CE Credit Package 10A

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Table of Contents CE

Credit Package 10 A

Repeat Cesarean Section

Off-pump Coronary Artery Bypass Grafting

Sterilization – Killing the Prehistoric Beast

When Unexpected Complications Arise During Surgery

Blood Pressure

Safety Concepts in the Surgical Setting

Necrotizing Fasciitis

Treatment of War Casualties

Wrist Fusion: Fighting Back Against Rheumatoid Arthritis

Disasters Follow No Rules: Preparing Your Hospital for Disaster Response

Challenging and Changing the Experience of Pain: Acute Pain Management in the Perioperatvie Setting in Patients with a Substance Abuse History

Gangrene: Recognizing and Treating Cellular Necrosis

CE Exams

Repeat Cesarean Section 1. When should the field be cleared of sharp and metal

objects?a. Before the deliveryb. Prior to uterine incisionc. After the shoulders are deliveredd. After the umbilical cord is clamped

2. The uterus was palpated to determine ____.a. Fetal distressb. Abnormal uterine actionc. Fetal positiond. Location of umbilical cord

3. The __ count is performed ___.a. 4th, after the skin is closedb. 2nd, before the uterus is palpatedc. 1st, after the initial skin incisiond. 3rd, while the peritoneum is closed

4. Cord blood gas was _____.a. Drawn prior to clamping umbilical cordb. Sent to pathology for analysisc. Collected by the neonatal nursed. None of the above

5. Which of the following is incorrect for this problem?a. Bulb syringe, one per infantb. Core blood vial, one per infantc. Cord clamp, one per infantd. Both a. and c.

6. The uterine incision was _______.a. Carried bilaterally with Lister bandage Scissorsb. Closed in one layersc. Followed by oxytocin injectiond. Closed prior to cord blood collection

7. Indications for cesarean section include:a. Diabetes mellitusb. Placenta previac. Ovarian tumorsd. All of the above

8. The neonate presented with _______.a. Abnormal heart rateb. Umbilical cord prolapsec. Breech presentation -footlingd. Dystocia

9. The bolster under the patient’s right hip reducedpressure on the:

a. Vena cavab. Uterusc. Umbilical cordd. Femoral artery

10. In the final stages of a cesarean section, oxytocin maybe administered to ___.

a. Stimulate lactationb. Control uterine hemorrhagec. Decrease postpartum bleedingd. Prevent uterine rupture

Off-pump Coronary Artery Bypass Grafting 1. The first OPCAB was performed in

a. 1954 c. 1973b. 1967 d. 1995

2. What are the main branches of the left main trunka. RIMA AND LIMAb. RCA AND PDAc. LAD and left circumflexd. Diagonal and obtuse marginal

3. All of the following are risks of conventual CABGexcept:a. Systemic Inflammatory Responseb. Aortic dissectionc. Embolismd. Shorten hospital stay

4. OPCAB is beneficial to all of the following except:a. Jehovah’s Witnessb. Prone to CVAsc. Need valve replacementd. Heavily calcified aortas.

5. The chest incision for OPCAB is called?a. Midlineb. Median sternotomyc. Subxyphoidd. Femoral

6. Anesthesia delivers the following drugs for OPCABexcept:

a. Milrinone c. Albuminb. Heparin d. Plavix

7. The XPOSE device is set at what pressure?a. 350 mmHgb. 500 mmHgc. 50 mmHgd. 150 mmHg

8. Which of the following is not a conduit used inOPCAB?

a. LIMAb. Saphenous vein graftc. Temporal artery graftd. RIMA

9. All of these items are placed prior to sternal closureexcept:

a. Vascular bulldogb. Temporary pacing wiresc. Mediastinal chest tubed. Pleural chest tube

10. Postoperative arrhythmias can be treated by all of thefollowing except:

a. Cardioversionb. Temporary pacemakerc. Intraaortic balloon pumpd. Intravenous medication

Sterilization – Killing the Prehistoric Beast 1. What is the minimum time needed to flash sterilize a

crile clamp in a gravity displacement sterilizer?a. 15 min c. 4 minb. 10 min d. 3 min

