Scar formation is part of the normal healing process following injury. Which of the following tissues has the ability to heal without scar formation? a. Liver b. Skin c. Bone d. Muscle

Scar formation is part of the normal healing process following injury. Which of the following tissues has the ability to heal without scar formation? a. Liver b. Skin c. Bone d. Muscle
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Answer: c  Every tissue in the body undergoes reparative processes after injury. Bone has the unique ability to heal without scar and liver has the potential to regenerate parenchyma, the only organ that has maintained that ability in the adult human. Although liver does regenerate, it often heals with scar (cirrhosis) as well. With these exceptions, all other mature human tissues heal with scar
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The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues? A. Central nervous system. B. Skeletal muscle. C. Bone. D. Kidney. E. Tissue in the healing wound.

Description : The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues? A. Central nervous system. B. Skeletal muscle. C. Bone. D. Kidney. E. Tissue in the healing wound.

Last Answer : Answer: ADE DISCUSSION: Glucose is produced in increased amounts to satisfy the fuel requirements of the healing wound. In addition, nerve tissue and the renal medulla also utilize this substrate. Skeletal muscle primarily utilizes fatty acids, and bone utilizes mineral substrate

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

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

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

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

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 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 true concerning excessive scarring processes? a. Keloids occur randomly regardless of gender or race b. Hypertrophic scars and keloid are histologically different c. Keloids tend to develop early and hypertrophic scars late after the surgical injury d. Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound closed by secondary intention

Description : Which of the following statement(s) is/are true concerning excessive scarring processes? a. Keloids occur randomly regardless of gender or race b. Hypertrophic scars and keloid are histologically different ... scar can be useful in certain situations such as a wound closed by secondary intention

Last Answer : Answer: d True keloids are uncommon and occur predominantly in dark skinned people with a genetic predisposition for keloid formation. In most cases, the gene appears to be ... subside. Hypertrophic scars usually develop within the first month after wounding and often subside gradually

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 statements regarding cytokines is incorrect? A. Cytokines act directly on target cells and may potentiate the actions of one another. B. Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury. C. Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability. D. Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates.

Description : Which of the following statements regarding cytokines is incorrect? A. Cytokines act directly on target cells and may potentiate the actions of one another. B. Interleukin 1 (IL-1) ... organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates.

Last Answer : Answer: C DISCUSSION: Cytokines are soluble peptide molecules that are synthesized and secreted by a number of cell types in response to injury, inflammation, and infection. Cytokines, which ... is thought to play a central role in the stress response, particularly in response to endotoxemia

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 the vascular response to injury? a. Vasoconstriction is an early event in the response to injury b. Vasodilatation is a detrimental response to injury with normal body processes working to avoid this process c. Vascular permeability is maintained to prevent further cellular injury d. Histamine, prostaglandin E2 (PGE2) and prostacyclin (PGI2) are important mediators of local vasoconstriction

Description : Which of the following statement(s) is/are true concerning the vascular response to injury? a. Vasoconstriction is an early event in the response to injury b. Vasodilatation is a ... Histamine, prostaglandin E2 (PGE2) and prostacyclin (PGI2) are important mediators of local vasoconstriction

Last Answer : Answer: a After wounding, there is transient vasoconstriction mediated by catecholamines, thromboxane, and prostaglandin F2 (PGF2a). This period of vasoconstriction lasts for only five to ten minutes. Once ... and mast cells and enhance the egress of cells and substrate into the wound and tissue

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 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

A 47-year-old patient undergoing a complicated laparotomy for bowel obstruction develops a postoperative enterocutaneous fistula. Which of the following statement(s) is/are true concerning parenteral nutritional support in the postoperative period? a. Oral intake can result in severe dehydration, electrolyte abnormalities, and perifistula skin injury b. Total parenteral nutrition increases the spontaneous closure rate of intestinal fistula c. Total parenteral nutrition decreases mortality rate in patients with intestinal fistulas d. The use of TPN better prepares the patient for surgery if surgical intervention proves necessary

Description : A 47-year-old patient undergoing a complicated laparotomy for bowel obstruction develops a postoperative enterocutaneous fistula. Which of the following statement(s) is/are true concerning parenteral ... use of TPN better prepares the patient for surgery if surgical intervention proves necessary

Last Answer : Answer: a, b, d Patients with gastrointestinal-cutaneous fistulas represent the classical indication for TPN. In such patients, oral intake of food almost invariably results in increased ... treated more aggressively surgically after a defined period of nutritional support (unless closure occurs)

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

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

Total body mass is composed of an aqueous component and a nonaqueous component. The nonaqueous component is made up of which of the following? a. Liver b. Tendons c. Skeletal muscle d. Extracellular fluid e. Adipose tissue

