Which of the following tissues contain significant collagen useful for placing sutures to allow the prolonged tension necessary to maintain tissue approximation? a. Dermis b. Intestinal submucosa c. Muscular fascia d. Blood vessel wall

Which of the following tissues contain significant collagen useful for placing sutures to allow the prolonged tension necessary to maintain tissue approximation? a. Dermis b. Intestinal submucosa c. Muscular fascia d. Blood vessel wall
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Answer: a, b, c, d  It takes at least three weeks for collagen to undergo sufficient remodeling and cross linking to attain moderate strength. Since most skin sutures are removed at one to two weeks, the wound has only a small fraction of its eventual strength and may therefore disrupt with even modest stress. Therefore, deep sutures are placed in collagen containing structures to maintain the prolonged tension necessary. Dermis, intestinal submucosa, muscular fascia, tendon, ligament, Scarpa’s fascia, and blood vessel wall represent a partial list of tissues with high collagen content
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There are two properties of the cell necessary to maintain nonequilibrium cellular composition; the first is selectivity and the second is energy conversion. Which of the following statement(s) is/are true concerning energy converting transport? a. The site of energy conversion and transport in the plasma membrane involves the phospholipid component b. The Na+-K++-ATPase derives energy from hydrolysis of extracellular ATP c. In some systems, energy inherent in the transmembrane ion gradient can be used to drive transport of a second species d. Examples of species transported via secondary active transport include hydrogen ions, calcium, amino acids and glucose

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Which of the following statement(s) is/are true concerning the role of antibiotics in wound care? a. Systemic antibiotics are indicated for all open wounds b. Bacterial resistance can occur with systemic but not topical antibiotics c. An indication for systemic antibiotic administration is a granulation tissue bacterial count in excess of greater than 105 organisms/gram of tissue on quantitative analysis d. Silver sulfadiazine is useful only for the management of burns

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Which of the following statement(s) is/are correct concerning the management of an open wound? a. Frequent surgical debridement is usually necessary b. Water irrigation can effectively debride most wounds c. Hydrogen peroxide is particularly useful in the management of open wounds d. A number of the newer dressing products have clearly been shown to promote wound healing compared to simple moist occlusive dressing

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Which of the following statements regarding fibroblasts and their function in wound healing are true? a. IL-1 has both inhibitory and promotional effects on fibroblast growth b. TNFa stimulates fibroblast collagen synthesis c. IL-1 and TNFa have opposite effects on the healing of bone d. In human clinical trials, EGF (epithelial growth factor) has been demonstrated to accelerate epidermal regeneration in cutaneous wounds

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Last Answer : Answer: a, b, d TGF-b appears to be one of the key cytokines in control of tissue repair. TGF-b is strongly chemotactic for neutrophils, T cells, monocytes, and fibroblasts. ... TGF-b stimulates the proliferation of densely plated human marrow fibroblasts, but is inhibitory at high concentrations

Which of the following statement(s) is/are true concerning pharmacologic agents used to accelerate wound healing? a. A number of these agents are now currently approved for use in this country b. PDGF (platelet-derived growth factor) promotes fibroblast proliferation, chemotaxis, and collagenase synthesis c. PDGF has been demonstrated in a number of clinical trials to promote healing in chronic wounds d. Growth hormone functions by promoting fibroblast proliferation and collagen synthesis

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Which of the following statement(s) is/are true concerning the remodeling phase of wound healing? a. Total collagen content increases steadily through this phase b. The normal adult ratio of collagen is approximately 4:1 of type I to type III collagen. c. Eventually a scar will achieve the strength of unwounded skin d. The proteoglycans are responsible for the ground substance of the extracellular matrix

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Last Answer : Answer: b, d The transition from the proliferative phase to the remodeling phase of wound healing is defined by reaching collagen equilibrium. Collagen accumulation within the wound becomes maximal by ... in strength for six months or more, eventually reaching 70% of the strength of unwounded skin

Which of the following statement(s) is/are true concerning the proliferative phase of wound healing? a. The macrophage is the predominant cell type b. The pink or purple-red appearance of a wound is due to ingrowth and proliferation of endothelial cells c. Collagen, the dominant structural molecule of the wound matrix, contains two unique amino acids, hydroxyproline and hydroxylysine d. The predominant collagen type in a scar is type 3

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Last Answer : Answer: b, c The proliferative phase of wound healing begins with the formation of a provisional matrix of fibrin and fibronectin as part of the initial clot formation. Initially, the provisional ... The principal collagen type scar is type 1, with lesser amounts of type 3 collagen also present

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.

