NURSING EXAM QUESTIONS WITH ANSWERS CORRECTLY VERIFIED UPDATES 2024 UPDATES GRADED A+, Exams of Nursing

Download NURSING EXAM QUESTIONS WITH ANSWERS CORRECTLY VERIFIED UPDATES 2024 UPDATES GRADED A+ and more Exams Nursing in PDF only on Docsity! D. Calcium E. B Fluids and mannitol Sep NURSING EXAM QUESTIONS WITH ANSWERS CORRECTLY VERIFIED UPDATES 2024 UPDATES GRADED A+ 1. A 39-year old man is suspected of having a transfusion reaction during resuscitation for an upper gastrointestinal (GI) bleed. Which of the following is appropriate in the management of this patient? A. Removal of non-essential foreign body irritants, for example, foley catheter B. Fluid resuscitation C. 0.1M HC1 infusion D. Steroids 2. A 62-year old man is suffering from arrhythmias on the night of his triple coronary bypass. Potassium has been administered. His urine output is 20 to 30mL/h. Serum potassium level is 6.2. Which of the following medications counteracts the effect of potassium without reducing the serum potassium level? A. Sodium polystyrene sulfonate (Kayexalate) B. Sodium bicarbonate C. 50% dextrose E. Insulin 3. A 65-year old man undergoes a low anterior resection for rectal cancer. On the fifth day in hospital, his physical examination shows a temperature of 39’C (102’F), blood pressure of 150/90mmHg, pulse of 110 beats per minute. A computed tomography scan of the abdomen reveals abscess in the pelvis. Which of the following most accurately describes his present condition? A. Systemic inflammatory response syndrome (SIRS) C. Severe sepsis D. Septic shock E. Severe septic shock 4. A 43-year old man is examined by trauma bay after being stabbed in the chest with a long kitchen knife. A chest tube is placed and 800mL of blood is recovered, with subsequent drainage of approximately 50mL/h. Resuscitation is best facilitated by which of the following? A. A placement of long 18-guage subclavian vein catheter response to the first bolus B. Placement of percutaneous femoral vein catheter C. Placement of short, large-bore percutaneous peripheral intravenous catheter D. Infusion of cold whole blood 5. A 21-year old girl is the unrestrained backseat passenger in a high-speed moving vehicle collision. She is intubated in the field for unresponsiveness and on the presentation to the ER, her heart rate is 160 beats per minute and her blood pressure is 60/35mmHg. She weighs 40 kg. Which of the following is the most appropriate recommendation for her fluid resuscitation? A. Bolus 1L of normal saline initially B. Bolus 1L of 5% albumin initially C. Bolus 400ml of packed RBCs initially D. Blood transfusion should be initiated if there is only a transient response to the first bolus Blood transfusion should be initiated after one repeat of bolus if there is no 6. Causes of hypotension in adults include all the following EXCEPT: A. An upper gastrointestinal bleed B. Intracranial bleeding C. Myocardial infarction D. Infarction of the small bowel E. Systemic infection with Gram-negative organisms 7. AIDS results from infection with: A. Lentovirus B. Retrovirus C. Pseudomonas aeruginosa D. HIV-1 8. An adult male is brought to the emergency department following injury in a house fire. The patient was found in a closed room. He has signed facial hair and full- thickness burns over 30% of his body surface area. All of the following are important in his initial stabilization and treatment EXCEPT: A. Endotracheal intubation B. Intravenous fluid resuscitation C. Insertion of a ureteral catheter D. Systemic antibiotics 9. All blast wounds should be left open and delayed primary closure performed days later A. 4-6 B. 2-3 C. 5-7 E D. Wounds debridement first 24.For a closed and multiple rib fractures (Flial chest), which treatment is NOT correct? A. Small areas: local pressure bandaging B. Large areas: Tracheal intubation or tracheotomy and mechanical ventilation C. Thorough debridement D. Immobilization methods like traction and internal fixation 25.Which is NOT the definition of Tetrology of Fallot (TOF)? A. Stenosis of pulmonary artery B. Left to right shunt C. Hypertrophy of the right ventricle D. VSD, dextroposition and overriding of the aorta 26.Continuous murmur or machinery murmur is the second intercostal space to the left side of