2. What does a chemical indicator measure?a. Removal of residual airb. Exposure to the sterilization processc. Sterilityd. Steam pressure

3. Which Blood biological indicator is used in a gravitydisplacement autoclave?a. Chemical indicatorb. Bowie-Dickc. Blue Lid rapid readoutd. Brown Lid rapid readout

4. What is the minimum time needed to sterilize aFrazier suction tip in a pre-vac sterilizer?a. 15 min c. 4 minb. 10 min d. 3 min

5. What is the number of minutes that a closed flash pansystem should be sterilized in a gravity displacementsterilizer?a. 3b. 5c. 8d. 10

6. Immediate – use sterilization was designed for _____.a. Quick room turnoverb. Instruments that were forgotten during openingc. Sterilizing power equipmentd. Instruments that were dropped during surgery

7. Bacteria form spores when:a. Steam is presentb. In humid climatesc. Unfavorable conditions arise for the bacteriad. Favorable conditions arise for the bacteria

8. Biological indicators are routinely run:a. In the morning c. In every loadb. Daily d. Once

9. What is the minimum temperature for flashsterilization?a. 250° F c. 272°Fb. 270° F d. 275° F

10. What is the purpose of running distilled water throughlumens before flash sterilization?a. To irrigate the cannulab. To pre-clean the lumenc. To allow for steam to heat the lumend. Hospital policy

When Unexpected Complications Arise During Surgery 1. Which ligaments hold the ovaries in place?

a. Suspensoryb. Broadc. Ovariand. All of the above

2. Which unexpected surgical instrument did the surgeonrequest to drain the uterus?a. Jackson-Pratt drainb. Thoracic trocarc. Gallbladder trocard. Red Robinson drain

3. ____attempts were made to close the vaginal cuff bysuture.a. 27b. 18c. 23d. 31

4. TAH is not indicated for which of the following?a. Uterine sarcomab. Ascitesc. Tubal malignancyd. Dysfunctional uterine bleeding

5. The round ligament terminates at the ______.a. Anterior cul-de-sacb. Vestibulec. Labia majorad. Fallopian-uterine attachment

6. Care was taken to avoid the ______ when the initialmidline incision was made.a. Falciform ligamentb. Xiphoid processc. Symphysis pubisd. Umbilicus

7. What size and type of suture was primarily used tocontrol bleeding?a. 1 Chromicb. 2-0 Chromicc. 0 Vicryld. 2-0 Vicryl

8. Estimated blood loss up to the first time the patientwas transported to the ICU:a. 16,000 cc c. 18,000 ccb. 17,000 cc d. 19,000 cc

9. The triangular space at the base of the bladder iscalled ______.a. Trikatesb. Trielconc. Trigoned. Trilabe

10. The uterine sac was incised with __________.a. Jorgenson scissorsb. Metzenbaum scissorsc. #10 KB on #3 KHd. Curved Mayo scissors

Blood Pressure 1. The kidneys help regulate blood pressure by:

a. Controlling sodium absorptionb. Providing negative feedbackc. Triggering baroreceptorsd. Providing positive feedback

2. Renin is produced…a. During a hypotensive episodeb. By the juxtaglomerular apparatus of the kidneysc. By the liverd. To decrease cardiac output

3. Secondary hypertension may occur with:a. Toxemia during pregnancyb. Vascular and kidney diseasesc. Diabetesd. All of the above

4. ____ is/are not a suspected cause of essentialhypertension.a. Sodium intakeb. Beta blockersc. Obesityd. Sedentary lifestyle

5. Diastolic pressure is measured during ___ ofKorotkoff’s sounds.a. Phase IIb. Phase IIIc. Phase IVd. Phase V

6. _____ hypertension cannot be attributed to anyspecific cause.a. Geneticb. Arterialc. Essentiald. Secondary

7. Systolic pressure is heard druing ___ of Korotkoff’ssounds.a. Phase I c. Phase IIIb. Phase II d. Phase IV

8. Following the release of ______, sodium reabsorption____ in the kidneys.a. Angiotensinogen; decreasesb. Aldosterone; increasesc. Angiotensin II; decreasesd. Epinephrine; increases