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Which of the following is an adhesion glycoprotein? A. Fibronectin. B. Tenascin. C. Laminin. D. Hyaluronic acid. E. Collagen type IV.

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

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During which stage of pressure ulcer development does the ulcer extend into the subcutaneous tissue? a) Stage III Clinically, a deep crater with or without undermining of adjacent tissues is noted. b) Stage IV A stage IV pressure ulcer extends into the underlying structure, including the muscle and possibly the bone. c) Stage II A stage II ulcer exhibits a break in the skin through the epidermis or dermis. d) Stage I A stage I pressure ulcer is an area of nonblanchable erythema, tissue swelling, and congestion, and the patient complains of discomfort.

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A 55-year-old renal transplant patient has been hospitalized in a Surgical Intensive Care Unit, receiving a prolonged course of antibiotics following an attack of acute cholecystitis. The following statement(s) is/are true concerning his management. a. Due to the potential risk of Candida infection, prophylaxis with oral nystatin should be instituted early in the patient’s course b. A Candida urinary tract infection should be treated with systemic amphotericin B c. Changes of Candida retinitis are of little significance d. The presence of a virulent Candida bacteremia should suggest a dosage reduction in immunosuppressive agents until the infection can be adequately controlled

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Von Willebrand’s disease is a common, congenital bleeding disorder. Which of the following statement(s) is/are true concerning Von Willebrand’s disease? a. As in hemophilia, it is much more common in men b. A history of spontaneous bleeding is common c. Screening laboratory tests will include a prolonged aPTT with a normal prothrombin time d. Pre-treatment for elective surgery require administration of cryoprecipitate to achieve levels of 23–50% of normal

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Which of the following statements are true of the multiple organ dysfunction syndrome (MODS)? A. The “two-hit” model proposes that secondary MODS may be produced when even a relatively minor second insult reactivates, in a more amplified form, the systemic inflammatory response that was primed by an initial insult to the host. B. The systemic inflammatory response syndrome (SIRS), shock due to sepsis or SIRS, and MODS may be regarded as a continuum of illness severity. C. Prolonged stimulation or activation of Kupffer cells in the liver is thought to be a critical factor in the sustained, uncontrolled release of inflammatory mediators. D. The incidence of MODS in intensive care units has decreased owing to increased awareness, prevention, and treatment of the syndrome.

Description : Which of the following statements are true of the multiple organ dysfunction syndrome (MODS)? A. The two-hit model proposes that secondary MODS may be produced when even a relatively ... intensive care units has decreased owing to increased awareness, prevention, and treatment of the syndrome.

Last Answer : Answer: ABC DISCUSSION: MODS is part of a clinical continuum that begins with the systemic inflammatory response syndrome, which is the host's stress response to any major insult such ... pathogenesis of MODS, the incidence of MODS continues to increase without a significant improvement in outcome

Which of the following statement(s) is/are true concerning the physiology of the microvascular system? a. Filtration of capillary fluid into the interstitial and the subsequent reabsorption is influenced by Starling’s law of ultrafiltration b. The most important variable controlling blood to a capillary bed is the length of the vessel c. Most of the resistance to systemic blood flow occurs at the arteriolar level d. Adrenergic vasoconstriction can arrest blood flow to an entire capillary bed

Description : Which of the following statement(s) is/are true concerning the physiology of the microvascular system? a. Filtration of capillary fluid into the interstitial and the subsequent reabsorption is ... the arteriolar level d. Adrenergic vasoconstriction can arrest blood flow to an entire capillary bed

Last Answer : Answer: a, c, d Exchange of material between the vascular space and the cell of various tissues via the interstitial space is essential for organ viability and occurs at the ... contractions are potent enough that blood flow to entire capillary beds can be arrested by adrenergic vasoconstriction

Which of the following statement(s) is/are true concerning carbon dioxide kinetics? a. The amount of carbon dioxide produced is equivalent to the amount of oxygen consumed b. Carbon dioxide levels in blood, present mostly as a bicarbonate ion, can quickly change c. Normally the amount of carbon dioxide excreted through the lung is exactly equal to the amount of carbon dioxide produced in peripheral tissues d. The amount of carbon dioxide excreted is a function of ventilation of perfused alveoli

Description : Which of the following statement(s) is/are true concerning carbon dioxide kinetics? a. The amount of carbon dioxide produced is equivalent to the amount of oxygen consumed b. Carbon dioxide levels ... tissues d. The amount of carbon dioxide excreted is a function of ventilation of perfused alveoli

Last Answer : Answer: a, c, d The total amount of carbon dioxide produced by systemic metabolism is roughly equivalent to the amount of oxygen consumed (100-120 cc/m2/min, 200 cc/min in a typical ... carbon dioxide excreted is a function of ventilation of perfused alveoli (i.e. the alveolar ventilation/min).

