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You start coumadin on a patient with a pulmonary embolus. Three days later, he starts sloughing off skin across his arms and legs. All of the following are true of this patients most likely condition except: a. This likely would have been prevented by starting heparin before coumadin b. Patients with protein C deficiency are more susceptible to this problem c. The skin sloughing is caused by skin necrosis d. This is likely due to hemophilia A - - CORRECT ANS- - (d) Coumadin-induced skin necrosis occurs in patients started on coumadin without being given heparin first. It results from a relatively hypercoagulable state that can occur in some individuals because of the shorter half-life of protein C & S compared to factors II, VII, IX, and X. Protein C & S โ after coumadin before the other factors โ, resulting in a relatively hypercoagulable state. 2 weeks after a whipple operation, your patient continues to have early satiety with oral intake. You decide to start metoglopramide (Reglan) and erythromycin. Through what mechanism does erythromycin โ gastrointestinal motility? a.) ACh b.) Serotonin c.) Motilin d.) Gastrin - - CORRECT ANS- - (c)
Motilin (found primarily in the stomach, duodenum, and colon) Proteins are synthesized from: a. mRNA b. tRNA c. dsDNA d. ssDNA - - CORRECT ANS- - (a) mRNA 1 week after an APR, our patient develops urosepsis requiring volume resuscitation, antibiotics, and moderate amounts of levophed and vasopressin. E. coli grows out from the blood cultures. What portion of the lipopolysaccharide complex accounts for its toxicity a.) Lipid A b.) LPS c.) NO d.) TLR4 - - CORRECT ANS- - (a) Lipid A (with gram negative sepsis; stimulator of TNFฮฑ) Steroid hormones: a. Bind a receptor on the plasma membrane and activate a plasma membrane enzyme b. Bind a cytoplasmic receptor, enter the nucleus, and affect transcription of proteins c. Bind a receptor in the nucleus and affect transcription of proteins
Cell cycle length is determined by what phase of the cell cycle? a. G b. S c. G d. M - - CORRECT ANS- - (a) G1-G0 phase determines cell cycle length (most variable cell period) Most RNA/protein synthesis Of the following, which is the most critical component in the neovascularization of tumor metastases? a. HER receptor b. VEGF receptor c. Neu receptor d. FGF receptor - - CORRECT ANS- - (b) Vascular endothelial growth factor (VEGF) receptor For its anticoagulation effects, heparin binds: a. Protein C b. Protein S c. Anti-thrombin III
d. Factor VII - - CORRECT ANS- - (c) ATIII (heparin-ATIII complex binds thrombin, factor IX, factor X, and factor XI) 7 days after a kidney transplant, your patient develops severe acute rejection with vasculitis on biopsy. You decide to start the monoclonal antibody OKT3. Monoclonal antibodies: a. Bind 1 epitope at one site b. Bind 1 epitope at multiple sites c. Bind multiple epitopes on a single antigen d. Bind multiple epitopes on multiple antigens - - CORRECT ANS- - (a) They bind one epitope at the exact same binding site While performing a LAR for colon cancer in a patient on chronic dialysis, you notice a significant amount of bloody oozing from your dissection plane. All of the following are true of uremic induced platelet dysfunction except: a. Down regulates GpIb b. Down regulates GpIIb/IIIa c. Stimulates von Willebrand's factor release d. Treatment of choice is dialysis - - CORRECT ANS- - (c) Uremia downregulates GpIb, GpIIb/IIIa, and vWF Dialysis is the initial treatment of choice for uremic coagulopathy. Other therapeutic options include DDAVP and conjugated estrogens (which stimulate the release of factor VIII and vWF).
Platelets are stored at room temperature (~5 days) which offers a good medium for bacterial growth Half-life โโ in cold temperature The most common bacterial contaminant in blood products is: a. GPC b. GNRs c. Anaerobes d. CPRs - - CORRECT ANS- - (b) Gram negative rods (E. coli) The most common acquired hospital infection is: a. Pneumonia b. Blood stream infection c. UTI d. Colitis - - CORRECT ANS- - (c) Often related to placement of urinary catheters. Best treatment of a UTI is removal of the catheter. The most common cause of bloodstream infection:
a. UTI b. Pneumonia c. Colitis d. Central line sepsis - - CORRECT ANS- - (d) Workup after a fever: blood, urine, and sputum cultures; CXR (rule out pulmonary infiltrate); change all lines; check WBC count Antibiotics can be subdivided into bacteriostatic and bacteriocidal antibiotics. Each of the following antibiotics is considered bacteriostatic except: a. Bactrim b. Tetracycline c. Erythromycin d. Gentamicin e. Chloramphenicol - - CORRECT ANS- - (d) The mechanism of aminoglycoside resistance is: a. Plasmids for ฮฒ-lactamase b. Changes in cell wall binding protein c. Decreased active transport due to modifying enzymes d. Enhanced metabolism of the bacteria - - CORRECT ANS- - (c) Resistance due to modifying enzymes leading to decreased active transport The mechanism of penicillin resistance is:
c. Peak 40-80, trough 20- 40 d. Peak <1, trough 5- 10 - - CORRECT ANS- - (b) A patient on gentamicin has a peak level of 80 and a trough of <1. The most appropriate management is: a. Continue current dosing b. Decease dose but maintain frequency c. Decrease dose and decrease frequency d. Maintain dose and decrease frequency - - CORRECT ANS- - (b) If peak too high โ โ amount of each dose If trough too high โ โ frequency of doses The mechanism of action for fluoroquinolones is: a. Inhibition of RNA polymerases b. Inhibition of DNA gyrase c. Inhibition of ribosomes d. Production of oxygen radicals - - CORRECT ANS- - (b) Bacteriocidal The mechanism of action for metronidazole is: a. Inhibition of RNA polymerases
