Surgery

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Surgery

  1. 1. True and False:<br />1. All neutropenic patients become febrile.<br />False- fever is a common sign of infection in neutropenic patients (Langhorne et al., pg. 490)<br />2. All febrile patients become septic.<br />False- fever is a common sign of sepsis (Kaplan, 2006)<br />3. All septic patients are neutropenic.<br />False<br />4. A patient who is neutropenic with an oral temperature of > 38.3 C is considered septic.<br />False<br />5. A neutropenic patient develops sepsis because the body is unable to provide a systematic<br />inflammatory response to pathogenic microorganisms and associated endotoxins in the<br />blood.<br />False<br />6. Septic Shock can be caused by which of the following:<br />a) Bacteria<br />b) Fungus<br />c) Virus<br />d) Protozoal organisms<br />e) All of the above<br />The presence of an invading pathogen should stimulate an immune response from the patient<br />but in immunocompromised patients it may result in an infection which can lead to lifethreatening<br />complications. (Langhorne et al., pg. 437)<br />2<br />7. Which of the following are characteristics of ‘warm shock’ (which is also known as a<br />hyperdynamic state)?<br />a) Vasodilation<br />b) Decreased peripheral vascular resistance and increased cardiac output<br />c) Rapid respirations<br />d) Patient feeling warm and flushed<br />e) All of the above<br />(Langhorne et al., pg. 439)<br />8. In septic shock, the goals of the treatment include:<br />i. maintain BP<br />ii. maintain tissue perfusion<br />iii. treat the underlying pathogen<br />iv. prevent bleeding<br />v. maintain electrolytes<br />a) i and ii<br />b) i, ii and iii<br />c) i, iii and iv<br />d) ii, iii and v<br />The identified stage of septic shock will determine necessary interventions and prompt<br />treatment is essential in preventing progression of symptoms. (Langhorne et al., pg. 442)<br />9. Which of the following is not an example of a triggering event for Disseminated<br />Intravascular Coagulation (DIC)?<br />a) a gram positive , gram negative sepsis<br />b) a mucin producing GI adenocarcinoma.<br />c) multiple whole blood transfusions.<br />d) a prothormbin time of 10 - 13 secs.<br />(Langhorne et al., pg. 421)<br />10. What are the clinical manifestations commonly seen in DIC?<br />Bleeding is typical and it may be overt or occult. Prolonged bleeding from venipuncture<br />sites, gum bleeding, hemoptysis, epistaxis, GI bleeding and petechiae may also be seen.<br />Change in mental status, tachycardia, and orthopnea are also examples of DIC<br />manifestations. (Langhorne et al., pg. 423)<br />3<br />11. Explain the rationale for administering blood component therapy in DIC cases.<br />Transfusion of blood products such as platelets, fresh frozen plasma and PRBCs are used to<br />stop bleeding in severe cases. It is necessary to alter the clotting process and control<br />bleeding. Platelets contain platelet factor III. Factor III strengthens the endothelium, assists<br />to convert prothrombin to thrombin. (Langhorne et al., pg. 424)<br />12. In DIC, hemorrhage and thrombosis occurs simultaneously as a result of:<br />a) Ruptured blood vessels<br />b) Depletion of clotting factors<br />c) An increase in clotting factors<br />d) Endotoxins released in the circulation<br />DIC is an alteration in the blood-clotting mechanism, which accelerates the “coagulation<br />cascade” and results in thromboses and hemmorhage. (Langhorne et al., pg. 421)<br />13. Examples of endothelial injury that may cause DIC include all of the following except:<br />a) Shock or trauma<br />b) Infections<br />c) Obstetric complications<br />d) Pancreatitis<br />Endothelial injuries such as shock or trauma, infections, obstetric complications, and<br />malignancies may result in a DIC. (Langhorne et al., pg. 421)<br />14. _________________ has been used as first line therapy for moderate to severe<br />hypercalcemia:<br />a) Plicamycin<br />b) Gallium nitrate<br />c) Pamidronate<br />d) Osteoprotegerin<br />Pamidronate is a second generation biphosphonate (a selectively concentrated compound in<br />bone which inhibits the action of osteoclasts) and used as a first-line therapy (Langhorne et<br />al., pg. 429)<br />15. Which of the following is NOT a treatment option for hypercalcemia:<br />a) Hydration with normal saline (isotonic solutions)<br />b) Use of a loop diuretic such as furosemide<br />c) Use of glucocorticoids<br />d) Hydroxyurea<br />(Langhorne et al., pg. 429-430)<br />4<br />16. Malignancies associated with hypercalcemia include all of the following conditions<br />except:<br />a) Cancer of the breast and kidneys<br />b) Squamous cell cancer of the lung, head and neck or esophagus<br />c) Lymphoma and myeloma<br />d) Cancer of the bones<br />(Langhorne et al., pg. 429)<br />17. Tumour lysis syndrome (TLS) is defined as a metabolic triad of the following:<br />a) Hypocalemia; Hyperkalemia; Hyperuricemia<br />b) Hyperuricemia; Hyperkalemia; Hyperphosphatemia<br />c) Hypokalemia; Hyperphosphatemia; Hypercalemia<br />d) None of the above<br />“As malignant cells are lysed, intracellular contents are rapidly released into the bloodstream.