sternum, the most congenital heart disease is: A. Patent ductusarteriosus (PDA) B. Pulmonary stenosis C. Atrial septal defect D. Ventricular septal defect 27.Which factor is the major determinant of type of treatment for the upper tract urothelial tumors? A. Size B. Number C. Stage and grade D. Contralateral renal function E. Level of lesion 28.Serum PSA levels vary with which factor? A. Age B. Race C. Prostrate volume D. ACT concentration 29.What is the best first test for a suspected seminal vesicle abnormality? A. CT B. Transrectal ultrasonography C. MRI D. Fine-needle biopsy E. Vasography 30.Stones generally do not pass spontaneously if it is larger than what size? A. 2mm B. 3mm C. 4mm D. 5mm E. 6mm 31.A 41-year old male complains of acute epigastric pain radiating to his back. He has vomited repeatedly. On examination, his abdomen is tender. His temperature is 38’C and his serum amylase is 1856U/L. What is the most likely diagnosis? Please select one of the following: A. Gastric ulcer B. Cholecystitis C. Acute pancreatitis D. Pancreatic cancer E. Cholangitis 32.A 60-year old male alcoholic is admitted to the hospital with hematemesis. His bloos pressure is 100/60mmHG, the physical examination reveals splenomegaly and ascites, and the initial hematocrit is 25%. Nasogastric suction yields 300mL of fresh blood. After initial resuscitation, this man should undergo: A. Esophageal balloon tamponade B. Barium swallow C. Selective angiography D. Esophagogastroscopy E. Exporatoryc eliotomy 33.An 80-year old man is admitted to the hospital complaining of nausea, abdominal pain, distension and diarrhea. A cautiously performed transanal contrast study reveals and “apple core” configurationin the rectosigmoid. Appropriate management at this time would be: A. Colonoscopic decompression and rectal tube replacement B. Saline enemas and digital disimpaction of fecal matter from the rectum C. Colon resection and proximal colostomy D. Oral administration of metronidazole and checking a clostridium difficile titer E. Evaluation of an electrocardiogram and obtaining an angiogram to evaluate for colonic mesenteric ischemia 34.A 37-year old woman with a long history of heavy smoking undergoes femoral artery-popliteal artery bypass for resting pain in her left leg. Because of her serious underlying respiratory insufficiency, she continues to require ventilator support for 4 days after her operation. As soon as her endotracheal tube is removed, she begins complaining of vague upper abdominal pain. She has daily fever spikes to 39’C (102.2F) and leukocyte count of 18,000/uL. An upper abdominal ultrasonogram reveals dilated gallbladder, but no stones are seen. A presumptive diagnosis of acalculous cholecystitis is made. You would recommend? A. Nasogastric suction and broad spectrum antibiotics B. Immediate cholecystectomy with operative cholangiogram C. Percutaneous drainage of the gallbladder D. Endoscopic retrograde cholangiopancreatography (Ercp) to visualize and drain the common bile duct E. Provocation of cholecystokinin release by caution feeding the patient 35.During an appendectomy for acute appendicitis, a 4cm mass is found in the mid portion of the appendix. Frozen section reveals this lesion to be a carcinoid tumor. Which of the following statement is true? A. No further surgery is indicated B. A right hemicolectomy should be performed C. There is about 50% chance that this patient will develop the carcinoid syndrome D. Carcinoid tumors arise from islet cells E. Carcinoid syndrome can occur only in the presence of liver metastasis 36.What is the commonest type of hernia in women? Please select one of the following: A. Inguinal B. Femoral C. Incisional D. Epigastric E. Hiatal hernia 37.A 49-year old has a firm 2cm mass in the right breast that has been present for 3 months. Assessment of a breast lump includes all of the following EXCEPT: A. Clinical examination B. Mammography C. Mastectomy D. Punch biopsy E. MRI 38.Mrs. Wang, a 47-year old lady is complaining of epigastric and right hypochondrial pain. She also feels nauseous and has been vomiting for the past 24 hours. She recalls that the symptoms started when she was eating a cheese cake. The pain did not respond to over the counter antacids and pre-kinetics (gastric mobility enhancing drugs) which she tried. On examination she was an obese lady. Her liver enzymes are marginally elevated. Which ONE of the following is the most appropriate next level investigation for this patient? A. Erect abdominal X-Ray B. Endoscopy C. Ultransound scan of the abdomen D. HI breath test for H. Pylori E. CT abdomen B. Pain C. Swelling D. Stiff 51. What is the single most important determinant of outcome in the treatment of upper tract tumors? A. Grade B. Stage C. Early Diagnosis D. Extent of surgery E. Size and focality of lesion 52. Which of the following tests has the highest positive predictive value for prostStones generally do not pass spontaneously rate cancer? A. PSA B. DRE C. TRUS D. Combination of DRE and TRUS E. Human glandular kallikrein(hK2) 53. Stones generally do not pass spontaneously if its larger than what size? A. 2mm B. 3mm C. 4mm D. 5mm E. 6mm 54. What is the preferred treatment approach for a 0.9cm stone in a kidney pelvis? A. ESWL B. Flexible ureteroscopy C. PNL D. PNL plus fulguration of the diverticulum E. Laparoscopic divertiulectomy 55. What is the best method for differentiation of a benign from a malignant seminal vesicle mass? A. Biopsy of the lesion B. Contrast-enhanced CT C. Gadolininum-enhanced MRI D. Transrectal ultrasonography E. Rectal examination 56. What is the best first test for a suspected seminal vesicle abnormality? A. CT B. Transrectal ultrasonography C. MRI D. Fine-needle biopsy E. Vasography 57. The following statements are true concerning the investigation of perotinitis EXCEPT: A. AXR occasionally helpful: dilated gas-filled loops of bowel B. Erect CXR may show free peritoneal gas (perforated viscus) C. Ultrasound?CT scanning increasingly used D. Peritoneal fluid aspiration (with or without ultrasound guidance may be helpfulul) E. Stool analysis usually shows raised red blood cells 58. The following statements are true concerning the cardinal features of acute intestinal obstruction EXCEPT: A. Abdominal pain B. Abdominal distension C. Shock D. Vomiting can occur persistently E. Acute constipation 59. In ulcerative colitis with toxic megacolon lowest recurrence is seen in? A. Complete protocolectomy and Brook’s ileostomy B. Ileorectal anastomoses C. Kock’s pouch D. Ileo-anal pull through procedure 60. Which is TRUE? In contrast to ulcerative colitis, Crohn’s disease of the colon: A. Is not associated with increased risk of colon cancer B. Seldom presents with daily hematochezia C. Has a lower incidence of perianal fistulas D. Never develop toxic megacolon 61. Which of the following is the symptoms and signs of right-sidded colon cancer? A. Iron deficiency anemia, abdominal mass B. Rectal bleeding, alteration in bowel habit, tenesmus, obstruction C. Jaundice, ascites, hepatomegaly. D. There may be considerable overlap between the above symptoms 62. The following statements are true concerning the causes of intestinal strangulation EXCEPT: A. External compression B. Intramural lesions C. Interrupted mesenteric blood flow (a twist of bowel loop on its mesenteric pedicle) D. Increased intraluminal pressure E. Mesenteric infarction 63. Which tumor derived from parafollicular cells? A. Papillary carcinoma B. Follicular carcinoma C. Medullary carcinoma D. Anaplastic carcinoma 64. Three positions of internal hemorrhoids as seen through a protoscope with patient in lithotomy position are: A. 3,7,11 o’clock B. 3,6,9 o’clock C. 4,7,12 o’clock D. 1,7,11 o’clock 65. Voice hoarse was one of the complications following thyroid surgery, which was caused by injury of: A. Reccurent laryngeal nerve B. Superior laryngeal nerve C. Vagus nerve D. Parathyroid gland 66. Adult rectum is approximately: A. 5-8cm B. 10-12cm C. 18-20cm D. 20-22cm 67. The signs of recurrence of rectal cancer does NOT include: A. Persistent pelvic pain B. Jaundice C. Trauma D. Idiopathic 78. Which one of the listed statements is NOT the indication for spleenectomy? A. Splenomegaly B. Trauma C. Hematological D. Portal hyprtension 79. Which one of the listed statements is NOT the complication of liver trauma? A. Intrahepatic hematoma B. Liver abscess C. Biliary fistula D. Portal hypertension 80. Which method is the “Golden standard” for cholecystectomy? A. Open cholecystectomy B. Laparoscopic cholecystectomy C. Single-incision laparoscopic cholecystectomy D. NOTES 81. Which does not belong to the treatments of osteoarthritis of knee? A. NSAIDs drugs B. Weight loss C. Physiotherapy D. Intra-articular pain-killer injection. 