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

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
by

1 Answer

Answer :

Answer: b, c  Currently there are no approved clinical agents that accelerate normal healing. Although a number of clinical trials are in progress, no agents are currently approved. PDGF (platelet-derived growth factor) accelerates wound healing by promoting fibroblast proliferation and chemotaxis and collagenase synthesis. Clinical trials have demonstrated that PDGF has accelerated healing in patients with chronic wounds such as pressure sores and diabetic ulcers. Growth hormone has been successfully used in some situations to reverse the catabolic effect of severe injuries. Wound healing is fundamentally an anabolic event, and in the setting of a severe burn, growth hormone administration significantly accelerates donor site healing, presumably due to its effects in minimizing catabolism
by
selected

Related questions

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

Description : 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 ... EGF (epithelial growth factor) has been demonstrated to accelerate epidermal regeneration in cutaneous wounds

Last Answer : Answer: a, d IL-1 appears to be important in the process of normal wound repair. IL-1 has been shown to stimulate skin fibroblast and keratinocyte growth, as well as ... that recombinant EGF enhances keratinocyte migration. EGF is also a potent chemoattractant for granulation tissue fibroblasts

Which of the following is/are true concerning wound fibroblasts? A. Fibroblasts synthesize and secrete collagen molecules. B. Wound fibroblasts are derived from blood-borne precursor cells. C. Fibroblasts migrate to a wound along fibrin strands, which are used as a scaffold. D. Large amounts of fibrin or blood clot can act as a physical barrier to fibroblast penetration, which delays normal wound healing.

Description : Which of the following is/are true concerning wound fibroblasts? A. Fibroblasts synthesize and secrete collagen molecules. B. Wound fibroblasts are derived from blood-borne precursor cells. C. ... clot can act as a physical barrier to fibroblast penetration, which delays normal wound healing.

Last Answer : Answer: ACD DISCUSSION: Fibroblasts appear in the wound on about the third day of healing and begin to synthesize and secrete collagen molecules. Wound fibroblasts arrive from cells surrounding ... enzymes, and large amounts of fibrin and blood clot prevent fibroblasts from entering the wound

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

Description : 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 ... amino acids, hydroxyproline and hydroxylysine d. The predominant collagen type in a scar is type 3

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 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

Description : 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 ... products have clearly been shown to promote wound healing compared to simple moist occlusive dressing

Last Answer : Answer: b Although there are numerous dressing products commercially available at present, no treatment has been demonstrated to improve healing beyond that of standard treatment which adheres to basic ... healing is achieved, there has been no evidence that one product is better than another

Which of the following statement(s) is/are true concerning the clinical management of an open wound? a. A wet-to-dry dressing is the most optimal form of wound management b. A moist occlusive dressing promotes epithelialization and reduces pain c. The protein rich plasma exudate covering the open wound facilitates healing d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

Description : Which of the following statement(s) is/are true concerning the clinical management of an open wound? a. A wet-to-dry dressing is the most optimal form of wound management ... wound facilitates healing d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

Last Answer : Answer: b Epithelialization is more rapid under moist conditions than dry conditions. Without dressings, a superficial wound, or one with minimal devitalized tissue forms a scab or ... dysfunction, increases the distance for diffusion from oxygen and nutrient sources to their metabolic targets

Which of the following statements regarding transforming growth factor b (TGF-b) are true? a. TGF-b expression is autoregulated b. TGF-b enhances collagen synthesis c. TGF-b inhibits extracellular matrix production d. TGF-b may inhibit or promote cellular proliferation

Description : Which of the following statements regarding transforming growth factor b (TGF-b) are true? a. TGF-b expression is autoregulated b. TGF-b enhances collagen synthesis c. TGF-b inhibits extracellular matrix production d. TGF-b may inhibit or promote cellular proliferation

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 cell types are not crucial for healing a clean, incisional wound? A. Macrophage. B. Platelet. C. Fibroblast. D. Polymorphonuclear leukocyte. E. Myofibroblast.

Description : Which of the following cell types are not crucial for healing a clean, incisional wound? A. Macrophage. B. Platelet. C. Fibroblast. D. Polymorphonuclear leukocyte. E. Myofibroblast.

