Wound Healing

Question 1

Wound healing occurs in non-overlapping phases: Inflammatory
Proliferative
Remodeling

Answer 1

F
Overlapping. Phase order is correct.
sometimes haemostasis added as the first stage to make 4 stages

Question 2

The depth of the wound determines the degree of contraction and the source of keratinocytes used for re-epithelialisation.

Answer 2

T

Question 3

Sharp wounds created by scalpels heal faster than wounds created by destructive or ablative methods.

Answer 3

T

Question 4

Platelets are the first cell to appear in the healing process.

Answer 4

T

Question 5

Macrophages are the most important cell in the healing process.

Answer 5

T

Question 6

Older patients tend to heal faster.

Answer 6

F
Slower.
Patient age is a critical factor in wound healing

Question 7

Older patients’ wounds tend to have less tensile strength which correlates with reduced amounts of collagen and a worse cosmetic outcome.

Answer 7

F

Better cosmetic outcome. Everything else is true.

Question 8

An erosion is defined as a wound that involves structures deep to the dermis.

Answer 8

F

This is true for an ulcer. Erosion = wound with only epidermal loss.

Question 9

A partial-thickness wound is an ulcer that involves the epidermis and varying parts of the dermis.

Answer 9

T

Question 10

A full-thickness wound is one that involves all of the dermis and deeper structures.

Answer 10

T

Question 11

In partial-thickness wounds, skin appendages remain and serve as reservoirs of epithelial cells to repopulate the epidermis.

Answer 11

T

Question 12

Partial-thickness wounds heal to some extent by contraction, while there is minimal contraction in full-thickness wounds.

Answer 12

F

Other way around.

Question 13

Second intention healing refers to the process by which an acute wound heals on its own.

Answer 13

T

Occurs primarily by contraction of myofibroblasts.

Question 14

Primary intention healing occurs when a surgeon directs closure of the wound by approximating the wound edges.

Answer 14

T

Question 15

The method by which a wound was created does not tend to influence its healing.

Answer 15

F Wounds created by sharp steel (eg. surgery) heal faster than others.

Question 16

The process of wound haemostasis can be divided into two parts – development of a fibrin clot and coagulation.

Answer 16

T

Question 17

Almost immediately after injury, polymorphonuclear leukocytes begin to adhere to the sticky endothelium of venules.

Answer 17

T

Question 18

The term margination refers to the process by which the entire endothelial margin of the venules may be covered with neutrophils.

Answer 18

T

Question 19

In the early inflammatory state, macrophages predominate at the site of injury.

Answer 19

F

Neutrophils and monocytes. Macrophages later.

Question 20

As inflammation persists the number of neutrophils increases although macrophages predominate

Answer 20

F

Neutrophils decrease

Question 21

The presence of wound contamination prolongs the neutrophilic presence within the wound.

Answer 21

T

Question 22

Neutrophils release elastase and collagenase

Answer 22

T

Question 23

Macrophages phagocytise, digest and kill pathogenic organisms, scavenge tissue debris and destroy remaining neutrophils

Answer 23

T

Question 24

Macrophages tolerate severe hypoxia well.

Answer 24

T

Question 25

The presence of macrophages may act to reduce collagen deposition

Answer 25

F | May enhance it

Question 26

Macrophages are essential for production of growth factors – they synthesize and secrete PDGF, fibroblast growth factor, vascular endothelial growth factor, TGF beta and TGF alpha

Answer 26

T

Question 27

Mast calls help regular haemostasis by releasing substances such as platelet activiating factor, heparin, tryptase, chymase and t-plasminogen activator

Answer 27

T

Question 28

The proliferation phase of wound healing involves re-epithelialisation (the creation of a permeability barrier), angiogenesis (the establishment of an appropriate blood supply) and fibroplasia (the reinforcement of injured tissue).

Answer 28

T

Question 29

Keratinocyte migration is a late event in wound re-epithelialisation.

Answer 29

F | Early event, starts within 24hrs

Question 30

Keratinocytes use their surface integrin receptors to interact with fibronectin from the fibronectin-rich provisional matrix for their migration

Answer 30

T

Question 31

Migrating keratinocytes procude matrix metalloproteinases (MMPs) that act to degrade damaged matrix

Answer 31

T

Question 32

While epidermal cells are migrating, their proliferative potential remains intact.

Answer 32

F | Proliferative potential is inhibited.

Question 33

Within 3-5 days of the reformation of the epidermis the BMZ returns to normal

Answer 33

F | 7-9days

Question 34

Collagen IV is the most abundant collagen in the BMZ.

Answer 34

T

Question 35

Collagen V proteins, also called anchoring fibrils span from the lamina densa to the upper papillaru dermis where that form a structure known as anchoring plaque

Answer 35

F | Collagen VII

Question 36

Laminins are the major collagenous extracellular matrix components

Answer 36

F | Non-collagenous

Question 37

All laminins are large heterotrimeric glycoproteins with the component chains together forming a symmetric cross-shaped structure

Answer 37

F | Asymmetrical

Question 38

Deficiency in the alpha chain of laminin-332 is associated with the blistering disease, junctional epidermolysis bullosa

Answer 38

F | Any chain can have a deficiency

Question 39

Laminin-511 has been located within the lamina densa and shows strong effects promoting human keratinocyte attachment

Answer 39

T

Question 40

At approximately day 4 fibroblasts start to migrate into the provisional matrix of the wound clot where they lay down collagen-rick matrix

Answer 40

T | fibroblasts in the wound edges begin to proliferate early after injury but donet migrate until day 4

Question 41

Granulation tissue begins to form within 5-7 days of injury.