82. Which one is NOT disadvantages of cementing techniques for fixing implants A. Fir must be perfect B. Cement gets hot C. Fragments may cause third body wear body wear and stimulate aseptic loosening D. Difficult to remove at revision 83. There is a wide range of normality in development of the musculoskeletal system, the shape, and the alignment of lower limb changes with growth in the first years A. 5 B. 6 C. 7 D. 8 E. 9 84. In DDH, acetabular dysplasia refers to an acetabulum is ( ) than normal A. Shallower B. Deeper C. Bigger D. Smaller 85. In DDH, adolescent and young adult, in which case need surgery? A. A short leg B. A painful hip C. Severe cases D. Teratogenic dislocation 86. Stress fractures are most common in the weight-bearing bones of the lower extremity, especially the lower leg and: A. The tibia B. Fibia C. The ankle D. The foot 87.( ) is most important sign for meniscal tears: A. Knee locking B. Pain C. Swelling D. Stiff 88. MCL injury will cause instability A. Valgus B. Varus C. Anterior D. Posterior 89. Which one is the unstable pelvic fracture: A. Anterosuperior iliac spine B. Ischial tuberosity C. Transversely oriented sacral fracture D. Bilateral ischiopubic rami E. Open book fracture 90. Which one is not the high risk fracture of metastatic bone tumor? A. Lytic lesion B. Intertrochantic lesion C. Pain with activity D. Bone destruction involving two-thirds of the diameter of the bone in any radiograph view: 91. Which one is NOT the component of the medial longitudinal; arch of foot? A. 1st degree digits and their metatarsals B. Calcaneum C. Navicular bone D. Cuneiforms E. Talus 92. Which one is NOT the early complications of acetabular fractures? A. Sciatic nerve palsy B. Wound infection C. Heterotopic ossification D. Gluteal Palsy E. Post-traumatic osteoarthritis 93. Which one is NOT the feature of osteochondroma? A. Matrix formation B. Accounting for about 35% of benign tumors C. The majority are diagnosed between first and third decades D. Consisting of a cartilage cap perched on a bone pedestal E. Arising from metaphyses of bone 94. Which is the associated acetabular fractures? A. Posterior wall B. Anterior wall C. T-shaped fractures D. Transverse fractures E. Anterior column 95. Are the principal cause of bone and joint infections in all age groups: A. Staphylococci B. Escherichia coli C. Gonococci D. Fungi E. Streptococci 12. Glasgow Coma 11. Locking knee: a "locked knee" is a term used to describe a patient's inability to either bend or straighten their knee. There are two general types of locked knees. The locked knee can either be caused by a mechanical block to knee motion, or a locked knee can be caused by pain that is too severe to allow knee motion. a standardized system for assessing response to stimuli in a neurologically impaired patient,assessing eye opening, verbal response, and motor ability. Reaction scores are depicted in numerical values, thus minimizing the problem of ambiguous and vague terms to describe the patie nt's neurologic status. 13. Intracranial pressure (ICP): is the pressure of the brain contents within the skull. The pressure of the blood flowing through the brain is referred to as the cerebral perfusion pressure (CPP). The pressure of the blood in the body is the mean arterial pressure (MAP). Normal CBF: 50ml/100gm of brain/min "AUTOREGULATION". Normal CPP is 60-150. 14. Raccoon eye: also known as panda eyes, though that term commonly refers to excess or smeared dark make-up around the eyes or to dark rings around the eyes or periorbital ecchymosis is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges, or (rarely) certain cancers. Raccoon eyes may be accompanied by Battle's sign. 15. Battle sign: also mastoid ecchymosis, is an indication of fracture of posterior cranial fossa of the skull, and may suggest underlying brain trauma. 