BURNS, WOUND HEALING AND WOUND CARE

Question 1

1.PMNs are the first infiltrating cells to enter the wound site
a. True
b. False

Answer 1

A] TRUE. Polymorphnuclear (PMN) Leukocytes are the first infiltrating cells to enter the wound sites and peaking at about 24-48 hours then increase vascular permeability and local prostaglandin release as well as the presence of your chemotactic substances which will all stimulate neutrophil migration

Question 2

2. Which is the initial matrix in healing wounds?
   a. Glycosaminoglycan
   b. Proteoglycans
   c. Collage Type III
   d. Collagen Type I

Answer 2

[C] COLLAGE TYPE III. The principal function of collagen is to act as a scaffold in connective tissues, mostly in its Type I, II and III forms. In early healing wounds, TYPE III is laid down first, with the proportion of type I increasing as scar formation progresses and is remodeled

Question 3

3. Once a biofilm colony forms, it will continuously shed bacteria to uncolonized areas
   a. True
   b. False

Answer 3

[A] TRUE. The presence of biofilms protects bacteria from host defenses. So, once a biofilm colony forms, it will continuously shed bacteria to colonized areas, causing more biofilm colonies to form. Thus, presume its function.

Question 4

4. Components in myofibroblasts responsible for contraction
   a. cytoskeletal structure
   b. stress fibers
   c. smooth muscle myosin
   d. aandbonly
   e. all of the above

Answer 4

[E] ALL OF THE ABOVE. Normal fibroblasts in possesses a cytoskeletal structure, typically the cells contain alpha-smooth muscle actin in the thick bundles called the stress fibers which give myofibroblasts contractile capability. So, the a-smooth muscle actin is undetectable until 6th day.

Question 5

5. Ischemia is the greatest contributor to diabetic foot ulcer formation
   a. True
   b. False

Answer 5

[B] FALSE. Major contributors are neuropathy (60-70%), ischemia (15-20%) and a combination of both (15-20%).

Question 6

6. As scar matures, the content proteoglycans gradually increases
   a. True
   b. False

Answer 6

[B] FALSE. As scar matures, the content proteoglycans gradually decreases.

Question 7

7. Which kind of skin graft is taken from a nonidentical donor or cadaver?
   a. autograft
   b. heterograft
   c. xenogeneic graft
   d. allograft

Answer 7

[D] ALLOGRAFT. Allogeneic grafts (allografts, homografts) are transplants from one individual to another of the same species not identical to the donor. May it be from a cadaver.

Question 8

8. Which is false about epithelialization?
   a. Final step is establishing tissue integrity
   b. The process begins within day 3 of injury
   c. It is characterized by proliferation and migration of
   epithelial cells adjacent to the wound
   d. Cell movement is in a leapfrog fashion
   e. none of the above

Answer 8

[B] THE PROCESS BEGINS WITHIN DAY 3 OF INJURY. It usually begins within 1 day of injury and is seen as thickening of the epidermis at the wound edge.

Question 9

9. Which chronic wound presents with dryness of skin, shallow ulcer with a pale base?
   a. arterial ulces
   b. venous ulcer
   c. pressure ulcer
   d. diabetic ulcer

Answer 9

[A] ARTERIAL ULCER. These wounds are commonly present at the most distal portions of the extremities such as the interdigital clefts, although more proximal locations are also encountered. It shows dryness of skin, hair loss, scaling and pallor. It is mostly shallow with smooth margins, with a pale base and surrounding skin.

Question 10

10. Which is not part of an effective therapy to combat biofilm?
    a. effective removal of biofilm
    b. unimodal therapy
    c. antimicrobial eradication of bacteria
    d. prevention of biofilm recurrence

Answer 10

[B] UNIMODAL THERAPY. To achieve effective therapy to combat biofilm, it may need repetition to multiple times.

