Classification and brief description of Shock

1.Which of the following clinical signs is not typical for a classic presentation
of shock?

a. Cool extremities

b. Weak pulses

c. Systemic hypertension

d. Tachypnea

2. A dog presents with tachycardia, tachypnea, hypotension, elevated blood

lactate, hypoglycemia, neutropenia, and hypothermia. On thoracic
radiographs the VHS is 8.3 and the pulmonary arteries and veins are small.
Which of the following forms of shock is most likely, and what treatment is
reasonable for this situation?

a. Septic shock; administer crystalloid fluids and broad-spectrum antibiotics

b. Hemorrhagic shock; administer fresh frozen plasma and norepinephrine

c. Hypovolemic shock; administer crystalloid fluids and high dose corticosteroids

d. Cardiogenic shock; administer crystalloid fluids and norepinephrine

3. In shock, which of the following statements is true relative to oxygen

consumption (VO2)

a. Oxygen demand exceeds oxygen delivery

b. Oxygen delivery and oxygen demand are determined by stroke volume

c. Because DO2 is greater than VO2 in shock situations, anaerobic metabolism

results in formation of lactate

d. As long as VO2 is greater than DO2, anaerobic metabolism will be minimal and
blood lactate levels will remain normal

4. ‘Shock’ associated with trauma is characterized by:

a.Increased core body temperature.

b. Decreased blood pressure after hemorrhage.

c.Tachycardia in excess of 120 bpm.

d. decreased blood pressure after anesthetic induction.

€ Metabolic acidosis.

5. A 13-year-old SF Maltese presents to your clinic after the owner found her
collapsed. She appears to be having difficulty breathing and membranes are
cyanotic. Upon auscultation you hear pulmonary crackles and a loud systolic
heart murmur. Thoracic radiographic findings include left atrial enlargement
and perihelia pulmonary edema. She is hypotensive, with an elevated blood
lactate, and the overall clinical picture is typical for cardiogenic shock. Which
of these therapies would usually be contraindicated in this case?

a. Intravenous crystalloid fluids

b. Intravenous furosemide

c. Oxygen administration

d. Pimobendan

6.What is the treatment of choice to correct Hypovolemic Shock?

a. Have the patient drink a large bottle of Gatorade.

b. Replace fluids intravenously as quickly as possible.
c. Administer a vasopressor (ex: Dopamine or Norepinephrine)
d. All of the above.
7.What causes decreased BP in neurogenic shock?

a. Movement of fluid into the cells

b. Movement of fluid into the vasculature

c. Disrupted SNS communication

d. Polyuria
8.What type of sensitivity reaction is anaphylactic shock?

a. Type I, Immediate Hypersensitivity Disorder

b. Type II, Antibody-mediated Disorder

c. Type III, Immune Complex-Mediated Disorder

d.Type IV, Cell Mediated Hypersensitivity Disorder

9.Which of the following could be a sign of septic shock upon assessment?

Choose from the combinations listed below. A. Hyperthermia (fever) or
hypothermia B. Confusion C. Tachycardia D. Poor Skin Turgor?

a. A,B,C

b. B,C

c. A,D

d. A,C

10. What is the primary cause of septic shock?

a. Bleeding

b. Medication Allergy

c. Infection

d. Poison

11. Which of the following causes of fluid volume loss is considered to be

Absolute Hypovolemia?

a. Ascites

b. Burns

c. GI Bleed

d. Bowel obstruction

12. What is the preferred treatment for an anaphylactic shock?

a. Epinephrine

b. Placing the patient in a sitting position and administer oxygen

c.Preventing the reaction from occurring through patient teaching

d.Placing a bag of ice on the area, administer antihistamines and corticosteroids.

13. Which of the following

is not a major mechanism for lack of oxygen delivery to tissues?
a. Inadequate blood volume

1. Why are transfusions given?

A. To increase the amount of blood
B. To increase the blood's ability to carry oxygen
C. To decrease the risk of bleeding
D. All of the above

2.Which parts of the blood can be transfused?