9. A patient who experiences orthostatic hypotension waslikely:a. Hunched overb. Standingc. Lying downd. Sitting with legs crossed

10. Angiotensin II causes:a. Decreased fluid reabsorptionb. Renin production in the liverc. Vasodilationd. Increased cardiac output

Safety Concepts in the Surgical Setting 1. When the patient is moving between two surfaces:

a. Three people should be available, one on each sideand one at the head

b. Four people should be available, two on each sidec. Two people should be available, one on each sided. Five people should be available, two on each side,

one at the head, one at the foot

2. Abduction of the upper extremities greater than 90degrees can lead to:a. Decreased blood flow c. Skin Breakdownb. Brachial plexus palsy d. Gangrene

3. The application of force greater than tissue resistancecan cause:a. Ischemia c. Gangreneb. Necrosis d. All of the above

4. Common pressure points are:a. Ear, nose, toeb. Elbow, pelvis, headc. Ear, nose, chind. Elbow, pelvis, back

5. The force created on skin by the movement ofunderlying tissues results ina. Decreased blood flowb. Hyperextensionc. Skin irritationd. Contact dermatitis

6. Thermal tissue injury can result from:

a. Shear forceb. Fiberoptic light sourcesc. Neurovascular compromised. Class 1 lasers

7. When using electrosurgery, what must be applied tothe patient to deliver the current back to theelectrosurgery unit?a. Active electrodeb. Patient return electrodec. Electrosurgical generatord. Electrical switch

8. How is a laser similar to an endoscope?a. Both emit lightb. Both are dependent on photon energyc. Both produce gamma raysd. Both rely on sound waves

9. A medicated patient is never left alone in order toprevent:a. Hyperextensionb. Dislodging of tubes and cathetersc. Fallsd. Cardiovascular complications

10. If a team member is exposed to an infrared laser, he orshea. Feels immediate painb. Loses eyesight immediatelyc. May hear a popping noised. Experiences photokeratitis

Necrotizing Fasciitis 1. Group A hemolytic streptococcus may cause:

a. Impetigob. Necrotizing fasciitisc. Strepd. All of the above

2. The effectiveness of streptococcus pyogenes can beattributed to:a. Colonizing and rapidly multiplyingb. Creating an abscessc. Developing fluid-filled blistersd. Secreting powerful exotoxins

3. Bacteroides often reside in thea. Liver c. Intestineb. Lungs d. Mouth

4. Which of the following is not normally inhabited bybacterium?a. Intestineb. Musclec. Mouthd. Nasopharynx

5. Which of the following carries the highest risk for thetransmission of NF?a. Diabetes c. Open skin woundb. Alcoholism d. Cancer

6. Which comorbid condition carries the greatest risk forthe patient to be infected by NF?a. Cancer c. Diabetesb. Alcoholism d. all of the above

7. Advanced symptoms of NF include:a. Blisters increase in sizeb. Drop in blood pressurec. Peeling or discolored skind. All of the above

8. Doctors and patients often fail to recognize NFbecause it:a. Resembles the flueb. NO apparent woundc. Body begins to decomposed. Discoloration of skin spreads

9. Methods of treatment utilize:a. Hyperbaric chambersb. Leechesc. NSAIDSd. Aspirin

10. Death from necrotizing fasciitis is correlated to:a. How early the diagnosis is madeb. How soon treatment beganc. Gas in the subcutaneous fascial planesd. a&b

Necrotizing Fasciitis – questions Continued

11. Which of the following microbiological stainingmethods can be used to determine whether a type I ortype II infection is present?a. Acid – FAST c. Simpleb. Gram d. Negative

12. Which of the following antibiotic is an alternative topenicillin G?a. methicillin. c. amoxicillin.b. benzathine. d. clindamycin.

13. A common region of the body in which group Ahemolytic streptococcus may be found is the.a. colon. c. skin.b. lungs. d. liver.

14. The gaseous toxin of streptococcus pyogenes isreleaseda. When cell death occurs due to invasion by

bacteriophages.b. From the bacterial cell wall.c. When antitoxins invade causing cellular lysis.d. When the cell binds to the plasma membrane of an

organ.

