Wound healing US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Wound healing. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Wound healing US Medical PG Question 1: A 30-year-old man comes to the physician for a follow-up examination 1 month after sustaining a chemical burn over the dorsum of his right hand and forearm. Physical examination shows hyperextension of the hand at the wrist. The skin over the dorsum of the wrist is tense and there is a thick, epithelialized scar. Range of motion of the right wrist is restricted. This patient's contracture is most likely due to activity of which of the following cells?
- A. Fibroblasts
- B. Myofibroblasts (Correct Answer)
- C. Neutrophils
- D. Macrophages
- E. Endothelial cells
Wound healing Explanation: ***Myofibroblasts***
- The patient presents with a **contracture** (restricted range of motion and hyperextension of the hand due to a thick scar) after a burn, which is characteristic of the action of **myofibroblasts**.
- Myofibroblasts are specialized cells that possess features of both fibroblasts (synthesizing **collagen** and extracellular matrix) and smooth muscle cells (containing **actin microfilaments**), allowing them to exert contractile force which leads to scar contraction.
*Fibroblasts*
- While fibroblasts are crucial for **wound healing** by producing collagen and other extracellular matrix components, they primarily lay down the foundation for scar tissue.
- They lack the strong contractile capabilities that lead to significant **tissue retraction** and contracture.
*Neutrophils*
- Neutrophils are **acute inflammatory cells** that primarily function in the early stages of wound healing to phagocytose debris and pathogens.
- They do not play a direct role in the formation of **scar tissue** or **contractures**.
*Macrophages*
- Macrophages are important **immune cells** involved in clearing debris, presenting antigens, and releasing growth factors during the later stages of wound healing.
- They also influence fibroblast activity, but they do not directly cause **tissue contraction** or scar formation.
*Endothelial cells*
- Endothelial cells line **blood vessels** and are essential for **angiogenesis** (formation of new blood vessels) during wound healing.
- They are not involved in the **contractile process** that leads to scar contracture.
Wound healing US Medical PG Question 2: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?
- A. Disallow the mother to be present in the examination room throughout the entirety of the visit
- B. Give the patient a social history questionnaire to fill out in the exam room
- C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
- D. Ask the patient the questions directly, with her mother still in the exam room
- E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed
Wound healing Explanation: ***Ask the mother to step outside into the hall for a portion of the visit***
- This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns.
- Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being.
*Disallow the mother to be present in the examination room throughout the entirety of the visit*
- This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit.
- While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents.
*Give the patient a social history questionnaire to fill out in the exam room*
- While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues.
- Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers.
*Ask the patient the questions directly, with her mother still in the exam room*
- Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval.
- This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients.
*Speak softly to the patient so that the mother does not hear and the patient is not embarrassed*
- Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation.
- This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.
Wound healing US Medical PG Question 3: A 56-year-old male died in a motor vehicle accident. Autopsy reveals extensive atherosclerosis of his left anterior descending artery marked by intimal smooth muscle and collagen proliferation. Which of the following is implicated in recruiting smooth muscle cells from the media to intima in atherosclerotic lesions?
- A. Vascular endothelial growth factor
- B. Platelet-derived growth factor (Correct Answer)
- C. Factor V Leiden
- D. IgE
- E. Prostacyclin
Wound healing Explanation: ***Platelet-derived growth factor***
- **Platelet-derived growth factor (PDGF)** is a crucial **chemotactic** and **mitogenic** factor for **smooth muscle cells (SMCs)**, promoting their migration from the tunica media to the tunica intima and subsequent proliferation in atherosclerotic lesions.
- Released by activated platelets, macrophages, and endothelial cells, PDGF contributes significantly to the **fibroproliferative response** seen in **atherosclerosis**.
*Vascular endothelial growth factor*
- **Vascular endothelial growth factor (VEGF)** is primarily involved in **angiogenesis** and **vascular permeability**.
- While angiogenesis can play a role in advanced atherosclerotic plaques, VEGF is not the primary mediator of **smooth muscle cell migration** and proliferation into the intima.
*Factor V Leiden*
- **Factor V Leiden** is a **genetic mutation** that increases the risk of **thrombosis** due to resistance to inactivation by activated protein C.
- It is a risk factor for **venous thromboembolism** and does not directly recruit smooth muscle cells to the intima in atherosclerosis.
*IgE*
- **Immunoglobulin E (IgE)** is an antibody class primarily involved in **allergic reactions** and **parasitic infections**.
- IgE has no direct role in the recruitment or proliferation of **smooth muscle cells** in the context of atherosclerosis.
*Prostacyclin*
- **Prostacyclin (PGI2)** is a **vasodilator** and a potent **inhibitor of platelet aggregation**.