A. Whole blood
B. Platelets
C. Red blood cells
D. All of the above

3. What is the minimum you should weigh to donate blood?

A. 100 pounds
B. 110 pounds
C. 115 pounds
D. 125 pounds

4. How often can a donor give blood?

A. At any time
B. Every 2 months
C. Every 3 months
D. Every 6 months
5. How much blood usually is donated at a time?
A. 1 pint
B. 2 pints
C. 1 quart
D. 2 quarts

6. What are the common risks of donating blood?

A. Contract common viruses
B. Bacterial infection
C. Low blood pressure
D. None of the above

7. Donated blood undergoes screening for which diseases?

A. HIV (the virus that causes AIDS)
B. Viral hepatitis
C. Diabetes
D. A and B
8. Which agency regulates blood donation?
A. American Medical Association
B. U.S. Health and Human Services
C. FDA
D. American Red Cross
9. An advisory panel of experts has suggested that anyone who received
transfusions before March 1992 be screened for which of these
diseases?
A. HIV
B. Hepatitis C
C. Mononucleosis
D. Leukemia
10. Which is the most common blood type among Americans?
A. O positive
B. O negative
 C. AB positive
D. AB negative

11.The term "hemorrhagic" comes from the

a) Greek✔
b) Latian
c) British

12.Bleeding under the skin is known as:

a) Bruise✔
b) Strokes
c) vaginal bleeding

13.Common types of blood transfusions:

a) RBc transfusions
b) Platelets transfusion
c) plasma transfusion
d) All of these ✔

14.The disease cannot be transmitted through transfusion of blood is:

a) Hepatitis B
b) AIDS
c) Cancer ✔
d) Malaria

15.The lower limit of Hb in female blood donor is:

a) 10 gm/dl
b) 12 gm/dl ✔
c) 13 gm/dl
d) 14 gm/dl

16.Blood grouping and cross matching is must prior to infusionof:

a) Gelatin
b) Albumin
c) Dextran ✔
d) Hemaceal
 Fluid and electrolytes balance

All the following are important electrolytes in the body except:

A) potassium ions
B) carbon ions
C) chloride ions
D) sodium ions
A base may be defined as a chemical compound that:
A) removes hydrogen ions from a solution
B) adds sodium chloride to a solution
C) adds hydrogen ions to a solution
D) eliminates sodium ions from a solution

The intracellular fluid compartment refers to all the water found in:
A) the bones of the body
B) areas outside the body cells
C) areas within the gastrointestinal tract
D) all cells of the body

Approximately one-third of the body water exists in the

A) kidneys and urinary bladder
B) blood
C) extracellular fluid compartment
D) transcellular fluid compartment

The interstitial fluid is generally poor while the plasma is generally rich in:
A) hydrogen ions
B) sodium and chloride ions
C) protein
D) carbohydrates

Water leaves the body by all the following mechanisms except:

A) through air expired from the lungs
B) through metabolic reactions taking place in the cells
C) through sweat given off at the skin
D) from feces eliminated from the intestine

In the process of osmosis:

A) water moves from a region of high solute concentration to a region of low
solute concentration
B) water moves from a region of low solute concentration to a region of high
solute concentration
C) sodium ions move through a semipermeable membrane
D) chloride ions follow the movement of sodium ions ot a region of low
concentration

When the concentration of solutes is the same on both inside and outside cells,
then:
A) water leaves the cells
B) water rushes into the cells
C) water flows out of the cells into the transcellular environment
D) the osmotic pressure is zero

Osmoreceptors detect a decreased blood volume and increased blood

concentration of salt and stimulate:
A) increased kidney activity
B) increased salivary secretions
C) thirst
D) increased secretion of progesterone

The hormones aldosterone and ADH both have an important function in:
A) fluid balance in the body
B) the regulation of acid concentrationin the body
C) stimulation of a conscious desire for water
D) the activity of buffer systems

A buffer system generally contains:

A) a strong acid and its accompanying base
B) a strong acid and its accompanying salt
C) a weak acid and a strong base
D) a weak acid and a salt of that acid
The carboxyl groups of amino acids in proteins:
A) function as bases
B) take up hydrogen ions from the surrounding environment
C) increase the acidity of the surrounding environments
D) react with amino acids in the protein

The rate and depth of breathing has a regulatory influence on the:

A) acid/base balance of the body
B) protein metabolism of the body
C) amount of water taken into the body
D) rate at which fats are broken down in the body

The loss of bicarbonate ions from the body through urine excretion:
A) relieves the alkaline condition of the blood
B) increases the excretion of protein from the blood
C) has an effect on the nerve conduction system
D) changes the temperature at the body surface

The normal pH of the venous blood and interstitial fluid is slightly:

