increased cardiac index, unchanged venous capacitance
A. Hypotension B. Increased cardiac index, decreased venous capacitance
B. Decreased cardiac output C. Variable change in cardiac index (can increase or decrease),
C. Decreased oxygen delivery increased venous capacitance
D. Cellular energy deficit D. Variable change in cardiac index (can increase or decrease),
decreased venous capacitance
2. Which of the following can initiate afferent impulses to the CNS
which triggers the neuroendocrine 10. What percentage of the blood volume is normally in the
response of shock? splanchnic circulation?
A. Severe alkalosis A. 10%
B. Hypothermia B. 20%
C. Hyperthermia C. 30%
D. Hyperglycemia D. 40%

3. Vasoconstriction is one of the initial physiologic responses to Clinical questions


hypovolemic shock. This is mediated by 1. Which of the following can be used to indirectly estimate the
A. Activation of alpha adrenergic receptors on the oxygen debt incurred during shock?
arterioles A. Arterial pH
B. Downregulation of alpha adrenergic receptors on the arterioles B. Arteriolar-alveolar O2 gradient
C. Activation of beta adrenergic receptors on the arterioles C. Base deficit
D. Downregulation of beta adrenergic receptors on the arterioles D. Serum bicarbonate

4. Anti-diuretic hormone (ADH) is secreted in response to shock 2. A 70-kg -man with a laceration to the brachial artery loses a total
and remains elevated for approximately 1 week. Which of the of 800 mL of blood. What ACS (American College of Surgeons)
following is seen as a result of this increased level of ADH? class of hemorrhage would this represent?
A. Decreased water permeability in the distal tubule A. Class I hemorrhage
B. Increased sodium loss in the distal tubule B. Class II hemorrhage
C. Mesenteric vasoconstriction C. Class III hemorrhage
D. Mesenteric vasodilation D. Class IV hemorrhage

5. Hypoxia at the cellular level decreases ATP production (also 3. A patient arrives in the ER following a motor vehicle accident
called dysoxia). This results in with multiple injuries. Hypotension in this patient is defined as
A. Changes in intracellular calcium signaling systolic blood pressure less than
B. Increased cell membrane potential A. 110
C. Increased intracellular pH B. 90
D. Increased number of mitochondria C. 70
D. 50
6. Toll-like receptors play a role in the “danger signaling” pathway
which modulates the immune response to injury. Stimulation of 4. 2 hours following major surgery with significant blood loss, a
these receptors is by molecules released from patient has a base deficit of –6. This would be classified as
A. The pituitary A. Mild base deficit
B. The adrenal medulla B. Moderate base deficit
C. Macrophages C. Severe base deficit
D. Damaged cells D. Extremely severe base deficit

7. Which of the following cytokines is released immediately after 5. The probability of death for a patient with a base deficit of –6 is
major injury? approximately
A. IL-10 A. 5%
B. IL-2 B. 15%
C. TNF-alpha C. 25%
D. TNF-beta D. 35%

8. Which of the following is an anti-inflammatory cytokine? 6. In a patient with ongoing hemorrhage, the risk of death increases
A. IL-1 1%
B. IL-6 A. Every 3 minutes in the ER
C. IL-8 B. Every 10 minutes in the ER
D. IL-10 C. Every 30 minutes in the ER
D. Every 60 minutes in the ER

ps. read at your own risk  good luck guys!


