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ABS2 Flashcards

1
Q

First cells to infiltrate the wound

A

PMNs
*Peaks at 24-48 hours post-injury

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2
Q

Cells that bridges transition from inflammation to proliferative phase

A

Lymphocytes (T cells)

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3
Q

Cells that peaks at 48 – 96 hours post-injury

A

Macrophages

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4
Q

Open cardiac massage is considered as what operative wound class

A

Class III

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5
Q

Final step in establishing tissue integrity

A

Epithelialization

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6
Q

The peak of fibroblasts in a healing wound occurs

A

6 days after injury

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7
Q

Macrophages are present in the wound starting on the 4th day after injury until the wound is completely healed. The primary function of the macrophages in wound healing is

A

Activation of cell proliferation, matrix synthesis, and angiogenesis

*Activation and recruitment of other cells via mediators such as cytokines and growth factors, as well as directly by cell-cell interaction and intercellular adhesion molecules
*Modulation of the wound environment = T lymphocytes in the wound

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8
Q

There are 18 types of collagen in the human body. Which two are the most important in wound healing

A

Type I and III

*Type I – the major component of extracellular matrix in skin
*Type III – normally present in the skin, becomes more prominent and important during the repair process

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9
Q

The tensile strength of a completely healed wound approaches the strength of uninjured tissue

A

NEVER

*The mechanical strength of the scar never achieves that of the uninjured tissue
*Scar remodelling – continues for 6 to 12 months postinjury

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10
Q

How long does re-epithelialization (i.e., complete repair of the external barrier) take in a well-approximated surgical wound

A

2 days (48 hours)

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11
Q

What protein is defective in patients with Marfan’s syndrome

A

Fibrillin

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12
Q

What protein is defective in patients with osteogenesis imperfecta (OI)

A

Collagen type I

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13
Q

What component of wound healing is impaired in a child with acrodermatitis enteropathica (AE)

A

Formation of granulation tissue

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14
Q

Most well-known element in wound healing

A

Zinc

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15
Q

Important cytokine mediator of wound healing

A

TGF β – primarily by mediating angiogenesis

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16
Q

The most common mode of inheritance of Ehlers-Danlos Syndrome is

A

Autosomal dominant

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17
Q

Layer of the intestine has the greatest tensile strength (i.e., ability to hold sutures)

A

Submucosa

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18
Q

Leaks from a bowel anastomosis most commonly occur 5 to 7 days after surgery. The reason is

A

Increased collagenolysis

*Lysis of collagen is carried out by collagenase derived from neutrophils, macrophages, and intraluminal bacteria
*During the first 3 to 5 days collagen breakdown far exceeds collagen synthesis
*Collagenase activity – not as significant role in cutaneous wounds

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19
Q

Ehlers-Danlos Syndrome (EDS) must be considered in every child with recurrent hernias and coagulopathy, especially when accompanied by

A

Platelet abnormalities and low coagulation factor levels
*Elevated PT/PTT

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20
Q

A patient with epidermolysis bullosa (EB) requires placement of a feeding gastrostomy due to esophageal erosions. What kind of dressing should be placed after surgery

A

Nonadhesive pad with circumferential bulky dressing
*To avoid blistering

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21
Q

Which phase of healing is most affected by exogenous corticosteroids

A

Initial phase of cell migration and angiogenesis

*Major effect of steroids – to inhibit the INFLAMMATORY PHASE of wound healing (angiogenesis, neutrophil and macrophage migration, and fibroblast proliferation) and release of lysosomal enzymes
*Steroid used after the first 3 to 4 days postinjury do not affect wound healing
*Effect on collagen synthesis – steroid also inhibit epithelialization and contraction and contribute to increased rates of wound infection, regardless of the time of administration

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22
Q

What vitamin should be given to promote wound healing in patients receiving steroids

A

Vitamin A
*Collagen synthesis of steroid-treated wounds can be stimulated by vitamin A

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23
Q

How long does protein calorie malnutrition need to be present in patients in order to affect wound healing

A

Days

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24
Q

A homeless, malnourished 48-year-old patient is admitted to the ICU after a severe blunt injury. A reasonable daily dose of vitamin C for this patient would be

A

≥ 1 g or as high as 2 g daily

*In severely injured or extensively burned patients = As high as 2 g daily
*Recommended dietary allowance = 60 mg daily

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25
Q

In severely injured patient, supplemental doses of VITAMIN A have been recommended ranging from

A

25,000 to 100,000 IU per day

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26
Q

The ideal time to administer prophylactic antibiotics to a patient undergoing a colon resection is

A

1 hour before surgery

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27
Q

A 28-year-old patient with chronic granulomatous disease is scheduled for cystoscopy under general anesthesia. What test should be obtained pre-operatively

