In contrast to adult wound healing with scar formation, which of the following are characteristic of scarless fetal skin repair? A. Matrix rich in hyaluronic acid. B. Increased inflammatory response. C. Increased production of TGF-b. D. No collagen deposition. E. Minimal angiogenesis.

In contrast to adult wound healing with scar formation, which of the following are characteristic of scarless fetal skin repair? A.  Matrix rich in hyaluronic acid. B.  Increased inflammatory response. C.  Increased production of TGF-b. D.  No collagen deposition. E.  Minimal angiogenesis.
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Answer: AE  DISCUSSION: The ability of a fetus to heal without scar formation depends on its gestational age at the time of injury and the size of the wound defect. In general, linear incisions heal without scar until late in gestation, whereas excisional wounds heal with scar at an earlier gestational age. The profiles of fetal proteoglycans, collagens, and growth factors are different from those in adult wounds. The less differentiated state of fetal skin is probably an important characteristic responsible for scarless repair. There is minimal inflammation and angiogenesis in fetal wounds. Fetal wounds are characterized by high levels of hyaluronic acid and its stimulator(s) with more rapid, highly organized collagen deposition. The roles of peptide growth factors such as TGF-b and basic fibroblast growth factor are less prominent in fetal than in adult wound healing. An understanding of scarless tissue repair has possible clinical applications in the modulation of adult fibrotic diseases and abnormal scar-forming conditions
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Description : The neurohormonal arm of the stress response is well defined. Less is known about the inflammatory arm mediated primarily by cytokines. Which of the following statement(s) is/are true ... Cytokine release may stimulate the release of other cytokines leading to an important cascade of events

Last Answer : Answer: a, d Cytokines, which are produced at the site of injury by endothelial cells and by diverse immune cells throughout the body, also occupy a pivotal position in the stress response ... act as hormones and spill over into the systemic circulation and become detectable in the bloodstream

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Description : Which of the following interfere with normal collagen formation or cross-linking? A. Beta-aminopropionitrile. B. Iron chelators. C. Vitamin C depletion. D. Proline analogs (e.g., cis-hydroxyproline). E. D-Penicillamine.

Last Answer : Answer: ABCDE DISCUSSION: Intramolecular and intermolecular cross-links are crucial for collagen structural stability. Formation of cross-links can be inhibited by two ... concentration, proline analogs prevent collagen formation with minimal effects on noncollagenase protein synthesis

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Description : A 55-year-old male undergoes a total abdominal colectomy. Which of the following statement(s) is/are true concerning the hormonal response to the surgical procedure? a. Adrenocorticotropic ... in serum insulin and a fall in glucagon accelerate hepatic glucose production and maintain gluconeogenesis

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Description : There are a multitude of various dressings available. Which of the following statement(s) is/are true concerning options for surgical dressings? a. Hydrocolloids, such as karaya compounds, offer ... are highly useful in debriding necrotic and fibrous material from wounds and absorbing wound serum

Last Answer : Answer: a, d Although the simplest dressing of gauze and tape combined with the use of antibacterial ointment can achieve moist wound healing in most patients. A multitude of other ... agents have high absorbency for tissue wound fluid and debride necrotic and fibrous material from the wound

A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ failure. Which of the following statement(s) is/are true concerning necessary changes to be made in his nutritional management? a. Carbohydrate load should be reduced in the face of respiratory failure b. In patients with renal failure, protein intake should be diminished c. During hemodialysis protein intake should be limited to the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Description : A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ ... the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Last Answer : Answer: a, b The most severe complication of sepsis is multiple system organ dysfunction syndrome, which may result in death. The development of organ failure requires changes in the ... should be provided as fat emulsion. If encephalopathy develops, protein load should also be reduced0

Cytokines are endogenous signals that stimulate: A. Local cell proliferation within the wound. B. The central nervous system to initiate fever. C. The production of “acute-phase proteins.” D. Hypoferremia. E. Septic shock.

Description : Cytokines are endogenous signals that stimulate: A. Local cell proliferation within the wound. B. The central nervous system to initiate fever. C. The production of “acute-phase proteins.” D. Hypoferremia. E. Septic shock.

Last Answer : Answer:ABCD DISCUSSION: Although cytokines exert primarily autocrine and paracrine effects, they may also cause systemic effects

Which of the following statements about respiratory acidosis are true? A. Compensation occurs by a shift of chloride out of the red blood cells. B. Renal compensation occurs rapidly. C. Retention of bicarbonate and increased ammonia formation are normal compensatory mechanisms. D. Narcotic administration is an unusual cause of respiratory acidosis. E. The ratio of bicarbonate to carbonic acid is less than 20:1.

Description : Which of the following statements about respiratory acidosis are true? A. Compensation occurs by a shift of chloride out of the red blood cells. B. Renal compensation occurs rapidly. C. Retention of ... of respiratory acidosis. E. The ratio of bicarbonate to carbonic acid is less than 20:1.

Last Answer : Answer: CE DISCUSSION: Renal compensation for acute hypoventilation is relatively slow. Depression of the respiratory center by morphine can lead to respiratory acidosis. Renal retention of bicarbonate, ... into red cells combine to increase the ratio of bicarbonate to carbonic acid to 20:1

A long-term effect of which of the following procedures post acute MI induces angioneogenesis? a) Transmyocardial laser revascularization TNR procedures usually involves making 20 to 40 channels in ventricular muscle. It is thought that some blood flows into the channels, decreasing the ischemia directly. Within the next few days to months, the channels close as a result of the body’s inflammatory process of healing a wound and new blood vessels form as a result of the inflammatory process.

