- Which of the following is true regarding hemostatic effects of hyperthermia?
a. High body temperatures (>42C) decrease platelet aggregation and enhance fibrinolysis
b. Normalization of body temperature increases fibrinolysis, but does not decrease the hypercoagulable state
c. Prolonged prothrombin time and activated partial thromboplastin time at 12 to 24 hours after presentation have been shown to be associated with death
d. Increased D-dimer concentration and decreased antithrombin activity have been shown to be associated with death
c. Prolonged prothrombin time and activated partial thromboplastin time at 12 to 24 hours after presentation have been shown to be associated with death
Which of the following is true regarding the effect of hypothermia on the cardiovascular system?
a. Mild hypothermia leads to bradycardia due to decreased spontaneous depolarization of pacemaker cells
b. Vasoconstriction in moderate hypothermia is due to increased alpha-1 receptor affinity for norepinephrine
c. Hypothermia slows myocardial conduction leading to abnormal depolarization & repolarization
d. The most common arrhythmias are ventricular tachycardia and ventricular fibrillation
c. Hypothermia slows myocardial conduction leading to abnormal depolarization & repolarization
Which of the following paralytic agents works as a depolarizing agent:
a. Succinylcholine
b. Atracurium
c. Rocuronium
d. Dantrolene
a. Succinylcholine
. If an overdose of Rocuronium is administered, the following is the MOST EFFECTIVE agent in
reversing the effects:
a. Neostigmine
b. Sugammadex
c. Atropine
d. Pyridostigmine
b. Sugammadex
Minor variations in systolic arterial pressure can be seen between inspiration & expiration during spontaneous breathing and mechanical ventilation. Which of the following is true:
a. During spontaneous breathing, SAP is slightly higher during inspiration than expiration
b. During spontaneous breathing, SAP is slightly lower during inspiration than expiration
c. During mechanical ventilation, SAP is slightly lower during inspiration than expiration
d. During both spontaneous breathing & mechanical ventilation, SAP is slightly lower during inspiration than expiration
b. During spontaneous breathing, SAP is slightly lower during inspiration than expiration
Systolic pressure variation (SPV) and pulse pressure variation (PPV) have both been investigated as non-invasive or indirect markers of hypovolemia. Which of the following is true?
a. An SPV of > 5 mmHg has been shown to correlate with hypovolemia in human patients
b. SPV has a stronger correlation to hypovolemia and volume responsiveness than PPV in human patients
c. PPV has a stronger correlation to hypovolemia and volume responsiveness than SPV in human patients
d. Studies have suggested that a PPV > 5 mmHg may be consistent with a volume-responsive state in dogs
. PPV has a stronger correlation to hypovolemia and volume responsiveness than SPV in human patients
Fluid-filled hemodynamic monitoring systems are prone to error from both underdamping and overdamping. Which of the following is true about damping?
a. Underdamping causes falsely low systolic and falsely high diastolic pressure readings
b. Overdamping causes falsely high systolic and falsely low diastolic pressure readings
c. Overdamped waveforms have non-physiologic points and spikes, extra waves, and appear exaggerated
d. Overdamped pressure waveform has slurred upstrokes and downstrokes, loss of detail, and a generally flattened appearance
Overdamped pressure waveform has slurred upstrokes and downstrokes, loss of detail, and a generally flattened appearance
Neutrophil activation occurs when
a. pattern recognition receptors (PRRs) bind to pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs)
b. pathogen-associated molecular patterns (PAMPs) bind to pattern recognition receptors (PRRs) and damage-associated molecular patterns (DAMPs)
c. damage-associated molecular patterns (DAMPs) bind to pathogen-associated molecular patterns (PAMPs) and pattern recognition receptors (PRRs)
d. pattern recognition receptors (PRRs) bind to a reactive oxygen species generator (NADPH oxidase complex)
pattern recognition receptors (PRRs) bind to pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs)
Which of the following is true?
a. cell-mediated (or cellular) immunity is mediated by neutrophils
b. humoral immunity is mediated by B lymphocytes
c. humoral immunity is mediated by T lymphocytes
d. cell-mediated (or cellular) immunity is mediated by B lymphocytes
b. humoral immunity is mediated by B lymphocytes
Granulocyte colony-stimulating factor (G-CSF) has been shown to:
a. decrease the differentiation of progenitor cells into neutrophils
b. decrease release of neutrophils into circulation
c. act on mature neutrophils to increase chemotaxis
d. decrease IgA-mediated phagocytosis by neutrophils
c. act on mature neutrophils to increase chemotaxis
The majority of NaCl is reabsorbed in which portion of the nephron?
a. proximal tubule
b. loop of henle
c. distal tubule
d. collecting duct
a. proximal tubule
Recall that tubuloglomerular feedback is a local intrarenal negative feedback mechanism in response to increased sodium chloride in the distal tubule. Which pump is responsible for transporting NaCl across the cells in the macula densa?
a. Na + H + antiporter
b. Na + K + 2Cl - cotransporter
c. Na + Cl - cotransporter
d. Na + Pi - IIa transporter
b. Na + K + 2Cl - cotransporter
What is the pathogenesis of negative pressure pulmonary edema?
a. Massive neuronal and sympathetic activity results in a sequence of events causing both hydrostatic and increased permeability edema, as well as acute cardiac insufficiency
b. Extreme subatmospheric intrathoracic pressures causes pulmonary vascular overload, an increase in vascular return, and preload. This is exacerbated by sympathetic stimulation associated with hypoxia and results in both hydrostatic pressure edema and microvascular damage
c. Pronounced microvascular permeability, leukocyte activation, and alterations in cytokine production results in protein-rich edema and the presence of eosinophilic hyaline membranes in the walls of the alveolar ducts
d. Decreased surfactant levels in collapsed lung tissue and negative interstitial pressure results in mechanical disruption of pulmonary parenchyma, oxygen free radical formation and reperfusion injury.