Answer 41

F | 3-4 days

Question 42

Granulation tissue consists of new vessels that migrate into the wound as well as the accumulation of fibroblasts and ground substances.

Answer 42

T

Question 43

The fibronectin matrix provides a scaffold for collagen fibrils and mediates wound contraction.

Answer 43

T

Question 44

Integrin receptors are involved only in the proliferative phase of wound repair.

Answer 44

F | Involved in all stages.

Question 45

For full-thickness wounds, contraction begins soon after wounding and peaks at 2 weeks.

Answer 45

T

Question 46

Partial-thickness wound contact less than full-thickness wounds and in direct proportion to their depth.

Answer 46

T

Question 47

Myofibroblasts within the wound align themselves along the lines of contraction.

Answer 47

T

Question 48

Angiogenesis refers to new vessel growth or neovascularisation by sprouting of pre-existing blood vessels.

Answer 48

T

Question 49

The remodelling phase of wound repair consists of the deposition of matrix materials and their subsequent change over time.

Answer 49

T

Question 50

The total amount of collagen increases early in repair, reaching a maximum between 1-2 weeks after injury.

Answer 50

F | 2-3 weeks.

Question 51

Tensile strength will be 40% of strength prior to injury at 1 month

Answer 51

T

Question 52

The tensile strength of a healed wound will gradually return to 100% of its pre-injury strength, although this process may take up to 1 year.

Answer 52

F | Never greater than 80% of its pre-injury strength.

Question 53

Type II collagen is the major collagen synthesised by fibroblasts in granulation tissue.

Answer 53

F | Type III collagen.

Question 54

Over the period of 1 year or more, the dermis returns to the stable pre-injury phenotype, consisting largely of type I collagen.

Answer 54

T

Question 55

Hyaluronic acid is found in the highest amounts in the first 7-10 days of wound healing.

Answer 55

F | 4-5days.

Question 56

Hyaluronic acid serves as a stimulus for fibroblast proliferation and migration, and can absorb large amounts of water producing tissue oedema.

Answer 56

T

Question 57

Proteoglycans are non-sulfated glycosaminoglycans.

Answer 57

F | Sulfated. Hyalyronic acid is non-sulfated.

Question 58

Type III collagen is gradually replaced by type I collagen with ageing.

Answer 58

T

Question 59

Penicillin can impair wound strength.

Answer 59

T

Question 60

The use of occlusive dressings on acute wounds speeds healing and improves cosmesis but is NOT effective over primarily closed wounds

Answer 60

F | Is also true for primarily closed wounds

Question 61

Inflammation lasting longer than 2 weeks is chronic

Answer 61

T | Longer than the usual 2 and usually many weeks or months

Question 62

chronic inflammation occurs when a wound contains foreign bodies, necrotic tissure or is contaminated with pathogens

Answer 62

T

Question 63

chronic inflammation contains many granulocytes and mononuclear cells

Answer 63

F characterised by absence of granulocytes but persistence of mononuclear cells, specifically lymphocytes, monocytes, and macrophages and later granulomaotus inflammation predominates

Question 64

The presence of bacterial products in the wound directly impairs healing

Answer 64

T | keratinocyte migration in chronic wounds may be directly inhibited by bacterial lipopolysaccharide

Question 65

Formation of the basement membrane zone (BMZ) is not essential for re-establishing the integrity and function of the skin

Answer 65

F | is essential

Question 66

Full thickness grafts inhibit wound contraction

Answer 66

T | much less contraction with FTSG than there is with flaps, SSG or secondary intention healing

Question 67

systemic steroids suppress wound healing

Answer 67

T presence of systemic steroids in the first 3 days post-wounding blocks the initial inflammatory process. causes longer healing time

Question 68

wound healing suppression caused by corticosteroids has been shown to be ameliorated with administration of local and systemic vitamin A, and a single injection of TGF-β

Answer 68

T

Question 69

malnutrition, protein deprivation, and deficiencies of Zinc, vitamin A and vitamin C, medications such as corticosteroids, penicillamine, nicotine, NSAIDs, and antineoplastic agents can all interfere with wound healing

Answer 69

T Also Chronic debilitating illness, endocrine disorders, systemic vascular disorders, and connective tissue disease and old age

Question 70

Ascorbic acid (vitamin C) is a cofactor for the collagen cross-linking.

Answer 70

T

Question 71

wounds covered with an occlusive dressing healed up to 20% faster than those left exposed to air

Answer 71

F 40% faster May be by enhancement of keratinocyte migration with maintenance of a moist environment, prevention of infection, establishment of an electromagnetic current, or containment of wound fluid and the growth factors present within the wound bed

Question 72

misuse of occlusive dressings can lead to the prolongation of healing

Answer 72

T | early removal or not removing gently can strip away newly fromed epithelium