15. Which of the following antibiotics is ineffectiveagainst Peptostreptococcus?a. penicillin G c. metronidazoleb. chloramphenicol d. ampicillin

16. Routine X-rays are not considered a reliable methodfor diagnosing NF because thea. Contrast media are ineffective in aiding in the

diagnosis of NF.b. Detection of gas can be due to many other factors.c. Radiographs cannot adequately show the fascial

planes.d. Infection is superficial and will not appear on the

radiographs.

17. Mechanical debridement is not often used due toa. the removal of healthy tissueb. inadequate removal of dead tissue.c. contributing to the spread of the bacteria to healthy

tissue.d. time inefficiency allowing spread of the bacteria.

18. ____ of adult reported cases of NF report toxicshock and multi-organ failure.a. 12% c. 37%b. 25% d. 50%

19. Which of the following bacteria is increasinglycausing NF?a. Helicobacter pylorib. MRSAc. Escherichia colid. Pseudomonas aeruginosa

20. The number of reported cases of GAS disease in theU.S. is ____ the number of strep throat cases.a. equal tob. more thanc. less thand. variable as compared to

Treatment of War Casualties 1. Today, __ percent of GIs reaching a field hospital

survive the ordeal.a. 69.7b. 75.4c. 76.4d. 90.5

2. Uncontrollable hemorrhage accounts for almost __percent of combat fatalities.a. 30b. 40c. 50d. 60

3. This article compared the wounds experienced in___ and ___.

a. Germany and Vietnamb. Vietnam and Iraqc. Iraq and Germanyd. Japan and North Korea

4. The surgeon began his tour of duty in Vietnam witha __ orientation phase.a. 1 week c. 3 weekb. 2 week d. 1 month

5. Since cause of death is still exsanguination, surgeonssay ___ are still the single greatest life-saving devicein the Iraq conflict.a. Tourniquetsb. Stentsc. Montgomery strapsd. Stent dressing

6. The concept of the Forward Surgical Team wasdeveloped after the ____.a. American Revolutionary Warb. Civil Warc. Gulf Ward. World War II

7. Primary blast injuries which cause damage mainlyto gas-filled structures, such as eardrums, lungs and___.a. Arteriesb. Pancreasc. Kidneysd. Intestines

8. During the Vietnam War, the average length of timefrom initial treatment to transfer to the continentalUnited States was ___days.a. 45b. 46c. 47d. 48

9. Which tourniquet is not 100 percent effective inoccluding distal arterial Doppler sound in the armsand legs?a. Emergency & Military Tourniquetb. Combat Application Tourniquetc. Special Operations Force Tactical Tourniquetd. War Applications Tourniquet

10. Intravenous treatment begins with procoagulantsand whole blood, type ___, followed by fresh wholeblood with thawed plasma instead of crystalloids.a. AB+b. AB-c. O d. B+

Wrist Fusion: Fighting Back Against Rheumatoid Arthritis 1. Diagnosis of rheumatoid arthritis does not involve:

a. Reviewing family historyb. Examining joints for inflammation and deformityc. Blood testsd. Stress tests

2. A/an _____ utilizes a sterile needle and syringe todrain joint fluid.a. Arthrocentesisb. Arthroscopyc. Spinal tapd. Synovectomy

3. _____ develops during the early, acute inflammatorystage.a. Subluxation of the ulnab. Intrinsic contracturec. Fixed DRUJd. Bony compression

4. _____ bones are the long bones in the palm.a. Phalanges c. Carpalb. Trapezium d. Metacarpal

5. The proximal row does not include the:a. Scaphoid c. Trapezoidb. Lunate d. Pisiform

6. The ___ coordinates the movement of the distal andproximal rows.a. Radius c. Hamateb. Scaphoid d. Carpal

7. Carpal bones connect the _____ and ____ to thebones in the hand.a. Capitate and trapeziumb. Scaphoid and pisiformc. Radius and ulnad. Trapezoid and lunate