<br />This results in high levels of potassium (hyperkalemia), phosphate (hyperphosphatemia), and<br />uric acid (hyperuricemia)” (Langhorne et al., pg. 449)<br />18. Renal dysfunction associated with TLS can be attributed to all of the following except:<br />a) Hypovolemia<br />b) Ischemia<br />c) Uric acid nephropathy<br />d) Tumour invasion<br />(Langhorne et al., pg. 448)<br />19. TLS is most commonly associated with which of the following cancers:<br />a) Breast<br />b) Multiple myeloma<br />c) Lymphomas<br />d) Pancreatic<br />The incidence in high-grade lymphomas is as high as 42% & pts most at risk are those with a<br />large tumour cell burden, such as high grade lymphomas (Langhorne et al., pg. 448)<br />5<br />20. The only class of antineoplastic agents that has never been documented to induce a<br />hypersensitivity reaction is:<br />a) Nitrosureas (carmustine, lomustine)<br />b) Antimetabolites (Gemcytabine)<br />c) Vinca alkaloids (Vincristine, Vinblastine)<br />d) Alkylating agents (Cisplatin, Carboplatin)<br />e) Anti-tumour Antibiotics (Daunorubicin, Doxorubicin)<br />Increased risk of HSR is known to occur with drugs that are proteins (L-asperaginase) ;<br />heavy metal compounds (cisplatin); and drugs prepared in antigenic diluents (i.e. taxanes<br />and podiphyllotoxins) *N.B. see Table 24-6 (Langhorne et al., pg. 432)<br />21. In the first phase called _______________, the patient is exposed to the foreign substance<br />or antigen thereby causing the formation of IgE antibodies that attach to the receptors on<br />basophils and mast cells.<br />a) Activation phase<br />b) Sensitization phase<br />c) Exposure phase<br />d) Type I reaction<br />This is when the patient is exposed to the foreign substance (antigen) which causes formation<br />of specific antibodies that attach to the receptors on basophils & mast cells. (Langhorne et al.,<br />pg. 432)<br />22. What antineoplastic agent has been associated with the highest risk of HSR?<br />a) L-asparaginase<br />b) Anthracyclines<br />c) Mitoxantrone<br />d) 5-Fluorouracil<br />See rationale for # 20 (Langhorne et al., pg. 432 & 433)<br />23. SIADH is characterized by:<br />a) Elevated serum blood levels of ADH and hyponatremia<br />b) Excessive water retention and hypoosmolality<br />c) Hypertension, Edema and Hypokalemia<br />d) a & b<br />“SIADH is characterized by elevated serum blood levels of ADH, excessive hater retention,<br />hypoosmolality, and hyponatremia” (Langhorne et al., pg. 444)<br />6<br />24. Treatment for mild hyponatremia include fluid restrictions to:<br />a) 200-250 mL/day<br />b) 500-1000mL/day<br />c) 1000-1500mL/day<br />d) Patients are not placed on fluid restrictions<br />Fluid restriction of 500- 1000 mL/day in order to promote a negative water balance which<br />should correct plasma sodium levels in 3 to 5 days.(Langhorne et al., pg. 447)<br />25. Treatment for severe hyponatremia include:<br />i. Fluid restrictions (2000mL-2500mL/day)<br />ii. Hypertonic saline infusions (3%)<br />iii. Lop diuretics (i.e. lasix)<br />iv. Potassium sparing diuretics (i.e. spironolactone)<br />v. Demeclocycline-(a medication that induces nephrogenic diabetis<br />insipidus)<br />a) i and ii<br />b) ii and iii<br />c) i, iv and v<br />d) ii and iv<br />Severe hyponatremia usually develops over 1-2 days and is considered a medical emergency.<br />Care must be taken not to correct Na levels too quickly (Langhorne et al., pg. 447<br />What are the differences in the Anabolic Solution for bodybuilders vs powerlifters? As wrestlers we have some concerns from both areas. We need strength and even a certain amount of mass for our particular style of wrestling (Russian Sambo). We are also concerned with dropping fat to meet weight class requirements and to increase speed and agility. Is there enough of a significant difference between the two where we would need to reference both versions? Or would one serve our needs better than the other?:<br />The differences in the two Anabolic Solution books are due to the differences in the two sports. In