Wound Healing — MCQs
Delayed wound healing is seen in all except-
First cell to migrate into a wound due to chemotaxis to start the process of wound healing is -
Regeneration is characterized by:
Which of the following protein molecules is responsible for cell-to-cell adhesion?
A 43-year-old window cleaner fell off a scaffold. He sustained an open wound on the right leg. Debridement was carried out in the emergency department, and the edges of the wound were left open. Which factor is least likely to inhibit wound contraction?
What diagnosis is suggested by the finding on the sole of this patient's foot?
Closure for clean wounds within 6 hours of injury is called.
An Incisional wound heals by
Which of the following type of collagen is present in healing and granulation tissue?
A 20 year old female was operated for perforation peritonitis and after closing the rectus sheath her abdominal wound was left open to heal with proliferative granulation tissue which contracted and epithelialized to form a scar. This patient had undergone healing by:
Wound Healing Indian Medical PG Practice Questions and MCQs
Question 1: Delayed wound healing is seen in all except-
- A. Hypertension (Correct Answer)
- B. Malignancy
- C. Infection
- D. Diabetes
Explanation: ***Hypertension*** - While **severe or uncontrolled hypertension** with microvascular complications may theoretically affect tissue perfusion, hypertension **alone is not classically listed** among the primary independent causes of delayed wound healing in standard surgical teaching. - Unlike the other options, hypertension is **not a direct metabolic or local tissue factor** that impairs the wound healing cascade. - The major recognized factors causing delayed wound healing are infection, metabolic disorders (diabetes, malnutrition), malignancy, and immunosuppression—hypertension does not fall into these classical categories. *Diabetes* - **Hyperglycemia** impairs neutrophil function, reduces collagen synthesis, and causes **microvascular disease** that reduces oxygen and nutrient delivery to wounds. - **Diabetic neuropathy** prevents early wound detection, and peripheral vascular disease further compromises healing. - Diabetes is one of the **most important systemic causes** of chronic non-healing wounds. *Infection* - **Bacterial colonization** prolongs the inflammatory phase and prevents progression to proliferation and remodeling. - Pathogens produce **proteases and toxins** that destroy granulation tissue, consume oxygen, and create a hostile wound environment. - Infection is a **local factor** that directly impairs all phases of wound healing. *Malignancy* - **Cancer-associated cachexia** and malnutrition deprive the body of resources needed for tissue repair. - Tumors can **directly invade** wound sites, and cancer treatments (chemotherapy, radiation) impair cellular proliferation and angiogenesis. - Malignancy creates a **systemic catabolic state** unfavorable for healing.
Question 2: First cell to migrate into a wound due to chemotaxis to start the process of wound healing is -
- A. Lymphocyte
- B. Macrophage
- C. Platelet
- D. Neutrophil (Correct Answer)
Explanation: ***Neutrophil*** - Neutrophils are the **first responders** in the wound healing process, rapidly migrating to the site due to **chemotactic signals** [1,2]. - Their primary role includes **phagocytosing pathogens** and debris, facilitating the subsequent healing phases. *Lymphocyte* - Lymphocytes typically arrive later in the healing process and are mainly involved in **immune response** rather than initial wound healing. - They play a significant role in **adaptive immunity** but do not participate in the **early inflammatory phase**. *Platelet* - While platelets aggregate at the wound site and are crucial for **clot formation**, they do not migrate into the wound through chemotaxis like neutrophils [1]. - Their primary function is to initiate the **hemostatic response** rather than directly phagocytosing debris. *Macrophage* - Macrophages are important for **later stages** of wound healing, clearing debris and coordinating tissue repair, but they arrive after neutrophils. - They are involved in the **remodeling phase** and are not the first cells to respond to the wound. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 188-189. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Migration in the tissues toward a chemotactic stimulus, pp. 86-87. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 87-89.
Question 3: Regeneration is characterized by:
- A. Granulation tissue
- B. Repairing by different type of tissue
- C. Cellular proliferation is largely regulated by biochemical factors
- D. Repairing by same type of tissue (Correct Answer)
Explanation: ***Repairing by same type of tissue*** - **Regeneration** involves the replacement of damaged cells and tissues with cells of the **same type**, leading to a complete restoration of normal structure and function [1]. - This process is seen in tissues with high proliferative capacity, like the **epidermis** or the **liver**, following injury [2]. *Granulation tissue* - **Granulation tissue** is characteristic of **repair by fibrosis** (scar formation), not regeneration [1]. - It consists of proliferating fibroblasts, new blood vessels (angiogenesis), and inflammatory cells, which eventually mature into a fibrous scar. *Repairing by different type of tissue* - The replacement of damaged tissue with a **different type of tissue** (typically fibrous connective tissue) is known as **repair by fibrosis** or **scar formation** [1]. - This occurs when the tissue's regenerative capacity is limited or when the injury is severe, resulting in the loss of normal tissue architecture and function [3]. *Cellular proliferation is largely regulated by biochemical factors* - While **cellular proliferation** is indeed regulated by **biochemical factors** (growth factors, cytokines) in both regeneration and repair, this statement describes a mechanism common to cellular growth and healing in general, not a defining characteristic unique to regeneration [1]. - This regulation guides both the replacement with original tissue (regeneration) and scar formation, so it's not specific enough to define regeneration alone. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 113-115. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 112-113. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 113.
