Abnormalities in wound healing — MCQs

A 62-year-old woman is hospitalized for an open reduction of a fracture of her right femur following a motor vehicle accident 2 hours prior. She has had rheumatoid arthritis for 12 years. She was hospitalized 1 month ago for an exacerbation of rheumatoid arthritis. Since then, she has been taking a higher dose of prednisone to control the flare. Her other medications include calcium supplements, methotrexate, and etanercept. She has had appropriate nutrition over the years with regular follow-ups with her healthcare providers. Her vital signs are within normal limits. Cardiovascular examination shows no abnormalities. In order to reduce the risk of post-operative wound failure, which of the following is the most appropriate modification in this patient’s drug regimen?

A 55-year-old African American female presents to her breast surgeon for a six-month follow-up visit after undergoing a modified radical mastectomy for invasive ductal carcinoma of the left breast. She reports that she feels well and her pain has been well controlled with ibuprofen. However, she is frustrated that her incisional scar is much larger than she expected. She denies any pain or pruritus associated with the scar. Her past medical history is notable for systemic lupus erythematosus and multiple dermatofibromas on her lower extremities. She has had no other surgeries. She currently takes hydroxychloroquine. On examination, a raised hyperpigmented rubbery scar is noted at the inferior border of the left breast. It appears to have extended beyond the boundaries of the initial incision. Left arm range of motion is limited due to pain at the incisional site. Abnormal deposition of which of the following molecules is most likely responsible for the appearance of this patient’s scar?

A 48-year-old man is brought to the emergency department with a stab wound to his chest. The wound is treated in the emergency room. Three months later he develops a firm 4 x 3 cm nodular mass with intact epithelium over the site of the chest wound. On local examination, the scar is firm, non-tender, and there is no erythema. The mass is excised and microscopic examination reveals fibroblasts with plentiful collagen. Which of the following processes is most likely related to the series of events mentioned above?

A 35-year-old man is pulled out of a burning building. He is unconscious and severely injured. He is transported to the nearest emergency department. Upon arrival, he is stabilized and evaluated for burns and trauma. Approximately 40% of his body is covered in burns. The burned areas appear blackened and charred but the skin is mostly intact. It is noted that the patient has loss of pain sensation in the burnt areas with minimal blanching on palpation. The affected area is leathery when palpated. What category of burn did the patient most likely to suffer from?

A 56-year-old woman undergoes open reduction and internal fixation of the distal tibia 1 day after a fall. She has had rheumatoid arthritis for 12 years and diabetes mellitus for 2 years. Her medications over the past year have included metformin, prednisone, calcium supplements, and methotrexate. Prior to surgery, insulin was added to her medications, and the dose of prednisone was increased. She has had appropriate nutrition over the years with regular follow-ups with her healthcare professional. Which of the following is the most appropriate supplement to prevent wound failure in this patient?

A 31-year-old Israeli male with a history of heavy smoking presents to your office with painful ulcerations on his hands and feet. Upon examination, he is found to have hypersensitivity to intradermally injected tobacco extract. Which of the following processes is most likely responsible for his condition?

A 62-year-old man comes to the physician because of a swollen and painful right knee for the last 3 days. He has no history of joint disease. His vital signs are within normal limits. Examination shows erythema and swelling of the right knee, with limited range of motion due to pain. Arthrocentesis of the right knee joint yields 7 mL of cloudy fluid with a leukocyte count of 29,000/mm3 (97% segmented neutrophils). Compensated polarized light microscopy of the aspirate is shown. Which of the following is the most likely underlying mechanism of this patient's knee pain?

A 42-year-old man who recently immigrated from Mexico presents to the clinic with fever, a productive cough streaked with blood, back pain, and night sweats. He was found to be HIV-positive 3 years ago but does not know his most recent CD4+ count. With further questioning, the patient notes that he had previously experienced these symptoms when he was in Mexico, but he has no recollection of taking any treatment. Which of the following characteristics would best describe the histology of a lung biopsy specimen obtained from this patient?

A 48-year-old man comes to the physician because of a 2-day history of fever, flank pain, and hematuria. He has chronic back pain, for which he has been taking meloxicam for the past 2 weeks. His temperature is 38.9°C (102°F). Physical examination shows a diffuse maculopapular rash over his trunk and extremities. Urinalysis shows 10–15 RBC/hpf, 20 WBC/hpf, and numerous eosinophils. Histologic examination of a kidney biopsy specimen is most likely to show which of the following findings?

A 3-year-old boy is brought to the physician for follow-up examination 5 days after sustaining a forehead laceration. Examination shows a linear, well-approximated laceration over the right temple. The wound is clean and dry with no exudate. There is a small amount of pink granulation tissue present. Microscopic examination of the wound is most likely to show which of the following?