- It works to prevent thrombus formation and has a protective role against atherosclerosis, rather than promoting **smooth muscle cell migration**.
Wound healing US Medical PG Question 4: A 14-year-old girl is brought to the physician after she accidentally cut her right forearm earlier that morning while working with her mother's embroidery scissors. She has no history of serious illness. The mother says she went to elementary and middle school abroad and is not sure if she received all of her childhood vaccinations. She appears healthy. Her temperature is 37°C (98.6 °F), pulse 90/min, and blood pressure is 102/68 mm Hg. Examination shows a clean 2-cm laceration on her right forearm with surrounding edema. There is no erythema or discharge. The wound is irrigated with water and washed with soap. Which of the following is the most appropriate next step in management?
- A. Administer Tdap only (Correct Answer)
- B. Administer DTaP only
- C. No further steps are necessary
- D. Administer TIG only
- E. Intravenous metronidazole
Wound healing Explanation: ***Administer Tdap only***
- A 14-year-old with an unknown or incomplete vaccination history requires a **Tdap (tetanus, diphtheria, acellular pertussis) booster** for **tetanus prophylaxis** after a wound.
- The wound is clean, and there are no signs of active infection or high-risk features that would necessitate tetanus immune globulin (TIG).
*Administer DTaP only*
- **DTaP (diphtheria, tetanus, acellular pertussis)** is typically administered to children younger than 7 years of age.
- This patient is 14 years old, making Tdap the more appropriate vaccine formulation for her age group.
*No further steps are necessary*
- Given the patient's **unknown vaccination history** and a laceration, tetanus prophylaxis is crucial to prevent **tetanus**, a potentially life-threatening condition.
- Simply cleaning the wound is insufficient protection without adequate vaccination status.
*Administer TIG only*
- **Tetanus immune globulin (TIG)** is typically reserved for patients with **dirty or severe wounds** and an unknown or incomplete vaccination history, or for those who are immunocompromised.
- This patient has a **clean laceration** with no indication of high-risk features that would warrant TIG.
*Intravenous metronidazole*
- **Metronidazole** is an antibiotic used to treat **anaerobic bacterial infections** and certain parasitic infections.
- The patient has no signs of infection (no erythema, discharge, or fever) that would necessitate antibiotic treatment at this time.
Wound healing US Medical PG Question 5: A 35-year-old male is brought into the emergency department for a trauma emergency. The emergency medical services states that the patient was wounded with a knife on his upper left thigh near the inguinal ligament. Upon examination in the trauma bay, the patient is awake and alert. His physical exam and FAST exam is normal other than the knife wound. Large bore intravenous lines are inserted into the patient for access and fluids are being administered. Pressure on the knife wound is being held by one of the physicians with adequate control of the bleeding, but the physician notices the blood was previously extravasating in a pulsatile manner. His vitals are BP 100/50, HR 110, T 97.8, RR 22. What is the next best step for this patient?
- A. CT lower extremities
- B. Radiograph lower extremities
- C. Coagulation studies and blood typing/crossmatch
- D. Tourniquet of proximal lower extremity
- E. Emergent surgery (Correct Answer)
Wound healing Explanation: ***Emergent surgery***
- The pulsatile bleeding from a thigh wound near the inguinal ligament is highly suggestive of a major arterial injury, such as to the **femoral artery**.
- Given the potential for rapid blood loss and hemodynamic instability, **emergent surgical exploration and repair** are necessary to control the bleeding and prevent further compromise.
*CT lower extremities*
- While CT angiography could further delineate vascular injury, the presence of **active pulsatile bleeding** necessitates immediate surgical intervention rather than delaying for imaging.
- Delaying surgery for imaging risks **exsanguination** and worsening patient outcomes, especially with a blood pressure of **100/50 mmHg** and a heart rate of **110 bpm**, indicating early shock.
*Radiograph lower extremities*
- A radiograph would primarily visualize bone structures and foreign bodies but would not provide adequate information regarding the **vascular injury** and active bleeding.
- It would not change the urgent need for **surgical exploration** to address the pulsatile hemorrhage.
*Coagulation studies and blood typing/crossmatch*
- These are important preparatory steps for major surgery involving significant blood loss, but they should be carried out **concurrently with preparations for emergent surgery**, not instead of it.
- Delaying surgery to await these results would be inappropriate when facing **active arterial bleeding**.
*Tourniquet of proximal lower extremity*
- While a tourniquet can be used for temporary hemorrhage control, especially in an uncontrolled external hemorrhage, the current bleeding is being controlled by **direct pressure**.
- Applying a tourniquet could cause **ischemic damage** to the extremity if applied for too long, and for a deep stab wound, direct compression is often effective until surgical control can be achieved.
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