NBR 2 - Clinical Skills/Critical Care

Question 1

For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all.
A. enflurane
B. etomidate
C. halothane . 
D. isoflurane
E. ketamine
F. thiopental
1. increases cerebral blood flow (CBF) and cerebral metabolic rate of oxygen consumption (CRM02)

Answer 1

Jawab : E

Question 2

For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all.
A. enflurane
B. etomidate
C. halothane . 
D. isoflurane
E. ketamine
F. thiopental
2. Of the volatile anesthetics, it increases CBF the least.

Answer 2

Jawab : D

Question 3

For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all.
A. enflurane
B. etomidate
C. halothane . 
D. isoflurane
E. ketamine
F. thiopental
3. induces seizure discharges

Answer 3

Jawab : A

Question 4

For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all.
A. enflurane
B. etomidate
C. halothane . 
D. isoflurane
E. ketamine
F. thiopental
4. dissociative anesthetic

Answer 4

Jawab : E

Question 5

For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all.
A. enflurane
B. etomidate
C. halothane . 
D. isoflurane
E. ketamine
F. thiopental
5. decreases CBF and CRM02 and produces cardiovascular depression

Answer 5

Jawab : F

Question 6

For questions 1 to 6, match the anesthetic agent with the description. Each response may be used once, more than once, or not at all.
A. enflurane
B. etomidate
C. halothane . 
D. isoflurane
E. ketamine
F. thiopental
6. decreases CBF and CRM02 and suppresses adrenocortical response to stress

Answer 6

Jawab : B

Question 7

7. Which antiemetic medication lowers seizure threshold
A. Phenergan
B. droperidol
C. Tigan
D. Zofran
E. Reglan

Answer 7

Jawab : A

Question 8

8. The most appropriate drug to administer to a stable patient with a narrow complex upraventricular tachycardia (no serious signs or symptoms) after vagal stimulation is
A. adenosine
B. figoxin
C. procainamide
D. quinidine
E. verapamil

Answer 8

Jawab : A
Adenosineatan initial doseof6mg over 1 to 3 seconds, followed by a repeat of 12 mg in 1 to 2 minutes prn, is the initial drug of choice. If lidocaine is ineffective,procainamide at a dose of20to30mglmin for a maximum of 17mglkg is given.

Question 9

9. Each is true of fat embolism except
   A. Cerebral manifestations frequently occur in the absence of pulmonary manifestations.
   B. Increased serum lipase occurs in up to half of all patients.
   C. Petechia over the shoulders and chest is a classic finding.
   D. Symptoms typically occur 12 to 48 hours after trauma.
   E. Tachycardia and tachypnea are characteristic.

Answer 9

Jawab : A
Sch p. 459.Neurologic involvement does not develop in the absence of pulmonary abnormalities unless there is the rare event of a paradoxical embolus through a patent foramen ovale.

Question 10

10. Gamma irradiation of blood helps prevent
A. graft-versus-host disease
B. hemolytic transfusion reactions 
C. hepatitis B transmission
D. nonhemolytic transfusion reactions
E. transfusion siderosis

Answer 10

Jawab : A

Har p. 737.Transfusion-associated graft-versus-host disease may result if viable lymphocytes in blood are not irradiated

Question 11

11. Citrate toxicity from massive transfusions results from the
    A. binding of free ionized Ca2+
    B. decrease of 2,3-diphosphoglyceric acid (DPG) levels
    C. inactivation of factors 5 and 8
    D. interaction with platelets, rendering them dysfunctional
    E. precipitation of autoimmune hemolytic anemia

Answer 11

Jawab : A

Question 12

For questions 12 to 14, match the description with the disease.
A. Cushing’s disease
B. ectopic adrenocorticotropic hormone (ACTH) production
C. both
D. neither
12. Cortisol is suppressed with low-dose dexamethasone.

Answer 12

Jawab : D

Question 13

For questions 12 to 14, match the description with the disease.
A. Cushing’s disease
B. ectopic adrenocorticotropic hormone (ACTH) production
C. both
D. neither
13. Cortisol is suppressed with high-dose dexamethasone.

Answer 13

Jawab : A

Question 14

For questions 12 to 14, match the description with the disease.
A. Cushing’s disease
B. ectopic adrenocorticotropic hormone (ACTH) production
C. both
D. neither

14. increase in urinary 17-hydroxycorticosteroids after a metyrapone test.

Answer 14

Jawab : A

Question 15

15. Which of the following scenarios reflects hypochromic, microcytic anemia?
    A. decreased mean corpuscular volume (Mev) and decreased total iron binding capacity (TIBC)
    B. decreased MCV and increased TIBC
    C. decreased Mev and normal TIBC
    D. increased MCV and decreased TIBC
    E. increased Mev and increased TIBC

Answer 15

Jawab : B

Question 16

16. Prolongation of bleeding time usually occurs in
I. von Willebrand's disease
II. use of nonsteroidal anti-inflammatory agents
III. uremia
IV. factor VII deficiency
A. I, II, III
B. I, III
C. II, IV
D. IV
E. all of the above

Answer 16

Jawab : A
Har pp. 358-359.Although patients with von Willebrand’s disease usually have an abnormal bleeding time, it may occasionally be normal due to cycli- cal variations in the von Willebrand factor. Factor VII deficiency causes pro- longation of the prothrombin time (PT) and partial thromboplastin time (PlT).Uremia and the use of nonsteroidal anti-inflammatory agents result in platelet dysfunction (the latter by decreasing cyclooxygenaseactivity).