A) more basic than arterial blood
B) neutral as compared to arterial blood
C) more acidic than arterial blood
D) the same as arterial blood

Chest and abdominal trauma

1. What is a closed abdominal injury?

A. Penetrating wounds and penetrating organs

B. Object stuck in the chest

C. Direct blow from a blunt object.

D. Falling off a chair

2. How do you treat an open abdominal injury?

A. Cover the protruding organs with moist, clean, dressing.

B. Place the person in a position with their legs pulled towards their chest.

C. Cover it with a dry paper towel.

D. Do not touch and leave the wound open.

3. What is an open chest wound?

A. The ribs are broken.

B. The chest skin is NOT broken.

C. The chest appears bruised and tender.

D. The chest wall is penetrated by some type of object and the skin is broken.

4. True or False: Remove object embedded in the chest.

A. True

B. False

5.Which of the following are symptoms to look for in a chest wound?

A. Blood bubbling out of the chest wound.

B. Pain in the hip and back.

C. Air coming in and out of the wound.

D. Blood coming out of the head.

6-Nasotracheal intubation:

A. Is preferred for the unconscious patient without cervical spine injury.

B. Is preferred for patients with suspected cervical spine injury.

C. Maximizes neck manipulation.

D. Is contraindicated in the patient who is breathing spontaneously.

Answer: B

7-Cardiac contusions caused by blunt chest trauma:

A. Are fairly easy to diagnose.

B. Occur in up to 20% to 40% of patients with major blunt thoracic trauma.

C. Do not usually cause right ventricular dysfunction.

D. Demonstrate arrhythmia as the most common complication.

Answer: Both B And D

8-What percentage of patients with thoracic trauma require thoracotomy?

A. 10%–15%.

B. 20%–25%.

C. 30%–40%.

D. 45%–50%.

Answer: A

9-The radiographic findings indicating a torn thoracic aorta include:

A. Widened mediastinum.

B. Presence of an apical “pleural cap.”

C. First rib fractures.

D. Tracheal deviation to the right.

E. Left hemothorax.

Answer:- All
10-Which of the following statement(s) is/are true concerning the epidemiology
of trauma?

a. Trauma is the leading cause of death of individuals less than 44 years of age

b. Trauma follows only cancer and heart disease as leading causes of productive
life lost

c. Motor vehicle accidents are the most common cause of traumatic death in
young males of all ethnic groups

d. Young males are the population at highest risk for trauma death

e. Both a and d
Answer:Both a, d

11-Which of the following statement(s) is not true concerning the biomechanics

of blunt trauma?

a. A small child and a large adult have a markedly different level of energy
transfer in a high speed vehicular collision

b. Shear strain injuries result from rapid acceleration or deceleration

c. Tensile strain results from direct compression of tissues

d. The tolerance of biologic tissue to trauma injury is directly proportional to the

elasticity of the organ

Answer: A

12-Which of the following steps is not part of the primary survey in a trauma
patient?

a. Insuring adequate ventilatory support

b. Measurement of blood pressure and pulse

c. Neurologic evaluation with the Glasgow Coma Scale

d. Examination of the cervical spine

Answer: d

13-Immediate life-threatening injuries that preclude air exchange which can be

treated in the field not included which of the following?

a. Tension pneumothorax

b. Massive open chest wounds

c. Sucking chest wounds

d. Tracheal disruption

Answer: d

14-Peritonitis would MOST likely result following injury to the:

a.Liver

b.Spleen

c.Kidney

d.Stomach

15-Which of the following organs would be the MOST likely to bleed profusely if
severely injured?

a-Liver

b-Kidney

c-Stomach

d-Gallbladder

Liver

16-Even when seatbelts are worn properly and the airbags deploy, injury may
occur to the:

a-Chest
b-Extremities

c-Iliac crests

d-Lower ribcage

Iliac crests

17-While inspecting the interior of a wrecked automobile, you should be MOST

suspicious that the driver experienced an abdominal injury if you find:

a-A deformed steering wheel

b-That the airbags deployed

c-A crushed instrument panel

d-Damage to the lower dashboard

A deformed steering wheel

18-You are transporting a patient with possible peritonitis following trauma to the
abdomen. Which position will he MOST likely prefer to assume?