7. A 24-year-old arrives at the emergency department (ED) with 14. A 72-year-old woman suffered an acute MI and, 12 hours later,
multiple stab wounds to the abdomen, severe blunt trauma to the is in cardiogenic shock. Which of the following is the best
head (GCS 10), and a systolic blood pressure of 80 mm Hg. treatment for this patient?
An appropriate goal for resuscitation in the ED would be a systolic A. Inotropic support until stabilized then PTCA (percutaneous
blood pressure of transluminal coronary
A. 80–90 mm Hg angiography)
B. 90–100 mm Hg B. Immediate PTCA with stenting, if feasible
C. 100–110 mm Hg C. Immediate PTCA to define anatomy followed by coronary artery
D. 110–120 mm Hg bypass
D. None of the above
8. An INR of 1.5 on arrival to the intensive care unit (ICU) is
associated with what probability of 15. An unconscious patient with a systolic BP of 80 and a HR of 80
death? most likely has
A. INR is not predictive of outcome A. Cardiogenic shock
B. 10% B. Hemorrhagic shock
C. 20% C. Neurogenic shock
D. 30% D. Obstructive shock

9. In a patient requiring massive transfusion, 1 unit of FFP (fresh BURNS


frozen plasma) should be given for every 1. The affinity of carbon monoxide for hemoglobin is
A. 1.5 units of PRBCs (1 to 1.5 ratio FFP:PRBC) A. 2-5 times greater than oxygen
B. 3 units of PRBCs (1 to 3 ratio FFP:PRBC) B. 20-50 times greater than oxygen
C. 6 units of PRBCs (1 to 6 ratio FFP:PRBC) C. 200-250 times greater than oxygen
D. 8 units of PRBCs (1 to 8 ratio FFP:PRBC) D. 2000-2500 times greater than oxygen