Question 17

17. Drugs that antagonize the anticoagulant effect of warfarin (Coumadin) include
I. cholestyramine
II. phenobarbital
III. rifampin
IV. cimetidine
A. I, II, III
B. I, Ill
C. II, IV
D. IV
E. all of the above

Answer 17

Jawab : A
Har pp. 427-428.Trimethoprim sulfamethoxazole (Bactrim) increases the effect of Coumadin by decreasing clearance. Barbiturates and rifampim accel- erate Coumadin clearance by inducing hepatic metabolizing enzymes, and cimetidine inhibits its oxidative metabolism.

Question 18

18. Contraindications to the use of thiazide diuretics include
I. diabetes mellitus
II. hyperuricemia
III. primary aldosteronism
IV. lupus erythematosus
A. I, II, III
B. I, III
C. II, IV
D. IV
E. all of the above

Answer 18

Jawab : A
Har p. 1326.Metabolic side effects of thiazide diuretics include hypokalemia from renal potassium loss, hyperuricemia from uric acid retention, carbohy- drate intolerance, and hyperlipidemia.

Question 19

19. Plasma levels of phenytoin (Dilantin) are increased by all of the following except
A. carbamazepine
B. cimetidine
C. Coumadin
D. isoniazide
E. sulfonamides

Answer 19

Jawab : A

Har pp. 427,2364-2365.Carbamazepine (Tegretol)decreases plasma levels of phenytoin (Dilantin).

Question 20

20. The most common electrocardiogram (EKG) finding in patients with pulmonary emboli is
    A. a peaked T wave
    B. an Sl-Q,-T 3 pattern
    C. rightward shift of the QRS axis
    D. sinus tachycardia (ST) and T wave changes
    E. tachycardia

Answer 20

Jawab : D

Sch p. 1017.Nonspecific sinus tachycardia (ST) and T wave changes occur in 66%of patients

Question 21

21. Which of the following disorders leads to hypernatremia?
    A. Addison’s disease
    B. hyperaldosteronism
    C. hypothyroidism
    D. renal failure
    E. syndrome of inappropriate antidiuretic hormone (SIADH)

Answer 21

Jawab : B

Question 22

22. The most common acid-base disturbance in mild to moderately injured patients without severe renal, circulatory, or pulmonary decompensation is
    A. respiratory acidosis and metabolic alkalosis
    B. respiratory alkalosis and metabolic acidosis
    C. respiratory or metabolic acidosis
    D. respiratory or metabolic alkalosis

Answer 22

Jawab : D

Question 23

23. The reabsorption of Na+ ions in the thin ascending Henle’s loop
    A. is by active transport
    B. is by a Na+ -K+ exchange pump
    C. passively follows the active transport of Cl- ions
    D. passively follows the active transport of water molecules

Answer 23

Jawab : C

Question 24

For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all.
A. abciximab (Reopro)
B. aspirin
C. clopidogrel (Plavix)
D. eptifibatide (Integrilin)
E. ticlopidine (Ticlid)
24. Of the two prod rugs that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. it has a slightly more favorable toxicity profile.

Answer 24

Jawab : C
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.

Question 25

For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all.
A. abciximab (Reopro)
B. aspirin
C. clopidogrel (Plavix)
D. eptifibatide (Integrilin)
E. ticlopidine (Ticlid)
25. is the Fab fragment of a monoclonal antibody directed against the lIb/IlIa receptor

Answer 25

Jawab : A
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.

Question 26

For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all.
A. abciximab (Reopro)
B. aspirin
C. clopidogrel (Plavix)
D. eptifibatide (Integrilin)
E. ticlopidine (Ticlid)
26. is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the glycoprotein lIb/IlIa

Answer 26

Jawab : D
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.

Question 27

For questions 24 to 27, match the antiplatelet agent with the description. Each response may be used once, more than once, or not at all.
A. abciximab (Reopro)
B. aspirin
C. clopidogrel (Plavix)
D. eptifibatide (Integrilin)
E. ticlopidine (Ticlid)

27. blocks production of thromboxane A2

Answer 27

Jawab : B
see G&G pp. 1534-1536.Aspirin inactivates cyclooxy- genase,theenzymethat producestheprecursorofthromboxaneA2.Ticlodipine and clopidogrel are thienopyridines that block the Gi-coupled platelet adenosine diphosphate (ADP) receptor. They are thought to be prodrugs requiring conversion to the active metabolite. Thrombocytopenia and leukopenia occur less commonly with clopidogrel. Reopro and Integrilin are the inhibitors of glycoprotein Ilb/llIa receptor, but the former is the Fab frag- ment of a humanized monoclonal antibody against the receptor, and the latter is a cyclic peptide inhibitor of the arginine-glycine-aspartate (RGD) binding site on the receptor.

Question 28

28. Which laboratory findings in disseminated intravascular coagulation (DIC) correlates most closely with bleeding?
    A. decreased fibrinogen
    B. increased fibrin degradation products
    C. increased prothrombin time (PT)
    D. increased partial thromboplastin time (PTI)
    E. increased thrombin time (IT)

Answer 28

Jawab : A

Question 29

29. The definition of oxygen saturation is the
    A. amount 0” oxygen dissolved in plasma
    B. fractional concentration of inspired oxygen
    C. partial pressure of oxygen in the blood
    D. percentage of hemoglobin that is bound to oxygen
    E. ratio of unbound to bound hemoglobin

Answer 29

Jawab : D

Question 30

30. Metabolic responses to trauma include each of the following except
A. hypoglycemia
B. increased rate of lipolysis
C. increased Na+ reabsorption
D. increased water reabsorption
E. metabolic' alkalosis

Answer 30

Jawab : A

Sch pp. 26-33.Hyperglycemia, not hypoglycemia, is one of the metabolic responses to trauma.