16. Shock: A clinical state in which tissue blood flow is inadequate for tissue requirements or oxygen utilization is impaired. There is either insufficient oxygen delivery, mal-distribution of oxygen delivery to vital tissues or impaired utilization. LONG 1. Why do we cardiologists and cardiac surgeons choose hybrid technique to treat coronary heart disease patients? • Less post-op complications, less mortality, less intraoperative and postoperative blood products , light nervous system damage, less hospital infection, shorter hospital stay. • Due to using smaller incisions, avoiding cardiopulmonary bypass, “No- touch aorta technique”. • Minimal surgical trauma, long-term best efficacy and outcomes can be achieved by hybrid techniques, which include to graft LIMA to LAD, and PCI ( DES or BMS) to other target vessels. • The application of hybrid technology is the co-operation between cardiologists and cardiac surgeons, which can greatly increase the both sides enthusiasm and initiative to treat multivessel coronary artery disease, and then improve the level and efficacy of the treatment of coronary multivessel disease. • Hybrid technology can meet the patients’ demand for the safety, effectiveness, minimally invasive surgery and good early rehabilitation and long-term outcomes. • Compromise a huge potential medical market and socio- economic benefits. • The long-term outcomes need more clinical applications and clinical trials (RCTs) to be verified. 2. Risk factors for prostate cancer. Risk factors are not clear but may be related to familial and genetic influences, role of androgen, estrogen, sexual activity, vasectomy etc may be responsible for carcinoma of prostate. More than 70% of all prostate cancers are diagnosed in men over the age of 65. Genetics is an important factor. Men with one or more first-degree relatives (ie, father, brother) who have had prostate cancer have a 2 to 11 times greater chance of being diagnosed with prostate cancer. Prostate cancer results from damaged DNA (the genetic blueprint for the body’s cells); this damage can either be inherited or acquired during one’s lifetime. Researchers don’t know exactly what causes Prostate cancer, but have identified some risk factors: a) Age. b) Race (The death rate for prostate cancer is more than twice as high in African-American men than in Caucasian men). c) Environment. d) Diet. e) Genetics and family history. • What role does testosterone play? I. Testosterone, a male sex hormone, is an important factor in the normal growth and function of the prostate gland. II. Testosterone can stimulate hormone-dependent prostate cancer. III. As long as the body produces testosterone, prostate cancer is likely to continue to grow and possibly spread. IV. For advanced prostate cancer, luteinizing hormone-releasing hormone agonists (LH-RHa) can stop the production of testicular testosterone. 3. Symptoms of prostate cancer. a) Early prostate cancer usually does not cause any symptoms. b) As the tumor grows, the following symptoms may appear, but may be alleviated by reducing the body’s production of testosterone: 1) Frequent urination (especially at night). 2) Weak urinary stream. 3) Inability to urinate. 4) Interruption of urinary stream (stopping and starting). 5) Pain or burning on urination. 6) Blood in the urine. 7) Pain in the lower back, pelvis, or upper thighs. 4. TNM staging of prostate cancer. • TNM Staging is based on tumor size (T) and on whether the cancer has spread to lymph nodes (N) or metastasized to distant sites (M). • Tumor size is graded from 1 to 4: 1) T1: tumors are confined to the prostate gland and can’t be detected by DRE. 2) T2: tumors are confined to the prostate but are big enough to be detected by DRE or ultrasound. 3) T3 and T4 tumors have spread beyond the prostate into surrounding tissues. • Lymph node involvement is graded from 0 to 3, with 0 indicating that the cancer has not spread into lymph nodes. • Metastasis is rated 0 or 1, with 0 indicating absence of metastasis. 5. A-D system staging of prostate cancer. • classifies the disease into 4 clinical categories rated A through D. 1) Stage A is early cancer – the tumor is located within the prostate gland and can’t be detected by a DRE. 2) In Stage B, the tumor is confined to the prostate but large enough to be felt during a DRE. 3) By Stage C, the tumor has spread outside the prostate to some surrounding areas and can be felt during a DRE. 4) In Stage D, the cancer has spread to the nearby and distant organs, such as bones and lymph nodes. 