Basic Principles

Question 1

Phase I

Answer 1

Hemostasis and inflammation

Question 2

First infiltrating cell to enter wound

Answer 2

PMN

Question 3

2nd pop of inflammatory cell that invade wound

Present until healing is complete

Answer 3

Macrophage

Question 4

Peaks about 1w post injury

Serves as bridge from phase 1 to 2

Answer 4

T lymphocyte

Question 5

Debridement and microbial stasis

Answer 5

PMN

Mac

Question 6

Directs which cells to activate

Answer 6

Mac

Cytokine and growth factors

Question 7

Phase II

Arrival of fibroblast and endothelial cell

Answer 7

Proliferation

Question 8

Last cell to infiltrate the wound

Answer 8

By PDGF

Fibroblast and endothelial cell

Question 9

Reorganization of previously synthesized collagen

Answer 9

Remodelling or maturation

Question 10

3 matrix formed

Answer 10

Type III collagen early
Proteoglycan
Type I final

Question 11

Most abundant protein in body

Answer 11

Collagen

Question 12

Phase III

Answer 12

Maturation and Remodelling

Question 13

Scar

Answer 13

Mature avascular

Only 80% of original strength of skin after 3 phases

Question 14

Suturing

Answer 14

Primary intention

Question 15

Granulate heal on its own dirty

Answer 15

Secondary intention

Question 16

Treat infection then suture

Answer 16

Tertiary

Question 17

Class I contamination

Answer 17

Clean

Hemorrhoid
Hernia
Breast
Respi GI Genito not violated

Question 18

Class II

Answer 18

Clean contaminated
Elective colon resection
So bowel prep was done

Question 19

Class III

Answer 19

Contaminated

GSW colon

Question 20

Class IV

Answer 20

Dirty
Firecracker
Fournier’s

Question 21

Factors affecting wound healing (6)

Answer 21

Advanced age
Hypoxia, anemia, hypoperfusion
Steroid and chemotherapeutic drug
Metabolic Disorder
Nutrition
Infection

Question 22

Major cell resp for wound contraction

Answer 22

Myofibroblast

Question 23

Stimulates epithelialization of wound affected by steroid

Answer 23

Vit A

Question 24

AA most active in terms of wound fibroplasia

Answer 24

Arginine

Question 25

deficiency leads to failure of collagen synthesis and cross linking

Answer 25

Vit C

Question 26

Stays within confines of original wound

Answer 26

Hypertrophic

Question 27

Extend beyond border of orig wound

Answer 27

Keloid

Question 28

Wounds that have not healed more than 3 mos

Answer 28

Chronic wounds

Question 29

Stage I PU

Answer 29

Erythema of intact skin

Question 30

Stage II PU

Answer 30

Partial thickness skin loss

Question 31

Stage III PU

Answer 31

Full thickness skin loss

Question 32

Stage IV PU

Answer 32

muscle and bone

Question 33

TBW

Answer 33

60%

Question 34

Intracellular

Answer 34

40%

Question 35

Extracellular

Answer 35

20%

Question 36

Pressure needed to prevent osmosis

Answer 36

Osmotic pressure

Question 37

Most common fluid disorder in surgical px

Answer 37

ECF volume deficit

Most common cause is GI loss

Question 38

Inadequate delivery of o2 and nutrients to maintain normal tissue and cellular function

Answer 38

Shock

Question 39

Most common type of shock in surg pxs

Answer 39

Hypovolemic shock

Presumed hemorrhagic until proven otherwise in trauma and post op

Question 40

Bedside indicator to assess px in early hypovolemic shock

Answer 40

heart rate

Question 41

Apparent clinical shock results from at least

Answer 41

25-30% loss of blood volume

Question 42

Most common internal hemorrhagic shock

Answer 42

Peritoneal

Question 43

Failure of heart as pump

Answer 43

Cardiogenic shock

Mc MI

Question 44

Confirmation of cardiogenic shock

Answer 44

ECG 2D ECHO

Question 45

Failure of vascular smooth muscle to constrict appropriately

Answer 45

septic

Question 46

Loss of vasomotor tone from peripheral bed
Secondary to SCI
Epidural hematoma by impingement on SC

Answer 46

Neurogenic shock

Question 47

Mechanical obstruction

Answer 47

Obstructive

Question 48

Combined and systemic effects of mediators

Answer 48

Traumatic