Question 31

31. A normal PT. a prolonged PTI. and a bleeding disorder would result from a deficiency off actor
A. II
B. V
C. VIII
D. X
E. XII

Answer 31

Jawab : C
Har p. 359. Deficiency of factors 11. V, or X causes prolonged IT and PTT. A deficiency of factor XI1 causes a prolonged PITbut no clinical bleeding.

Question 32

For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
32. shortest half-life

Answer 32

Jawab : B

Question 33

For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
33. reflects the extrinsic pathway

Answer 33

Jawab : B

Question 34

For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
34. deficient or abnormal in hemophilia A (classic)

Answer 34

Jawab : C

Question 35

For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
35. deficient in hemophilia B (Christmas disease)

Answer 35

Jawab : D

Question 36

For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
36. All except this factor are vitamin K-dependent factors.

Answer 36

Jawab : C

Question 37

For questions 32 to 37. match the coagulation factor with the description. Each response may be used once. more than once. or not at all.
A. factor II
B. factor VII
C. factor VIII
D. factor IX
E. factor X
37. Deficiency of factor II or this factor results in prolonged PT and PTI.

Answer 37

Jawab : E

Question 38

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
38. antithrombin III deficiency

Answer 38

Jawab : E

Question 39

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
39. DlC

Answer 39

Jawab : A

Question 40

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
40. von Willebrand’s disease

Answer 40

Jawab : D

Question 41

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time

41. dysfibrinogenemia

Answer 41

Jawab : A

Question 42

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time
42. malnutrition

Answer 42

Jawab : B

Question 43

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time

43. factor VII deficiency

Answer 43

Jawab : B

Question 44

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time

44. factor XIII deficiency

Answer 44

Jawab : C

Question 45

For questions 38 to 45. match the combination of laboratory values with the hematologic diagnosis. Each response may be used once. more than once. or not at all.
A. abnormal PT. PTI. and bleeding time
B. abnormal PT. normal PTI and bleeding time
C. normal PT. PTI. and bleeding time
D. normal PT. abnormal PTI and bleeding time
E. hypercoagulable state
F. normal PT. abnormal PTI. normal bleeding time

45. factor VIII deficiency

Answer 45

Jawab : F

Question 46

For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
46. often occurs with hypokalemia

Answer 46

Jawab : C
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.

Question 47

For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis

47. Addison’s disease

Answer 47

Jawab : B
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.

Question 48

For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis
48. salicylate overdose (early stage)

Answer 48

Jawab : D
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.

Question 49

For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis

49. myasthenia gravis

Answer 49

Jawab : D
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.

Question 50

For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis

50. ethylene glycol overdose

Answer 50

Jawab : A
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.

Question 51

For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis

51. Cushing’s disease

Answer 51

Jawab : C
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.

Question 52

For questions 46 to 52, match the acid-base disturbance with the description or diagnosis. Each response may be used once, more than once, or not at all.
A. increased anion-gap metabolic acidosis
B. normal anion-gap metabolic acidosis
C. metabolic alkalosis
D. respiratory acidosis
E. respiratory alkalosis

52. primary aldosteronism

Answer 52

Jawab : C
see Har pp. 285-291.Respiratory alkalosis is the earliest abnormality and may be the only acid-base disorder in some patients with salicylate overdose. Production of a mixture of endogenous acids, from a metabolic block, may later lead to metabolic acidosis.

Question 53

53. The formula for mean arterial pressure is (OBP = diastolic blood pressure; SBP = systolic blood pressure)
A. (OBP + SBP)/2
B. OBP + (SBl- OBP)/2
C. OBP/2 + SBP/3
D. OBP + (SBP - OBP)/3
E. OBP/2 + (SBP - OBP)/3

Answer 53

Jawab : D
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 54

For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither
54. parathyroid hyperplasia or adenoma

Answer 54

Jawab : C
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 55

For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither

55. pancreatic islet cell hyperplasia, adenoma, or carcinoma

Answer 55

Jawab : A
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 56

For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither

56. pituitary hyperplasia or adenoma

Answer 56

Jawab : A
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 57

For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither

57. Pheochromocytomas are common.

Answer 57

Jawab : B
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 58

For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither

58. Medullary thyroid carcinomas are common.

Answer 58

Jawab : B
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 59

For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither

59. mucosal and gastrointestinal tumors

Answer 59

Jawab : D
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 60

For questions 54 to 60, match the description with the syndrome.
A. multiple endocrine neoplasia (MEN) type I (Werner’s syndrome)
B. MEN type llA (Sipple’s syndrome)
C. both
D. neither

60. marfanoid features

Answer 60

Jawab : D
see Har pp. 2184-2185,2187. MEN type I (Werner’s syndrome) is characterized by parathyroid, pancreatic, and pituitary tumors, most commonly.MEN type IIA (Sipple’s syndrome)is characterized by medullary thyroid carcinoma, pheochromocytoma, mucosal and gastrointestinal neuromas, and marfanoid features. Rarely, pheochromocytomas may be seen in MEN type I.