6. Surgical techniques for treating prostate cancer. 1) Radical prostatectomy: i. Involves removal of the entire prostate gland. ii. Performed to remove early-stage prostate cancer before it can spread to other parts of the body. iii. Takes about two hours and requires general anesthesia. iv. Complications include incontinence and impotence. v. Some physicians may use hormonal therapy to shrink the tumor before surgery so that it can be removed more effectively. vi. Often, biopsies are taken of the pelvic lymph nodes to determine if the cancer has spread. 11. What Is Lethal 10. Advantages, indications &Contraindications for laparoscopy inguinal hernia. Advantages of laparoscopic inguinal hernia: a) Tension free repair that reinforces the entire myo-pectoneal orifice. b) Less tissue dissection and disruption of tissue planes. c) Three ports are adequate for all type of hernias. d) Less pain postoperatively. Low intra-operatively and postoperative complications. e) Early return to work. Indications: the same as repairing the hernia conventionally . *Bilateral inguinal hernias. *Recurrent inguinal hernias. Even in patients with clinically unilateral defect, there is 20-50 % incidence of a contra lateral asymptomatic hernia being found . Contraindications: non-reducible or incarcerated inguinal Hernia. I. Prior laparoscopic herniorrhaphy. II. Massive Scrotal hernia. III. Prior pelvic lymph node resection. IV. Prior groin irradiation.  The lethal triad is the combination of acidosis, coagulopathy, and hypothermia in a critically ill patient. It is an indication of very severe illness and has a poor prognosis.  Metabolic failure: Hypothermia , acidosis, coagulopathy.  These three derangements become established quickly in the exsanguinating trauma patient and once established form a vicious circle which may be impossible to overcome. 1) Hypothermia: • The majority of major trauma patients are hypothermic on arrival in the emergency department due to environmental conditions at the scene. • Inadequate protection, intravenous fluid administration and ongoing blood loss will worsen the hypothermic state. It has dramatic systemic effects on the bodies functions but most importantly exacerbates coagulopathy and interferes with blood homeostatic mechanisms. 2) Acidosis : Uncorrected hemorrhagic shock will lead into inadequate cellular perfusion, anaerobic metabolism and the production of lactic acid. This leads to profound metabolic acidosis which also interferes with blood clotting mechanisms and promotes coagulopathy and blood loss. 3) Coagulopathy : Hypothermia, acidosis and the consequences of massive blood transfusion all lead to the development of a coagulopathy. Even if control of bleeding is achievable, patients may continue to bleed from all cut surfaces which leads to worsening of hemorrhagic shock and so a worsening of hypothermia and acidosis, prolonging the vicious cycle. 12. What are the primary management of damage control surgery? • Control hemorrhage, prevent contamination and avoid further injury. • Damage control surgery is the most technically demanding and challenging surgery a trauma surgeon can perform. There is no margin for error and no place for careless surgery. a) Preparation: prehospital and ER time should be minimized in those patients. • Investigations that will not affect the immediate management of patients should be deferred. • Cyclic fluid resuscitation prior to surgery is futile and will worsen hypothermia and coagulopathy. • The patients should be rapidly transferred to operating room without attempts of restoring of circulatory volume. • They require operative control hemorrhage and simultaneously vigorous with blood and clotting factors. • Anesthesia should be induced on the operating table when the patients are prepared and draped and surgeons ready. • All fluids should be warmed. b) Bleeding Control: The next step after preparation is identify the source of bleeding. • The careful inspection of four quadrants of abdomen are necessary. • Immediate control of hemorrhage is with direct blunt pressure using the surgeon fingers, swabs, sticks or abdominal packs. • Proximal and distal control techniques are rarely useful in acute stage. • Bleeding from the liver, spleen or kidney can generally be achieved by applying pressure with several large abdominal packs. c) Prevention of contamination: achieved by the rapid closure of hollow viscous injury. • Inspection of the ends and re-anastomosis is performed at the second procedure. 