Last Answer : Answer: DE DISCUSSION: Experimental studies have shown that healing may progress normally in the absence of polymorphonuclear leukocytes in an uninfected wound. In contrast, depletion of monocytes and ... wound contraction in open defects but have little if any role in clean, incisional wounds

Cytokines with clearly defined actions in acute inflammation and early tissue injury include which of the following? a. Cysteine-X-Cysteine (C-X-C) chemokines b. Tumor Necrosis Factor (TNFa) c. Transforming Growth Factor-b (TGF-b) d. Interleukin-6 (IL-6) e. Platelet Derived Growth Factor (PDGF)

Description : Cytokines with clearly defined actions in acute inflammation and early tissue injury include which of the following? a. Cysteine-X-Cysteine (C-X-C) chemokines b. Tumor Necrosis Factor (TNFa) c. Transforming Growth Factor-b (TGF-b) d. Interleukin-6 (IL-6) e. Platelet Derived Growth Factor (PDGF)

Last Answer : Answer: a, b, c, d, e Polypeptide mediators, such as TNFa and IL-1, are considered early response cytokines and are actively involved in the initiation of the ... of tissue repair. Thus, coagulation and platelet activation provide the initial foundation for subsequent cellular recruitment

Which of the following is/are true? A. Because of its thickness, the tensile strength of a healing wound on the eyelid is much less than one on the thick skin of the back. B. By 2 days, the experimental burst strength of skin is minimal since collagen has been formed in the wound but has not yet cross-linked. C. Wound strength reaches a plateau by 3 weeks. D. Wounds rarely, if ever, regain the strength of intact tissues.

Description : Which of the following is/are true? A. Because of its thickness, the tensile strength of a healing wound on the eyelid is much less than one on the thick skin of the back. B. By 2 days, ... strength reaches a plateau by 3 weeks. D. Wounds rarely, if ever, regain the strength of intact tissues.

Last Answer : Answer: BD DISCUSSION: Tensile strength measures load per cross-section area at rupture, whereas burst strength measures load required to break a wound, regardless of dimension. Therefore, skin wounds have ... a slower rate for more than a year. Wounds do not regain the strength of normal tissue

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

Description : 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 ... unwounded skin d. The proteoglycans are responsible for the ground substance of the extracellular matrix

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

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 the primary advantage of increased absorptive ability b. Films, such as Op-site, provide a water impermeable environment to achieve a dry wound c. Impregnates are fine gauze impregnated with a variety of substances such as antibiotics or moisturizing agents that adhere tightly to the wound and do not require a secondary dressing d. Absorptive powders and paste are highly useful in debriding necrotic and fibrous material from wounds and absorbing wound serum

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

Which of the following is/are true of the actions of transforming growth factor beta (TGF-b) during wound repair? A. Increased matrix and proteoglycan synthesis. B. Inhibition of proteases. C. Stimulation of plasminogen inhibitor. D. Chemotaxis for fibroblasts and macrophages. E. Autoinduction of TGF-b.

Description : Which of the following is/are true of the actions of transforming growth factor beta (TGF-b) during wound repair? A. Increased matrix and proteoglycan synthesis. B. Inhibition of proteases. ... of plasminogen inhibitor. D. Chemotaxis for fibroblasts and macrophages. E. Autoinduction of TGF-b.

Last Answer : Answer: ABDE DISCUSSION: Through autocrine and paracrine mechanisms TGF-b stimulates the deposition of collagen and other matrix components by fibroblasts, inhibits proteases, blocks plasminogen inhibitor, ... effects. The sustained production of TGF-b at the wound site leads to tissue fibrosis

Which of the following factors have been demonstrated to promote wound healing in normal individuals? a. Vitamin A supplementation b. Vitamin C supplementation c. Vitamin E application to the wound d. Zinc supplementation e. None of the above

Description : Which of the following factors have been demonstrated to promote wound healing in normal individuals? a. Vitamin A supplementation b. Vitamin C supplementation c. Vitamin E application to the wound d. Zinc supplementation e. None of the above

Last Answer : Answer: e Several important systemic factors or conditions influence wound healing. Interestingly, there are no known systemic conditions that lead to enhanced or more rapid wound healing. ... support the concept that supranormal provision of these factors enhance wound healing in normal patients

Which of the following statement(s) is/are true concerning tumor necrosis factor (TNF)? a. TNF is a product of activated macrophages secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or inflammatory stimuli b. The liver and gut appear to be a major source of TNF following hypoperfusion c. Circulating levels of TNF correlate well with severity of tissue injury in shock d. Recently completed clinical trials of anti-TNF antibody in septic patients shows a marked improvement in survival