Question 11

1.Burn dressing that confers autolytic debridement
a. Hydrocolloid Dressings
b. Silver Sulfadiazine
c. Silver Nitrate
d. Mafenide Acetate

Answer 11

A] HYDROCOLLOID DRESSINGS. Duoderm/Hydrocolloid Dressings are wafer type of dressing with gel-forming agents, water resistant outer layer, adherent. That provides a moist healing environment and can promote fibrinolysis, angiogenesis and wound healing without softening or breaking down the tissue. It enables autolytic debridement and insulation

Question 12

2. The following are important prognostic factors for burn mortality and morbidity, except;
   a. age
   b. % TBSA
   c. weight
   d. inhalational injury
   e. NOTA

Answer 12

[C] WEIGHT. Revised Baux Score which accounts for age, burn size and inhalation injury has been found independently associated with mortality and morbidity

Question 13

4. 3. A burn patient was treated with Mafenide acetate. What possible side effect should we watch out for?
      a. Methemoglobinemia
      b. Metabolic acidosis
      c. Electrolyte Extravasation
      d. Metabolic Alkalosis

Answer 13

[B] METABOLIC ACIDOSIS. Mafenide Acetate is a topical antimicrobial effective even in the presence of escar. It is absorbed systematically and major side effect is known to be metabolic acidosis since it is from carbonic anhydrase inhibition.

Question 14

4. Formula for calculating total caloric needs in adult burn patients that takes into consideration more factors and is thus more preferred in the ICU setting
   a. Schofield equation
   b. Harris-Benedict equation c. Curreri Formula
   d. Toronto Formula

Answer 14

D] TORONTO FORMULA. Curreri’s Formula may overestimate caloric requirements thus resulting to overfeeding to some patients. So, Toronto Formula is said to be more appropriate since titrating caloric needs will be possible avoiding overfeeding to ICU patients.

Question 15

5. The following compromise treatment for inhalational injury except:
   a. Pulmonary Toilet
   b. Bronchoconstrictors
   c. N-acetyl cysteine
   d. Heparin

Answer 15

[B] BRONCHOCONSTRICTORS. Nebulized bronchodilators such as albuterol can be used as primary supportive in treating inhalational injuries.

Question 16

6. A 9-year-old is brought to the emergency room after accidentally touching a hot iron with his forearm. On examination, the burned areas have light pinkish skin and is slightly anesthetic. What is the burn depth?
   a. First degree
   b. Third degree
   c. Fourth degree
   d. Second degree (superficial partial)
   e. Second degree (deep partial)

Answer 16

[E] SECOND DEGREE (DEEP PARTIAL). Deep partial thickness burn is white to pale pink; moist to dry to waxy, slightly anesthetic which are less painful and will heal 3-5 weeks resulting in hypertrophic scarring and potential contractures.

Question 17

7. Colloids must be initiated for massive burns as early as the first 8 hours’ post-burn
   a. True
   b. False

Answer 17

[B] FALSE. For massive burns, colloid infusion can be started as early as 12 hours’ post-burn. It is to decrease total fluid replacements and lessen edema.

Question 18

8. A 40-year-old flame burn patient is received at the ER approximately 2 hours post injury. He is estimated to weigh around 65 kgs. Upon examination, he is noted to have partial and full thickness burns involving the half of the Left upper extremity, 1⁄3 of the anterior chest and entire Left lower extremity. How will you resuscitate this patient?
   a. 7.4 L in six hours, 7.4 L in the next 16 hours
   b. 3.7 L in six hours, 3.7 L in the next 16 hours
   c. 6.3 L in eight hours, 6.3 L in the next 16 hours
   d. 3.8 L in eight hours, 3.8 L in the next 16 hours
   e. 2.9 L in six hours, 2.9 L in the next 16 hours
   f. none of the above

Answer 18

B] 3.7 L IN SIX HOURS, 3.7 L IN THE NEXT 16 HOURS
1/2 L upper extremity - 4.5%
1/3 of anterior chest - 6%
entire L lower extremity - 18%
TOTAL %BSA - 28.5%

• 4ml x 65 kg (wt) x 28.5 (%BSA) = 7410 / 24 hours
• 1st half first 6hours = 3705 / 6 hours or 618cc / hr
• 2nd half next 16 hours = 3705 / 16 hours or 232cc / hr
  6 hours because it was consulted 2 hours post injury.

Question 19

9. Tangential excision is less bloody than fascial excision but
   with greater cosmetic defect
   a. True
   b. False

Answer 19

[B] FALSE. Fascial excision is less bloody than Tangential excision but with greater cosmetic defect.