10. Shock following severe carbon monoxide poisoning is most 2. A 100-kg patient with a 50% TBSA full thickness burn receives 10
commonly L of 0.9% NaCl solution intransit to the hospital. His laboratory
A. Hypovolemic shock values 6 hours after the injury are likely to reflect which of the
B. Neurogenic shock following:
C. Cardiogenic shock A. Acidosis
D. Vasodilatory shock B. Alkalosis
C. Hypoxia
11. Insulin drips should be used to maintain serum glucose in D. Dilutional anemia
nondiabetic, critically ill patients at
levels between 3. The topical antimicrobial agent mafenide acetate is most likely to
A. 80 and 110 mg/dL cause which of the following complications:
B. 100 and 150 mg/dL A. Methemoglobinemia
C. 120 and 200 mg/dL B. Neutropenia
D. 150 and 250 mg/dL C. Metabolic acidosis
D. Nephrotoxicity
12. A 62-year-old man is involved in a moving vehicle accident. He
suffered significant blunt trauma to the sternum during the Clinical questions
accident. He has a systolic blood pressure of 95 on arrival to the 1. Which of the following patients should be immediately referred
ER. His CVP is 15 and his CXR is normal. Which of the following is to a burn center?
the most likely cause of his hypotension? A. A 20-year-old with a 12% partial thickness burn
A. Cardiac contusion B. A 30-year-old with a major liver injury and a 15% partial
B. Spinal cord injury thickness burn
C. Myocardial infarction C. A 2% TBSA partial thickness burn to the anterior leg, crossing
D. Intra-abdominal hemorrhage the knee
D. A 10-year-old with a 7% partial thickness burn
13. A patient unresponsive to catecholamines after an acute
myocardial infarction is placed on amrinone. Which of the following 2. Which of the following should prompt immediate, elective
is a common side effect of amrinone? intubation in a patient with a major burn?
A. Neutropenia A. Subjective dyspnea
B. Anemia B. Singed nasal hair
C. Thrombocytopenia C. Perioral burns
D. Bone marrow failure D. Oxygen saturation 96%
3. Which of the following is indicated in a 46-year-old patient with D. Early excision of the burn wound
a 22% TBSA partial thickness burn?
A. Prophylactic 1st generation cephalosporin ONCOLOGY
B. Prophylactic clindamycin 1. What is the most common cancer in the world?
C. Tetanus booster A. Breast
D. Tetanus toxoid B. Gastric
C. Lung
4. A 4-year-old patient presents with a diffuse scald wound after D. Liver
being held in a hot tub of water. There are circumferential blisters
present over the right leg (from hip to toes) and circumferential 2. Approximately how many people die of cancer annually in the
blistering over the lower left leg (from knee to toes). The right United States?
thigh, abdomen and back below the umbilicus, as well as the A. 100,000
buttocks and perineum are red but without blisters. What is the B. 500,000
total BSA burn? C. 2,000,000
A. 25% D. 5,000,000
B. 36%
C. 46% 3. The incidence of breast cancer is highest in developed nations
D. 54% with the exception of
A. France
5. 100% inhaled oxygen decreases the half-life of carbon monoxide B. England
from 250 minutes to approximately C. Japan
A. 200 minutes D. Australia
B. 150 minutes
C. 100 minutes 4. Which of the following is associated with an increased incidence
D. 50 minutes of liver cancer?
A. Salted food
6. Which of the following is used to treat severe hydrogen cyanide B. Infection with Hepatitis A
poisoning? C. Exposure to aflatoxin
A. Hydroxocobalamin D. Helicobacter pylori
B. Methylene blue
C. Dialysis 5. Which of the following is NOT one of the six cell alterations
D. None of the above—there is no effective treatment that permit malignant growth to occur in cells?
A. Self-sufficiency of growth signals
7. Most chemical burns require large volumes of water to remove B. Predisposition to apoptosis
the chemical. Which of the following chemical burns should be C. Angiogenesis
treated by careful wiping or sweeping of the skin, rather than D. Invasion and metastasis
water?
A. Powdered form of lye 6. Which of the following occurs in abnormally proliferating,
B. Formic acid transformed cells?
C. Hydrofluoric acid A. Anchorage-dependent growth
D. Acetic acid B. Immortalization
C. Increased contact inhibition
8. Formic acid burns are associated with D. Increased cell-cell adherence
A. Hemoglobinuria
B. Rhabdomyolosis 7. A “field effect” is best described as
C. Hypocalemia A. The effect of oncogene amplification in a cell on the adjacent
D. Hypokalemia cells
B. The effect of loss of tumor-suppressor gene function in a cell on
9. The agent most effective in treating hydrofluoric acid burns is the adjacent cells
A. Calcium C. Increased oncogene amplification or loss of tumor-
B. Magnesium suppressor gene function in a group of cells
C. Vitamin K D. The effect of radiation on a tumor
D. Vitamin A
8. Malignant cells are LEAST likely to be in which of the following
10. The major improvement in burn survival in the 20th century stages of the cell cycle?
can be attributed to the introduction of which of the following A. S phase
therapies: B. G0 phase
A. Antibiotics C. G1 phase
B. Central venous fluid resuscitation D. M phase
C. Nutritional support
9. Which of the following is a proto-oncogene that is activated to 17. APC (adenomatosis polyposis coli tumor-suppressor gene) is
promote malignant growth by gene abnormal in what percentage of sporadic (nonsyndromic) colon
amplification? cancer?
A. BRCA 1 A. 5%
B. ras B. 15%
C. HER2/neu C. 50%
D. p53 D. 80%

10. HER2, also known as neu, is an oncogene that promotes Clinical questions
malignant potential by 1. Which of the following is thought to have contributed to a
A. Forming a hetrodimer with other EGFR members decrease in the worldwide mortality rate of gastric cancer?
B. Increasing cell proliferation and growth A. Lower intake of fruits
C. Suppressing apoptosis B. Better food preservation
D. All of the above C. Routine laboratory monitoring
D. More effective therapy after diagnosis
11. What percentage of malignant tumors have activating mutations
in one of the ras genes? 2. A patient with breast cancer is considered to be cancer free (no
A. 1% further risk of primary recurrence or metastatic tumor) after
B. 5% A. 3 years
C. 20% B. 5 years
D. 70% C. 10 years
D. Never
12. Which of the following stimulates the extrinsic (death receptor)
apoptotic pathway? 3. Which of the following is the most common etiology of Li-
A. Tumor necrosis factor Fraumeni syndrome?
B. DNA damage A. Exposure to aflatoxin
C. Release of cytochrome C from the mitochondria B. Exposure to radiation
D. BcL-2 activation C. Mutation in the p53 gene
D. Mutation in the BRCA1 gene
13. Which of the following is INCORRECT?
A. A feature of malignant cells is invasion 4. What percentage of breast cancers are hereditary?
B. In situ cancer lies above the basement membrane A. 1%
C. Invasion involves changes in adhesion, motility, and B. 5-10%
proteolysis of extracellular matrix C. 30%
D. E-cadherin molecules increase invasion D. 50%