Description : Which of the following statement(s) is/are true concerning tumor necrosis factor (TNF)? a. TNF is a product of activated macrophages secreted in response to contact with endotoxin or ... completed clinical trials of anti-TNF antibody in septic patients shows a marked improvement in survival

Last Answer : Answer: a, b Tumor necrosis factor (TNF), a protein product of activated macrophages, is secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or ... patients utilizing infusion of monoclonal antibodies to the TNF molecule have shown no overall survival benefit

Which of the following statement(s) is/are true concerning pharmacologic agents used in the treatment of shock? a. The primary difference between dopamine and dobutamine is the absence of significant a adrenergic activity b. The renal and mesenteric vasoconstrictive effects of norepinephrine complicate and sometimes restrict its use c. The apparent paradoxical use of vasodilators, such as nitroprusside, in shock is indicated as a means to augment cardiac function d. Isoproterenol with its potent b-adrenergic effect, is a particularly useful agent in the treatment of all forms of shock

Description : Which of the following statement(s) is/are true concerning pharmacologic agents used in the treatment of shock? a. The primary difference between dopamine and dobutamine is the absence of significant a ... b-adrenergic effect, is a particularly useful agent in the treatment of all forms of shock

Last Answer : Answer: a, b, c Therapeutic adjustments of intravascular volume (preload) and systemic vascular resistance (afterload) form the basis of the treatment strategies for all ... careful constant monitoring of arterial pressure and repeated hemodynamic measurements with a pulmonary artery catheter

Which of the following statement(s) is/are true concerning wound contraction? a. Wound contraction accounts for similar rates of reduction of wound size regardless of their location b. The fibroblast, at the cellular level, is the primary force driving wound contraction c. Excessive wound contraction, when occurring over a joint, may lead to disability d. Actin microfillaments are found in fibroblasts and may play a role in wound contracture

Description : Which of the following statement(s) is/are true concerning wound contraction? a. Wound contraction accounts for similar rates of reduction of wound size regardless of their location b. The fibroblast ... d. Actin microfillaments are found in fibroblasts and may play a role in wound contracture

Last Answer : Answer: b, c, d Wound contraction is an important event which contrasts healing open wounds and closed incisions. When open wounds contract, the surrounding skin is pulled over the open wound ... number in contracting wounds and are felt to play an active role in the process of wound contraction

The following statement(s) is/are true concerning initial microbiologic diagnostic techniques. a. Appropriate expeditious transport of specimens to the microbiology laboratory is essential for obtaining accurate clinical information b. The use of potassium hydroxide in preparing a specimen slide for light microscopy will be useful in identification of anaerobic bacteria c. Antibiotic sensitivity is determined by exposing the specific microorganism to varying amounts of antibiotic with the concentration of the antibiotic inhibiting growth referred to as the MIC (minimal inhibitory concentration) d. Serum levels of antimicrobial agents should achieve in excess of a 4-to 8-fold increase over the MIC to be considered clinically efficacious.

Description : The following statement(s) is/are true concerning initial microbiologic diagnostic techniques. a. Appropriate expeditious transport of specimens to the microbiology laboratory is essential for obtaining accurate ... a 4-to 8-fold increase over the MIC to be considered clinically efficacious.

Last Answer : Answer: a, c, d Because most surgical infections are polymicrobial, specimens should be cultured for aerobic and anaerobic bacteria, as well as fungi. Although aerobic and aerotolerant ... fold increase over MIC during the peak serum level have been demonstrated to be clinically efficacious

Reconstitution of the epithelial barrier (epithelialization) begins within hours of the initial injury. Which of the following statement(s) is/are true concerning the process of epithelialization? a. Bacteria, protein exudate, and necrotic tissue all will compromise this process b. Epithelial cells exhibit contact proliferation c. Epithelialization occurs only from the margins of the wound d. Visible scarring can occur only when the injury extends deeper than the superficial dermis

Description : Reconstitution of the epithelial barrier (epithelialization) begins within hours of the initial injury. Which of the following statement(s) is/are true concerning the process of epithelialization? a. ... d. Visible scarring can occur only when the injury extends deeper than the superficial dermis

Last Answer : Answer: a, d The initial step of epithelialization involves epithelial cells from the basal layer of the wound edge flattening and migrating across the wound, completing wound coverage within 24- ... abrasions and burns may scar significantly. Whenever the dermis is incised, a scar will form

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

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 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

Description : 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 ... of tissue on quantitative analysis d. Silver sulfadiazine is useful only for the management of burns