Description : A long-term effect of which of the following procedures post acute MI induces angioneogenesis? a) Transmyocardial laser revascularization TNR procedures usually involves making 20 to 40 channels in ventricular muscle. ... e.g., clopidigrel [Plavix]) therapy for 2 weeks and lifetime use of aspirin).

Last Answer : a) Transmyocardial laser revascularization TNR procedures usually involves making 20 to 40 channels in ventricular muscle. It is thought that some blood flows into the channels, decreasing the ischemia directly. ... healing a wound and new blood vessels form as a result of the inflammatory process.

The main feature of a healing wound is: C A. Lymphocyte accumulation B. Fibrin deposition C. Granulation tissue D. None of these

Description : The main feature of a healing wound is: C A. Lymphocyte accumulation B. Fibrin deposition C. Granulation tissue D. None of these

Last Answer : Granulation tissue

Which of the following statements concerning perioperative nutrition is true concerning the above-described patient? a. Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition b. Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens c. Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements d. A jejunal feeding catheter should be placed at the time of surgery for postoperative enteral feeding

Description : Which of the following statements concerning perioperative nutrition is true concerning the above-described patient? a. Since the patient's weight had been stable with no preoperative nutritional deficit ... feeding catheter should be placed at the time of surgery for postoperative enteral feeding

Last Answer : Answer: a Most patients undergoing elective operations are adequately nourished. Unless the patient has suffered significant preoperative malnutrition, characterized by weight loss greater than ... gastrointestinal surgery, this technique would not appear indicated in the patient described above

Leukocyte activation and adhesion to vascular endothelial cells is a critical step in the inflammatory process. This process is regulated by which of the following molecules? a. The selectins b. The b5 integrins c. The immunoglobulin supergene family d. Nitric oxide e. IL-8

Description : Leukocyte activation and adhesion to vascular endothelial cells is a critical step in the inflammatory process. This process is regulated by which of the following molecules? a. The selectins b. The b5 integrins c. The immunoglobulin supergene family d. Nitric oxide e. IL-8

Last Answer : Answer: a, c, d, e The temporal events that initiate and propagate neutrophil recruitment and inflammation include endothelial cell activation and expression of endothelial-derived ... role in neutrophil recruitment and activation, and the continued propagation of the inflammatory response

Factors that decrease collagen synthesis include all of the following except: A. Protein depletion. B. Infection. C. Anemia. D. Advanced age. E. Hypoxia.

Description : Factors that decrease collagen synthesis include all of the following except: A. Protein depletion. B. Infection. C. Anemia. D. Advanced age. E. Hypoxia.

Last Answer : Answer: C DISCUSSION: Collagen synthesis, an integral part of wound healing, is affected by many local and systemic factors. Protein depletion impairs fibroplasia. Hypoproteinemia leads to diminution of ... more than any other factor, wound infection is associated with the risk of wound failure

Interleukin-6 is recognized as the cytokine primarily responsible for the alteration in hepatic protein synthesis recognized as the acute phase response. Which of the following statement(s) is/are true concerning acute phase protein response to surgical stress? a. Glucocorticoid hormones inhibit this response b. Proteins such as albumin and transferrin which serve in serum transport are generally increased in this response c. Examples of acute phase proteins include fibrinogen and C-reactive protein d. In general, the physiologic role of acute phase proteins are to reduce the systemic effects of tissue damage

Description : Interleukin-6 is recognized as the cytokine primarily responsible for the alteration in hepatic protein synthesis recognized as the acute phase response. Which of the following statement(s) is/are true ... physiologic role of acute phase proteins are to reduce the systemic effects of tissue damage

Last Answer : Answer: c, d IL-6 is now recognized at the cytokine primarily responsible for the alteration in hepatic synthesis recognized as the acute phase response. Glucocorticoid hormones augment ... that generally inhibit the tissue destruction that is associated with the local initiation of inflammation

Sepsis causes a marked metabolic response. Which of the following statement(s) is/are true concerning the metabolic response to sepsis? a. Oxygen consumption is increased in the face of infection b. In a patient with a maximal metabolic rate secondary to trauma, the presence of infection will increase the rate further c. Metabolic rate increases at a rate of approximately 10% for each increase of 1°C in central temperature d. The extent of increase in oxygen consumption relates to the severity of the infection

Description : Sepsis causes a marked metabolic response. Which of the following statement(s) is/are true concerning the metabolic response to sepsis? a. Oxygen consumption is increased in the face of infection ... d. The extent of increase in oxygen consumption relates to the severity of the infection

Last Answer : Answer: a, c, d Oxygen consumption is usually elevated in the infected patient. The extent of this increase is related to the severity of the infection, with peak elevations reaching 50% ... suggest that the metabolic rate increases 10% to 13% for each elevation of 1°C in central temperature

Although TPN has major beneficial effects to the patient and specific organ systems, TPN has a downside which is related to intestinal disuse. Which of the following statement(s) is/are true concerning the effects of TPN on the GI tract? a. Patients receiving TPN have an accentuated systemic response to endotoxin challenge compared to enterally fed volunteers b. TPN can result in disruption of intestinal microflora c. In experimental models, bacterial translocation from the gut is increased d. Effects of TPN on the gut may lead to multiple organ failure

Description : Although TPN has major beneficial effects to the patient and specific organ systems, TPN has a downside which is related to intestinal disuse. Which of the following statement(s) is/are true concerning the ... from the gut is increased d. Effects of TPN on the gut may lead to multiple organ failure

Last Answer : Answer: a, b, c, d A number of studies have examined the effects of TPN on intestinal function and immunity. Although most of these studies have been done in animal models, ... the release of bacteria and/or cytokines leading to pronounced systemic responses and possibly multiple organ failure