14. Which of the following is NOT a gene associated with 5. The risk of developing breast cancer by age 70 for a woman with
hereditary cancer a BRCA1 mutation is
A. FBN1 approximately
B. CDH1 A. 10%
C. HER2 B. 20%
D. RET C. 30%
D. 40%
15. Certain breast cancer subtypes preferably spread to certain
organs. This is an example of 6. BRCA2 mutations are associate with all of the following EXCEPT
A. Tumor dormancy A. Gastric cancer
B. “Seed and soil” theory B. Lung cancer
C. Lymphatic spread C. Ovarian cancer
D. In situ carcinoma D. Prostate cancer

16. Mutations in the Rb1 gene were first associated with 7. A patient with Lynch syndrome 2 is at increased risk for
A. Breast cancer A. Carcinoma of the endometrium
B. Colorectal cancer B. Secretory carcinoma of the breast
C. Rhabdomyosarcoma C. Osteosarcoma
D. Retinoblastoma D. Melanoma

8. Cowden syndrome is associated with an increased incidence of


A. Thyroid cancer
B. Adrenal cancer
C. Colorectal cancer
D. Gastric cancer 17. Which of the following is an alkylating agent?
A. Cyclophosphamide
9. Patients with hereditary melanoma due to a p16 mutation are B. Doxorubicin
also at higher risk for C. Pactitaxel
A. Thyroid cancer D. Vincristine
B. Pancreatic cancer
C. Colorectal cancer 18. Which of the following molecularly targeted therapies is
D. Breast cancer directed against the HER2 gene?
A. Cetuximab
10. Which of the following chemical carcinogens has been B. Sunitinib
associated with angiosarcoma of the liver? C. Trastuzumab
A. Benzene D. Temsirolimus
B. Diethylstilbestrol ABSITE 10th edition
C. Vinyl chloride SHOCK
D. Coal tar 1. Shock caused by a large tension pneumothorax is categorized as
A. rauma shock
11. Exposure to coal tar is associated with which of the following B. Vasodilatory shock
cancers? C. Cardiogenic shock
A. Bladder cancer D. Obstructive shock
B. Nasopharyngeal cancer
C. Scrotal cancer 2. What is true about baroreceptors?
D. Breast cancer A. Volume receptors can be activated in hemorrhage with
reduction in le atrial pressure.
12. Epstein Barr virus (EBV) is associated with which of the B. Receptors in the aortic arch and carotid bodies inhibit
following cancers? the autonomic nervous system (ANS) when stretched.
A. Nasopharyngeal carcinoma C. When baroreceptors are stretched, they induced
B. Non-Hodgkin’s lymphoma increased ANS output and produce constriction o
C. Adult T-cell leukemia peripheral vessels.
D. Kaposi’s sarcoma D. None of the above.

