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Surgery > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

Ehlers Danlos Syndrome commonly presents as

A

Recurrent hernia (inguinal)
Coagulopathy
Platelet abnormality

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2
Q

Defect in collagen formation over half of affected manifesting genetic defects encoding alpha chains of type V

Friable skin
Easy bruisibility
Poor wound healing
Atrophic scar formation
Hyperextensible joints
A

Ehlers Danlos

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3
Q 
Tall stature
Arachnodactyly
Lax ligament
Myopia
Scoliosis
Pectus excavum
Aneurysm of ascending aorta
Hernia
No delay in wound healing despite skin hyperextensibility
A

Marfan

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4
Q

Genetic defect in Marfan

A

Mutation in FBN1 encoding for fibrillin

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5
Q

Investigation of RLQ of abdomen for retraction which is an indication of intussuseption

A

Dance’s sign

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6
Q

Sausage shaped mass in right abdomen

Currant jelly stool

Vomiting

A

Intussuseption

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7
Q

Intussuseption xray finding

A

Coiled spring sign

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8
Q

Most common GI emergency in neonatal period

A

NEC

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9
Q

Most common risk factor in NEC

A

prematurity

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10
Q

Radiographic sign in NEC

A

Pneumatosis intestinalis

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11
Q

Neonatal infection resulting from inadequate care of umbilical cord

Umbilical stump is colonized with bacteria from maternal genital tract and environment

Spreads to abdominal wall or to umbilical or portal vessel liver and peritoneum resulting in sepsis

A

Omphalitis

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12
Q

Most common site of necrotizing enterocolitis

A

proximal colon

distal ileum

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13
Q

Mutation in FBN1 gene cause increased

A

TGFB signalling aortic wall

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14
Q 
Brittle bones
Osteopenia
Low muscle mass
Hernia 
Ligament and joint laxity
A

Osteogenesis imperfecta

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15
Q

OI is a mutation in

A

Type I Collagen

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16
Q

OI is also caused by mutation in the enzyme that cleaves c-terminal proline and hydroxyproline

A

prolidase

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17
Q

AD
Mild bone fragility
Blue sclera

A

OI Type I

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18
Q 
Prenatal lethal
AD
Crumpled long bones
Thin ribs
Dark blue sclera
A

OI Type II

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19
Q

Progressively deforming, multiple fracture
Early loss of ambulation
AD/AR

A

OI Type III

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20
Q

Mild to moderate bone fragility
AD
Normal or gray sclera
Mild short stature

A

OI Type IV

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21
Q

Blistering and ulceration
Impairment in tissue adhesion within epidermis, bm, dermis resulting in tissue separation and blistering with minimal trauma

A

Epidermolysis bullosa

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22
Q

Dystrophic
AR
Epidermolysis bullosa is caused by mutation in this gene important in connecting epidermis to dermis

A

COL7A1

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23
Q

Epidermolysis bullosa types

A

Simplex
Junctional
Dystrophic
Kindler’s

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24
Q

Multiple blisters throughout different layers of skin

A

Kindler’s

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25
Q

AR
In children, inability to absorb sufficient zinc from breast milk or food affecting uptake of zinc in intestine and preventing binding
Mutation in gene SLC39A4

Impaired granulation tissue formation
Cofactor for DNA polymerase
Erythematous pustular dermatitis of extremity and bodily orifice

Dx: low blood zinc level (>100)

A

Acrodermatitis enterohepatica

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26
Q

disease with deficient reduced NADPH dependent oxide enzyme impairing intracellular killing of microorganism

A

Chronic granulomatous disease

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27
Q

Used to dx CGD

A

Nitroblue tetrazolium

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28
Q

Stored and secreted by anterior pituitary and by pools located within macrophage

Reverses antiinflammatort effects of cortisol

A

Macropphage Migration Inhibiting Factor

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29
Q

Promote protein synthesis
Insulin resistance
Enhance mobilization of fat stores

A

GH

IGF-I

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30
Q

Produced by chromaffin cells

Elevated postinjury 24-48 hours before returning to baseline

A

Catecholamines

NE
Epi

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31
Q

Hyperglycemia during critical illness has immunosuppressive effects and thus is associated with an increased risk for infection

A

Insulin

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32
Q

<24 h
Role: Maintenance of blood volume
Catecholamines, cortisol, aldosterone

Dec BMR
Dec O2
VASOCONSTRICTION 
Inc CO
Inc HR
A

Ebb phase

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33
Q

3-10 days (Catabolic)
Role: Maintenance of energy

Inc insulin
10-60 days (Anabolic)
Recovery
Growth hormone, IGF

A

Flow phase

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34
Q

Stress induced hyperglycemia is primarily due to

A

Peripheral resistance to insulin

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35
Q

Reduced resting energy expenditure is characteristic of this phase of surgical metabolism

A

Ebb phase

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36
Q

SIRS Criteria

A

2 or more of the following
Temp >/= 38.0 100.4 or = 36.0 96.8
HR >90
RR > 20
PaCO2 <32 mmHg or mechanical ventilation
WBC >/= 12,000 or = 4,000 or >10% band forms

