Shifting 16.

What anticoagulant results in the synthesis of dysfunctional

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

2. Which of the ff subs causes vasodilatation? 17. what anticoag catalyzes the action of anti-thrombin III on F2?
- prostacycline - epinephrine - Heparin
- serotonin - Thromboxane 2
18. After cardiopulmonary bypass, what subs is given to reverse the
3. Which of the ff injury is least likely to stop bleeding? action of heparin?
- obliquely incised branchial artery - protamine sulfate
- completely transected radial artery
- avulsed venules in gastrocnemius area 19. What is the treatment for patients with idiopathic
- completely transected popliteal artery thrombocytopenic purpura?
- prednisone
4. What is the normal lifespan of platelets?
- 7 – 10 days 20. a 24 yo F G1P0 noted absence of fetal movements 1 wk ago, she
was noted to have epistaxis, UGIB platelet count of 40 000/ mm3.
5. What is the main reason why injured veins may remain open and What is most likely dx?
continue to bleed? - consumptive coagulopathy due to dead fetus
- thin muscular layer
21. What is considered as MC abnormality of hemostasis?
6. What is considered initial platelet reaction to injury? - thrombocytopenia
- adhesion
22. What platelet pathology is asso in patient w/ portal hpn due to
7. Which of the ff prevents platelet clump together? schistosomiasis?
- prostaglandin - thrombocytopenia due to ↑ platelet destruction