Last Answer : Answer: c The role of antibiotics in wound care is controversial. All open wounds are colonized with bacteria. Only when surrounding tissue is invaded (cellulitis) are systemic antibiotics clearly ... of relevant drug-resistant plasmids in bacteria, and its low cost make it a good choice

Which of the following statement(s) is/are true concerning septic shock? a. The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents b. The circulatory derangements of septic shock precede the development of metabolic abnormalities c. Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance d. Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

Description : Which of the following statement(s) is/are true concerning septic shock? a. The clinical picture of gram negative septic shock is specifically different than shock associated with ... mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

Last Answer : Answer: d The clinical findings in sepsis and septic shock represent the host response to infection. Gram-positive and gram-negative bacteria, viruses, fungi, rickettsiae, and ... intravascular volume, exogenous volume resuscitation must be provided to restore venous return and ventricular filling

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 hormone (ACTH) is secreted from the anterior pituitary gland b. ACTH stimulation results in elevation of serum cortisol levels for up to a week after the operation c. An increased secretion of aldosterone and ADH may contribute to postoperative fluid retention d. An increase in serum insulin and a fall in glucagon accelerate hepatic glucose production and maintain gluconeogenesis

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

Last Answer : Answer: a, c One of the earliest consequence of a surgical procedure is the rise in levels of circulating cortisol that occur in response to a sudden outpouring of ACTH ... hepatic glucose production, and, with other hormones (epinephrine and glucocorticoids), gluconeogenesis is maintained

A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his diagnosis and management? a. The low blood pressure can be assumed to be due to neurogenic shock b. The sole cause of hypotension is the loss of sympathetic input to the venous system c. Despite significant hypotension, secondary organ injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Description : A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/ ... injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Last Answer : Answer: c Neurogenic shock results from interruption of sympathetic vasomotor input and develops after spinal cord injury, spinal anesthesia, and severe head injury. Under normal conditions, baseline ... the cause is not neurogenic and search for occult blood loss or cardiogenic causes of shock

Which of the following statement(s) is/are true concerning the diagnosis and management of hypovolemic shock? a. A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock b. The treatment of shock is generic regardless of the etiology c. Pharmacologic intervention to increase myocardial contractility in hypovolemic shock is an important part the early management d. Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock

Description : Which of the following statement(s) is/are true concerning the diagnosis and management of hypovolemic shock? a. A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock b. The ... d. Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock

Last Answer : Answer: d Hypovolemic shock is readily diagnosed when there is an obvious source of volume loss and overt signs of hemodynamic instability and increased adrenergic output are present. ... response systems and consequences of their disseminated, indiscriminate cellular injury can be quite profound

The following statement(s) is/are true concerning newer detection methods of systemic infection. a. Enzyme-linked immunosorbent assay (ELISA) is a rapid immunologic assay used for both antigen and antibody detection b. Southern, northern, and western immunoblot techniques are used to detect DNA, RNA, or proteins, respectively c. Polymerase chain reaction (PCR) is a sensitive assay used to detect small amounts of microbial DNA, thus detecting infection at its early stages d. Infectious agents currently detected using advanced molecular techniques include cytomegalovirus (CMV) and human immunodeficiency virus (HIV)

Description : The following statement(s) is/are true concerning newer detection methods of systemic infection. a. Enzyme-linked immunosorbent assay (ELISA) is a rapid immunologic assay used for ... detected using advanced molecular techniques include cytomegalovirus (CMV) and human immunodeficiency virus (HIV)

Last Answer : Answer: a, b, c, d Although the classic detection of infection based on clinical signs of infection and bacterial culture remain the most common clinical tools, increasing ... including CMV and HIV. Furthermore, preliminary investigations into possible detection of fungal pathogens are underway

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.

Description : 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.

Last Answer : 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 ... repair has possible clinical applications in the modulation of adult fibrotic diseases and abnormal scar-forming conditions

A number of prospective clinical trials have addressed the role of total parenteral nutrition in the cancer patient. The results have been somewhat conflicting. Which of the following statement(s) have been proven correct by prospective trials? a. Preoperative TPN is beneficial in surgical patients with severe preoperative nutrition b. Postoperative TPN is of value following pancreatic resection c. Routine use of perioperative (including prior to the procedure) TPN is of benefit in patients undergoing hepatectomy for hepatoma d. TPN is of no benefit in patients undergoing bone marrow transplant

Description : A number of prospective clinical trials have addressed the role of total parenteral nutrition in the cancer patient. The results have been somewhat conflicting. Which of the following statement(s) ... hepatectomy for hepatoma d. TPN is of no benefit in patients undergoing bone marrow transplant