Question 61

61. Characteristics of hyperaldosteronism include each of the following except
A. edema
B. hypokalemia
C. increased diastolic blood pressure
D. metabolic alkalosis
E. polyuria

Answer 61

Jawab : A

Har pp. 2095-2096.In the absence of associated disorders, edema is charac- teristically absent.

Question 62

62. Adequacy of pulmonary ventilation is assessed by
A. FiO2
B. oxygen saturation
C. Pa CO2
D. partial pressure of O2 in blood
E. tidal volume

Answer 62

Jawab : C

Question 63

For questions 63 to 68, match the abnormality in the EKG with the diagnosis. Each response may be used once, more than once, or not at all.
A. atrial fibrillation
B. J-point elevation
C. peaked T wave
D. prolonged QT interval
E. U wave
63. hypocalcemia

Answer 63

Jawab : D

Question 64

For questions 63 to 68, match the abnormality in the EKG with the diagnosis. Each response may be used once, more than once, or not at all.
A. atrial fibrillation
B. J-point elevation
C. peaked T wave
D. prolonged QT interval
E. U wave

64. hypokalemia

Answer 64

Jawab : E

Question 65

For questions 63 to 68, match the abnormality in the EKG with the diagnosis. Each response may be used once, more than once, or not at all.
A. atrial fibrillation
B. J-point elevation
C. peaked T wave
D. prolonged QT interval
E. U wave

65. hyperkalemia

Answer 65

Jawab : C

Question 66

For questions 63 to 68, match the abnormality in the EKG with the diagnosis. Each response may be used once, more than once, or not at all.
A. atrial fibrillation
B. J-point elevation
C. peaked T wave
D. prolonged QT interval
E. U wave

66. hypothermia

Answer 66

Jawab : B

Question 67

For questions 63 to 68, match the abnormality in the EKG with the diagnosis. Each response may be used once, more than once, or not at all.
A. atrial fibrillation
B. J-point elevation
C. peaked T wave
D. prolonged QT interval
E. U wave

67. hyperthyroidism

Answer 67

Jawab : A

Question 68

For questions 63 to 68, match the abnormality in the EKG with the diagnosis. Each response may be used once, more than once, or not at all.
A. atrial fibrillation
B. J-point elevation
C. peaked T wave
D. prolonged QT interval
E. U wave

68. quinidine toxicity

Answer 68

Jawab : D

Question 69

69. Which of the following is false of malignant hyperthermia?
    A. Calcium is released from the muscle cell’s sarcoplasmic reticulum.
    B. end-tidal pC02 increases
    C. It is precipitated by the use of inhalational anesthetics.
    D. Treatment is with dantrolene.
    E. Use of succinylcholine can help prevent it.

Answer 69

Jawab : E

Har pp. 92,94.Barash pp. 521-529.Succinylcholinecan precipitate malignant hyperthermia.

Question 70

70. Of the following, the best choice for Clostridium diffidle enterocolitis is
A. clindamycin orally
B. metronidazole (Flagyl) orally
C. penicillin G orally
D. penicillin VK intravenously
E. vancomycin intravenously

Answer 70

Jawab : B

Har pp. 926-927.Oral vancomycin is also effective in the treatment of this infection

Question 71

For questions 71 to 73, match the description with the process.
A. cardiac tamponade
B. tension pneumothorax
C. both
D. neither
71. pulsus paradoxus

Answer 71

Jawab : A

Question 72

For questions 71 to 73, match the description with the process.
A. cardiac tamponade
B. tension pneumothorax
C. both
D. neither

72. increased venous pressure

Answer 72

Jawab : C

Question 73

For questions 71 to 73, match the description with the process.
A. cardiac tamponade
B. tension pneumothorax
C. both
D. neither

73. increased pulse pressure

Answer 73

Jawab : D

Question 74

74. Meningitis occurring within 72 hours after a basilar skull fracture is most commonly secondary to
A. Haemophilus influenzae
B. Neisseria meningitidis
C. Staphylococcus aureus
D. Staphylococcus epidermidis
E. Streptococcus pneumoniae

Answer 74

Jawab : E

Question 75

75. Postoperative shunt infections are most commonly caused by
A. coagulase-negative staphylococci
B. H. influenzae
C. Pseudo"+onas species
D. S. aureus
E. S. Pneumoniae

Answer 75

Jawab : A

Question 76

76. The most likely cause of a fever occurring in the first 24 hours after surgery is
A. atelectasis
B. deep vein thrombosis
C. pneumonia
D. urinary tract infection
E. wound infection

Answer 76

Jawab : A

Question 77

For questions 77 to 81, match the description with the drug.
A. dobutamine
B. dopamine
C. both
D. neither
77. a positive inotropic agent

Answer 77

Jawab : C

Question 78

For questions 77 to 81, match the description with the drug.
A. dobutamine
B. dopamine
C. both
D. neither

78. has very little effect on a-adrenergic receptors

Answer 78

Jawab : A

Question 79

For questions 77 to 81, match the description with the drug.
A. dobutamine
B. dopamine
C. both
D. neither

79. is the second-line drug for symptomatic bradycardia

Answer 79

Jawab : B

Question 80

For questions 77 to 81, match the description with the drug.
A. dobutamine
B. dopamine
C. both
D. neither

80. has no effect on beta 2 receptors

Answer 80

Jawab : D

Question 81

For questions 77 to 81, match the description with the drug.
A. dobutamine
B. dopamine
C. both
D. neither

81. has a dose-related effect

Answer 81

Jawab : B

Question 82

82. Of the following, the most common cause of neonatal meningitis is
A. H. influenzae
B. Listeria species
C. N. meningitidis
D. staphylococci
E. streptococci

Answer 82

Jawab : E

Har p. 2462.Gram-negative bacilli and group B streptococci are the most common causes of neonatal meningitis.