bodybuilding the emphasis is on maximizing muscle mass, minimizing body fat, and on appearance. In powerlifting the emphasis is on maximum strength at certain bodyweights, which also means maximum functional muscle at any one bodyweight. Having been both a competitive wrestler and powerlifter, I would suggest that you buy the Anabolic Solution for Powerlifting as it will suit your purposes better, especially in dropping bodyweight while at the same time maximizing strength, muscle mass and performance<br />What kind of workout routines should I be using to increase growth hormone output?:<br />As far as the training routine to use to increase GH and to create a favorable anabolic and fat burning environment, most of that is in the Anabolic Solution books where I spell out the diet and supplements to use to accomplish this. For example Exersol, a product that contains three formulas, used before, during and after training) does just that. For more information on these supplements and what they do have a look at the individual and combo supplements on www.MetabolicDiet.com<br />GEN MX-7 Methoxyflavone: What is your opinion on this product?:<br />This isoflavone (Methoxyflavone is 5-methyl 7-methoxyisoflavone) is a phytoestrogen and has weak estrogenic activity. Theoretically, some phytoestrogens, because they may inhibit the aromatase enzyme and thus decrease estrogen formation from testosterone and androstenedione, and because they may act as inhibitors of estrogen by competitively binding to the estrogen receptor, may increase testosterone production much the same way that anti-estrogens (such as clomiphene – Clomid) and the newer aromatase inhibitors (such as anastrazole – Arimidex), by decreasing the inhibitory effects of estrogen on GnRH and LH (resulting in LH driven increased testicular steroidogenesis and subsequently increased testosterone production). Many animal studies and studies on postmenopausal women, however, have shown, that while the various phytoestrogens vary somewhat in their properties in general they have a dampening effect on the hypothalamic-pituitary-testicular axis and result in decreased levels of both total and, due also to increased levels of SHBG, bioavailable testosterone. As well, isoflavones (such as Methoxyflavone) are significantly poorer inhibitors of aromatase than flavones (such as chrysin – the ingredient I use in my TestoBoost product). The bottom line is that phytoestrogens, while they may have specific health benefits, and may act to control endogenous sex hormone levels in both men and women, are generally counterproductive for athletes wishing to increase muscle mass and strength. On the other hand, as already mentioned, some bioflavonoids (a somewhat loose umbrella term that includes isoflavones, anthocyanins, flavans, favonols, flavones, flavanones hesperidin, rutin, and citrus bioflavonoids), however may be useful under certain circumstances. For example, in one study, quercetin and fisetin, two naturally occurring bioflavonoids were shown to mobilize lipids and enzymes in the absence or presence of epinephrine in intact rat adipocytes . The results of this study suggest that some flavonoids act synergistically with epinephrine on beta-adrenergic receptors to stimulate adipocyte lipolysis. Thus these bioflavonoids may be especially useful in the high fat, high protein, low carbohydrate anabolic diet. I included quercetin in both Thermo and ReNew, two of the three formulations in Cellusol, my weight and fat loss product). Quercetin also has significant immune system and antioxidant effects (another reason why it’s particularly useful in ReNew – for info on ReNew check it out on my web site www.MetabolicDiet.com.<br />You say that you should eat no more than 30 grams of carbs for the first 12 days and then following week days. however I see in some of your sample diets example the 4000 and 4500 strict versions you have a carb value of 50 carbs a day is this a mistake?:<br />As far as the 30 gram carb limit, it's not written in stone. As you increase your caloric intake, especially at the high end, you can increase the carb intake without causing any problems as far as adapting to the diet. Again, the diet plans at the end of my book are only examples and each person has to find the best carb levels that suits their metabolism. For some, the 30 carb limit, even when taking in 4500 calories, may work best. For others, depending on their abilities to oxidize fat as their main fuel, 100 grams of carbs or even more, may work best. The troubleshooting guide that I included in the Metabolic Diet is geared to helping you find that level of carbs that works