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

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

13. what surgical procedure is least likely to develop leeding due to 28. Where is Vit K synthesized and absorbed?
release of activated plasminogen? - SI
- modified radical mastectomy
29. What is the end product of coag cascade?
14. A patient with deep vein thrombosis was given regular heparin - fibrin
at 80 units kg bw, ___ was maintained on heparin drip. What test of
coag will you request to determine if the therapeutic level of 30. A patient w/ pancreatic head tumor, w/ acholic stool & tea
heparin is reached? colored urine, will undergo surgery. What can you give this patient
- partial thromboplastin time to minimize the risk of bleeding?
- Vit K
15. A patient who underwent aortic valve replacement was given
coumarin at 5 mg OD, what can you request to monitorthe effects of 31. What plasminogen activator is most efficient and is non
coumadin of the patient? antigenic?
- prothrombin time w/ INR - urokinase
32. Which of the ff condition is least likely to cause elevation of
plasminogen levels in the blood?
- 100% O2 saturation of an extremity
33. What intrinsic F causes the activation of plasminogen to
plasmin?
- F2
34. Which of the ff congenital hemostatic defect is char by ↑
platelet destruction?
- Wiscott-aldrich syndrome - bernard-souier syndrome
-von willebrand disease - hereditary thrombocytopenia
35. What is the blood component is cheapest and readily avail F8
replacement but has lowest [ ] of F8?
- Fresh frozen plasma
36. The integrity of the cell is compromised. The maintenance of cel
membrane potential and volume is impaired. The main F resp is?
- activity of the membrane NaK-ATPase pump slows
37. The imperical initial treatment of any patient in any form of
shock are the ff except
- secure airway - maintain circ
- adequate breathing - identify duration and degree of shock state
38. In a hemorrhaging patient, the loss of how many % circulating
volume will produce obvi__ and symptoms (mild tach, anxiety)
- 15 – 25%
39. In cardiogenic shock, the ff are treatment options for
documented profound cardiac dysfucntion EXCEPT:
- inotrophic support w/ dopamine & dobutamine
- use of mech support (intra, aortic, ballon pump)
- early coronary re vascularization
- liberal use and infusion of fluids to regain volume loss
40. The ff is/are diff factors w/c support diagnosis of septic shock?
- episode severe infection
- sevre vasodilatation of vessels due to isoform Nitric Oxide synthase
rendering it resistant to the effects of vasoconstructing agents
- warm extremities despite hypotension
- all of the above
41. The classic description of neurogenic shock consists of the ff
except?
- ↓ BP w/ bradycardia
- warm extremities
- motor and sensory deficits
- radiographic evidence of vertebral and lung parenchymal injury
42. Which is true regarding to neurogenic shock?
- admin of vasoconstrictors will improve peripheral vascular tone
- admin of vasoconstrictors should only be considered once
hypovolemia is excluded and dx of neurogenic shock established
- it implies loss of vasoconstrictor impulses w/ inc vascular
capacitance, ↓ venous return, and ↓ CO
-all
43. Neurogenic shock is usually secondary to spinal cord injuries.
The pathophysio involves:
- anatomic disruption of sympa regulation of peripheral vasc tone
- sympa input to the heart is disrupted w/ the loss of ↑ heart rate
and cardiac contract
- there is loss of typical reflexive tachycardia that occurs w/
hypovolemia
-all
44. In obstructive shock, the main pathophysio is mech obstruction
of venous return in trauma patients. In tension pneumothorax,
which is not true?
- involved hemithorax has positive pressure due to continous leak of
air from parenchyma or airway
- ↑ intrathoracic pressure causes the shift of the mediastinal
structure to the contralateral hemithorax
- the mediastinal shift causes the heart to twist in its axix, thereby
causing obstruction of the venous return to the heart
- tension pneumothorax is best diagnosed w/ a chest x ray
45. Findings that are sufficient to make a dx of tension
pneumothorax except
- ↓ lung sounds
- hypertympany of the involved hemithorax on percussion
- hypertension
- hypotension
46. True of cardiac tamponade
- accum of fluid in pericardial sac to restrict blood entrance to the R
ventricle
- manifestation of cardiac tamponade are always of total circ
collapse
- patient will have flat neck veins
- beck’s triad is always present and readily appreciated
47. The ff procedures may relieve cardiac tamponade
, except?
- pericardiocentesis
- tube thoracostomy
- pericardial window
- pericardiotomy
48. Which procedure may relieve tension pneumothorax
- needling
- pericardiocentesis
- corfirm w/ an chest x ray
- volume resuscitation
49. As cellular ATP is depleted under hypoxic conditions the ff occurs
- Na accumulates intracellularly while K leaks into EC space
- Net gain of IC Na is accompanied by gain in IC water and
development of cellular swelling
- the resulting swelling causes rupture of diff IC organeles leading
to cell death and necrosis
50. Which describes the immune and inflam response
- the immune response to shock encompasses the elaboration of
mediators w/ only proinfla properties
- the exagerated immune response is advantagous to restoring
homeostasis
- if excessive, the immune response may promote cellular and organ
repair
- it is responsible for the development of ARDS, MODS and post
traumatic intussuception that can prolong recovery.
51. The ff are features of inflam phase of wound healing, except:
- this phase is marked by loss of fucntion of the wounded area, as
well as pain, redness and swelling
- This phase lasts a finite length of time of approximately 4 days in
primary intention healing
- this phase is marked by an increased rate of collagen synthesis
from fibroblasts
- In this pahse, neutrophil phagocytosis aids in the removal of clot,
bacteria and other debris from the wound
52. The stages of wound healing in order are:
- proliferative phase, substrate phase, remodeling phase
- fibrin phase, remoeling phase, inflammatory phase
- substrate phase, proliferative phase, remodeling phase
- connective tissue regeneration involves contraction
53. Which of the ff is INCORRECT, regarding stages of wound
healing?
- the 1st phase is inflam or reactive phase
- the most importsant cell in the prolif pahse is neutrophil
- the remodeling phase can take place b/w 6 wks to 2 yrs
- connective tissue regeneration involves contraction
54. Collage most abundant in prolif stage of wound healing?
- Type III
55. Which of the ff statement is false?
- a laceration refers to an intact skin over a crash injury
- a contusion is a bruise without a break in the skin
- an abrasion is a superficial removal of skin
- an avulsion refers to a total or partial removal of tissue
56. All of the ff impair wound healing EXCEPT?
- smoking
- immunosupression
- hyperntsion
- vitamin A
57. Maximum tensile strenght of wound is reach on the?
- 40th – 50th day
58. Mechanism of wound healing whreby keratocytes migrate abd
then divide to surface partial thickness loss of skin or mucosa?
- epithelialization
59. The cytokine present in wound healing that stimulate epithelial
cell and fibroblast prolif and granulation tissue formation
- EGF (epidermal growth factor)
60. With regards to keloids and hypertrophic scars, the ff statements
are true?
- hypertrophic scars outgrow their original border
61. All of the ff are contraindications to primary wound closure
except?
- too much tension on the wound
- animal/ human bites
- < 6 hrs post injury
- Infection
62. Which of the ff is true regarding leg ulcers
- venous ulcer are common over the medial malleolus
63. Which of the ff is not indicated for the management of
chronologically contaminated wounds?
- freq dressing change
- systemic antibiotics
- debridement
- final closure w/ skin graft or flap
64. Incorrent in tretament of human bites?
- debride wound, cleanse thoroughly
- culture the wound
- broad spectrum antibiotics
- suturing the wound
65. Not a component of an ideal ulcer dressing?
- improved aesthetics
- Immobilization
- Absorption
- compression
66. A patient has chronic ulcer loc on the lower L leg, over medial
malleolus. It is moderately painful with some relief when elevated.
This ulcer is most likely of which type?
- Venous ulcer
67. Human bite injuries in the hand are treated with irrigation,
exploration and debridement, G +/- culture as well a broad spectrum
antibiotic coverage. In addition, the ff tretament?
- Tetatnus, if no immunization in the last 10 yrs, Clavulinic acid, 2ry
closure
68. A 19 yo man went to emergency room after a fist fight, early
sunday AM bec of laceration over his knuckles. Most approp tx?
- clean, do not suture, give antibitics and tetanus booster
69. Bacterial toxin present in local wound env’t?
- ↑ host cell pdxn of matrix metalloproteases
70. An ICU pt presented w/ infection w/c lead to gangrene of subcu
tissue and subsequent necrois of more superficial layers. He was dx
w/ necrotizing fascitis?
- beta hemolytic strep
71. All of the ff are true of cellulitis except?
- MC org are staph aureus and BH strep
- erythema w/ sharply demarcated borders are present
- Can lead to ascending lymphagitis
- Often occurs secondary to trauma
72. 1st cll to arrive at injury site?
- neutrophil
73. At 3 months the tensile wound strenght is what percent of final
strenght?
- 80%
74. TGF-B is involved in
- organization of extracellular matrix, scar remodelling and wound
contracture
75. All of the ff are char of aminoglycosides, except?
- active against broad spectrum of G – aerobves
- emergence of resistant bacterial strain does not occur
- narrow margin b/w therapeutic and toxic levels
- nephrotoxic
76. antibiotic that disrups membrane barrier fxn?
- Amphoterecin B
77. Antibiotics that disrupts ribosomal PRO synthesis
- aminoglycosides
78. A 30 yo M pt has an elective herniorrhaphy. On 2nd post op day 96. inc in net collagen synthesis – C
he develops excruciating pain over the wound and a thin, brown, 97. common in burns, may subside and cause contractures – A
foul smelling discharge. He is tachycardic w/ high fever. G strain of 98. intralesional tx of steroids – C
exudate shows G + drumstick 99. growth beyond the borders of original wound – B
- clostridium welchii 100. sometimes preventable - A

