The vital capacity of the lungs includes which lung volumes?
a. TV, FRV, expiratory reserve volumes?
b. TV, ex RV, insp RV
c. TV, residual volume, insp RV
D. TV, RV, exp RV
B: tidal volume, expiratory reserve volume, inspiratory reserve volume
Anatomic dead space in the lung is defined as:
a. the portion of tidal volume that relies upon diffusion for gas flow
b. the portion of the airways that contains occasional alveolar buds
c. one third of the tidal volume
d. the volume of the conducting airways
D: the volume of the conducting airways
For a patient in sternal recumbency, the regional ventilation and perfusion for the dorsal region of the lung can be described as:
a. Low V, low Q
B. low v high Q
C. high V low Q
D. high V high Q
A. low V low Q
Which of the following statements is correct regarding the natural barrier of the stomach that consists of mucus, gel, bicarbonate and surfactant phospholipids
a. the layer is known as the stirred layer
b. the layer prevents penetration of pepsin
c. the layer cannot be penetrated by bile salts
d. the layer contains peptides that decrease gel viscosity
b. the layer prevents penetration of pepsin
Within the stomach, prostaglandins
a. inhibit acid secretion from chief cells
b. stimulate bicarb secretion from parietal cells
c. promote mast cell activation
d. preserve tight junctions between epithelial cells
d. preserve tight junctions between epithelial cells
When suturing small intestines which layer is the primary holding layer?
A. serosa
b. muscular
c. submucosa
d. mucosa
submucosa
which of the following hormones increases the release of free fatty acids from adipocytes?
a. epinephrine
b. insulin
c. e-series prostaglandings
d. dopamine
a. epinephrine
Under physiologic conditions, where does the activation of pancreatic zymogens occur?
a. pancreatic duct
b. pancreatic acing cells
c. gastric lumen
d. duodenum
Duodenum
Trypsinogen is activated by the enzyme ____, secreted by the intestinal mucosa in response to chyme in contact with the GI mucosa?
a. enterkinase
b. trypsin
c. chymotrypsinogen
d. amylase
A. enterokinase
Which of the following are ALL examples of non-enzymatic free radical scavengers?
carotene, cobalamin, glutamate
vitamin E, glutathione, melatonin
vitamin K, vitamin C, vitamin D
catalase, NADH, vitamin C
vitamin E, glutathione, melatonin
Which of the following is the mechanism by which steroid-induced immunosuppression reduces red blood cell destruction in immune-mediated hemolytic anemia?
rapid decrease in erythrophagocytosis by macrophages
rapid decrease in immunoglobulin concentration
rapid decrease in membrane attack complex formation
rapid decrease in pro-inflammatory interleukins
rapid decrease in erythrophagocytosis by macrophage
Erythropoietin production should increase in which of the following scenarios?
myeloproliferative disorders
post-red blood cell transfusion
symptomatic onion toxicity
systemic hypertension
symptomatic onion toxicity
An animal is transferred to you for continued care 5 days following intestinal resection and anastomosis for a gastrointestinal foreign body. Upon arrival, you note that the patient is obtunded, tachycardic and febrile, with brick red mucous membranes and weak pulses. The patient has abdominal pain and AFAST reveals an abdominal fluid score of 2/4. The patient’s doppler blood pressure is 83 mmHg. In-house blood work reveals a lactate of 4.1 mmol/L, blood glucose of 57.6 mg/dl (3.2 mmol/L), an elevated creatinine and hyperbilirubinemia. A blood smear notes an inflammatory leukogram with left shift, and abdominal fluid cytology notes intracellular bacteria. According to the Sepsis-3 definitions, this patient has
SIRS.
sepsis.
septic shock.
severe sepsis.
sepsis
According to the 2018 Surviving Sepsis Campaign update, which of the following are components of the hour-1 bundle of care which should be applied to this patient?
Remeasure serum lactate concentration and obtain blood cultures prior to the administration of antibiotics.
Administer empiric broad spectrum antibiotics and administer fresh frozen plasma to provide colloidal support.