best for your metabolism, at least as far as maximizing muscle mass and minimizing body fat. Keep in mind that I usually recommend that you increase your calories in the high carb phase more than the low carb phase of the Metabolic Diet. This information was more evident in my Anabolic Diet (a 100 page how to book for bodybuilders), which I'm presently revising. For example, one bodybuilder who has been on the diet for over 5 years does it this way. In his bulk up phase he usually takes in about 3500 calories during the weekdays and then may take as much as 12,000 calories a day on the weekends (no kidding). He gains the weight he wants and then starts cutting back drastically on the weekend calories (if he got up to 12,000 calories a day on the weekends then he begins his definition phase with a cut of 2,000 calories per week for the first three week, 1000 calories per week for the next two weeks and then about 200 calories per week) and about 100 calories a day per week on the weekday calories. Keep in mind that his cutting phase lasts about 16 weeks. Depending on how his fat/weight is doing he may make minor modifications on this plan. To give you an idea of how this worked for him he weighed 217 lbs at 6% bodyfat the last major contest he was in prior to starting my diet (he had been competing for almost ten years). After two years of following my diet he weighed 254 lbs at 5% bodyfat and won his division of the Mr. Universe. Mind you his diet wasn't very good prior to going on my diet so I can't take all the credit. It's quite possible that he would have made some progress just by improving his diet along conventional means. On the other hand you don't see those changes in a seasoned pro unless something drastic happens. Also keep in mind that there were no other changes except for the diet and a few nutritional supplements (I made his some custom supplements much the same as my current nutritional line sold by APT Nutrition).<br />I am reading your book the anabolic solution for powerlifters which I find very good. Can you suggest a good weight gaining diet?:<br />There are a lot of sample diets on the MetabolicDiet.com site. Have a look at http://www.metabolicdiet.com/mdiet_index.htm to see a variety of diets at different calorie levels. As far as a good weight gaining diet have a look at the sample 4500 calorie diets. If you want to go higher it's simply a matter of increasing the portion sizes. One way to gain weight is to keep the calorie count moderate during the week but raise it substantially during the weekend. One chap who's been on the diet for several years finds that the best way for him to bulk up is to go around 4000 calories during theweek and up to 10,000 calories on Saturday and Sunday.<br />Im a 42 yr old powerlifter- for my own recreation, I need help choosing which of you books will help me lose 50 lbs of unwanted fat, while maintaining muscle and energy levels.:<br />The best book for you is the Anabolic Solution for Powerlifting. You'll need to read the whole book first and then make the changes you need to make for your circumstances, especially for dropping that 50 lbs in body fat. For example, in chapter seven you would go right into the Cutting Phase (starts on page 150) and cycle between the Strength and Cutting Phases until you get to your desired body composition - level of lean body mass and body fat. The book will explain everything to you as far as the diet and nutritional supplements to use so that you maintain energy levels and make steady progress, including strength gains and favorable changes in your body composition.<br />While sticking to the Anabolic Solution, do you feel it's OK to use LoCarb Sports Bars during the week, 1 or 2 max.?:<br />The Low Carb bars are fine to use. The LoCarb Sports Bars I formulated are the best on the market and unfortunately also one of the most expensive to manufacture. The cost of the ingredients (which include CLA, glutamine peptides and taurine), in my bars are four times as much as in the major competing bars on the market. Unfortunately my bars, because of theingredient mix, don't taste as good as some since these bars are real food, not Mars Bars competitors.<br />What would a subject do if they had 80 or more pounds to lose? Would they stay on the Radical Diet for the whole 80 pounds? How does one not gain weight back once they go off of 800 calories a day?:<br />The Radical Diet is only meant for a short term rapid weight loss session. Although several people have continued on the diet and done well, I usually recommend that they switch over to the Metabolic Diet, either as in the Metabolic Diet book, or if they're inclined toward increasing muscle mass and getting really buffed, the Anabolic Solution for Bodybuilders (or Powerlifters). These two books offer a long term solution to weight and fat loss rather than a quick fix. On the other hand the quick fix does wonders for the psyche and motivates people to go long term on a healthier and more long term regimen.