A 35-year-old female has undergone an elective procedure for the repair of an
inguinal hernia. She is doing fine post-procedure with no complications. Vital
signs are pulse rate 75/min, blood pressure 118/74 mmHg, respiratory rate
16/min, and temperature 98.6 F (37°C). Physical examination reveals a dry
surgical site with no soakage. She is scheduled to be discharged tomorrow.
Which of the following is responsible for the strength of the wound?
A. Increased elastin
B. Cross linking of collagen
C. Zinc chelation to subcutaneous tissues
D. Scar formation
B. Cross linking of collagen
A 16-year-old boy is brought to the emergency department after falling from
the roof of a friend's house. X-rays demonstrate a displaced fracture of the
right femur. Open reduction for the femur fracture is planned. History is
significant for persistent nausea and vomiting. Physical examination reveals
injected conjunctiva, impaired coordination, and slowness in responding to
questions. During the preoperative assessment, he refuses to give a urine
sample. Which of the following is most likely responsible for the persistent
vomiting?
A. Alcohol
B. Marijuana
C. Phencyclidine
,D. Alprazolam B. Marijuana
er
A 30-year-old female presents to the emergency department after falling from
a motorbike. Examination shows a 3x1 cm skin laceration on the left forearm.
The wound is cleaned with antiseptic. Prior to closing the wound, local
anesthetic needs to be given. The nurse gives the provider a bottle of lidocaine
(pKa 7.7) and a bottle of bupivacaine (pKa 8.1). Which one should be used
and why?
A. Lidocaine because it has a faster onset of action
B. Lidocaine because it has a slower onset of action
C. Bupivacaine because it has a faster onset of action
D. Bupivacaine because it has a slower onset of action
A. Lidocaine because it has a faster onset of action
A 25-year-old woman in the 33rd week of her pregnancy presents to the
hospital with complaints of lower abdominal cramping and sharp pain,
causing pulling sensations in her lower abdomen. She is diagnosed with the
pain of round ligaments. The artery supplying this ligament branches off from
which of the following artery?
A. Vaginal artery
B. Uterine artery
C. Obturator artery
D. Vesical artery
B. Uterine artery
A 33-year-old woman is scheduled for elective surgery. The patient is already
prepped and draped, and the surgeon has the scalpel in his hand. He is
anxious to complete the surgery quickly since this is his fifth surgery of the
,day. During the time-out, the patient states that she does not want to be
resuscitated if an emergency develops, but she has not previously documented
this wish. Which of the following should the surgeon do next?
A. The surgeon should say that there are witnesses, so no further
documentation needs to be performed.
B. The surgeon should stop the procedure and have the patient document
her wishes for end-of-life care on the corresponding state scope of treatment
form.
C. The surgeon should call the hospital ethics committee chairperson to
serve as a witness before proceeding with the surgery.
D. The surgeon should allow the surgery to proceed and afterward have
the patient document her wishes for end-of-life care on the corresponding
state scope of treatment form.
B. The surgeon should stop the procedure and have the patient document her
wishes for end-of-life care on the corresponding state scope of treatment form.
Moving a patient from the supine to Trendelenburg position is least likely to
increase which of the following?
A. Systemic arterial blood pressure
B. Central venous pressure
C. Intracranial pressure
D. Heart rate
D. Heart rate
A 38-year-old male patient with a past medical history of hypertension and
coronary artery disease presents to a clinic. An electrocardiogram shows sinus
rhythm at a rate of 52 beats per minute.
, Below what heart rate defines bradycardia?
A. 60 beats per minute
B. 70 beats per minute
C. 80 beats per minute
D. 90 beats per minute
A. 60 beats per minute
A 17-years-old student was brought to the emergency department after being
stabbed by a knife.
Inspection revealed a deep open wound a few inches above his umbilicus that
is bleeding profusely. Further examination reveals a mass of small bowel
protruding out of a 4x2cm stab wound, and the patient's abdomen exhibits
generalized tenderness and rigidity. On auscultation, his chest is bilaterally
clear. His abdomen, however, is silent with absent bowel sounds. His vitals on
presentation are: heart rate:- 130 beats/min, blood pressure:- 85/50 mmHg,
respiratory rate: 25/min, temperature:- 98.6 F, O2 saturation:- 93% on room
air. The patient is resuscitated on the lines of acute trauma life support. What
is the best immediate step to protect the exposed bowel loop?
A. Immediately replace abdominal contents
B. Cover abdominal contents with sterile gauze
C. Shift the patient for an emergency laparotomy
D. Wash abdominal contents with .9% saline
B. Cover abdominal contents with sterile gauze
A patient presents to the hospital with high fever, rigid neck, and vomiting.
The patient is hyperventilating, and a lumbar puncture reveals bacterial
meningitis. Irritation of which of the following structure has most likely
caused a disturbance in the basic respiratory rhythm in this patient?
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