8. Second-line drugs include all but:a. Cortisone c. Gold saltsb. Methotrexate d. Adalimumab

9. If the ____ is not fused, a patient will have continuedrotation in the hand.a. Radius c. Ulnab. Hamate d. Lunatec.

10. Fusing wrist bones together may:a. Prevent deformityb. Eliminate painc. Improve alignmentd. All of the above

Wrist Fusion: Fighting Back Against Rheumatoid Arthritis – questions cont. 11. The intraoperative phase of a wrist fusion begins with

a:a. Dissection down the extensor retinaculumb. Opening of the radiocarpal jointc. Dorsal, longitudinal incision over Lister tubercled. Synovectomy

12. Types of NSAIDS are:a. Subluxation of the ulnab. Traditional NSAIDSc. Cox-2 selective inhibitorsd. All of the above

13. Prostaglandins do all but:a. Promote inflammationb. Facilitate the function of blood plateletsc. Protect the stomach liningd. Halt joint damage

14. Disease-modifying anti-rheumatic drugs areeffective ina. Rheumatoid arthritisb. Psoriatic arthritisc. Ankylosing spondylitisd. All of the above

15. _____ is a hormone produced in the adrenal gland.a. Calcitonin c. Cortisolb. Thyroxine d. GnRh

16. Steroids are used to alleviate:a. Lupusb. Rheumatoid arthritisc. Vasculitisd. All of the above

17. _____ stimulate or restore the ability of the immunesystem to fight disease or infection.a. Analgesicsb. Corticosteroidsc. BRMsd. Cox-2

18. _____ block the Cox enzymes and reduceprostaglandins.a. Steroids c. BRMsb. Analgesics d. NSAIDS

19. The distal ulnar resection was performed usinga/an:a. Oscillating saw c. Osteotomeb. Burr d. Bone cutting forceps

20. Which of the following is not a first-line drug?a. Methylprednisolone acetateb. Cortisonec. Hydroxycloroquined. Aspirin

Disasters Follow No Rules: Preparing Your Hospital for Disaster Response 1. What is the easiest way to designate a patient’s

status at a disaster scene?a. A simple spreadsheetb. Move patients to screening areasc. Triage tagsd. Mobile rescue units

2. The central focus of disaster triage is:a. Stabilize patient that cannot walkb. Find and tag patients that require immediate carec. Providing definitive cared. Stabilizing critically injured patients

3. ____ medical care improves the casualty’scondition.a. Expertb. Specializedc. Definitived. General

4. Casualty collection sites should not be located:a. On hospital propertyb. Downwind from hazardsc. Downhill from contaminated areasd. All of the above

5. “Decompressing” a disaster scene means:a. Evacuating patients who are consuming

resourcesb. Dismissing excess medical staffc. Expanding the search parameters for survivorsd. Frequently re-triaging patients

6. The ____ simplifies communication among disasterresponders:

a. Emergency Response Systemb. Incident Command Systemc. Emergency Response Networkd. Disaster Preparedness System

7. Using the START method, triage evaluation shouldtake:

a. 15 secondsb. 30 secondsc. One minuted. Up to two minutes

8. During disaster triage, if a patient does not startbreathing after simple airway maneuvers:

a. Immediately move patient to secondary carefacility

b. Tag as red/immediate and move onc. Tag as black/dead and move ond. Call for assistance

9. Which scenario has the greatest casualty potential?a. A terrorist attack on a major cityb. A natural disasterc. A nuclear power plant meltdownd. A pandemic disease outbreak

10. What was the greatest pandemic in US history?a. Spanish Flub. Avian (Bird) Fluc. West Nile Virusd. SARS

Disasters Follow No Rules: Preparing Your Hospital – questions cont. 11. What is a hospital’s first response to a disaster

scenario?a. Postpone all elective surgeriesb. Divert all EMS units not arriving from disaster

scenec. Place hospital under security lockdownd. All of the above

12. Surging in a place does not involvea. Rapidly discharge existing patientsb. Canceling scheduled elective proceduresc. Hiring more support personneld. Increasing the number of patient-care staff

13. A key reason for hospitals losing money is:a. Increasing cost of energyb. Underfunding of Medicare and Medicaidc. High costs of updating equipmentd. Personnel salaries

14. The National Implementation Plan does not include:a. Preparedness and communicationb. Initiating an emergency response alertc. Surveillance and detectiond. Response and containment