Which of the following statement(s) is/are true concerning oxygen delivery? a. The amount of oxygen delivered to peripheral tissues is dependent upon the oxygen content in arterial blood and cardiac output b. Oxygen content is commonly measured in arterial blood c. The normal arterial-venous difference is 4 cc O2/dL d. Normal systemic oxygen delivery for a typical adult is approximately 1000 cc/min

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Last Answer : Answer: a, c, d The amount of oxygen that is delivered to peripheral tissues is the product of the oxygen content in arterial blood times the cardiac output. Normally, oxygen content of arterial blood is ... of venous blood is 16 cc/dL. Hence, the normal arterial-venous difference is 4 cc O2/dL

All of the following statements about hemorrhagic shock are true except: A. Following hemorrhagic shock, there is an initial interstitial fluid volume contraction. B. Dopamine, or a similar inotropic agent, should be given immediately for resuscitation from hemorrhagic shock, to increase cardiac output and improve oxygen delivery to hypoperfused tissues. C. The use of colloid solutions or hypertonic saline solutions is contraindicated for treatment of hemorrhagic shock. D. In hemorrhagic shock, a narrowed pulse pressure is commonly seen before a fall in systolic blood pressure.

Description : All of the following statements about hemorrhagic shock are true except: A. Following hemorrhagic shock, there is an initial interstitial fluid volume contraction. B. Dopamine, or a similar inotropic ... shock, a narrowed pulse pressure is commonly seen before a fall in systolic blood pressure.

Last Answer : Answer: BC DISCUSSION: Hemorrhagic shock is associated with a contraction of the interstitial fluid compartment because of precapillary vasoconstriction and reabsorption of interstitial fluid ... definitive evidence that such solutions are better than standard crystalloid solutions is lacking

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues? a) Scleroderma Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death.

Description : Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues? a) Scleroderma Scleroderma occurs initially in the ... In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

Last Answer : a) Scleroderma Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death.

Determinants of cerebral blood flow include: A. Preoperative neurologic dysfunction. B. Arterial CO 2 tension. C. Arterial O 2 tension. D. Systemic arterial pressure. E. All of the above.

Description : Determinants of cerebral blood flow include: A. Preoperative neurologic dysfunction. B. Arterial CO 2 tension. C. Arterial O 2 tension. D. Systemic arterial pressure. E. All of the above.

Last Answer : Answer: BCD DISCUSSION: Determinants of cerebral blood flow include arterial CO 2 and O 2 tensions, systemic arterial pressure, and temperature. Other factors that may affect cerebral ... and intracranial pressure are head position, jugular venous obstruction, and positive end-expiratory pressure

Rank the following laboratory tests and procedures in terms of their relative value to a 65-year-old woman who is to undergo elective resection of a sigmoid cancer. A. Carcinoembryonic antigen (CEA). B. Blood urea nitrogen (BUN). C. Electrocardiogram (ECG). D. Hemoglobin concentration (Hgb). E. Serum creatinine (Cr). F. Arterial blood oxygen tension (PaO 2) on room air. G. Serum sodium concentration (Na+).

Description : Rank the following laboratory tests and procedures in terms of their relative value to a 65-year-old woman who is to undergo elective resection of a sigmoid cancer. A. Carcinoembryonic antigen (CEA). B. ... Arterial blood oxygen tension (PaO 2) on room air. G. Serum sodium concentration (Na+).

Last Answer : Answer: CDFEBAG DISCUSSION: The most important test by far is the electrocardiogram, with its capacity to indicate signs of occult heart disease. The second most important evaluation is the hemoglobin ... for resection of the colon is always normal and would be of least value among these tests

Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock c. Arterial vasoconstriction affects all vascular beds equally d. The total circulating blood volume is equally split between the arterial and venous system

Description : Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. ... d. The total circulating blood volume is equally split between the arterial and venous system

Last Answer : Answer: a Central in the general cardiovascular response to shock is the action of the heart itself. The principle determinants of cardiac function in the normal heart are the volume of blood ... Blood flow to the skin is sacrificed early, followed by that to the kidneys and splanchnic viscera

Wounds are classified according to the likelihood of bacterial contamination. Which of the following statement(s) is/are true concerning wound classifications? a. A clean-contaminated wound would be that associated with an elective colon resection with adequate mechanical and antibiotic bowel preparation b. A contaminated wound would include a resection of obstructed bowel with gross spillage of intestinal contents c. In a clean wound, no viscus is entered d. Antibiotic prophylaxis should be administered for all clean-contaminated and contaminated wounds and selectively in patients involving a clean wound