Last Answer : Answer: a, c Numerous clinical trials have failed to yield a consensus with regard to the efficacy of TPN in cancer patients. In 1991, a multicenter VA cooperative trial demonstrated ... patients receiving bone marrow transplantation has also been shown to be a valuable component of overall care

Which of the following statement(s) is/are true concerning hemophilia A? a. Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII b. A positive family history for bleeding disorders present in all patients c. Laboratory tests reveal a prolongation of aPTT, prothrombin time (PT), thrombin clotting time and platelet aggregation d. Spontaneous bleeding is unusual with factor VIII levels greater than 10% of normal

Description : Which of the following statement(s) is/are true concerning hemophilia A? a. Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII b. A positive family history for ... platelet aggregation d. Spontaneous bleeding is unusual with factor VIII levels greater than 10% of normal

Last Answer : Answer: a, d Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII although 0% of cases are secondary to spontaneous mutation. The incidence of this abnormality is ... factor levels as low as 1% have been noted and patients are at risk for spontaneous bleeding

Antibacterial agents can be classified with regard to their structure, mechanism of action, and activity pattern against various types of bacterial pathogens. Which of the following statement(s) is/are true concerning antimicrobial classes? a. Penicillins and cephalosporins share the compound structure of a b-lactam ring which binds to bacterial division plate proteins b. Tetracyclines and macrolides such as erythromycin inhibit bacterial ribosomal activity and therefore protein synthesis c. Aminoglycosides act in a similar fashion to tetracyclines and therefore are both bacteriostatic d. Sulfonamides and trimethoprim act synergistically to inhibit purine synthesis

Description : Antibacterial agents can be classified with regard to their structure, mechanism of action, and activity pattern against various types of bacterial pathogens. Which of the following ... are both bacteriostatic d. Sulfonamides and trimethoprim act synergistically to inhibit purine synthesis

Last Answer : Answer: a, b, d Penicillins, cephalosporins, and monobactams possess a b-lactam ring of some type and act to bind bacterial division plate proteins, thus inhibiting cell wall ... act in different mechanisms to inhibit protein synthesis, therefore two agents in combination act synergistically

A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He is agitated and complains of shortness of breath. Which of the following statement(s) is/ are correct concerning his diagnosis and management? a. Myocardial ischemia secondary to preexisting coronary artery disease is most likely the underlying cause of this problem b. Invasive hemodynamic monitoring with a Swan-Gantz catheter will demonstrate a low cardiac output, a high systemic vascular resistance, and elevated cardiac filling pressures c. The use of morphine sulphate and nitrates should be part of the initial management d. The primary pharmacologic treatment involves the use of moderate doses of inotropic ag

Description : A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He ... use of moderate doses of inotropic agents e. Afterload reduction with nitroprusside is absolutely contraindicated

Last Answer : Answer: a, b, d Intrinsic cardiogenic shock results from failure of the heart as an effective pump. Coronary artery disease is the most common cause of myocardial ... hemodynamic monitoring. Infusion of afterload-reducing agents can be administered in conjunction with inotropic support

Products of platelet degranulation include: a. Tumor necrosis factor b. Interleukin-1 c. Transforming growth factor b d. Platelet-derived growth factor

Description : Products of platelet degranulation include: a. Tumor necrosis factor b. Interleukin-1 c. Transforming growth factor b d. Platelet-derived growth factor

Last Answer : Answer: c, d The initial response to injury and disruption of a blood vessel is bleeding. The hemostatic response to this is clot formation to stop hemorrhage. Platelet plug ... . Tumor necrosis factor and interleukin-1 also stimulate fibroblast proliferation, however are produced by macrophages

Which of the following factors can be associated with impaired wound healing? a. Chemotherapy b. Chronic steroid use c. Peripheral vascular disease d. Radiation therapy e. Diabetes mellitus

Description : Which of the following factors can be associated with impaired wound healing? a. Chemotherapy b. Chronic steroid use c. Peripheral vascular disease d. Radiation therapy e. Diabetes mellitus

Last Answer : Answer: a, b, c, d, e Bone marrow suppression, a common consequence of chemotherapy, is detrimental to wound healing. Quantitative and qualitative lymphocyte and monocyte deficiency impairs cellular ... be a primary cause of impaired healing, and may be also a cofactor with other conditions

Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of the following statement(s) is/are true concerning intracellular receptors? a. The messengers or hormones must by lipophilic b. These intracellular receptors generally regulate protein synthesis c. The intracellular receptors are located entirely in the nucleus of the cell d. A heat-shock protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Description : Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of ... protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Last Answer : Answer: a, d Although most hormone and other messenger receptors are extracellular, intracellular receptors have been identified. The hormone messengers involved for these receptors are primarily ... DNA-binding domain of the receptor. Activation involves the dissociation of the inhibitor protein

Which of the following statement(s) is/are correct concerning the immunoinflammatory response to shock? a. The anaphylactoxins, C3a and C5a, are products of activation of only the classical pathway of the compliment cascade b. Eicosanoids, such as prostaglandins are stored in platelets and endothelial cells and released in response to inflammatory stimuli c. Thromboxane and PGI2 have similar effects d. Platelet-activating factor can be released by both circulating and fixed tissue cells

Description : Which of the following statement(s) is/are correct concerning the immunoinflammatory response to shock? a. The anaphylactoxins, C3a and C5a, are products of activation of only the classical pathway ... effects d. Platelet-activating factor can be released by both circulating and fixed tissue cells

Last Answer : Answer: d Inflammatory mediators have recently been recognized as playing a significant role in the clinical manifestations and progression of shock and the development ... increased pulmonary vascular resistance, bronchoconstriction, peripheral vasodilatation, and increased vascular permeability

Which of the following is/are acceptable reasons for the transfusion of red blood cells based on currently available data? A. Rapid, acute blood loss with unstable vital signs but no available hematocrit or hemoglobin determination. B. Symptomatic anemia: orthostatic hypotension, severe tachycardia (greater than 120 beats per minute), evidence of myocardial ischemia, including angina. C. To increase wound healing. D. A hematocrit of 26% in an otherwise stable, asymptomatic patient.

Description : Which of the following is/are acceptable reasons for the transfusion of red blood cells based on currently available data? A. Rapid, acute blood loss with unstable vital signs but no available ... increase wound healing. D. A hematocrit of 26% in an otherwise stable, asymptomatic patient.

Last Answer : Answer: AB DISCUSSION: Currently accepted guidelines for the transfusion of packed red blood cells include acute ongoing blood loss, as might occur in an injured patient, and the development of ... not be given based solely or predominantly on a numerical value such as a hematocrit of 28%

Which of the following statement(s) is/are true about the role of macrophages in the wound healing process? a. Macrophages are the dominant cell type during the inflammatory phase of wound healing b. Macrophages are not essential for wound healing c. The macrophage role in wound healing is limited to phagocytosis d. Macrophages are a source of a number of humoral factors essential for wound healing

Description : Which of the following statement(s) is/are true about the role of macrophages in the wound healing process? a. Macrophages are the dominant cell type during the inflammatory phase of wound ... phagocytosis d. Macrophages are a source of a number of humoral factors essential for wound healing

Last Answer : Answer: a, d Within three or four days after injury, macrophages become the dominant cell type in the inflammatory phase of wound healing. The role of macrophages is not limited only ... . These studies confirm the dominant role of the macrophage and the inflammatory phase of wound healing

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

Which of the following statement(s) is/are true concerning ischemia reperfusion injury? a. During ischemia, ATP degradation results in increased plasma and intracellular levels of hypoxanthine and xanthene b. Oxygen free radicals such as the superoxide radical are involved in the expression of the proinflammatory phenotype of endothelial cells, macrophages and neutrophils c. The intracellular adhesion molecule-1 (ICAN-1) contributes to injury and disruption of the endothelial lining, with extensive capillary leak and resultant interstitial edema d. Animal models have demonstrated that passive immunization with antibodies to neutrophil adhesive complex lessen the ischemic/reperfusion microvascular injury

Description : Which of the following statement(s) is/are true concerning ischemia reperfusion injury? a. During ischemia, ATP degradation results in increased plasma and intracellular levels of ... immunization with antibodies to neutrophil adhesive complex lessen the ischemic/reperfusion microvascular injury

Last Answer : Answer: a, b, c, d During the ischemia and hypoperfusion phase, degradation of ATP stores essential to maintain cell integrity and significant loss of diffusible ... either the neutrophil adhesive complex or the endothelial selectins dramatically lessens ischemia/reperfusion microvascular injury

Which of the following substances, not normally present in the circulation, trigger the initiating events in the hemostatic process? a. Thrombin b. Platelet factor 3 c. Tissue factor d. Collagen