b. Inhibition of DNA gyrase c. Inhibition of ribosomes d. Production of oxygen radicals - - CORRECT ANS- - (d) Metronidazole produces oxygen radicals which break up DNA in bacteria. It is a bacteriocidal agent. A patient with an enterococcal blood stream infection is best treated by which of the following antibiotics: a.) Cefazolin b.) Ceftriaxone c.) Bactrim d.) Ampicillin - - CORRECT ANS- - (d) Ampicillin (ยฑ gentamicin) was specifically designed to treat enterococcus, although this will not pick up VRE. Vancomycin Timentin/Zosyn Sludging in the gallbladder and cholestatic jaundice is characteristic of which of the following antibiotics: a. Quinolones b. Bactrim c. Erythromycin
d. Pyrazinamide - - CORRECT ANS- - (a) Malignant hyperthermia is most commonly related to a defective receptor (ryanodine receptor) on the sarcoplasmic reticulum that controls calcium release. The first sign of malignant hypertermia after receiving succinylcholine in an intubated patient is: a. Fever b. Rigors c. Increased end-tidal COโ d. Tachycardia - - CORRECT ANS- - (c) Malignant hyperthermia can be triggered by either volatile gaseous inhalation anesthetics and is treated with dantrolene Succinylcholine administration can cause severe hyperkalemia in all of the following EXCEPT: a.) extensive burn injury b.) Duchenne muscular dystrophy c.) spinal cord transection d.) massive tissue trauma e.) massive transfusion - - CORRECT ANS- - (e) You are assisting in an antrectomy. The attending asks you to describe the vascular supply to the stomach. You reply with which of the following? a.) The right gastric artery arises from the celiac axis. b.) The left gastric artery arises from the common hepatic artery.
c.) The right gastroepiploic arises from the right hepatic artery. d.) The short gastric arteries arise from the splenic artery. e.) The left gastroepiploic arises from the left gastric artery. - - CORRECT ANS- - (d)
- Celiac trunk: L gastric, common hepatic a., splenic a. (L gastroepiploic & short gastric are branches of splenic a.)
- Greater curvature: R & L gastroepiploics, short gastrics
- Lesser curvature: R & L gastrics (R gastric is branch of common hepatic a.)
- Pylorus: gastroduodenal a. Which of the following is a cause HCl release from parietal cells? a.) Serotonin b.) Secretin c.) Histamine d.) Amino acids e.) none of the above - - CORRECT ANS- - (c) Acetylcholine Gastrin Histamine A patient diagnosed with a peptic ulcer has been prescribed a treatment regimen including omeprazole. The mechanism of action is best described by a.) It helps in the formation of a protective barrier b.) It neutralizes excessive gastric acid
Trypsin does not have any direct effect on the release of cholecystokinin. In fact, trypsin suppresses CCK release by digesting CCK released peptides from the duodenal mucosa, thereby decreasing the amount of CCK released. Causes of โ acid and โ gastrin include all BUT a.) ZES b.) Chronic gastritis c.) Antral cell hyperplasia d.) Renal failure e.) Gastric outlet obstruction f.) Short bowel syndrome - - CORRECT ANS- - (b) ZES, antral cell hyperplasia, retained antrum, renal failure, gastric outlet obstruction, short bowel syndrome Causes of โ gastrin and normal to โ acid level include all BUT a.) Pernicous anemia b.) chronic gastritis c.) Gastric CA d.) Post vagotomy e.) Medical acid suppression f.) B12 injection - - CORRECT ANS- - (f) Pernicous anemia, chronic gastritis, gastric CA, postvagotomy, medical acid suppression all contribute to the disease process
Gastric ulcers are: a.) malignant when located on the greater curvature b.) not associated with Helicobacter pylori c.) associated with hypersecretion of acid in over 90% of cases d.) more common in women e.) most commonly complicated by perforation - - CORRECT ANS- - (e) Gastric ulcers may occur anywhere in the stomach, but most are found on the lesser curvature near the incisura angularis. Most gastric ulcers are not associated with hypersecretion of acid. Helicobacter pylori has been shown to colonize the antral mucosa of most patients with peptic ulcer disease. It is associated with an antral gastritis and its presence has been correlated with the appearance of duodenal and gastric ulcers. Perforation is the most common complication of gastric ulcer. Other complications include hemorrhage and gastric outlet obstruction. Primary repair is an option for all of the following injuries EXCEPT: a.) knife wound to the right colon b.) gunshot wound to the descending colon c.) knife wound to the sigmoid colon d.) gunshot wound to the transverse colon & associated splenic injury e.) gunshot wound to the rectum - - CORRECT ANS- - (e) The management of colon injuries is trending toward repair. Primary repair or resection & anastomosis should be considered for all civilian patients with penetrating colon injuries. Primary repair can be performed for all colon injuries, excluding rectal injuries. The standard of care for penetrating rectal injuries continues to be drainage & diversion of the fecal stream.
a.) Dumping syndrome b.) Marginal ulceration c.) Afferent loop syndrome d.) Efferent loop syndrome e.) All of the above - - CORRECT ANS- - (b) โ Marginal ulceration and diarrhea Dieulafoy's ulcer is most commonly seen a.) Upper esophagus b.) Lower esophagus c.) Lesser curve of the proximal stomach d.) Greater curve e.) Antrum - - CORRECT ANS- - (c)