Question 83

83. Each of the following is true of nitroprusside except
    A. Cyanide is produced when the ferrous ion in the nitroprusside molecule reacts with sulfhydryl-containing compounds in the red blood cells.
    B. The cyanide is reduced to thiocyanate in the liver.
    C. The half-life of thiocyanate is 3 to 4 days.
    D. Thiocyanate is excreted in the gastrointestinal (GI) tract.
    E. With prolonged administration, accumulation of thiocyanate may cause an acute toxic psychosis.

Answer 83

Jawab : D
G&Gpp. 889-890.924.Cyanide is reduced to thiocyanate in the liver. and the thiocyanate is then excreted in the urine.

Question 84

84. Isoproterenol
    A. acts almost exclusively on ~ receptors
    B. decreases SBP
    C. increases DBP
    D. increases peripheral vascular resistance (PVR)
    E. relaxes smooth muscle

Answer 84

Jawab : E
G&Gp.228.Isoproterenolactsalmostexclusivelyonbeta receptors.Itincreases (or leaves unchanged) systolic blood pressure and decreases diastolic blood pressure, and mean arterial pressure typically falls. It also decreases peripheral vascular resistance and relaxes smooth muscle.

Question 85

85. Splenectomy for hereditary spherocytosis
    A. corrects the anemia
    B. corrects the defects in red blood cells
    C. has no effect on red blood cell survival
    D. is never followed by relapse
    E. should be performed before age 3

Answer 85

Jawab : A
Har pp. 682-683.Splenectomy for hereditary spherocytosis leads to normal or near normal red blood cell (RBC) survival. It does not correct the RBC deficit and should be performed after age4,when the risk of severe infections is low. Rare relapses have been reported.

Question 86

For questions 86 to 92, match the time period after creation of a wound with the event occurring during wound healing. Each response may be used once, more than once, or not at all.
A. 12 hours
B. 5 days
C. 17 days
D. 42 days
E. 2 years
86. Epithelial migration occurs.

Answer 86

Jawab : A

Question 87

For questions 86 to 92, match the time period after creation of a wound with the event occurring during wound healing. Each response may be used once, more than once, or not at all.
A. 12 hours
B. 5 days
C. 17 days
D. 42 days
E. 2 years
87. Increase in tensile strength occurs at least up to this point.

Answer 87

Jawab : E

Question 88

For questions 86 to 92, match the time period after creation of a wound with the event occurring during wound healing. Each response may be used once, more than once, or not at all.
A. 12 hours
B. 5 days
C. 17 days
D. 42 days
E. 2 years
88. Wound contraction begins.

Answer 88

Jawab : B

Question 89

For questions 86 to 92, match the time period after creation of a wound with the event occurring during wound healing. Each response may be used once, more than once, or not at all.
A. 12 hours
B. 5 days
C. 17 days
D. 42 days
E. 2 years
89. Maximum amount of total collagen occurs at this time.

Answer 89

Jawab : D

Question 90

For questions 86 to 92, match the time period after creation of a wound with the event occurring during wound healing. Each response may be used once, more than once, or not at all.
A. 12 hours
B. 5 days
C. 17 days
D. 42 days
E. 2 years

90. Visible collagen synthesis begins.

Answer 90

Jawab : B

Question 91

For questions 86 to 92, match the time period after creation of a wound with the event occurring during wound healing. Each response may be used once, more than once, or not at all.
A. 12 hours
B. 5 days
C. 17 days
D. 42 days
E. 2 years
91. Significant gain in tensile strength begins at this time.

Answer 91

Jawab : B

Question 92

For questions 86 to 92, match the time period after creation of a wound with the event occurring during wound healing. Each response may be used once, more than once, or not at all.
A. 12 hours
B. 5 days
C. 17 days
D. 42 days
E. 2 years

92. The rapid increase in collagen content slows considerably at this point.

Answer 92

Jawab : D

Question 93

93. Each of the following is consistent with the Zollinger-Ellison syndrome except a(n)
    A. decrease in serum gastrin with secretin injection
    B. duodenal ulcer
    C. duodenal wall gastrinoma
    D. pancreatic gastrinoma
    E. increased serum gastrin level

Answer 93

Jawab : A

Har p. 1661.Intravenous secretin increases serum gastrin in patients with a gastrinoma.

Question 94

For questions 94 to 99, match the description with the disease.
A. type I (distal) renal tubular acidosis (RTA)
B. type II (proximal) RTA
C. both
D. neither
94. nonanion gap acidosis

Answer 94

Jawab : C
see Har pp. 1602-1604. Hyperkalemia is found in renal tubular acidosis (RTA) type4. Nephro calcinosis is rare inRTA type2, and the urine pH is les than 5.5 in this type.

Question 95

For questions 94 to 99, match the description with the disease.
A. type I (distal) renal tubular acidosis (RTA)
B. type II (proximal) RTA
C. both
D. neither

95. hyperkalemic

Answer 95

Jawab : D
see Har pp. 1602-1604. Hyperkalemia is found in renal tubular acidosis (RTA) type4. Nephro calcinosis is rare inRTA type2, and the urine pH is les than 5.5 in this type.