a-Sitting up

b-Legs drawn up

c-Legs outstretched

d-On his right side

Legs drawn up

19-A 16-year-old boy was playing football and was struck in the left flank during a
tackle. His vital signs are stable; however, he is in severe pain. You should be
MOST concerned that he has injured his:

a-Liver

b-Spleen
c-Kidney

d-Bladder

Kidney

20-The term "hematuria" is defined as:

a-Blood in the stool

b-Blood in the urine

c-Vomiting up blood

d-Urinary bladder rupture

Blood in the urine

21-When the chest impacts the steering wheel during a motor vehicle crash with
rapid deceleration, the resulting injury, which often kills patients, usually within
seconds, is:

a-A hemothorax

b-Aortic shearing

c-A pneumothorax

d-A ruptured myocardium

Aortic shearing

22.Signs and symptoms of a chest injury include all of the following, EXCEPT:

a-Hemoptysis

b-Hematemesis

c-Asymmetrical chest movement

d-Increased pain with breathing

Hematemesis

23.During your assessment of a patient who was stabbed, you see an open wound
to the left anterior chest. Your MOST immediate action should be to:

a-Position the patient on the affected side

b-Transport immediately

c-Assess the patient for a tension pneumothorax

d-Cover the wound with an occlusive dressing

Cover the wound with an occlusive dressing

24.When caring for a patient with signs of a pneumothorax, your MOST

immediate concern should be:

a-Hypovolemia

b-Intrathoracic bleeding

c-Ventilatory inadequacy

d-Associated myocardial injury

Ventilatory inadequacy

25.Signs of a cardiac tamponade include all of the following, EXCEPT:

a-Muffled heart tones

b-A weak, rapid pulse

c-Collapsed jugular veins

d-Narrowing pulse pressure

Collapsed jugular veins

26.Paradoxical chest movement is typically seen in patients with:

a-A flail chest

b-A pneumothorax

c-Isolated rib fractures

d-A ruptured diaphragm

PAIN AND MANAGEMENT OF POST OPERATIVE

CARE

1. After surgery, a spirometer is used to prevent ________

A. Lung collapse

B. Gastric and intestinal problems

C. Elevated blood pressure

D. Blood Clotting

2. A preoperative assessment should include all of the following except:

A. Current medication and drugs

B. Psychological aspects

C. Patient knowledge of rehabilitation

D. Age, Weight, Height

 3. Spinal Anaesthesia used on a patient needs monitoring for ________
A. Oxygen levels

B. Hyper tension

C. Renal Function

D. Brain activity

4. Immediately after the surgery, the patient is usually shifted to

_____________
A. ICU

B. PACU

C. CCU

D. Recovery room

5. In the usual preparation for general surgery, the client may be

__________

A. Given specifically ordered oral medications with small amounts of water

B. Given ice chips

C. NPO for 12 to 14 hours before

D. Allowed regular diet

6. Which of the following is the primary purpose of maintaining NPO for 6 to

8 hours before surgery?
A. To prevent malnutrition.
B. To prevent electrolyte imbalance.

C. To prevent aspiration pneumonia.

D. To prevent intestinal obstruction.

7. Which of the following is experienced by the patient who is under general

anesthesia?

A. The patient is unconscious.

B. The patient is awake.
C. The patient experiences slight pain.
D. The patient experiences loss of sensation in the lower half of the body.

8. Which of the following postoperative patients is at risk for respiratory

complications?
A. The obese patient with a long history of smoking who had undergone
upper abdominal surgery.
B. The patient with a normal pulmonary function who had undergone
upper abdominal surgery.
C. An adolescent patient with diabetes mellitus who had undergone
cholecystectomy.
D. A football player who had undergone knee replacement surgery.

9. Which statement indicates the development of opioid tolerance?

A. Larger doses of opioids are needed to control pain, as compared to
several weeks earlier.
B. Stimulants are needed to counteract the sedating effects of opioids.
C. The patient becomes anxious about knowing the exact time of the next
dose of opioid.
D. The patient no longer experiences constipation from the usual dose of
opioid.
 10.The pain management nurse observes a patient with complex regional
pain syndrome who is not wearing the right-side jacket sleeve. The
patient reports intense, right arm pain upon light touch. The nurse
recognizes this pain as:
A. allodynia.
B. hypoalgesia.
C. neuritis.
D. paresthesia.