13. Structure and Composition of articular cartilage and its function? 1. Extracellular matrix (ECM). 2. Chondrocytes; a sparse population of highly specialized cells. 3. Cell, collagen fibers, proteoglycan aggregate molecules. 14. Write about the treatment of articular cartilage? 1) Non operative: Control symptoms, improve function. i. Non-pharmacological , Noninvasive therapy : deep heat, cryotherapy, external laser therapy and trancutaneous electric nerve stimulation(TENS). ii. Physical therapy or exercise, bracing, activity modification/ patient education. 2) Ph a r m a c o ther a pie s : Analgesics i. Nonsteriodal anti-inflammatory drugs (NSAIDs). ii. Glucosamine and chondroitin sulfate. iii. Topical Analgesics. 3) I n t r a - A r t i c u l a r M e d i c a l T her a pies: i. Intra-articular corticosteroid injections. ii. HA, large viscoelastic GAG: in both articular cartilage and synovial fluid. 18. Write about Plastic surgical skills and iii. Viscosupplementation. 4) Arthroscopic Debridement. 5) Reparative techniques: subchondral drilling, abrasion arthoplasty and MF. 6) Restorative Techniques: cartilage grafting and implantation of chondrocytes. I. Autologous osteochondral grafting. II. Autologous chondrocyte transplantation/implantation. III. Fresh allograft Transplantation. IV. Tissue Engineering techniques. 15. What are the stages of osteochondritis dissecans ? Stage 1: No discontinuity of base and cartilage, covered by intact cartilage. Stage 2: partially detached osteochondral lesion but stable. Stage 3: Completely detached osteochondral lesion but not dislocated. Stage 4: Displaced or loose osteochondral lesion within its bed. 16. What are the key components for tissue engineering? 1. Chondroprogenitor cell source. 2. Porous scaffold. 3. Bioactive factors. 17. Write about ear Reconstruction surgical technique? Stage 1: Skin expansion Stage 2: Autologous rib cartilage Stage 3: Tragus, cavity of articular cartilage. 1. Tissue expansion: is a technique that can assist the reconstructive surgeon if there is a shortage of suitable tissue(usually skin) near a defect. 2. Vacuum-assisted wound closure(VAC): is a method whereby a difficult wound such as a pressure sore is dressed with a special open-cell foam sponge. The foam is connected by a tube to a suction device. This set-up has a number of benefit to the wound. 3. Skin graft: two types of skin grafts.. a) Split-skin graft: only the upper layer of dermis is taken. The graft site re grows from epithelium around the Adnexa. Split-skin grafts are most used when a large area must be covered. b) Full thickness graft: these are very useful where cosmoses is important(face) or flexibility is important(over a joint). 4. Flaps: a flap is a piece of viable tissue with a blood supply which can be used to reconstruct a tissue defect. Types: local, distant, free, random, axial, skin, muscle and composite flaps. *Reconstructive ladder: to closed the wound defects, Plastic surgery have many choices, but in determining the ideal treatment, most scholars agree with first from the simplest way to begin, gradually transition to more complex method. 26. GLASGOW Coma 25. What are the symptoms and signs of increased ICP? • Diminishing level of consciousness. • Headache, vomiting and seizures. • Cushing’s Triad – ⬩ bradycardia. ⬩ hypertension. ⬩ abnormal respiration. • Pupillary changes. • Papilledema. 