79. The ff decribe the effects of advanced aging in wound healing,

except?
- the scar appears to be finer
- the fibroblasts have lost their proliferative potential in vitro studies
- skin suture should be removed early to avoid stich abscess
- infection rate is higher compared to ypunger indiv

80. Statement that is tru concerning use of antibiotics in wound

care?
5
- presence of cellulitis and bacterial count of 10

81. Ideal time to admin prophylactic antibiotics for patients

undergoing surgery?
- 1 hr prior to OR

82. Surgical wound carries 10-15% risk of developing wound infect?

- contaminated wound

83. prefered treatment of an infected FB inplanted in

musculoskeletal tissue
- removal of FB

84. Does not predisposed to dev’t of diabetic foot inf?

- short term steroid use

85. Most approp tx for abscess w/ cellulitis?

- incision + drainage + antibiotic

Modified Matching

A. Ehlers – Danlos Syndrome

B. Marfan
C. Osteogenesis Imperfecta
D. Epidermolysis Bullosa
E. Acrodermatiis Enterohepatica

86. result of mutation of type I collagen – C

87. Impair tissue adhession w/in dermis, epidermis or basement
membrane resulting in blistering and ulceration – D
88. Inability to absorb zinc from breast milk or food – E
89. group of 10 disorder that present as defect in colagen formtionA
90. defect in fibrilin an extracel PRO ASSO WITH ELASTIC FIBERS – b

A. Clean
B. Clean contaminated
C. Contaminated
D. Dirty

91. open surgical removal of gallbladder – B

92. emrgency operation to remove ruptured appendicits- D
93. elective repair of indirect inguinal hernia – A
94. debridement of diabetic foot – D
95 – excision of breast mass – A

A. Hypertrophic scar
B. Keloid
C. Both
D. Neither