Question 96

For questions 94 to 99, match the description with the disease.
A. type I (distal) renal tubular acidosis (RTA)
B. type II (proximal) RTA
C. both
D. neither

96. Nephrocalcinosis commonly occurs.

Answer 96

Jawab : A
see Har pp. 1602-1604. Hyperkalemia is found in renal tubular acidosis (RTA) type4. Nephro calcinosis is rare inRTA type2, and the urine pH is les than 5.5 in this type.

Question 97

For questions 94 to 99, match the description with the disease.
A. type I (distal) renal tubular acidosis (RTA)
B. type II (proximal) RTA
C. both
D. neither

97. urine pH > 5.5

Answer 97

Jawab : A
see Har pp. 1602-1604. Hyperkalemia is found in renal tubular acidosis (RTA) type4. Nephro calcinosis is rare inRTA type2, and the urine pH is les than 5.5 in this type.

Question 98

For questions 94 to 99, match the description with the disease.
A. type I (distal) renal tubular acidosis (RTA)
B. type II (proximal) RTA
C. both
D. neither
98. defect in reabsorption of bicarbonate

Answer 98

Jawab : B
see Har pp. 1602-1604. Hyperkalemia is found in renal tubular acidosis (RTA) type4. Nephro calcinosis is rare inRTA type2, and the urine pH is les than 5.5 in this type.

Question 99

For questions 94 to 99, match the description with the disease.
A. type I (distal) renal tubular acidosis (RTA)
B. type II (proximal) RTA
C. both
D. neither

99. hypokalemia

Answer 99

Jawab : C
see Har pp. 1602-1604. Hyperkalemia is found in renal tubular acidosis (RTA) type4. Nephro calcinosis is rare inRTA type2, and the urine pH is les than 5.5 in this type.

Question 100

100. The percentage of total body weight represented by total extracellular fluid volume is approximately
A. 5%
B. 15%
C. 20%
D. 40%
E. 60%

Answer 100

Jawab : C

Question 101

101. Each of the following occurs in venous air embolism except a(n)
     A. decrease in cardiac output
     B. increase in end-tidal peo2
     C. increase in pulmonary artery pressure
     D. increase in pulmonary vascular resistance
     E. ventilation-perfusion mismatch

Answer 101

Jawab : B

Barash p. 766. End-tidal pCOz decreases with venous air embolism.

Question 102

102. The most sensitive noninvasive monitor of venous air embolism is
     A. auscultation of the chest with a stethoscope
     B. end-tidal pC02
     C. end-tidal pN2
     D. precordial Doppler
     E. pulmonary artery catheterization

Answer 102

Jawab : D
Barash p. 766. The most sensitive is transesophageal echocardiography, the most sensitive noninvasive monitor is the precordial Doppler.

Question 103

103. Which EKG change in the anterior leads is the most characteristic finding in subendocardial ischemia?
A. hyperacute T wave
B. Qwave
C. ST depression
D. ST elevation
E. T wave inversion

Answer 103

Jawab : C

Har p. 1267. Transmural ischemia may lead to ST elevation in the electrocar- diogram (EKG).

Question 104

104. Which set of laboratory values is most consistent with hypothyroidism of hypothalamic or pituitary origin?
     A. Decreased thyroid-stimulating hormone (TSH) and decreased free thyroxine (T4)
     B. decreased TSH and increased free T4
     C. decreased TSH and normal free T 4
     D. increased TSH and decreased free T4
     E. increased TSH and increased free T4

Answer 104

Jawab : A
Har p. 2068. Occasionally, in patients with hypothyroidism of pituitary or hypothalamic origin, serum thyroid-stimulating hormone (TSH) concentra- tions may be slightly increased rather than decreased if the form of TSH secreted is immunoactive but not bioactive.

Question 105

105. Of the following treatment options for hyperkalemia, which one does not alter serum potassium?
A. calcium
B. cation-exchange resins
C. hemodialysis
D. insulin
E. sodium bicarbonate

Answer 105

Jawab : A

Har p. 282. Calcium gluconate infusion is useful for cardiotoxicity,but it does not reduce serum potassium.

Question 106

For questions 106 to 111, match the acid-base disturbance with the arterial blood gas result. Each response may be used once, more than once, or not at all.
A. respiratory acidosis
B. respiratory acidosis and metabolic acidosis
C. metabolic acidosis
D. metabolic acidosis and compensatory respiratory alkalosis
E. respiratory alkalosis
F. respiratory alkalosis and compensatory metabolic acidosis
G. uninterpretable
106. pH = 7.5, pC02 = 30, HC03 = 19

Answer 106

Jawab : E

Question 107

For questions 106 to 111, match the acid-base disturbance with the arterial blood gas result. Each response may be used once, more than once, or not at all.
A. respiratory acidosis
B. respiratory acidosis and metabolic acidosis
C. metabolic acidosis
D. metabolic acidosis and compensatory respiratory alkalosis
E. respiratory alkalosis
F. respiratory alkalosis and compensatory metabolic acidosis
G. uninterpretable

107. pH = 7.3, pC02 = 52, HC03 = 29

Answer 107

Jawab : A

Question 108

For questions 106 to 111, match the acid-base disturbance with the arterial blood gas result. Each response may be used once, more than once, or not at all.
A. respiratory acidosis
B. respiratory acidosis and metabolic acidosis
C. metabolic acidosis
D. metabolic acidosis and compensatory respiratory alkalosis
E. respiratory alkalosis
F. respiratory alkalosis and compensatory metabolic acidosis
G. uninterpretable