13. Which of the following is the most significant risk factor for 3. Chemoreceptors in the aorta and carotid bodies do NOT
invasive breast cancer when screening a patient for risk? sense which o the following?
A. >2 first-degree relatives with breast cancer A. Changes in O2 tension
B. 2 previous breast biopsies in a patient 50 years of age B. H+ ion concentration
C. Age 12 at menarche C. HCO 3– concentration
D. Atypical hyperplasia in a previous breast biopsy D. Carbon dioxide (CO2) levels

14. For average-risk patients, routine cancer screening is 4. Neurogenic shock is characterized by the presence of
recommended for all but the following disease? A. Cool, moist skin
A. Breast cancer B. Increased cardiac output
B. Colorectal cancer C. Decreased peripheral vascular resistance
C. Cervical cancer D. Decreased blood volume
D. Pancreatic cancer
5. When a patient with hemorrhagic shock is resuscitated
15. Tumor staging for most epithelial cancers includes all of the using an intravenous colloid solution rather than lactated
following EXCEPT Ringer solution, all of the following statements are true
A. Tumor size EXCEPT:
B. Tumor mutations A. Circulating levels of immunoglobulins are decreased.
C. Nodal involvement B. Colloid solutions may bind to the ionized fraction o
D. Distant spread serum calcium.
C. Endogenous production o albumin is decreased.
16. Which of the following tumor marker-disease associations is D. Extracellular fluid volume deficit is restored.
NOT correct?
A. PSA and prostate cancer 6. In hemorrhage, larger arterioles vasoconstrict in response
B. CEA and colon cancer to the sympathetic nervous system. Which categories of
C. CA19-9 and pancreatic cancer shock is associated with vasodilation of larger arterioles?
D. AFP and breast cancer A. Septic shock
B. Cardiogenic shock
C. Neurogenic shock
D. A & C
7. Which of the following is true about antidiuretic hormone B. Arginine vasopressin
(ADH) production in injured patients? C. Dobutamine
A. ADH acts as a potent mesenteric vasoconstrictor. D. Milrinone
B. ADH levels all to normal within 2 to 3 days of the initial insult.
C. ADH decreases hepatic gluconeogenesis. 15. Tight glucose management in critically ill and septic
D. ADH secretion is mediated by the renin-angiotensin patients
system. A. Requires insulin to keep serum glucose <140
B. Has no effect on mortality
8. Which of following occur as a result of epinephrine and C. Has no effect on ventilator support
norepinephrine? D. Decreases length of antibiotic therapy
A. Hepatic glycogenolysis
B. Hypoglycemia 16. Cardiogenic shock
C. Insulin sensitivity A. Is most commonly caused by exacerbation of congestive heart
D. Lipogenesis failure.
B. Cardiogenic shock following an acute myocardial
9. A patient has a blood pressure of 70/50 mm Hg and a infarction is typically present on admission.
serum lactate level of 30 mg/100 mL (normal: 6–16). His cardiac C. Cardiogenic shock occurs in 5 to 10% of acute MIs.
output is 1.9 L/min, and his central venous pressure is 2 cm H2O. D. Is characterized by hypotension, reduced cardiac
The most likely diagnosis is: index, and reduced pulmonary artery wedge pressure.
A. Congestive heart failure
B. Cardiac tamponade 17. All of the following result from the placement o an intra
C. Hypovolemic shock aortic balloon pump in a patient with acute myocardial
D. Septic shock failure EXCEPT
A. Reduction of systolic afterload
10. Which cytokine is anti-inflammatory and increases after shock B. Increased cardiac output
and trauma? C. Increased myocardial O2 demand
A. Interleukin (IL)-1 D. Increased diastolic perfusion pressure
B. IL-2
C. IL-6 18. Which constellation of clinical findings is suggestive of
D. IL-10 cardiac tamponade?
A. Hypotension, wide pulse pressure, tachycardia
11. Tumor necrosis actor-alpha (TNF-α) B. tachycardia, hypotension, jugular venous distension
A. Can be released as a response to bacteria or C. Hypotension, wide pulse pressure, jugular venous
endotoxin distension
B. Increased more in trauma than septic patients D. Hypotension, muffled heart tones, jugular venous
C. Induces procoagulant activity and peripheral Distension
vasoconstriction
D. Contributes to anemia of chronic illness 19. A 43-year-old man is struck by a motor vehicle while
crossing the street; he arrives in the ED hypotensive, bradycardic,
12. A 70-kg male patient presents to ED following a stab and unable to move his extremities. What is the
wound to the abdomen. He is hypotensive, markedly most likely cause of his hypotension?
tachycardic, and appears confused. What percent of A. Hypovolemic shock
blood volume has he lost? B. Obstructive shock
A. 5% C. Neurogenic shock
B. 15% D. Vasodilatory shock
C. 35%
D. 55% 20. Corticosteroids in the treatment of septic shock
A. Improves rates of shock reversal in patients requiring
13. Vasodilatory shock vasopressors
A. Is characterized by failure of vascular smooth muscle B. Improves mortality in patients with relative adrenal
to constrict due to low levels of catecholamines insufficiency
B. Leads to suppression of the renin-angiotensin system C. Is contraindicated in patients with positive bacterial
C. Can also be caused by carbon monoxide poisoning blood cultures
D. Is similar to early cardiogenic shock D. None of the above