Extreme subatmospheric intrathoracic pressures causes pulmonary vascular overload, an increase in vascular return, and preload. This is exacerbated by sympathetic stimulation associated with hypoxia and results in both hydrostatic pressure edema and microvascular damage
. Based on the available evidence, which pharmacologic therapy could be considered in management of early moderate to severe ARDS?
a. Corticosteroids
b. Inhaled surfactant
c. N-acetyl cysteine
d. Inhaled beta-agonists
a. Corticosteroids
Which of these statements describes behavior of effective osmoles?
a. Urea generates osmotic pressure.
b. In biologic fluids, glucose is not freely diffusible across cell membranes.
c. Sodium, urea, and glucose are effective osmoles.
d. Glucose is the major determinant of plasma osmolality.
. In biologic fluids, glucose is not freely diffusible across cell membranes.
Which of the following is a characteristic of body fluid balance?
a. Hypotonic fluid loss leads to hypotonic dehydration.
b. All hypovolemic patients will have evidence of interstitial dehydration.
c. Increased total body sodium content makes patients appear dehydrated, regardless of serum sodium levels.
d. Hydration status and plasma sodium concentration are clinically unrelated.
d. Hydration status and plasma sodium concentration are clinically unrelated.
When using thromboelastography, the Reaction time ( R ), represents which of the
following coagulation events:
a. Reaction time ( R ) represents overall clot strength
b. Reaction time ( R ) represents the rapidity of fibrin accumulation and cross-linking
c. Reaction time ( R ) represents the time from test initiation to the beginning of fibrin formation
d. Reaction time ( R ) represents the time to clot formation measure from the end of the R time until an amplitude of 20 mm is achieved
c. Reaction time ( R ) represents the time from test initiation to the beginning of fibrin formation
Which of the following descriptions of thromboelastography parameters would be
characteristic of a hypocoagulable patient profile?
a. A hypocoagulable thromboelestography tracing is characterized by a normal R and K, increased alpha angle and increased maximum amplitude (MA)
b. A hypocoagulable thromboelestography tracing is characterized by a prolonged R and K and a decreased alpha angle and decreased MA
c. A hypocoagulable thromboelestography tracing is characterized by a shortened R and K, increased alpha angle and MA
d. A hypocoagulable thromboelestography tracing is characterized by a shortened R and K, and a normal alpha angle and MA
A hypocoagulable thromboelestography tracing is characterized by a prolonged R and K and a decreased alpha angle and decreased MA
The thromboelastogram tracing for TEG is characterized by three phases that occur sequentially—which of the following options best describes these phases in the order by which they are represented on the tracing in order from first to last?
a. The thromboelastogram tracing for TEG is characterized by three phases—the first phase is stabilization, the second phase is initiation, the third phase is lysis
b. The thromboelastogram tracing for TEG is characterized by three phases—the first phase is initiation, the second phase is maximum amplitude, the third phase is lysis
c. The thromboelastogram tracing for TEG is characterized by three phases—the first phase is initiation, the second phase is stabilization , the third phase is lysis
d. The thromboelastogram tracing for TEG is characterized by three phases—the first phase is hemostasis, the second phase is proliferation, the third phase is lysis
The thromboelastogram tracing for TEG is characterized by three phases—the first phase is initiation, the second phase is stabilization , the third phase is lysis
What is the mechanism for metabolic acidosis in shock?
a. Pyruvate production via glycolysis
b. Increased consumption of ATP via hydrolysis
c. Oxidative production of ATP
d. Increased intracellular lactate
b. Increased consumption of ATP via hydrolysis
What is the primary ion transporter involved in cell death during shock?
a. Na + /K + ATPase pump
b. Ca 2+- ATPase pump
c. H + /K + ATPase pump
d. Sodium-Calcium exchanger
a. Na + /K + ATPase pump
What is the main mechanisms for hyperglycemia in shock?
a. Hepatic gluconeogenesis and glycogenolysis
b. Peripheral insulin resistance
c. Impaired GLUT transporters
d. Downregulation of counterregulatory hormones
a. Hepatic gluconeogenesis and glycogenolysis
Which of the following cytokines is considered a proinflammatory chemokine?
a. Interleukin-10
b. Interferon-gamma
c. Interleukin-8
d. Transforming Growth Factor-beta
c. Interleukin-8
Which of the following cytokines is responsible for promoting fever during an immune
response?
a. Interleukin-4
b. Interleukin-6
c. Interleukin-10
d. Interferon-gamma
b. Interleukin-6