A

Pulmonary function test

*Patients with CGD are predisposed to obstructive and restrictive lung disease
*Sutures should be removed as late as possible because wounds heal slowly
*Abscess drains should be left in place for a prolonged period until the infection in completely resolved
* Wound complications, mainly infection, are common

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28
Q

What should be performed in a patient with a suspected Marjolin ulcer

A

Biopsy

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29
Q

Considered the most effective therapy for venous stasis ulcers

A

Compression therapy
*Most commonly used method – the rigid, zinc oxide-impregnated, nonelastic bandage

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30
Q

Most likely to cause a diabetic ulcer

A

Neuropathy (60 to 70%)

*Duet to ischemia – 15 to 20%
*Motor neuropathy or Charcot foot – leads to collapse or dislocation of the interphalangeal or metatarsophalangeal joints, causing pressure on areas with little protection

31
Q

A teenage, African American girl presents with large keloids on both ear lobes 12 months following ear piercing. What therapy should be added to surgical debulking of the lesion

A

Intralesional corticosteroids

32
Q

The risk of small bowel obstruction in the first 10 years after left colectomy is

A

30%

33
Q

Intra-abdominal adhesions can be decreased after laparotomy by

A

Frequent irrigation to keep bowel surfaces moist

34
Q

A healthy 20-year-old presents to the emergency room with a large, contaminated laceration that he received during a touch football game. What solution should be used to irrigate the wound

A

Normal saline

*What suture should be used to close the subcutaneous layer = Absorbable braided
*Subcutaneous tissues should be closed with braided absorbable suture, with care to avoid placement of suture in fat

35
Q

Most suitable suture for approximating deep fascial layers, particularly in the abdominal wall

A

Nonabsorbable or slowly absorbing monofilament suture
*Drains may be placed in areas at risk of forming fluid collections

36
Q

An alginate dressing is best used in

A

An open surgical wound

*Used in:
 Skin loss
 Open surgical wounds with medium exudation
 Full-thickness chronic wounds

37
Q

What topical agent has been shown to improve healing in diabetic foot ulcers

A

Platelet derived growth factor BB (PDGF-BB)

38
Q

First vasopressor to be administered

A

Norepinephrine

39
Q

Preoperative dose timing for vancomycin administration is within before incision

A

120 minutes

40
Q

qSOFA parameters

A
  • RR >22/min (1point)
  • Altered mental status (or GCS <15) (1point)
  • SBP < 100mmHg (1point)
41
Q

The initiating event in shock

A

Cellular energy deficit and hypoperfusion

42
Q

Can initiate afferent impulses to the CNS which triggers the neuroendocrine response of shock

A

Hypothermia

*Initial inciting even usually is = Loss of circulating blood volume
*Other stimuli that can produce the neuroendocrine response include:
 Pain
 Hypoxemia
 Hypercarbia
 Acidosis
 Infection
 Change in temperature
 Emotional arousal
 Hypoglycemia

43
Q

Vasoconstriction is one of the initial physiologic responses to hypovolemic shock. This is mediated by

A

Activation of alpha adrenergic receptors on the arterioles

44
Q

Anti-diuretic hormone (ADH) is secreted in response to shock and remains elevated for approximately 1 week. Which is seen as a result of this increased level of ADH

A

Mesenteric vasoconstriction

*ADH acts as a potent mesenteric vasoconstrictor → shunting circulating blood away from the splanchnic organs during hypovolemia →may contribute to intestinal ischemia and predispose to intestinal mucosal barrier dysfunction in shock states
*Increase the production of ADH:
 Epinephrine
 Angiotensin II
 Pain
 Hyperglycemia

45
Q

Hypoxia at the cellular level decrease ATP production (also called dysoxia). This results in

A

Changes in intracellular calcium signalling

46
Q

Toll-like receptors play a role in the “danger signalling” pathway which modulates the immune response to injury. Stimulation of these receptors is by molecules released from

A

Damaged cells

47
Q

Which cytokine is released immediately after major injury

A

TNF-alpha

*Released by:
 Monocytes, macrophages, and T cells
 Bacteria or endotoxin → leads to development of shock and hypoperfusion
 Hemorrhage and ischemia
*Peak within 90 minutes of stimulation and return frequently to baseline levels within 4 hours
*Effects:
 Peripheral vasodilation
 Activate the release of other cytokines
 Induce procoagulant activity
 Stimulate wide array of cellular metabolic changes
*During the stress response, TNF-alpha contributes to the muscle protein breakdown and cachexia