<br />I was wondering if the Anabolic Solution for Powerlifters can be used by other athletes too?:<br />For most athletes, the Anabolic Solution for Powerlifters is a better book. That's because the book concentrates on strength and performance and although maximum lean functional muscle is also a factor, it isn't the primary focus of the book. The various training phases used by a powerlifter, at least as far as diet and nutritional supplements, are common to most athletes and as such translate easily<br />I have really appreciated the in-depth information provided on the website. The one thing I am very disappointed with is the information provided regarding supplements. I know the average consumer may not get into all of the ingredients and make-up of the supplements, but I think the average bodybuilder is somewhat of a chemist - as a result of having to know all about the various pro-hormones, amino acids, and " thermogenic" agents out there (not to mention if they have thought about using steroids). So, would it be possible to have more information available regarding your supplement line. I could not find the kind of detailed information that would cause me to justify $150+ on a thermogenic fat burner cycle - but if you could tell me what is in it, then I might be more inclined.:<br />The Anabolic Solution books and ebooks contain much more information on supplements and how to fit them into the training cycles. I'm also working on doing a detailed information piece on each of the supplements in my lineup. These information pieces, which will be ready in a few months or so, will be like the ones now available on Amino and GHboost (see http://www.metabolicdiet.com/store/comersus_viewitem.asp?idproduct=190 and look at the nutritional panel, the product brochure and the academic articles), and to a lesser extent my MRP LoCarb and Myosin Protein. I wouldn't hesitate in buying any of the products that I formulated. All of my products are research driven and have a complex synergistic blend of ingredients that are targeted for certain effects. They work and they're a bargain since my markup is only 3-5 times the ingredients cost. Contrast this with the other supplement companies that mark their product from 10 to 40 times, and more, the cost of the ingredients<br />I am following the Anabolic Solution. When do I take the Creatine Advantage in relation to my weight workouts and also my off-days (or cardio-only days) and also in relation to meals?:<br />You can use Creatine Advantage at a number of times and circumstances. If you're loading up by using two doses a day, you can take one dose before and one dose after your weight and cardio workout days, and twice a day on an empty stomach on other days. If you're down to one dose a day as a maintenance dose there are reasonable grounds for either taking it either before or after training, or some do, half before and half after training<br />I was wondering which book I should get the anabolic solution for bodybuilders or the metabolic diet. My main hobby is bodybuilding for the last couple years but I haven't given my diet very much thought until recently. I have always carried around about 20 extra pounds so I wasn't sure which book would be best for me. I also wanted to start my assessment phase but I was confused on the amount of fats. Being a bodybuilder I consume about 210 grams of protein daily and was wondering how many grams of fats I need. The website suggests 40-60% of fats but I don't know if that’s 40-60% of daily calories or 40-60% of daily gram intake.:<br />Your best bet is the Anabolic Solution for Bodybuilders. The Anabolic Solution series of books (there are two now with more planned) build on the dietary foundation of the Metabolic diet and provides specific nutrition, training and supplement programs for specific sports, such as bodybuilding. The Anabolic Solution books do not have the extensive appendices of nutritional information and meal plans that the Metabolic Diet book has, however that information is available through my website. The Anabolic Solution for Bodybuilders will explain the diet in detail. As far as the percentages of macronutrients, it refers to calories and not grams. For example if you limit your carb intake to 30 grams per day, it will usually make up anywhere from 4 to 10 percent of your calorie intake (daily calorie intake say between 1200 to 3000 calories). Of course in the bulking phase, if say you're taking 4500 calories per day, the 30 gram limit accounts for less than 3 percent of your calorie intake.