ANSWERS
1. A 35-year-old individual with a history of chronic intravenous drug use
presented to the emergency department with right upper limb pain and
swelling. On clinical examination, severe edema of the upper limb,
erythema, blistering of the arm, and crepitus over the shoulder were noted
(Figure 20A). X-ray of the affected limb revealed gases trapped within the
soft tissues (Figure 20B). The patient was started on broad-spectrum
antibiotics and underwent an emergency fasciotomy to remove necrotic
tissues. Cultures of tissue specimens obtained intraoperatively revealed the
presence of an anaerobic, gram-positive bacillus. What was the most likely
cause of the infection?
Clostridium perfringens
Clostridium difficile
Vibrio vulnificus
Streptococcus pyogenes
Bacillus anthracis
2. Which of the following is NOT a component of oxygen delivery?
Hemoglobin concentration
Oxygen extraction ratio
Cardiac Output
Arterial saturation of oxygen
,3. Which of the following oncogenes is commonly associated with breast
cancer?
Kras: K-ras
C-myc
Bcl-2
P53
4. How does malignant hyperthermia, an adverse reaction associated with
succinylcholine, typically manifest?
Profound hypothermia and bradycardia
Hypotension and respiratory depression
Excessive sedation and loss of consciousness
Hyperthermia, muscle rigidity, and metabolic acidosis
5. A 40-year-old patient comes to your office to discuss permanent
sterilization. He says he is interested in vasectomy but has concerns about
the procedure and follow-up. Which one of the following is true of
vasectomy?
Vasectomy is associated with a higher risk of prostate cancer.
Patients typically are instructed not to work for 1 week after the
procedure.
Patients must undergo follow-up semen analysis 8 to 16 weeks
after the procedure to confirm the absence of motile sperm.
Approximately 10% of men experience chronic scrotal pain requiring
treatment after the procedure.
,6. Which gastric tumor shows the best response to radiotherapy.
Adenocarcinoma
Sarcoma
Lymphoma
Leimyoma
7. In a scenario where a mother has low levels of IgG, what potential impact
could this have on her newborn's health?
Improved vaccine efficacy
Increased susceptibility to infections
Decreased risk of autoimmune diseases
Enhanced immune response
8. A patient presents with a non-functioning adrenal incidentaloma measuring
7cm. What is the most appropriate clinical action based on current
guidelines?
Monitor the incidentaloma with regular imaging
Advise the patient to avoid any surgical intervention
Refer the patient for hormone testing
Resection of the incidentaloma
9. Describe the significance of the sunburst pattern seen in osteogenic
sarcoma on x-ray imaging.
The sunburst pattern is indicative of a benign bone lesion.
The sunburst pattern suggests the presence of osteoporosis.
, The sunburst pattern indicates aggressive bone growth associated
with osteogenic sarcoma.
The sunburst pattern is a sign of normal bone healing.
10. Describe the role of Cytochrome P450 in drug metabolism and explain
why Coumadin does not stimulate it.
Cytochrome P450 is stimulated by all drugs equally, including
Coumadin.
Cytochrome P450 is involved in the metabolism of various drugs,
and Coumadin is an anticoagulant that does not induce its
activity.
Cytochrome P450 is primarily responsible for the synthesis of
Coumadin.
Cytochrome P450 is a type of enzyme that only metabolizes
Coumadin.
11. If a patient is diagnosed with Lynch II Syndrome, which screening protocol
should be emphasized for early detection of associated cancers?
MRI scans every two years
Annual chest X-rays
Monthly blood tests
Regular colonoscopies
12. To prevent decreased cerebral perfusion after brain injury, what is the
minimum reading of cerebral perfusion pressure that the nurse must
ensure?
15 mm Hg.