11.A 45-year-old patient who reports pain in the foot that moves up along
the calf says: "My right foot feels like it is on fire." The patient reports
that the pain started yesterday, and he or she has no prior history of
injury or falls. Which components of pain assessment has the patient
reported?
A. Aggravating and alleviating factors.
B. Exacerbation, with associated signs and symptoms.
C. Intensity, temporal characteristics, and functional impact.
D. Location, quality, and onset.

12.A 53-year-old patient who is receiving ibuprofen 400 mg twice a day,

for chronic, low back pain develops lower-extremity edema. The pain
management nurse suspects that the edema is caused by:
A. a decrease in renal function.
B. a low creatinine level.
C. an increase in glomerular filtration rate.
D. an increase in plasma proteins.

13.A distinguishing feature of a cluster headache is that it occurs:

A. bilaterally.
B. globally.
 C. occipitally.
D. unilaterally.
14:Which statement regarding the use of opioids for the management of acute
pain is true?

A. in adults patient weight is the best predictor of opioid requirements.

B. metabolism to codeine-6-glucuronide produces the analgesic effect of codeine.

C. morphine produces more nausea and vomiting than pethidine.

D. pethidine is superior to morphine in the management of renal colic pain.

E. tramadol has a lower risk of respiratory depression than other opioids at

equianalgesic doses.

Option E is correct.

15:In the treatment of phantom limb pain

A. calcitonin infusion is NOT effective.

B. gabapentin reduces the pain.

C. intravenous lignocaine reduces the pain.

D. ketamine provides long-term pain relief.

E. opiates are NOT effective.

Option B is correct

16:Each of the following is effective in the treatment of pain from acute herpes
zoster EXCEPT

A. acyclovir.

B. amitriptyline.

C. carbamazepine.
D. corticosteroids.

E. topical aspirin.

Option C is correct

17:When compared with intra-muscular or subcutaneous opioid regimens,

patient controlled analgesia (PCA} with opioids

A. is equally preferred by patients.

B. provides better analgesia.

C. results in less opioid-related adverse effects.

D. results in lower opioid consumption.

E. results in shorter hospital stay.

Option B is correct

18:Allodynia" is:

A. Pain caused by stimuli that are usually not painful.

B. The 'burning' sensation of causalgia.

C. Red flare with nerve damage.

D. Due to reflex sympathetic dystrophy.

E. Not associated with nerve damage.

Option A is correct
 Ulcer, sinus and fistula

1 There are types of ulcer

 1
 2
 3
 4

2 Ulcer may cause severe symptoms include :

 Vomiting
 Nausea
 Dark blood in stools
 All of the above.

3 Ulcer develop at upper level of small intestine :

 Duodenal ulcer
 Easophagul ulcer
 Genital ulcer
 None

4 Medications used to treat mild to moderate ulcer:

 Proton pump inhibitor

 Bismuth
 Antacids
 All of above

5 Sores on the lining of your stomach or small intestine is called .

 Ulcer
 Appendictis
 Goitor
 None of above
 . Undermined ulcer this present in
 a) Syphilis
b) Tuburculosis
c) Basal cell carcinoma
d) Hodgkin’s lymphoma

 2. Marjolin ulcer is
 a) Squamous cell carcinoma from scar
b) Adenoma of scar
c) Tuberculous ulcer
d) ameobic ulcer

 3. Sebaceous cyst does not occur in the

 a) Scalp
b) Scrotum
c) Back
d) Sole

 4. Commonest site of carcinoma tongue

 a) Apical
b) Lateral borders
c) Dorsum
d) Posterior 1/3

 5. Bedsore is an example of
 a) Tropical ulcer
b) tropic ulcer
c) venous ulcer
d) post thrombotic ulcer

 6. Carcinomatous ulcer is diagnosed by

 a) Everted and indurated borders
b) Everted punched out borders
c) Inverted undermined borders
d) None of the above

 7. Punched out edge is characteristic of which type of ulcer

 a) Tuburculosis
b) rodent ulcer
 c) syphilitic
d) non specific

 8. Malignant ulcer is differentiated from be benign by

 a) heaping up off margins
b) Fibrous scars radiating from crater
c) Induration of base
d) Clean base

 9. Quinsy is
 a) Peritonsillar Abscess
b) Infra temporal space infection
c) Para pharyngeal space infection
d) Lateral pharyngeal space infection

 10. The treatment of choice for naso pharyngeal carcinoma is

 a) Chemotherapy alone
b) Radiotherapy alone
c) Radiotherapy and surgery
d) Surgery alone