Description : Which of the following substances, not normally present in the circulation, trigger the initiating events in the hemostatic process? a. Thrombin b. Platelet factor 3 c. Tissue factor d. Collagen

Last Answer : Answer: c, d The initiating agents for hemostasis involve two substances that are not normally present in the circulation-collagen and tissue factor. Tissue factor is released from ... phospholipid surface to form the so-called prothrombinase complex which catalyzes the formation of thrombin

Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. Severe thrombocytopenia (platelet count less than 100,000) is seen in less than 10% of patients treated with heparin c. Heparin-associated thrombocytopenia is due to the aggregation of platelets and may result in thrombosis or embolic episodes d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Description : Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. ... d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Last Answer : Answer: b, c Heparin-associated thrombocytopenia occurs in 0.6% to 30% of patients who receive heparin, although severe thrombocytopenia (platelet counts less than 100,000) is seen in ... as coating on pulmonary artery catheters or low rate infusion into arterial catheters may cause this syndrome

A 16-year-old boy suffers a mid-gut volvulus with massive loss of small intestine. Which of the following statement(s) is/are true concerning his nutritional requirements and management? a. If at least 18 inches of residual small intestine survives, the patient may tolerate some form of enteral nutrition b. A nutritional regimen consisting of supplemental glutamine, growth hormone, and a modified high carbohydrate, low fat diet may be beneficial in this patient c. The regimen described above may decrease the cost of care d. TPN needs will increase after discontinuation of growth hormone

Description : A 16-year-old boy suffers a mid-gut volvulus with massive loss of small intestine. Which of the following statement(s) is/are true concerning his nutritional requirements and management? a. If ... above may decrease the cost of care d. TPN needs will increase after discontinuation of growth hormone

Last Answer : Answer: a, b, c Prior to the availability of TPN, most patients developing short bowel syndrome from either surgery or catastrophic event died. In selected patients, however, with ... the growth hormone did not increase TPN needs in patients once they had undergone successful gut rehabilitation

The use of prophylactic antibiotics has become commonplace. Which of the following statement(s) is/are true concerning the prophylactic use of antibiotics? a. The appropriate use of prophylactic antibiotics must include the initiation of the agent prior to the surgical procedure b. Continuing the antibiotic into the postoperative period has led to improved results in antibiotic prophylaxis c. The prophylactic administration of broad-spectrum agents (third-generation cephalosporins) has been shown to be particularly advantageous d. The topical use of antimicrobial agents is of no advantage in the prophylactic setting

Description : The use of prophylactic antibiotics has become commonplace. Which of the following statement(s) is/are true concerning the prophylactic use of antibiotics? a. The appropriate use of prophylactic ... d. The topical use of antimicrobial agents is of no advantage in the prophylactic setting

Last Answer : Answer: a Intravenous administration of an antibiotic is clearly indicated for patients undergoing clean contaminated operations. These antibiotics should be administered prior to surgery ... of antimicrobial agents is equivalent to the administration of intravenous antimicrobial agent antibiotics

Thrombolytic therapy has become a useful adjunct in the management of peripheral arterial occlusion. In this setting, direct intraarterial administration rather than intravenous has been advocated to decrease the risk of systemic bleeding. Which of the following true statement(s) concerning the use of thrombolytic agents for arterial occlusion is/are true? a. A standard technique involves infusing high-dose urokinase, 4000 units per minute for 1–2 hours, directly into the clot by a catheter embedded in the thrombus b. If progress is made, further fibrinolytic therapy is given at 1000 to 2000 units per minute until clot lysis has occurred c. The usual infusion time by the above-stated technique is usually in excess of 24 hours d. Successful clot lysis occurs more frequently in arterial graf

Description : Thrombolytic therapy has become a useful adjunct in the management of peripheral arterial occlusion. In this setting, direct intraarterial administration rather than intravenous has been advocated ... may be indicated for situations where complete clot evacuation cannot be accomplished surgically

Last Answer : Answer: a, b, e The most popular method for intraarterial thrombolytic therapy for arterial occlusion involves passing a guidewire through the thrombus with arteriographic guidance and ... acute arterial occlusion) or when distal vasculative is occluded and precludes appropriate inflow patency

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

Description : 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 ... suggest a dosage reduction in immunosuppressive agents until the infection can be adequately controlled

Last Answer : Answer: a, d Infections due to fungal pathogens have become increasingly common during the past decade, frequently occurring in patients undergoing prolonged hospitalization in the Surgical ... agents should be discontinued until evidence of infection is absolutely controlled or is eradicated