<br />What's the difference between your Anabolic Diet and your Metabolic Diet?:<br />The Anabolic Diet, and now my more sophisticated Metabolic Diet and Anabolic Solution series of books, take the low carb equation to a level above all the other low carb diets, not only because the carb level is matched to each person’s individual genetic makeup, but also because it involves a macronutrient shift. This shift from low to higher carbs is meant to increase the anabolic effects of the diet by making use of the anabolic effects of insulin while at the same time limiting the effect of insulin on fat metabolism. The Anabolic Solution for Recreational and Competitive Bodybuilders is an expanded, revised and updated Anabolic Diet. It takes the original Anabolic Diet and updates it with the new information and guidelines that are in the Metabolic Diet. But there’s more since it ties the dieting in with phases of training (mass, strength, cutting, etc.) and with my line of nutritional supplements (which were specifically formulated for the Anabolic/Metabolic Diet) - in other words the whole Monty. That's the reason I named it the Anabolic Solution rather than just an update of the Anabolic Diet. <br />I would like to know what the best way is for me to gain weight. I'm a 21 year old female, I'm 5 feet tall and weigh 96 pounds. Should I be eating high carb or high protein? I have been told to eat high carbs and lift lift heavy weights, and I have also been told to eat high protein and lift weights with only 15 minutes max of cardio. What should I do to be toned and add weight?:<br />The best way to gain weight is to simply eat more. And it doesn’t matter what you eat if all you want to do is gain weight. Calories are king here. I had the same problem when I was your age and after years of trying what other people told me I found out that I just wasn't consistently taking in enough calories on a daily basis for a long period of time. So basically you have to go on the seefood diet - if you see food you eat it. All of this of course is tempered by your personal taste, likes, dislikes, etc. If you regularly take in more calories than you need you'll put on weight. Once you've gained your weight then you can start fine tuning your body composition so that you're more toned/muscular/etc. As far as training, do a moderate weight training routine - nothing fancy. On the other hand if you want to gain mostly muscle and keep fat to a minimum then you need to get the Anabolic Solution, my new ebook that puts diet, exercise and nutritional supplements together as a formidable anabolic and fat burning force. You can order the ebook from www.MetabolicDiet.com. It’ll explain just what you should eat and how much to both gain muscle mass and lose body fat.<br />I am a high intensity athlete. Three days of weight training with three days of fairly intense cardio sessions. I've been following the general rule of eating 6 small meals a day, including carbs, fat, and protein. I am at a 15 % body fat. I am going in for surgery for a double hernia behind my belly button. I've been told no " real' exercise for at least 8 weeks, no cardio and no weight training. Please help me with how to keep my weight in check during this time. Could you recommend a general rule of thumb for totals on Carb, protein, and fat intake, also total calories, while I am not able to exercise, with the hope that I can maintain my weight??? Also, do you recommend any good books for reading in this area? I'll have plenty of reading time.:<br />Sounds like whatever you're doing has been working well for you. On the other hand not doing anything for at least 8 weeks could play havoc with both your fitness and your weight/body fat. You're probably going to have to cut back about 25 percent on your calories, taking it across the board as far as your macronutrient composition. Basically just lessen your portions by 25% and you should be OK. You'll be able to fine tune that week by week depending on your weight. As far as good books to read, I'd recommend my Metabolic Diet (www.MetabolicDiet.com). Also, if you're into bodybuilding at all, my new ebook, the Anabolic Solution (ties in the Metabolic Diet with phases of lifting and with nutritional supplements and retails for $24.95), would also make a good read<br />Question # 1 (Multiple Answer) Consequences of reduced sodium activation because of