27. Describe the intracranial lesions briefly. a) Epidural hematoma (EDH): • Collection of blood & clot b/n dura matter and bones of the skull. • Source: middle meningeal artery or dural venous sinuses. • Clinical manifestations: brief loss of consciousness, headache, drowsiness, dizzy, nausea, and vomiting. Rapid clinical deterioration • Talk & die. b) Subdural hematoma (SDH): • Most frequently from tearing of a bridging vein between the cerebral cortex and a draining venous sinus. • Acute - <24hrs. • Sub acute – 24hrs-2wks. • Chronic - >2wks. c) Intra-cerebral hematoma: • Formed within brain tissue & caused by shearing or tensile forces that mechanically stretch and tear deep small caliber arterioles. • Most common in temporal and frontal regions. • C/F depend on site involved. d) Diffuse intracranial lesions: 28. Types of primary brain 29. What are the four classes of • Concussion: temporary & brief interruption of neurological function after minor head injury. Manifested by headache, confusion and amnesia. • Multiple contusion. • Hypoxic/ischemic injury. • Diffuse axonal injury (DAI): Shearing forces disrupt the axonal fibers in the white matter. Shaken baby syndrome. Blunt trauma. Rapid rise in ICT. Prolonged or permanent. • Primary brain injury occurs at the time of impact and includes injuries such as brainstem and hemispheric contusions, diffuse axonal injury and cortical lacerations. 1. Diffuse axonal: results from shearing of grey-white interface 2. Cerebral concussion: defined by a period of amnesia. 3. Cerebral contusion and laceration: small areas of hemorrhage are visible on CT scan. 1. Distributive shock (abnormal vascular tone): abnormal total peripheral resistance • Hyper dynamic state with high cardiac output. • Normal to low filling pressures. • Decreased systemic vascular resistance. • Mixed venous oxygen may be normal or increased. • Causes: SIRS (sepsis, burns, trauma, pancreatitis), neurogenic (spinal trauma), anaphylaxis, endocrine (thyroid, myxoedema, adrenal) and pharmacologic (vasodilators, benzodiazepines). 2. Hypovolaemic shock (decreased blood volume): abnormal preload • LV preload is too low to support adequate stroke volume. • compensatory mechanisms: tachycardia, increased venous tone, increased vascular resistance, increased contractility, decreased urine output and Na+ reabsorption may help compensate for up to 1.5 L of blood loss. • shock develops when blood loss exceeds 20-25% of normal circulating volume • prolonged hypovolaemic shock leads to metabolic acidosis, then cardiogenic shock. • Causes: blood loss, polyuria, GI loss, burns, vasodilation, third space losses and vascular permeability. 3. Obstructive shock (obstructed blood volume): abnormal afterload • impaired diastolic filling. • increased right- or left-ventricular afterload. • Causes: tension pneumothorax, pulmonary emboli, mediastinal tumors, pericardial tamponade, constrictive pericarditis, acute pulmonary hypertension, aortic dissection, valvular (mitral stenosis, aortic stenosis) and vena-caval compression. 4. Cardiogenic shock (abnormal pump function): abnormal contractility • Cardiac index below 2 L/min/m2. • PCWP greater than 17-20 mmHg. • Causes: ischemia, myocardial contusion, valvular disease, Cardiomyopathy, myocarditis, dysrhythmias, septicemia, and pharmacologic. 32. What is Denis classification of thoracolumbar 33. What are the postoperative complications after surgery treatment of thyrotoxicosis? 30. What are CABG Indications, procedure, mortality and quality of life?  Indications : Stable and unstable angina.  Procedure : Under CPB, use left internal mammary artery (LIMA) to graft left ascending artery (LAD), and use saphenous vein to graft other target vessels.  Mortality : Older age, female, previous CABG, urgent operation. Etc.  Quality of life : Morbidity, recurrent angina, MI. 31. How do you diagnose the liver cancer? Treatment: surgery, embolization, chemotherapy and ablation. A. C o m pressio n Fr a c tur e : f ilure of an eri column. B.B ur s t F r a c ture s : failure of anterior and middle column (axial compression). +/- failure of posterior column. Most common at T/L junction. C. Flexion Distraction Injuries. D. F r a c tur e D is l o c a ti o n s : high energy and most have neuro deficit. 1. Hemo rhag . 2. Respiratory obstruction: most cases are due to laryngeal edema. 3. RLN paralysis: this may be unilateral or bilateral, transient or permanent. 4. Thyroid insufficiency: within 2 years. 5. Parathyroid insufficiency. 6. Wound infection. 7. Hypertrophic or keloid scar: this is more likely to form if the incision overlies the sternum. 8. stitch granuloma. 9. thyroid crisis (storm): this is an acute exacerbation of hyperthyroidism.