Which of the following statements regarding angiogenesis are true? a. Angiogenesis is a seminal biologic event with clinical relevance limited to its effect upon tumor growth b. C-X-C chemokines regulate angiogenesis c. PF-4 has angiogenic properties d. Sites of atherosclerosis demonstrate chronic angiogenic activity

Description : Which of the following statements regarding angiogenesis are true? a. Angiogenesis is a seminal biologic event with clinical relevance limited to its effect upon tumor growth b. C-X-C ... c. PF-4 has angiogenic properties d. Sites of atherosclerosis demonstrate chronic angiogenic activity

Last Answer : Answer: b, d An important component of tissue repair and wound healing is the process of angiogenesis. This normal, physiologic process is a local, transient event which is ... between these factors may govern overall angiogenic potential in a variety of physiological and pathophysiological states

The use of antibiotics can be based on either the clinical course of a patient without the benefit of well-defined microbiologic data (empiric therapy), or targeted at specific identified pathogens once sensitivity reports are available (directed therapy). The following statement(s) is/are true concerning these therapies. a. The issue of toxic side effects of antibiotics is only important in dealing with emperic therapy b. Single agent therapy is generally inferior to specific multi-drug therapy (aminoglycoside plus an antianaerobic agent) for the treatment of secondary bacterial peritonitis due to appendicitis, diverticulitis, penetrating gastrointestinal injury, or anastomotic leak c. With the empiric use of antibiotics, a diligent search for the septic source should be undertaken and co

Description : The use of antibiotics can be based on either the clinical course of a patient without the benefit of well-defined microbiologic data (empiric therapy), or targeted at ... which polymicrobial infection is identified, specifically-directed treatment for the predominant organism is satisfactory

Last Answer : Answer: c The use of empiric therapy without the benefit of well-defined microbiologic data is appropriate when there is sufficient clinical evidence to support the diagnosis such that it would ... components of the infection if the body site is such that these microorganisms may be present

Which of the following statement(s) describe the effects of aging on wound healing? a. A finer, more cosmetic scar might be expected b. In vitro studies demonstrate decreased proliferative potential of fibroblasts and epithelial cells c. Skin sutures should be left in for a longer period of time d. Wound infection occurs more frequently in elderly patients due to diminished ability to fight infection

Description : Which of the following statement(s) describe the effects of aging on wound healing? a. A finer, more cosmetic scar might be expected b. In vitro studies demonstrate decreased proliferative ... . Wound infection occurs more frequently in elderly patients due to diminished ability to fight infection

Last Answer : Answer: a, b, c There are important age-dependent aspects of wound healing. The elderly heal more slowly and with less scarring. There is a gradual attenuation of the inflammatory ... the sutures. There is no evidence to suggest that wound infections occur more commonly in elderly patients

Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema? a. Diuresis and blood transfusion is a valuable step b. Salt-poor albumin leaks through the capillaries and worsens the condition c. Mannitol is contraindicated as a diuretic in this clinical situation d. Isoproterenol is a poor choice as an ionotropic agent

Description : Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema? a. Diuresis and blood transfusion is a valuable step b. Salt-poor albumin leaks through the ... a diuretic in this clinical situation d. Isoproterenol is a poor choice as an ionotropic agent

Last Answer : Answer: a Treatment of pulmonary edema has two important goals, the first is to improve oxygenation if it is impaired, and the second is to minimize fibrosis and bacterial infection, which often ... leaks out , the short term effects of expanding blood volume and decrease in edema will appear

Which of the following statement(s) is/are true concerning the treatment of MOFS? a. Prevention and therapy of MOFS requires control of the infectious or inflammatory source b. Restoration of normal clinical parameters such as blood pressure, pulse rate, and urine output ensures optimal resuscitation in most patients c. Branch chain amino acids play and important role in the nutritional support of the patient d. Because of the nature of gut injury, total parenteral nutrition is preferred for most patients with MOFS

Description : Which of the following statement(s) is/are true concerning the treatment of MOFS? a. Prevention and therapy of MOFS requires control of the infectious or inflammatory source b. Restoration of normal ... of the nature of gut injury, total parenteral nutrition is preferred for most patients with MOFS

Last Answer : Answer: a, c The therapy of MOFS is directed towards interrupting the involving pathophysiologic process and providing an optimal physiologic environment for healing and recovery. ... Enteral absorption and processing of nutrients appears superior to TPN and lessens overall complications