Description : Total body mass is composed of an aqueous component and a nonaqueous component. The nonaqueous component is made up of which of the following? a. Liver b. Tendons c. Skeletal muscle d. Extracellular fluid e. Adipose tissue

Last Answer : Answer: b, e The nonaqueous portion of total body mass is made up of bones, tendons, and mineral mass as well as adipose tissue. The aqueous component contains the body cell ... and circulating blood cells. Also contributing to the aqueous portion is the interstitial fluid and intravascular volume

Answer: b, c The body contains fuel reserves which it can mobilize and utilize during times of starvation or stress. By far the greatest energy component is fat, which is calorically dense since it provides about 9 calories/gram. Body protein comprises the next largest mass of utilizable energy, but amino acids yield only about 4 kcal/gram. Unlike fat reserves, body protein is not a storage form of energy but rather serves as a structural functional component of the body; loss of body protein, if severe, is associated with functional consequences. Glycogen stored in muscle and liver and free glucose have a trivial caloric value of less than 1000 kcal for a 70 kg male

Description : Answer: b, c The body contains fuel reserves which it can mobilize and utilize during times of starvation or stress. By far the greatest energy component is fat, which is calorically dense since it ... liver and free glucose have a trivial caloric value of less than 1000 kcal for a 70 kg male

Last Answer : Which of the following statement(s) is/are true concerning the indications and administration of nutritional support to cancer patients? a. Preoperative nutritional support should be provided to all ... total parenteral nutrition solutions maintain integrity of the small bowel e. None of the above

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

Which of the following statements(s) is/are true concerning human energy requirement? a. In normal subjects, less than 5% of basal energy requirement is spent on cardiac output and the work of breathing b. Mechanical ventilation can decrease the energy expenditure for normal respiration c. For a 70 kg male, average resting energy consumption is almost 1500 kcal/day d. Similar increases in energy expenditures are associated with elective surgery and trauma or thermal injury

Description : Which of the following statements(s) is/are true concerning human energy requirement? a. In normal subjects, less than 5% of basal energy requirement is spent on cardiac output and the ... d. Similar increases in energy expenditures are associated with elective surgery and trauma or thermal injury

Last Answer : Answer: a, c Basal energy requirements are measured with the subject at rest when no external work is being done; the energy is used mainly for transport and synthetic work within cells. A ... average-sized adult who sustains a major burn rarely may require more than 3500 kcal/day for maintenance

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

Description : 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 ... O2/dL d. Normal systemic oxygen delivery for a typical adult is approximately 1000 cc/min

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

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.

Description : 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 ... area of nonblanchable erythema, tissue swelling, and congestion, and the patient complains of discomfort.

Last Answer : a) Stage III Clinically, a deep crater with or without undermining of adjacent tissues is noted.

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

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

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

Description : 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 ... healing in chronic wounds d. Growth hormone functions by promoting fibroblast proliferation and collagen synthesis

Last 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 ... hormone administration significantly accelerates donor site healing, presumably due to its effects in minimizing catabolism

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 surgical techniques lead to improved wound healing? a. Atraumatic handling of tissue b. Approximation of underlying fatty tissue to obliterate dead space c. Protecting the wound from water for at least one week d. Meticulous hemostasis

Description : Which of the following surgical techniques lead to improved wound healing? a. Atraumatic handling of tissue b. Approximation of underlying fatty tissue to obliterate dead space c. Protecting the wound from water for at least one week d. Meticulous hemostasis

Last Answer : Answer: a, d There are numerous practical implications for the care of wounds and surgical incisions. Meticulous hemostasis reduces the inflammation of phagocytosis necessary to clear the wound of ... or shower one or two days after surgery actually serves useful purpose in debriding the wound

Which of the following cells or blood elements play a role in the initial phases of wound healing? a. Polymorphonuclear leukocytes (PMNs) b. Platelets c. Monocytes d. Lymphocytes

Description : Which of the following cells or blood elements play a role in the initial phases of wound healing? a. Polymorphonuclear leukocytes (PMNs) b. Platelets c. Monocytes d. Lymphocytes

Last Answer : Answer: a, b, c, d Shortly after the initial injury, the wound is full of debris which is cleared over the next several days by recruited and activated phagocytic cells. ... in the initial hemostatic process as well as releasing chemotactic factors and factors leading to fibroblast proliferation

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

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

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 statements regarding IL-1 are correct? a. While IL-1 and TNFa share many biologic effects, IL-1 appears to be more potent b. IL-1 expression is in part autoregulated c. IL-1 inhibits prostaglandin production d. The ability of IL-1 to upregulate endothelial cell-neutrophil adhesion molecules is relatively limited

Description : Which of the following statements regarding IL-1 are correct? a. While IL-1 and TNFa share many biologic effects, IL-1 appears to be more potent b. IL-1 expression is in part ... production d. The ability of IL-1 to upregulate endothelial cell-neutrophil adhesion molecules is relatively limited

Last Answer : Answer: b IL-1 and TNFa share many biologic properties. In addition, each potentiates the effects of the other one when given concurrently. Overall, IL-1 alone probably has weaker effects than ... IL-1 provides a key step in the extravasation of leukocytes to sites of local inflammation and injury

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.