14. A patient in septic shock remains hypotensive despite


adequate fluid resuscitation and initiation of norepinephrine. What
is often given to patients with hypotension
refractory to norepinephrine?
A. Dopamine
21. What is FALSE about serum lactate? 8. Risk or invasive breast cancer development is increased
A. Generated from pyruvate in the setting of insufficient O2. or each factor EXCEPT
B. Metabolized by the liver and kidneys. A. Age at menarche <12.
C. Is an indirect measure of the magnitude and severity of shock. B. Age at first live birth >30.
D. The time to peak lactate from admission predicts rates C. Biopsy-proven atypical hyperplasia.
of survival. D. No previous breast biopsy.

BURNS-basahin niyo nalang sa mismong book. Sobrang gulo nung 9. Routine ongoing cancer screening is recommended or
format pag kinopya ih. hehe which of the following malignancies?
A. Ovary
ONCOLOGY B. Leukemia
1. The annual age-adjusted cancer incidence rates among C. Carcinoma of the kidney
men and women are decreasing or all o the ollowing D. Sarcoma
EXCEPT:
A. Colorectal 10. Depending on the tumor, acceptable approaches to
B. Oropharynx biopsy include any of the following EXCEPT
C. Lung A. Fine-needle aspiration
D. Thyroid B. Core needle biopsy
C. Incisional biopsy
2. Which of the following is NO a hallmark of cancer? D. Morcellation
A. Ability to invade and metastasize
B. Ability to evade apoptosis 11. Anticancer chemotherapy agents include all of the following
C. Ability to evade autophagy EXCEPT
D. Ability to evade immune destruction A. Alkylating agents
B. Antitumor antibiotics
3. Characteristics of tumorigenic transformation o cells C. Prometabolites
include which o the following? D. Plant alkaloids
A. Enhanced sur ace adherence
B. Monolayer confluence inhibition 12. Approved strategies or cancer chemoprevention include
C. Acquisition of chemoresistance all of the following EXCEPT
D. Immortalization A. Neurontin or malignant peripheral nerve sheath tumor
B. tamoxifen or breast cancer
4. T e cell cycle includes all of the following phases EXCEPT C. Celecoxib or FAP syndrome
A. S phase D. 13-cis-retinoic acid or oral leukoplakia
B. G1 phase
C. G2 phase
D. G3 phase

5. Which of the following actors are suggestive of a hereditary


cancer?
A. tumor development at a younger than normal age.
B. Presence of bilateral disease.
C. Association with paraneoplastic syndrome.
D. Presence of multiple primary malignancies.
6. Which of the following are associated with familial adenomatous
polyposis (FAP)
A. Osteomas
B. Glioblastoma multiforme
C. Meckel diverticulum
D. Esophageal atresia

7. Which mutated gene malignant disease association is


correct
A. PTEN and Li-Fraumeni syndrome
B. RET and MEN2 syndrome
C. P16 and synovial sarcoma
D. BRCA1 and adrenocortical carcinoma