48
Q

Anti-inflammatory cytokines

A

IL-4, IL-10, IL-13, prostaglandin E2, TGF-β

49
Q

Best describes the hemodynamic response to neurogenic shock

A

Increased cardiac index, unchanged venous capacitance

50
Q

What percentage of the blood volume is normally in the splanchnic circulation

A

20%

51
Q

Can be used to indirectly estimate the oxygen debt incurred during shock

A

Base deficit and lactate levels

*Mild (-3 to -5 mmol/L)
*Moderate (-6 to -9 mmol/L)
* Severe (less than -10 mmol/L)

52
Q

The probability of death for a patient with a base deficit of -6 is approximately

A

25%

53
Q

A 70-kg man with a laceration to the brachial artery loses a total of 800 mL of blood. What is the class of haemorrhage would this represent

A

Class II haemorrhage
*CLASSIFICATION OF HEMORRHAGE

54
Q

A patient arrives in the ER following a motor vehicle accident with multiple injuries. Hypotension in this patient is define as SBP

A

Less than 110

55
Q

In a patient with ongoing haemorrhage, the risk of death increase 1%

A

In every 3 minutes in the ER

56
Q

A 24-year-old arrives at the emergency department (ED) with multiple stab wounds to the abdomen, severe blunt trauma to the head (GCS 10), and a SBP of 80 mmHg. An appropriate goal for resuscitation in the ED would be a SBP of

A

80 to 90 mmHg

57
Q

An INR of 1.5 on arrival to the intensive care unit (ICU) is associated with what probability of death

A

20%

58
Q

Shock following severe carbon monoxide poisoning is most commonly

A

Vasodilatory shock

59
Q

Insulin drips should be used to maintain serum glucose in nondiabetic, critically ill patients at levels between

A

80 and 110 mg/dL

60
Q

An unconscious patient with a systolic BP of 80 and a HR of 80 most likely has

A

Cardiogenic shock

61
Q

A 72-year-old woman suffered an acute MI and, 12 hours later, is in cardiogenic shock. Best treatment for this patient

A

Immediate PTCA with stenting, if feasible

*Percutaneous Transluminal Coronary Angiography
*For patients with multiple vessel disease or left main coronary artery disease = Coronary artery bypass grafting

62
Q

A patient unresponsive to catecholamines after an acute myocardial infarction is placed on amrinone. What is the common side effect of amrinone

A

Thrombocytopenia

63
Q

Critical component of the initial response to bacterial contamination of the peritoneal cavity

A

Macrophage upregulation

64
Q

Severe sepsis is differentiated from sepsis by

A

Acute organ failure such as renal insufficiency
*Presence of new-onset organ failure
* Most common cause of death in noncoronary critical units

65
Q

What antifungal agent is associated with decreased cardiac contractility

A

Itraconazole

*Liposomal amphotericin B = Renal toxicity
*Voriconazole = Visual disturbances

66
Q

Antibiotic of choice in a penicillin allergic patient undergoing a cholecystectomy for acute cholecystitis is

A

Fluoroquinolone + Metronidazole or Clindamycin
*Ampicillin-sulbactam, ticarcillin-clavulanate, piperacillin-tazobactam

67
Q

Appropriate duration of antibiotic therapy for most patients with bacterial peritonitis from perforated appendicitis is

A

3-5 days

*12 to 24 hours – for penetrating GI trauma in the absence of extensive contamination
*3 to 5 days – for perforated or gangrenous appendicitis
*5 to 7 days for treatment of peritoneal soilage due to a perforated viscus with moderate degrees of contamination
*7 to 14 days – to adjunctively treat extensive peritoneal soilage (e.g., feculent peritonitis) or that occurring in the immunosuppressed host

68
Q

Best estimates the risk of surgical site infection (SSI) in a patient undergoing an elective low anterior colon resection

A

10 – 25%

69
Q

Components of PIRO staging for sepsis

A
  • (P) – Predisposing conditions/ pre-existing medical conditions
  • (I) – Insult (infection) / the nature and extend of the infection
  • (R) – Response / the nature and magnitude of the host response
  • (O) – Organ dysfunction / the degree of concomitant organ dysfunction
70
Q

Has been shown to decrease the rate of pancreatic abscess in patients with necrotizing pancreatitis

A

Enteral nutrition

71
Q

Most suggestive of a necrotizing soft tissue infection and would mandate immediate surgical exploration

A

A small amount of grayish, cloudy fluid from a wound

*Any of these findings mandates immediate surgical intervention:
 A small break or sinus from which graying turbid semipurulent material (“dishwater pus”) can be expressed
 Presence of skin changes – bronze hue or brawny induration, blebs, or crepitus

72
Q

The appropriate duration of antibiotic therapy for nosocomial urinary tract infection is

A

3-5 days

73
Q

The typical CXR finding in anthrax is

A

Widened mediastinum and pleural effusions

surgx (7 decks)

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