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

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 diabetic develops a severe perineal infection with skin necrosis, subcutaneous crepitance, and drainage of a thin, watery, grayish and foul-smelling fluid. Management should consist of: a. Gram stain of the fluid, which will likely demonstrate multiple bacteria including predominantly gram-positive rods b. A CT scan is indicated in a stable patient to define the extent of the disease c. Broad spectrum antibiotics followed with prompt extensive debridement is indicated d. A safe guideline is to resect infected necrotic tissue so that a several centimeter margin of grossly normal, healthy tissue can be achieved e. A colostomy is of little benefit in this situation

Description : A diabetic develops a severe perineal infection with skin necrosis, subcutaneous crepitance, and drainage of a thin, watery, grayish and foul-smelling fluid. Management should consist of: a. Gram stain ... normal, healthy tissue can be achieved e. A colostomy is of little benefit in this situation

Last Answer : Answer: a, b, c, d The presence of severe perineal infection (referred to as Fournier gangrene when this process involves the perineum and scrotum in males) is associated with a ... often provides improved wound care and patient management, although it is not invariably a positive outcome

Keloid scar during healing: B A. is normal scar and is common B. caused by the excess deposition of fibrin in the wound and are larger than the wound C. may be prevented by pressure dressing D. keloid are always harmful to the body

Description : Keloid scar during healing: B A. is normal scar and is common B. caused by the excess deposition of fibrin in the wound and are larger than the wound C. may be prevented by pressure dressing D. keloid are always harmful to the body

Last Answer : caused by the excess deposition of fibrin in the wound and are larger than the wound

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

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 neuroendocrine responses to shock? a. Sympathetic nerve endings release epinephrine which is responsible for greater than 80% of systemic vascular resistance b. Endogenous epinephrine is the primary contributor to systemic vascular resistance c. Increased pancreatic secretion of glucagon contributes to glucose intolerance associated with injury and sepsis d. The renin-angiotensin axis further augments the sympathetic-mediated vasoconstriction

Description : Which of the following statement(s) is/are true concerning the neuroendocrine responses to shock? a. Sympathetic nerve endings release epinephrine which is responsible for greater than 80% ... injury and sepsis d. The renin-angiotensin axis further augments the sympathetic-mediated vasoconstriction

Last Answer : Answer: c, d The neuroendocrine response to shock attempts to achieve restoration of effective blood volume, mobilization of metabolic substrates, and maintenance of central ... . Angiotensin II is an extremely effective vasoconstrictor that further augments sympathetic-mediated vasoconstriction

Which of the following statement(s) is/are true concerning the pulmonary response to shock? a. The acute pulmonary vascular response to shock differs markedly from that of systemic vasculature b. The pulmonary edema of ARDS occurs in the face of elevated left heart pressures c. The initial physiologic changes of ARDS involve the capillary endothelial cells and the type I pneumocyte d. Mechanisms proposed in the pathogenesis of ARDS include injury from mediators of inflammation elsewhere and from activated cellular elements e. A decrease in lung compliance may result from the loss of type I pneumocytes

Description : Which of the following statement(s) is/are true concerning the pulmonary response to shock? a. The acute pulmonary vascular response to shock differs markedly from that of systemic vasculature b. The ... elements e. A decrease in lung compliance may result from the loss of type I pneumocytes

Last Answer : Answer: c, d, e Contributing pathophysiologic processes to the pulmonary manifestations of shock include the pulmonary component of the cardiovascular response, disruption of the normal ... injury from mediators of inflammation elaborated elsewhere, and from activated cellular blood elements

Which of the following statement(s) is/are true concerning the various types of shock? a. Traumatic shock is more commonly associated with subsequent organ injury and multiorgan failure syndrome than hemorrhagic shock b. Cardiogenic shock can be of either an intrinsic or compressive nature c. Hypodynamic septic shock is associated with a decreased mortality risk when compared with hyperdynamic septic shock d. Hypoadrenal shock usually responds quickly to resuscitation e. Neurogenic shock occurs with the absence of sympathetic activity