108. 7.35, pC02 = 17, HC03 = 9

Answer 108

Jawab : D

Question 109

For questions 106 to 111, match the acid-base disturbance with the arterial blood gas result. Each response may be used once, more than once, or not at all.
A. respiratory acidosis
B. respiratory acidosis and metabolic acidosis
C. metabolic acidosis
D. metabolic acidosis and compensatory respiratory alkalosis
E. respiratory alkalosis
F. respiratory alkalosis and compensatory metabolic acidosis
G. uninterpretable

109. 7.55, pC02 = 32, HC03 = 12

Answer 109

Jawab : F

Question 110

For questions 106 to 111, match the acid-base disturbance with the arterial blood gas result. Each response may be used once, more than once, or not at all.
A. respiratory acidosis
B. respiratory acidosis and metabolic acidosis
C. metabolic acidosis
D. metabolic acidosis and compensatory respiratory alkalosis
E. respiratory alkalosis
F. respiratory alkalosis and compensatory metabolic acidosis
G. uninterpretable

110. 7.22, pC02 = 55, HC03 = 22

Answer 110

Jawab : B

Question 111

For questions 106 to 111, match the acid-base disturbance with the arterial blood gas result. Each response may be used once, more than once, or not at all.
A. respiratory acidosis
B. respiratory acidosis and metabolic acidosis
C. metabolic acidosis
D. metabolic acidosis and compensatory respiratory alkalosis
E. respiratory alkalosis
F. respiratory alkalosis and compensatory metabolic acidosis
G. uninterpretable

111. 7.25, pC02 = 28, HC03 = 12

Answer 111

Jawab : C

Question 112

112. If Q1 and Q2 are pulmonary shunt and total blood flow, respectively, and Ceo Co, and Cy are the oxygen contents of end-capillary, arterial. and mixed venous blood, respectively, then the shunt fraction Q1/Q2 =
A. C,/(C,-Cy)
B. (Co - Cy)/Cy
c. (Cy - Ca)/Ce
D. (C, - Ca)/(C, - Cy )
E. (Ca + Cy)/(Ca + C, + Cy)

Answer 112

Jawab : D

Question 113

113. Atropine toxicity produces each of the following except
A. blurred vision
B. decreased intestinal peristalsis .. ,
C. drymouth
D. increased pulse
E. increased sweating

Answer 113

Jawab : E

G&Gpp. 162-167. Decreased sweating is a manifestation of atropine toxicity.

Question 114

114. Each of the following is true of hyperosmolar coma except
     A. Free fatty acid concentration is lower than in ketoacidosis
     B. Glucose concentration is higher than in ketoacidosis
     C. It is more common in insulin-dependent diabetes mellitus (IDDM) thanin non-insulin dependent diabetes mellitus (NIDOM)
     D. Mortality is more than 50%
     E. Volume depletion is usually severe

Answer 114

Jawab : C
Har pp. 2116-2119. Hyperosmolar, nonketotic diabetic coma is usually a complication of non-insulin-dependent diabetes mellitus (NIDDM).

Question 115

For questions 115 to 119, match the autonomic drug with the description. Each response may be used once, more than once, or not at all
A. clonidine
B. isoproterenol
C. phenoxybenzamine
D. phentolamine
E. prazosin
115. beta agonist

Answer 115

Jawab : B

Question 116

For questions 115 to 119, match the autonomic drug with the description. Each response may be used once, more than once, or not at all
A. clonidine
B. isoproterenol
C. phenoxybenzamine
D. phentolamine
E. prazosin

116. pure alfa1 antagonist

Answer 116

Jawab : E

Question 117

For questions 115 to 119, match the autonomic drug with the description. Each response may be used once, more than once, or not at all
A. clonidine
B. isoproterenol
C. phenoxybenzamine
D. phentolamine
E. prazosin

117. noncompetitive alfa antagonist

Answer 117

Jawab : C

Question 118

For questions 115 to 119, match the autonomic drug with the description. Each response may be used once, more than once, or not at all
A. clonidine
B. isoproterenol
C. phenoxybenzamine
D. phentolamine
E. prazosin

118. competitive, nonselective alfa antagonist

Answer 118

Jawab : D

Question 119

For questions 115 to 119, match the autonomic drug with the description. Each response may be used once, more than once, or not at all
A. clonidine
B. isoproterenol
C. phenoxybenzamine
D. phentolamine
E. prazosin

119. central alfa 2 agonist

Answer 119

Jawab : B

Question 120

120. The most appropriate cholinergic agent to be used in urinary retention is
A. acetylcholine
B. bethanechol
C. carbachol
D. choline
E. methacholine

Answer 120

Jawab : A
G&Gpp. 159-160. Bethanechol and carbachol selectively stimulate the urinary and gastrointestinal (GI)tract. Carbacholis less desirable for urinary retention, however, because it has greater nicotinicaction at autonomic ganglia.

Question 121

121. Which of the following is false of polycythemia vera?
     A. Budd-Chiari syndrome is common.
     B. Hyperuricemia can complicate the disorder.
     C. It is the most common of the myeloproliferative disorders.
     D. Massive splenomegaly is usually the presenting sign.
     E. The use of alkylating agents should be avoided.