Question 4: Which of the following protein molecules is responsible for cell-to-cell adhesion?
- A. Laminin
- B. Fibronectin
- C. Collagen
- D. Cadherin (Correct Answer)
Explanation: ***Cadherin*** - **Cadherins** are transmembrane proteins that mediate **direct cell-to-cell adhesion** in a calcium-dependent manner - They form **adherens junctions** and **desmosomes**, which are essential for maintaining tissue integrity - Cadherins on adjacent cells bind to each other (**homophilic binding**), creating strong cell-cell connections - Critical for **embryonic development**, tissue architecture, and **epithelial barrier function** *Fibronectin* - **Fibronectin** is an extracellular matrix glycoprotein that mediates **cell-to-ECM adhesion**, not direct cell-to-cell adhesion - It binds to **integrins** on the cell surface, facilitating cell attachment to the extracellular matrix - Important for cell migration, wound healing, and embryonic development - Does not directly connect cells to each other *Collagen* - **Collagen** is the most abundant structural protein providing **tensile strength** to connective tissues - Primarily functions as **extracellular scaffolding**, not as an adhesion molecule - Provides mechanical support but does not mediate cell-cell adhesion *Laminin* - **Laminins** are major components of the **basal lamina** (basement membrane) - Mediate **cell-to-basal lamina adhesion** through integrin receptors - Important for cell differentiation, migration, and tissue organization - Function in cell-to-ECM adhesion, not cell-to-cell adhesion
Question 5: A 43-year-old window cleaner fell off a scaffold. He sustained an open wound on the right leg. Debridement was carried out in the emergency department, and the edges of the wound were left open. Which factor is least likely to inhibit wound contraction?
- A. Radiation
- B. Transforming growth factor β (Correct Answer)
- C. Full-thickness skin graft
- D. Cytolytic drug
Explanation: ***Transforming growth factor β*** - **TGF-β** is a potent **pro-fibrotic cytokine** that plays a crucial role in promoting wound contraction and fibrosis by stimulating **fibroblast proliferation**, **myofibroblast differentiation**, and **collagen synthesis**. - Its presence and activity would *enhance* rather than inhibit wound contraction, making it the **least likely factor to inhibit** this process. - In wound healing, TGF-β is essential for the contraction phase and tissue remodeling. *Radiation* - **Ionizing radiation** can damage cells, including **fibroblasts** and **myofibroblasts**, which are essential for wound contraction. - This cellular damage and reduction in viable cells can significantly **impair** the contractile forces within the wound. - Radiation therapy is a known factor that inhibits wound healing and contraction. *Full-thickness skin graft* - A **full-thickness skin graft** introduces a complete layer of skin, including the dermis, into the wound. - The presence of the **dermis** within the graft provides a structural barrier and helps to **anchor the wound edges**, thereby reducing the tendency for contraction. - In contrast, **split-thickness grafts** allow more wound contraction due to less dermal tissue. *Cytolytic drug* - **Cytolytic drugs** are designed to kill cells, and if applied to a wound, they would destroy **fibroblasts** and **myofibroblasts**. - The destruction of these critical cells would directly **inhibit** the cellular machinery responsible for pulling the wound edges together, hence preventing contraction. - These drugs impair the proliferative phase of wound healing.
Question 6: What diagnosis is suggested by the finding on the sole of this patient's foot?
- A. Chemical burn
- B. Pemphigus
- C. Plantar wart (Correct Answer)
- D. Radiation dermatitis
Explanation: ***Plantar wart (Verruca plantaris)*** - The image shows a **hyperkeratotic lesion with central black dots** on the sole of the foot, which is pathognomonic for a **plantar wart** - Plantar warts are caused by **human papillomavirus (HPV)** infection, most commonly types 1, 2, and 4 - The characteristic **black dots represent thrombosed capillaries**, not necrosis - Key diagnostic features include **interruption of skin lines** across the lesion and **tenderness on lateral compression** (pinch test) - They occur on **pressure-bearing areas** of the foot and can be solitary or multiple (mosaic warts) *Chemical burn* - Chemical burns present with **erythema, blistering, or ulceration** with more diffuse or irregular borders - History of **chemical exposure** would be present, and the lesion lacks the characteristic black dots seen in plantar warts - The pattern and location don't fit typical chemical injury *Pemphigus* - Pemphigus is an **autoimmune blistering disease** presenting with **flaccid bullae** that rupture easily - It primarily affects **mucous membranes and flexural areas**, rarely presenting as a solitary hyperkeratotic lesion on the sole - The clinical presentation is completely different from the hyperkeratotic lesion with black dots shown *Radiation dermatitis* - Radiation dermatitis occurs after **therapeutic or accidental radiation exposure** - Presents with **erythema, desquamation, hyperpigmentation, or fibrosis** in the radiation field - Would not present as a discrete hyperkeratotic lesion with black dots, and the sole of the foot is an unusual site for radiation therapy
Question 7: Closure for clean wounds within 6 hours of injury is called.