15. Natural disasters do not include:a. Hurricanesb. Mine cave-insc. Floodsd. Earthquakes

16. A Mass casualty event is defined as:a. An incident that produces a sufficient number

of casualties to disrupt normal functionsb. An event that affects more than one million

peoplec. An occurrence that is the result of terrorismd. And event that involves only facilities

17. The most important mission in a disaster responsescenario is:

a. Communicating the locationb. Alerting the national guardc. Triaged. Alerting evacuation teams

18. Disaster triage excludes:a. Providing the greatest good for the patientb. Response teams prioritizing the casualtiesc. Orderly treatmentd. Best use of equipment

19. ___ identifies a patient who will not survive withoutimmediate treatment.

a. Blackb. Redc. Yellowd. Green

20. Which triage color is used to identify “walkingwounded” patients?

a. Greenb. Yellowc. Whited. Orange

Disasters Follow No Rules: Preparing Your Hospital – questions cont. 21. ____ provides a common organizational structure

and language to simplify communication.a. START methodb. Incident Command Systemc. Emergency Medical Responsed. Decompressing

22. Small aircraft evacuation can be characterized by:a. Simple and generally availableb. More efficientc. High cost and complexityd. Removal of critical resources

23. More patients’ lives can be saved through:a. Temporizing damage-control surgeryb. Definitive surgeryc. Long-lasting surgical interventiond. Use of sophisticated technology

24. ICS is built around:a. Command/Operationsb. Planning/Logisticsc. Administration/Financiald. All of the above

25. ____ is when hospitals incorporate the ICS into theiremergency preparedness plans:

a. Triageb. HEICSc. Definitive medical cared. SARS

26. Definitive medical care is provided in:a. An existing hospitalb. Mobile facilityc. A and Bd. None of the above

27. ____ determines the organizational hierarchy of theICS:

a. Job titlesb. Seniorityc. Academic degreed. Functional requirements

28. ____ infected 2-0-40 percent of the world’spopulation

a. SARSb. Saranc. Spanish Flud. Bubonic Plague

29. The Spanish Flu caused death by:a. Bacterial pneumoniab. Massive hemorrhagesc. Edema in the lungsd. All of the above

30. A pandemic outbreak can result in:

a. Economic downturnb. Mass quarantinec. Overwhelmed medical communityd. All of the above

Pain Management for Patients with a Substance Abuse History 1. Health care workers should be cautious when

prescribing opioids to ___.a. Transplant recipientsb. Cardiac patientsc. Diabetic patientsd. Recovering addicts

2. One component of pain is_____.a. Physicalb. Pre-existingc. Pain scaled. Recovering addicts

3. The emotional components of pain include:a. Angerb. Sadnessc. Depressiond. All of the above

4. Acute pain in postoperative surgical patients is dueto:

a. Emotional distressb. Preexisting diseasec. Surgical procedured. A combination of B and C

5. _____leads to a rise in heart rate, increased oxygenconsumption and overall cardiac workload.

a. Opioid prescriptionb. Unrelieved painc. Arterial blockaged. Intoxication

6. ___ is a chronic, relapsing and treatable diseasecharacterized by lack of control over consumptionand compulsive use despite harmful consequences.

a. Addictionb. Diabetesc. Crohn’sd. Arthritis

7. The most important step in proper postoperativepain management is:

a. Administration of prescription drugsb. Maintaining the dopamine pathwayc. Proper preoperative assessmentd. Understanding and treating a patient’s

addiction

8. An example of a pain assessment tool is a:a. Numerical scaleb. Visual analog scalec. Picture scaled. All of the above

9. A patient’s altered level of consciousness in theacute postoperative phase of care due tointraoperative anesthetics makes it hard tosuccessfully administer:

a. An IV dripb. Oral analgesicsc. A pain assessmentd. All of the above

10. Physical indications of pain in the acutepostoperative setting include;

a. Sweatingb. Elevated heart ratec. Trouble moving/taking deep breathsd. All of the above

Pain Management for Patient’s with a Substance Abuse History – questions cont.11. One way to help ensure postoperative pain

management for a patient with a history of opioidaddiction is:a. Obtain a preoperative substance abuse historyb. Consult an addictionologistc. Administer frequent pain scale testsd. Begin a preoperative pain management regimen