Answer 121

Jawab : D
Has pp. 701-703. Although massive splenomegaly can be the presenting sign, the disorder is usually first recognized by a high hematocrit.

Question 122

122. The serum osmolarity of a patient with a sodium level of 130 meq/L. K of 4.0 meq/L, glucose of 126 mg/dL, and blood urea nitrogen (BUN) of 28 mg/dL, is
A. 276
B. 285
C. 296
D. 304
E. 310

Answer 122

Jawab : B
HndbkNS p. 14. Serum osmolarity can be calculated from the formula Serum osmolarity = 2(Na+K)+Glucosell8+BUNl2.8
= 2(130+4)+126118+2812.8
= 2(134)+7 +10=

Question 123

123. Each of the following is a result of the use of positive end-expiratory pressure (PEEP) in the ventilated patient except
A. decreased cerebral perfusion pressure
B. decreased physiologic dead space
C. decreased work of breathing
D. improved lung compliance
E. predisposition to barotraumas

Answer 123

Jawab : B
CC Med pp. 78-83. Positive end-expiratory pressure (PEEP) increases physio- logic dead space by raising intra-alveolar pressure and lung perfusion, thereby impairing C02elimination.

Question 124

124. The oxyhemoglobin dissociation curve is shifted to the right (decreased oxygen affinity) by
I. acidosis
II. decreased 2,3-diphosphoglyceric acid (2,3-0PG)
III. fever
IV. banked blood
A. I, II, III
B. I, III
C. II, IV
D. IV
E. all of the above

Answer 124

Jawab : B
Clin PR p. 171. The curve is shifted to the right by acidosis, fever, increased 2.3-diphosphoglyceric acid (DPG),and hypoxemia, and to the left by alkalo- sis, hypothermia, banked blood, and decreased 2,3-DPG

Question 125

125. Gastrointestinal carcinoids are most frequently found in the
A. appendix
B. colon
C. ileum
D. rectum
E. stomach

Answer 125

Jawab : A
Sch p. 1244. Forty-six percent of carcinoids of the GI tract are located in the appendix. The ileum (28%)and the rectum (17%)are less frequently involved.

Question 126

126. Alkalinization of the urine promotes excretion of
I. salicylates
II. tricyclic antidepressants
Ill. phenobarbital
IV. amphetamines
A. I, II, III
B. I, III
C. II,IV
D. IV
E. all of the above

Answer 126

Jawab : A
CC Med p. 232. The excretion of weak acids is facilitated by alkalinization of the urine and serum. Amphetamines are weak bases.

Question 127

For questions 127 and 128, match the description wih the substance.
A. cryoprecipitate
B. fresh frozen plasma
C. both
D. neither
127. reliably effective in von Willebrand’s disease

Answer 127

Jawab : A

Question 128

For questions 127 and 128, match the description wih the substance.
A. cryoprecipitate
B. fresh frozen plasma
C. both
D. neither

128. used in the treatment of hemophilia B

Answer 128

Jawab : B

Question 129

129. The free water deficit in a dehydrated 70 kg man with a Na+ of 160 is
A. 2L
B. 4L
C. 6L
D. 7L
E. 8 L

Answer 129

Jawab : C
Free water deficit can be calculated from the formula
Free water deficit (L) = [(Na- 140)/140]x body weight (kg) x 0.6 = [(I60- 140)/140]x 70 x 0.6
= 2012 x 0.6=6 L

Question 130

For questions 130 to 134, match the autonomic drug with the description. Each response may be used once, more than once, or not at all.
A. amrinone
B. dopamine
C. epinephrine
D. neosynephrine
E. norepinephrine
130. pure alfa Agonist

Answer 130

Jawab : D

Question 131

For questions 130 to 134, match the autonomic drug with the description. Each response may be used once, more than once, or not at all.
A. amrinone
B. dopamine
C. epinephrine
D. neosynephrine
E. norepinephrine
131. does not interact with alfa or beta receptors

Answer 131

Jawab : A

Question 132

For questions 130 to 134, match the autonomic drug with the description. Each response may be used once, more than once, or not at all.
A. amrinone
B. dopamine
C. epinephrine
D. neosynephrine
E. norepinephrine

132. Effects vary significantly with dose administered.

Answer 132

Jawab : B

Question 133

For questions 130 to 134, match the autonomic drug with the description. Each response may be used once, more than once, or not at all.
A. amrinone
B. dopamine
C. epinephrine
D. neosynephrine
E. norepinephrine

133. primarily an a. agonist with mild beta 2 activity

Answer 133

Jawab : E

Question 134

For questions 130 to 134, match the autonomic drug with the description. Each response may be used once, more than once, or not at all.
A. amrinone
B. dopamine
C. epinephrine
D. neosynephrine
E. norepinephrine
134. balanced alfa and beta agonist properties

Answer 134

Jawab : C

Question 135

135. Thallium intoxication causes each of the following except
A. cardiac dysfunction
B. GI disturbance
C. hirsutism
D. lower extremity joint pain
E. peripheral neuropathy

Answer 135

Jawab : C

Nelson pp. 191-192. Thallium poisoning causes alopecia, not hirsutism.

Question 136

136. Which of the following symptoms is least characteristic of acute intermittent porphyria?
A. abdominal pain
B. hypotension
C. polyneuropathy
D. psychosis
E. tachycardia

Answer 136

Jawab : B

V&A pp. 1389-1390. Hypertension. not hypotension. typically occurs during an attack.