Description : Which of the following statement(s) is/are true concerning the various types of shock? a. Traumatic shock is more commonly associated with subsequent organ injury and multiorgan failure ... responds quickly to resuscitation e. Neurogenic shock occurs with the absence of sympathetic activity

Last Answer : Answer: a, b, d, e Classification schemes of shock based on cause have been developed for the seemingly dissimilar processes leading to circulatory collapse and the shock state. ... and pressor agents. The response to exogenous corticosteroids is usually dramatic and potentially life-saving

Neutrophil chemotaxis is a fundamental aspect of inflammatory injury in conditions such as the Adult Respiratory Distress Syndrome (ARDS). Neutrophil chemotaxis is directly attributable to which of the following molecules? a. C5a b. TNFa c. LPS d. IL-1 e. ENA-78 (Epithelial Neutrophil Activating Protein)

Description : Neutrophil chemotaxis is a fundamental aspect of inflammatory injury in conditions such as the Adult Respiratory Distress Syndrome (ARDS). Neutrophil chemotaxis is directly attributable to which of the following molecules? ... TNFa c. LPS d. IL-1 e. ENA-78 (Epithelial Neutrophil Activating Protein)

Last Answer : Answer: a, e There is a large collection of peptide, polypeptide and lipid mediators which have chemotactic properties. Although TNF a, IL-1 and LPS were initially reported to have direct ... are several complement-derived peptides. Perhaps, the most potent of these is the short-lived C5a peptide

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

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 concerning this arm of the surgical stress response? a. Cytokines primarily work locally via direct cell-to-cell communication b. Cytokines are never detectable in the systemic bloodstream c. Cytokines are produced only by immune cells attracted to the site of injury d. Cytokine release may stimulate the release of other cytokines leading to an important cascade of events

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

Cytokines which play an important role in the metabolic response to injury include: a. Tumor necrosis factor—a (TNF) b. Interleukin-1 (IL-1) c. Interleukin-6 (IL-6) d. Interferon-g

Description : Cytokines which play an important role in the metabolic response to injury include: a. Tumor necrosis factor—a (TNF) b. Interleukin-1 (IL-1) c. Interleukin-6 (IL-6) d. Interferon-g

Last Answer : Answer: a, b, c, d TNF or cachetin is considered the primary mediator of the systemic effects of endotoxin, producing anorexia, fever, tachypnea, and tachycardia at low doses and hypotension, ... infected sells. IFN-g has the ability to upregulate the number of TNF receptors on various cell types

Answer: b Metabolic response to injury results in increased energy expenditure. If energy intake is less than expenditure, oxidation of body fat stores and erosion of lean body mass will occur with resultant loss of weight. When weight loss exceeds 10–15% of body weight, the complications of malnutrition interact with disease processes, with increased morbidity and mortality rates. The goal of nutritional support is maintenance of body cell mass and limitation of weight loss to less than 10% preinjury. The major impact of nutritional support in the trauma patient is to aid host defense. Under-nutrition may compromise the available host defense mechanism and may thus increase the likelihood of invasive sepsis, multiple organ system failure, and death. Resuscitation, oxygenation and arrest

Description : Answer: b Metabolic response to injury results in increased energy expenditure. If energy intake is less than expenditure, oxidation of body fat stores and erosion of lean body mass will occur ... requirements, caloric requirements should be distributed at a ratio of 70% as glucose and 30% as fat

Last Answer : Which of the following statement(s) is/are true concerning body fuel reserves? a. The largest fuel reserve in the body is skeletal muscle b. Fat provides about 9 calories/gram c. Free glucose and glycogen stores are a trivial fuel reserve d. Body protein is a valuable storage form of energy

Which of the following statements about head injury and concomitant hyponatremia are true? A. There are no primary alterations in cardiovascular signs. B. Signs of increased intracranial pressure may be masked by the hyponatremia. C. Oliguric renal failure is an unlikely complication. D. Rapid correction of the hyponatremia may prevent central pontine injury. E. This patient is best treated by restriction of water intake.

Description : Which of the following statements about head injury and concomitant hyponatremia are true? A. There are no primary alterations in cardiovascular signs. B. Signs of increased intracranial pressure may be ... central pontine injury. E. This patient is best treated by restriction of water intake.

Last Answer : Answer: A DISCUSSION: Acute symptomatic hyponatremia is characterized by central nervous system signs of increased intracranial pressure. Changes in blood pressure and pulse are secondary to ... lead to central pontine myelinolysis. Oliguric renal failure may rapidly develop in severe hyponatremia