12. Which of the following is not an alternative paintreatment?

a. Electric shock therapyb. Local and regional anesthesiac. Epidural blocksd. Local pain pumps

13. Postoperative fears for opioid-dependent patientsmay include:

a. Being judged by the care giverb. Suffering a relapse into drug usec. Not receiving enough pain medicationd. All of the above

14. Blocking the action of cyclooxygenase andinhibiting prostaglandin production can beaccomplished with:

a. Steroid treatmentb. A Clonodine patchc. NSAID therapyd. All of the above

15. ___ is a synthetic narcotic used to treat opioidaddiction.

a. Heroinb. Clonidinec. Methadoned. Prednisone

16. Methadone is used in the treatment of addiction to:a. Opiatesb. Alcoholc. Methamphetaminesd. All of the above

17. Side effects of Methadone use include:a. Impairs cognitive functionsb. Debilitating drowsinessc. Liver damaged. Methadone has no serious side effects

18. Opiates provide a flood of ___, which causes theeuphoric high associated with drug use.

a. Epinephrineb. Dopaminec. Endorphinsd. Morphine

19. The preoperative assessment for a substanceabuser should include:

a. The patient’s drug historyb. The patient’s recovery historyc. A full physicald. All of the above

20. Patients who take opiates in large doses have ahigher ___.

a. Pain thresholdb. Drug-seeking behaviorc. Toleranced. B & C

Gangrene: Recognizing and Treating Cellular Necrosis 1. Which is not the one of the three most common

variations of gangrene?a. Gasb. Dryc. Internald. Wet

2. Fournier’s gangrene affects the ____.a. Fingersb. Genitalsc. Feetd. Hands

3. The best treatment for gangrene is ___.a. Revascularizationb. Amputationc. Maggot debridement therapyd. Antibiotic therapy

4. Gangrene occurs when a body part ___.a. Becomes infectedb. Loses its blood supplyc. Is diseasedd. Loses feeling

5. What disease often contributes to the occurrenceof dry gangrene?

a. HIVb. High cholesterolc. Smokingd. Arteriosclerosis

6. Symptoms of gangrene include ___.a. Swelling of the affected areab. Discoloration of affected tissuec. Decreased heart rated. All of the above

7. ___ can occur if a bacterial infection fromgangrene spreads throughout the body.

a. Septic shockb. Necrosisc. Ischemiad. Decompression

8. The tissue becoming dry, shrunken and blackeneddescribes ___ gangrene.

a. Wetb. Gasc. Dryd. Internal

9. Which of the following are symptomatic of wetgangrene?

a. Swellingb. Blisteringc. Pungent odord. All of the above

10. Burns, frostbite and wound infections can resultin ___ gangrene.

a. Wetb. Gasc. Dryd. Internal

Gangrene : Recognizing and Treating Cellular Necrosis - questions cont. 11. Gas gangrene should ___ be treated as a

medical emergency.a. Alwaysb. Sometimesc. Neverd. Depends on the patient

12. A hernia, or a twist in the gastro-intestinaltract can result in ___ gangrene

a. Wetb. Gasc. Dryd. Internal

13. X-ray technology can be helpful in diagnosing___ gangrene.

a. Wetb. Gasc. Dryd. Internal

14. Sweating, difficulty breathing and convulsionscan be signs of ___.

a. Bacterial infectionb. Oxygen toxicityc. Fournier’s gangrened. Bacteriostasis

15. The primary function(s) of MDT is/are:a. Clean the woundb. Disinfect the woundc. Speed the rate of healingd. All of above

16. ___ larvae are the preferred species for MDT.a. Horse flyb. Greenbottle flyc. Fruit flyd. All of the above

17. Medical maggots are generally left in thewound for ___ days.

a. 1-2b. 2-3c. 304d. 4 -5

18. The risks associated with MDT include:a. There are no inherent risksb. Larvae attacking living tissuesc. Larvae burrowing into the wound and

breedingd. b and c

19. It has been reported, though unproven inclinical studies, that maggots can:

a. Improve blood clotting abilityb. Stimulate the production of granulation

tissuec. Remove bacteria from the bloodd. All of the above

20. Medical grade maggots are:a. Sterileb. Safec. A legitimate treatment optiond. All of above

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Repeat Cesarean Section a b c d a b c d