37
Q

Sepsis

A

Source of infection + SIRS

38
Q

Severe sepsis

A

Sepsis + Organ dysfunction

39
Q

Septic shock

A

Sepsis + Cardiovascular collapse (requiring vasopressor support)

40
Q

Induces cachexia and muscle breakdown

A

TNF a

cachectin

41
Q

Promotes lymphocyte proliferation, immunoglobulin production

A

IL 2

42
Q

Induces fever

A

IL 1

43
Q

Primary source of energy during stress state

A

fat 50-80% TAG lipase

44
Q

Cornerstone of management of sepsis

A

Fluid resuscitation

45
Q

Vasopressor first line for sepsis

A

NE

46
Q

qSOFA criteria

A

2 or more
SBP <100 mmHg
RR >20/min
Glasgow coma scale <14

> 1 sepsis mortality 10%

47
Q

Vasodilation in sepsis

A

NO

48
Q

Elicited by all immunologic cells as mediator or acute phase response

A

IL 6

49
Q

Chemoattractant

A

IL 8

50
Q

Activates macrophage

A

IFN gamma

51
Q

Two principle neuroendocrine pathways that orchestrate host response

A

HPA axis - glucocorticoids

Sympathetic Nervous System - catecholamines

52
Q

Marker of cytokine storm in COVID

A

Ferritin

53
Q

Characteristic early acid base picture of sepsis

A

Respiratory alkalosis

Hyperventilation
Tachypnea
Blow off CO2 hypocarbia
R alkalosis

54
Q

Acid base picture of late sepsis

A

Metabolic acidosis

55
Q

Cytokines capable of increasing cortisol release

A

IL 2

IFN gamma

56
Q

What factors contribute to release of ACTH

A 
Pain
Anxiety
Vasopresson
Angiotensin II
Cholecysetokinin
Vasoactive intestinal peptide
Catecholamine
57
Q

Natural ligand for GH-secretagogue receptor 1a (GHS-R1a)

Appetite stimulant that is secreted by the stomach

Play a role in promoting GH secretion and in glucose homeostasis, lipid metabolism, and immune function

A

Ghrelin

58
Q

Gives rise to Dehydroepiandrosterone

Androstenedione

Testosterone

Estradiol

A

17 alpha OH pregnenolone

59
Q

Pregenolone gives rise to

A

Progesterone

60
Q

Precursor of estradiol

A

Testosterone

61
Q

Enzyme that converts testosterone to estradiol

A

Aromatase

62
Q

3 aromatase inhibitors

A

Anastrazole - strongest
Letrozole
Exemestane

63
Q

Aromatase inhibitors in pregnancy cause

A

Virilization

Ambiguous genitalia

64
Q

Competitive inhibitor of aromatase enzyme

A

Vorozolew

65
Q

Most common cause of adrenal insufficiency

atrophic adrenal glands

A

Endogenous steroid

66
Q

Positive predictor of ICU survival in septic patients

A

High ghrelin

67
Q

Hormone opposite of ghrelin

A

Leptin

68
Q

Hyperglycemia from decreased insulin release is from stimulation of

A

a adrenergic receptors

69
Q

What vasodilator will affect insulin secretion/ inhibits by opening K channels of beta cells

Tx for islet cell tumor, insulinoma

A

Diazoxide

70
Q

Phase I wound healing

A

Hemostasis and inflammation

71
Q

Phase II wound healing

A

Proliferation

72
Q

Phase III wound healing

A

Maturation and remodelling

73
Q

Second population of inflammatory cells that invade the wound

Remain present until the wound healing is complete

Debridement and microbial stasis

A

Macrophage

74
Q

Major cell responsible for contraction of wound

A

Myofibroblast

75
Q

Produced from
Healing wound
Granuloma
Reticular fibers

A

Type III collagen

76
Q

Peaks about 1 week post injury

Serves as bridge

A

T lymphocytes

77
Q

Connects inflammatory to proliferative phase

A

T lymphocyte

78
Q

Debridement and microbial stasis

First infiltrating cell to enter wound site

A

PMN

79
Q

Tissue continuity is re-established

Involves arrival of fibroblast and endothelial cells

A

Proliferation

80
Q

Reorganization of previously synthesized collagen

A

Maturation and remodelling

81
Q

3 matrix formed during maturation

A

Type III collagen early matrix
Proteoglycan
Type I collagen final matrix

82
Q

Stimulate epithelialization of wound that was affected by steroid delayed healing

A

Vit A

83
Q

Ulcer seen in chronic non-healing wound

Precursor to SCC

A

Marjolin’s ulcer

84
Q

Dilute sodium chloride used in contaminated wounds

A

Dakin’s solution

85
Q

Amino acid that is most active in terms of wound fibroplasia

A

Arginine

86
Q

Epithelialization of a sutured wound

A

24-48 hours

87
Q

Carries highest SSSI rate

A

Colorectal surgery

88
Q

Stage IV bed sore
Plan to do a flap

Where will you get the flap?

A

Gluteus max flap

Surgery (17 decks)

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