reduced membrane potential (less negative): <br />A) decreased upstroke velocityB) reduced excitabilityC) decreased conduction velocityD) decreased effective refractory period<br />Question # 2 (Multiple Choice) In the cardiac Purkinje fiber action potential: the major current-carrying ion for phase 0 is: <br />A) potassiumB) sodiumC) calcium<br />Question # 3 (Multiple Choice) A polymorphic ventricular arrhythmia, especially associated with prolonged QT intervals; possibly induced by early afterdepolarizations <br />A) supraventricular tachyarrhythmiaB) Torsades de PointesC) bothD) neither<br />Question # 4 (Multiple Answer) Cardiac membrane ionic gate state(s) is/are controlled by: <br />A) ionic conditionsB) metabolic conditionsC) transmembrane potential (voltage)<br />Question # 5 (Multiple Answer) Cardiac cells tie in which the resting membrane potential drifts towards threshold: <br />A) normal His-Purkinje cellsB) normal ventricular muscle cellsC) SA nodal cellsD) ischemic ventricular muscle cells<br />Question # 6 (Multiple Answer) Factors that increase phase 4 depolarization: <br />A) mechanical cardiac muscle fiber stretchB) increased vagal toneC) beta-adrenergic stimulationD) hypokalemia<br />Question # 7 (Multiple Choice) The primary repolarization phase of the Purkinje fiber or ventricular muscle cell action potential: <br />A) Phase 0B) Phase 1C) Phase 2D) Phase 3E) Phase for<br />Question # 8 (Multiple Choice) Triggered automaticity: associated with significant prolongation of the action potential duration: <br />A) delayed afterdepolarization (DAD)B) early afterdepolarization (EAD)C) bothD) neither<br />Question # 9 (Multiple Choice) Phase of the Purkinje fiber action potential composed of the combination of inward, depolarizing calcium current balanced by an outward, repolarizing potassium current (delayed rectifier): <br />A) phase 0B) phase 1C) phase 2D) phase 3E) phase 4<br />Question # 10 (Multiple Choice) Factors reducing cardiac membrane resting potential and could reduce conduction velocity: <br />A) hyperkalemiaB) sodium pump blockadeC) ischemic cell damageD) B & CE) A, B & C<br />Question # 11 (Multiple Answer) Effective in treating Wolff-Parkinson-White-based arrhythmias: <br />A) antimuscarinic drugsB) beta-adrenergic blockersC) digitalis glycosidesD) beta-adrenergic agonistsE) calcium channel blockers<br />Question # 12 (True/False) Most common cardiac induction abnormality leading to arrhythmias -- reentry <br />A) trueB) false<br />Question # 13 (Multiple Choice) Primary inward, depolarizing current carrying ion in SA nodal and AV nodal tissues: <br />A) sodiumB) calciumC) potassium<br />Question # 14 (Multiple Choice) Less intense sodium current flow upon depolarization: <br />A) membrane potential = -80 mVB) membrane potential = -50 mV<br />Question # 15 (Multiple Answer) Increases slope of phase 4 depolarization: <br />A) edrophoniumB) atropineC) isoproterenolD) propranololE) physostigmine<br />Question # 16 (Multiple Answer) Factors which may precipitate or worsen arrhythmias: <br />A) ischemiaB) acidosisC) alkalosisD) cardiac fiber stretchE) drug action<br />Question # 17 (Multiple Choice) The cardiac cell membrane potential is closest to the equilibrium potential of this ion: <br />A) sodiumB) potassiumC) chlorideD) calciumE) inorganic anions<br />Question # 18 (Multiple Answer) Principal mechanism(s) associated with many tachyarrhythmias: <br />A) suppressed automaticityB) reentryC) triggered automaticity<br />Question # 19 (Multiple Answer) Cardiac transmembrane potential: mainly determined by these ionic gradients: <br />A) chlorideB) sodiumC) potassiumD) calciumE) magnesium<br />Question # 20 (Multiple Answer) Cardiac membrane permeability -- resting state: <br />A) sodium-- relatively impermeableB) potassium -- relatively impermeableC) sodium -- relatively permeableD) potassium -- relatively permeable<br />Question # 21 (Multiple Answer) Cardiac resting membrane potential is mainly determined by: <br />A) sodium concentrationB) extracellular potassium concentrationC) inward potassium rectifier channel stateD) chloride conductance<br />Question # 22 (Multiple Choice) Phase for depolarization (spontaneous depolarization) may occur because of: <br />A) gradual increase in membrane permeability to sodium or calciumB) decrease in repolarizing potassium currents (decreasing membrane potassium permeability)C) bothD) neither<br />Question # 23 (Multiple Answer) Arrhythmias may be caused or characterized by: <br />A) abnormal rateB) abnormal regularityC) abnormal impulse originationD) abnormal conduction<br />

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