Bailey and Love MCQs: Metabolic response to injury (Chapter 1)

Surgery MCQs with Answers
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Bailey and Love MCQs: Chapter 1

Metabolic response to injury

QuestionAnswer and Explanation
1. As a part of physiologic response to injury, all about growth hormone are true except:

A. It has direct lipolytic effect 
B. It has insulin-antagonising effect
C. It has proinflammatory properties
D. It has anti inflammatory properties
Answer: D
GH has direct lipolytic, insulin-antagonising and proinflammatory properties
2. All are true about hormone levels in response to stress except:

A. Increased Catecholamines
B. Increased Glucagon
C. Increased ACTH
D. Increased Insulin-like growth factor-1 (IGF-1) 
Answer: D
Stress response: Corticotrophin releasing factor (CRF) released from the hypothalamus increasesadrenocorticotrophic hormone (ACTH) release from the anterior pituitary. ACTH then acts on the adrenal to increase thesecretion of cortisol. Hypothalamic activation of the sympathetic nervous system causes release of adrenalin and also stimulates release of glucagon. There are, however, many other players,including alterations in insulin release and sensitivity, hypersecretion of prolactin and growth hormone (GH) in the presence of low circulatory insulin-like growth factor-1 (IGF-1) and inactivation of peripheral thyroid hormones and gonadal function. Other hormones that decrease are Insulin, Testosterone and T3.
3. Proinflammatory cytokines involved in surgical stress response causing pyrexia by acting on hypothalamus include all except:

A. Interleukin-1 (IL-1)
B. Tumour necrosis factor alpha (TNFα)
C. IL-3 
D. IL-6
Answer: C
Proinflammatory cytokines including interleukin-1 (IL-1), tumour necrosis factor alpha (TNFα), IL-6 and IL-8are produced within the first 24 hours and act directly on thehypothalamus to cause pyrexia.
4. Metabolic stress response to surgery  and trauma includes all except:

A. Immobility
B. Anabolism
C. Catabolism
D. Anorexia
Answer: C
Physiological response to injury includes:
■ Immobility/rest
■ Anorexia
■ Catabolism
5. The ebb phase begins at the time of injury and lasts for approximately 

A. <24 hours
B. 24-48 hours
C. 48-72 hours
D. 72-96 hours
Answer: B
The ebb phase begins at the time of injury and lasts for approximately 24–48 hours.
6. The ebb phase is characterised by all except:

A. Hypovolaemia
B. Hypothermia
C. Reduced cardiac output
D. Lactic acidosis. 
E. Increased basal metabolic rate
Answer: E
The ebb phase is characterised by hypovolaemia, decreased basal metabolic rate, reduced cardiac output, hypothermia and lacticacidosis. The main physiological role of the ebb phase is to conserve both circulating volume and energy stores for recovery and repair
7. The majority of trauma patients demonstrate energy expenditures approximately 

A. 5-15 per cent above predicted healthy resting values
B. 15–25 per cent above predicted healthy resting values
C. 25-35 per cent above predicted healthy resting values
D. 35-45 per cent above predicted healthy resting values
Answer: B
The majority of trauma patients (except possibly those withextensive burns) demonstrate energy expenditures approximately 15–25 per cent above predicted healthy resting values.  
8. What is the obligate requirement of glucose during starvation to sustain cerebral energy metabolism?

A. 50g
B. 100g
C. 150g
D. 200g
Answer: B
During starvation, the body is faced with an obligate need to generate glucose to sustain cerebral energy metabolism (100 g of glucose per day)
9. Modern guidelines on fasting prior to anaesthesia allow intake of clear fluids up to

A. 8hrs before surgery
B. 6hrs before surgery
C. 4hrs before surgery
D. 2hrs before surgery
Answer: D
Modern guidelines on fasting prior to anaesthesia allow intake of clearfluids up to 2 hours before surgery. 
10. Following play role in reducing the surgical stress response except:

A. Minimal access techniques
B. Epidural analgesia
C. Minimal periods of starvation
D. Immobilization
Answer: D
A proactive approach to prevent unnecessary aspects of the surgical stress response
■ Minimal access techniques
■ Blockade of afferent painful stimuli (e.g. epidural analgesia)
■ Minimal periods of starvation
■ Early mobilisation
Bailey and Love MCQs Chapter 1

Bailey and Love MCQs

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