Administer vasopressors if the patient remains hypotensive after fluid resuscitation and commence low-dose dopamine for renal protection.
Rapidly administer a crystalloid bolus for hypotension and use sodium bicarbonate therapy to improve hemodynamics or reduce vasopressor requirements.
Remeasure serum lactate concentration and obtain blood cultures prior to the administration of antibiotics.
The patient initially responded to therapy with the target mean arterial pressure achieved. However, two-hours later the patient deteriorated with worsening hypotension despite adequate volume resuscitation (based on ultrasonographic assessment of cardiac filling and vena cava collapsibility) and the addition of a 1 mcg/kg/min norepinephrine continuous rate infusion. According to the 2016 Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock, what is the most appropriate next step for this patient?
Administer an albumin infusion.
Administer intravenous hydrocortisone.
Add a dobutamine CRI.
Add a vasopressin CRI.
Add a vasopressin CRI.
Sepsis is now recognized to involve early activation of both pro- and anti-inflammatory responses. In this patient’s scenario, which toll-like receptor (TLR) and its pathogen-associated molecular pattern was likely involved in inducing the patient’s innate immune system?
TLR 4; Lipopolysaccharide
TLR 5; Flagellin
TLR 6; Lipopeptide
TLR 9; DNA
TLR 4; Lipopolysaccharide
Hypotension associated with sepsis is due to
increased production of prostaglandin F2.
decreased production of plasminogen activator inhibitor 1.
increased expression of inducible nitric oxide synthase.
decreased expression of interleukin-10
increased expression of inducible nitric oxide synthase.
Elevation of serum procalcitonin concentration in septic patients is primarily due to
increased secretion of procalcitonin stimulated by interferon-γ.
increased synthesis of procalcitonin by extra-thyroidal tissues.
decreased conversion of procalcitonin into calcitonin in thyroid parafollicular cells.
decreased renal clearance of procalcitonin.
increased synthesis of procalcitonin by extra-thyroidal tissues.
Increased levels of endogenous or exogenous catecholamines in sepsis lead to elevated plasma lactate concentrations secondary to
decreased cyclic guanosine monophosphate production via ɑ1-adrenergic stimulation.
decreased cyclic guanosine monophosphate production via β2-adrenergic stimulation.
increased cyclic adenosine monophosphate production via ɑ1-adrenergic stimulation.
increased cyclic adenosine monophosphate production via β2-adrenergic stimulation.
increased cyclic adenosine monophosphate production via β2-adrenergic stimulation.
Which of the following is a glycosaminoglycan component of the endothelial glycocalyx that has been investigated as a potential biomarker of endothelial glycocalyx degradation due to sepsis?
heparan sulfate
P-selectin
C-reactive protein
syndecan-1
heparan sulfate
Increased potassium in the extracellular fluid may lead to abnormal cardiac function due to
decreased resting membrane potential of the cardiac myocyte.
increased resting membrane potential of the cardiac myocyte.
increased translocation of calcium into the cardiac myocyte.
decreased translocation of calcium into the cardiac myocyte.
decreased resting membrane potential of the cardiac myocyte.
Which of the following factors may lead to an increase in extracellular potassium?
metabolic alkalosis
mineral acidosis
aldosterone
β-adrenergic stimulation
mineral acidosis
What effect does insulin have on extracellular potassium?
Insulin causes de-activation of the Na+/K+ pump, leading to increased extracellular K+.
Insulin and K+ are co-transported into the cell leading to decreased extracellular K+.
Insulin stimulates the Na+/H+ antiporter, leading to the activation of the Na+/K+ pump and ultimately decreasing extracellular K+.
Insulin stimulates the Na+/H+ antiporter, shifting H+ into cells and causing K+ translocation into the extracellular fluid compartment.
Insulin stimulates the Na+/H+ antiporter, leading to the activation of the Na+/K+ pump and ultimately decreasing extracellular K+.
Influx of which of the following occurs early in the development of ischemia-reperfusion injury, with the degree of subsequent damage dependent on both the extent and duration of the subsequent increase in its intracellular concentration?
magnesium
potassium
calcium
nitrogen
calcium