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Off- pump Coronary Artery Bypass Grafting a b c d a b c d Mark one box next to each

number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � �2. � � � � 8. � � � �3. � � � � 9. � � � �4. � � � � 10. � � � �5. � � � �6. � � � �

Sterilization – Killing Prehistoric Beast a b c d a b c d Mark one box next to each

number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � �2. � � � � 8. � � � �3. � � � � 9. � � � �4. � � � � 10. � � � �5. � � � �6. � � � �

When Unexpected Complications Arise During Surgery a b c d a b c d Mark one box next to each

number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 2. � � � � 8. � � � � 3. � � � � 9. � � � � 4. � � � � 10. � � � � 5. � � � � 6. � � � �

Blood Pressure a b c d a b c d Mark one box next to each

number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 2. � � � � 8. � � � � 3. � � � � 9. � � � � 4. � � � � 10. � � � � 5. � � � � 6. � � � �

Safety Concepts in the Surgical Setting a b c d a b c d Mark one box next

to each number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 2. � � � � 8. � � � � 3. � � � � 9. � � � � 4. � � � � 10. � � � � 5. � � � � 6. � � � �

Necrotizing Fasciitis a b c d a b c d a b c d a b c d Mark one box next

to each number. Only one correct or best answer will be selected for each question.

1. � � � � 7.� � � � 13. � � � � 19. � � � � 2. � � � � 8. � � � � 14. � � � � 20. � � � � 3. � � � � 9. � � � � 15. � � � � 4. � � � � 10. � � � � 16. � � � � 5. � � � � 11. � � � � 17. � � � � 6. � � � � 12. � � � � 18. � � � �

Treatment of War Casualties a b c d a b c d Mark one box next to each

number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 2. � � � � 8. � � � � 3. � � � � 9. � � � � 4. � � � � 10. � � � � 5. � � � � 6. � � � �

Wrist Fusion: Fighting Back Against Rheumatoid Arthritis a b c d a b c d a b c d a b c d Mark one box next

to each number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 13. � � � � 19. � � � � 2. � � � � 8. � � � � 14. � � � � 20. � � � � 3. � � � � 9. � � � � 15. � � � � 4. � � � � 10. � � � � 16. � � � � 5. � � � � 11. � � � � 17. � � � � 6. � � � � 12. � � � � 18. � � � �

Disasters Follow No Rules: Preparing Your Hospital For Disaster Response a b c d a b c d a b c d a b c d a b c d Mark one box

next to each number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 13. � � � � 19. � � � � 25. � � � � 2. � � � � 8. � � � � 14. � � � � 20. � � � � 26. � � � � 3. � � � � 9. � � � � 15. � � � � 21. � � � � 27. � � � � 4. � � � � 10. � � � � 16. � � � � 22. � � � � 28. � � � � 5. � � � � 11. � � � � 17. � � � � 23. � � � � 29. � � � � 6. � � � � 12. � � � � 18. � � � � 24. � � � � 30. � � � �

Pain Management for Patients with a Substance Abuse History a b c d a b c d a b c d a b c d Mark one box next

to each number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 13. � � � � 19. � � � � 2. � � � � 8. � � � � 14. � � � � 20. � � � � 3. � � � � 9. � � � � 15. � � � � 4. � � � � 10. � � � � 16. � � � � 5. � � � � 11. � � � � 17. � � � � 6. � � � � 12. � � � � 18. � � � �

Gangrene: Recognizing and Treating Cellular Necrosis a b c d a b c d a b c d a b c d Mark one box next

to each number. Only one correct or best answer will be selected for each question.

1. � � � � 7. � � � � 13. � � � � 19. � � � � 2. � � � � 8. � � � � 14. � � � � 20. � � � � 3. � � � � 9. � � � � 15. � � � � 4. � � � � 10. � � � � 16. � � � � 5. � � � � 11. � � � � 17. � � � � 6. � � � � 12. � � � � 18. � � � �