Question 20

10. Most common cause of mortality in the first 48 hours is inadequate fluid resuscitation
    a. True
    b. False

Answer 20

[A] TRUE.

Question 21

11. Early excision for burns is defined as within 2 weeks or 14 days’ post-burn.
    a. True
    b. False

Answer 21

[B] FALSE. – 7 days.

Question 22

WOUND CARE(PICS)

Question 23

________is a bad bruise. It happens when an injury causes blood to collect and pool under the skin. The pooling blood gives the skin a spongy, rubbery, lumpy feel. A hematoma usually is not a cause for concern. It is not the same thing as a blood clot in a vein, and it does not cause blood clots.

Answer 23

HEMATOMA

Question 24

known as a skin tear, it is a deep break to the skin, tearing it away from the underlying tissue.

Answer 24

AVULSION

Question 25

This is a 43, Male who consulted for chronic right leg wound with some peri wound cellulitis, moderate discharge. What is the BEST dressing for this type of wound?

a. Film
b. Hydrogels
c. Foams
d. Hydrocolloids
e. Alginates
f. Composite Dressings

Answer 25

[F] COMPOSITE DRESSINGS. These are wound covers that combine physically distinct components into a single product to provide multiple functions such as a bacterial barrier, absorption and adhesion. Usually, they are composed of multiple layers and incorporate semi or non-adherent pad that covers the wound.

Question 26

bruise also called a _____ happens when a part of the body is injured and blood from the damaged capillaries (small blood vessels) leaks out. With no place to go, the blood gets trapped under the skin forming a red or purplish mark that’s tender when touched.

Answer 26

CONTUSION

Question 27

This a 27, Male presenting with a superficial leg laceration from a broken glass piece. What dressing will you use for this type of wound?

a. Film
b. Hydrogels
c. Foams
d. Hydrocolloids
e. Alginates
f. Composite Dressings

Answer 27

[A] FILM. Film dressings provide a simple and effective method of creating a moist wound environment and promoting healing in shallow wounds. They are indicated for the management of minor burns and simple wounds and their flexibility also means that they can be used to cover sutures following surgery.

Question 28

This is a 65, Male presenting with a chronic leg ulcer with epithelizing edges, no signs of infection but with moderate, occasional heavy amount of exudates. What is the BEST dressing for this type of wound?

a. Film
b. Hydrogels
c. Foams
d. Hydrocolloids
e. Alginates
f. Composite Dressings

Answer 28

C] FOAMS. There are comfortable and highly efficient at absorbing large amounts of wound exudate while maintaining a moist wound environment. Generally, foam dressings are meant for partial and/or full thickness burn wounds.

Question 29

7. This is a 35, Female presenting with a superficial partial thickness scald burn (hot water) on her right forearm. What is the BEST dressing for this type of wound?

a. Film
b. Hydrogels
c. Foams
d. Hydrocolloids
e. Alginates
f. Composite Dressings

Answer 29

[D] HYDROCOLLOIDS. There are occlusive, waterproof dressings that are generally indicated for superficial wounds with low amounts of drainage.

Question 30

8. This is a 58, Female diabetic patient, came in with an eschar on her right sole, no signs of cellulitis noted. What is the BEST dressing for this type of wound?

a. Film
b. Hydrogels
c. Foams
d. Hydrocolloids
e. Alginates
f. Composite Dressings

Answer 30

[B] HYDROGELS. Unlike hydrocolloids, hydrogels are recommended for wounds that range from dry to mildly exudating wounds and can be used to degrade slough on the wound surface. Hydrogel have a marked cooling and soothing effect on the skin, which is valuable in burns and painful wounds.

Question 31

9. This is a 71, Male bedridden patient, presenting with a Grade 4 sacral ulcer. What is the BEST dressing for this type of wound?

a. Film
b. Hydrogels
c. Foams
d. Hydrocolloids
e. Alginates
f. Composite Dressings

Answer 31

[E] ALGINATES. Alginate dressings can absorb wound fluid in the dry form and gel forms. They minimize bacterial infections.

Question 32

_____ or cut refers to a skin wound. Unlike an abrasion, none of the skin is missing. A cut is typically thought of as a wound caused by a sharp object, like a shard of glass. Lacerations tend to be caused by blunt traumas.

Answer 32

LACERATION