Description : Wounds are classified according to the likelihood of bacterial contamination. Which of the following statement(s) is/are true concerning wound classifications? a. A clean-contaminated wound would ... all clean-contaminated and contaminated wounds and selectively in patients involving a clean wound

Last Answer : Answer: a, b, c, d Wounds are classified under three classes according to the likelihood of bacterial contamination: 1) clean (no viscus is entered; e.g., herniorrhaphy); 2) clean- ... tenet involves cases in which a prosthetic material may be used (artificial joint, heart valve, tissue patch)

Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition? a. Glutamine is an essential amino acid b. Glutamine appears to be of primary benefit in critical illness c. Glutamine is included in most standard TPN solutions d. Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

Description : Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition? a. Glutamine is an essential amino acid b. Glutamine appears to be of primary ... . Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

Last Answer : Answer: b Glutamine is the most studied gut-specific nutrient. Glutamine has been classified as a nonessential or nutritionally dispensable amino acid since glutamine can be synthesized in adequate ... . In contrast to glutamine, short chain fatty acids are primary energy source for colonocytes

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

Under certain circumstances, the gut may become a source of sepsis and serve as the motor of systemic inflammatory response syndrome. Microbial translocation is the process by which microorganisms migrate across the mucosal barrier to invade the host. Which of the following mechanisms can promote bacterial translocation? a. An increased number of gut bacteria b. Altered intestinal mucosal permeability c. Decreased host defense mechanisms d. Lack of enteral feeding

Description : Under certain circumstances, the gut may become a source of sepsis and serve as the motor of systemic inflammatory response syndrome. Microbial translocation is the process by which microorganisms ... intestinal mucosal permeability c. Decreased host defense mechanisms d. Lack of enteral feeding

Last Answer : Answer: a, b, c, d 99 Translocation is promoted in three general ways: 1) altered permeability of the intestinal mucosa as caused by shock, sepsis, distant injury, or cell toxins; 2) ... trauma patient d. Fifty percent of non-nitrogen caloric requirements should be provided in the form of fat

Which of the following terms refers to a muscular, cramp-like pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest? a) Intermittent claudication Intermittent claudication is a sign of peripheral arterial insufficiency. b) Aneurysm An aneurysm is a localized sac of an artery wall formed at a weak point in the vessel. c) Bruit A bruit is the sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel. d) Ischemia Ischemia is a term used to denote deficient blood supply.

Description : Which of the following terms refers to a muscular, cramp-like pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest? a) Intermittent claudication Intermittent ... or dilated vessel. d) Ischemia Ischemia is a term used to denote deficient blood supply.

Last Answer : a) Intermittent claudication Intermittent claudication is a sign of peripheral arterial insufficiency.

Useful steps to optimize systemic oxygen delivery include: a. Maintaining mean arterial blood pressure between 50 and 90 mm Hg b. Optimizing PEEP levels by monitoring mixed venous saturation c. Turning the patient prone d. Sedation or paralysis

Description : Useful steps to optimize systemic oxygen delivery include: a. Maintaining mean arterial blood pressure between 50 and 90 mm Hg b. Optimizing PEEP levels by monitoring mixed venous saturation c. Turning the patient prone d. Sedation or paralysis

Last Answer : Answer: a, b, c, d Optimizing systemic oxygen delivery in relationship to oxygen requirement is the primary goal of management. Improving oxygenation of the blood itself by ... sedation, and establishing muscular paralysis decrease oxygen consumption, and decrease the need for oxygen delivery

A patient with gross fecal contamination and peritonitis from a ruptured sigmoid diverticulum has his midline wound left open to heal by secondary intention. Which of the following statement(s) describes this healing process? a. Wounds healing in this fashion have an altered sequence of healing compared to a primarily closed wound b. A bed of granulation tissue forms over exposed subcutaneous tissue c. Epithelialization is enhanced in the face of bacterial colonization d. The ability of a wound to form granulation tissue is dependent on the blood supply of the tissue

Description : A patient with gross fecal contamination and peritonitis from a ruptured sigmoid diverticulum has his midline wound left open to heal by secondary intention. Which of the following statement(s) describes this ... of a wound to form granulation tissue is dependent on the blood supply of the tissue

Last Answer : Answer: b, d Open wounds, whether they be ulcers or open surgical incisions closing by secondary intention, heal with the same sequence of inflammation, matrix deposition, epithelialization ... via bacterial and phagocytic cell products such as proteases, collagenases, elastases, and other enzymes