- A. Primary closure (Correct Answer)
- B. Delayed primary closure
- C. Secondary closure
- D. Tertiary closure
Explanation: ***Primary closure*** - **Primary closure** is the immediate closure of a wound, typically within **6 hours** of injury, for **clean wounds** at low risk of infection. - This method promotes direct apposition of wound edges, leading to **faster healing** and **minimal scarring**. *Delayed primary closure* - This involves leaving a wound open for **4-6 days** to monitor for infection or edema, then closing it if conditions are favorable. - It is often used for **contaminated wounds** or those with a higher risk of infection, where immediate closure is not safe. - Also known as **tertiary closure**. *Secondary closure* - **Secondary closure**, or healing by secondary intention, occurs when a wound is left open and allowed to **heal naturally by granulation, contraction, and epithelialization**. - This method is used for **heavily contaminated** or **infected wounds** and results in a larger scar and a longer healing time. *Tertiary closure* - **Tertiary closure** is another term for **delayed primary closure**. - It involves leaving a wound open initially, then closing it after several days (typically 4-6 days) once the risk of infection has decreased. - This option is incorrect because the question asks about closure **within 6 hours**, not delayed closure.
Question 8: An Incisional wound heals by
- A. Primary Healing (Correct Answer)
- B. Secondary Healing
- C. Epithelialization
- D. Delayed primary Healing
Explanation: ***Primary Healing*** - An **incisional wound** is typically a clean, sharply incised wound with **minimal tissue loss** and edges that can be approximated. - **Primary healing** (or first intention) occurs when the wound edges are surgically closed, leading to rapid healing with minimal scarring. *Secondary Healing* - This type of healing occurs in wounds with **significant tissue loss** or infection, where the edges cannot be approximated. - The wound must heal by **granulation tissue formation** and **wound contraction**, resulting in a larger scar. *Epithelialization* - **Epithelialization** is a vital process in all types of wound healing, where epithelial cells migrate to cover the wound surface. - However, it describes a *process* rather than a *mode* of overall wound healing for a closed incisional wound. *Delayed primary Healing* - **Delayed primary healing** (or tertiary intention) involves leaving a wound open for a period (e.g., to control infection or edema) before closing it surgically. - This approach is not typical for a clean incisional wound but is used in cases where primary closure is initially unsafe.
Question 9: Which of the following type of collagen is present in healing and granulation tissue?
- A. Type II
- B. Type I
- C. Type III (Correct Answer)
- D. Type IV
Explanation: ***Type III*** - **Type III collagen** is prominently found in **granulation tissue** during the early stages of wound healing [1]. - It provides a **scaffold** for cellular migration and proliferation [2], contributing to the initial strength of the healing tissue. *Type II* - **Type II collagen** is the primary collagen type found in **cartilage**, particularly **hyaline cartilage**. - It is crucial for the **structural integrity** and resilience of articular surfaces, not typically in granulation tissue. *Type I* - **Type I collagen** is the most abundant collagen in the body, providing **tensile strength** to tissues like bone, skin, tendons, and ligaments. - While ultimately replacing type III collagen in mature scar tissue, it is **less prevalent in initial granulation tissue** compared to type III [1]. *Type IV* - **Type IV collagen** is a major component of **basement membranes**, forming a mesh-like network [3]. - It provides **structural support** and acts as a selective filter in tissues such as the kidneys and lungs, but not in healing granulation tissue. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 105-106. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 117-119. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 32-34.
Question 10: A 20 year old female was operated for perforation peritonitis and after closing the rectus sheath her abdominal wound was left open to heal with proliferative granulation tissue which contracted and epithelialized to form a scar. This patient had undergone healing by:
- A. Delayed primary intention
- B. Secondary intention (Correct Answer)
- C. Primary intention
- D. Tertiary intention
Explanation: ***Secondary intention*** - **Secondary intention healing** occurs when a wound is left open to heal from the bottom up, characterized by a large tissue deficit, **formation of granulation tissue**, wound contraction, and epithelialization [1, 2]. - This method is used in cases of infection, excessive tissue loss, or when there's a high risk of contamination, allowing the wound to heal naturally without surgical closure [1]. *Delayed primary intention* - This involves leaving a wound open for a few days to decrease the risk of infection or swelling, then **surgically closing it** once the risk is minimized. - The patient's wound was left open to heal by **granulation and epithelization**, not for eventual surgical closure. *Primary intention* - **Primary intention healing** occurs when wound edges are approximated, usually by sutures, staples, or adhesive, resulting in minimal tissue loss and a fine scar [1]. - This was not the case here as the wound was left open due to risks associated with perforation peritonitis. *Tertiary Intention* - **Tertiary intention** or delayed primary closure is where a wound is initially treated as secondary intention, but then closed surgically at a later date, typically 3-5 days after initial wound care. - The prompt specifies the wound was left open to heal by **granulation tissue** which then contracted and epithelized, without mention of later surgical closure. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 105-107. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 119.
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