Block 9 Wound Healing & Personality Theory MCQ's

1. A 65 year old alcoholic man is diagnosed with cirrhosis after 40 years of heavy drinking. Which of the following is most likely associated with his diagnosis?

Fibrosis

Regeneration

Repair

Regeneration at repair

The correct answer is "Fibrosis." Cirrhosis is a condition characterized by the scarring and fibrosis of the liver tissue. Prolonged heavy drinking can lead to chronic liver damage, causing the liver to replace healthy tissue with scar tissue. This fibrosis can impair liver function and lead to complications such as liver failure.

Explanation

The correct answer is "Fibrosis." Cirrhosis is a condition characterized by the scarring and fibrosis of the liver tissue. Prolonged heavy drinking can lead to chronic liver damage, causing the liver to replace healthy tissue with scar tissue. This fibrosis can impair liver function and lead to complications such as liver failure.

2. During your inquiry of his past medical history, your new patient, a 35-year-old male, reports that you are the 5^thprimary care doctor he has had during the past 7 years. Upon further inquiry, the patient informs you that, at first, he likes his doctors, but eventually they frustrate him by not listening to him, at which point he confronts them. Such confrontation inevitably results in him firing his physician and finding another one. Which of the following most accurately describes this patient's interpersonal process with his physicians?

Counter-transference

Emotionally corrective experience

Parapiaxis

Repetition-compulsion

The patient's pattern of repeatedly firing his physicians and finding new ones after feeling frustrated suggests a repetition-compulsion. This term refers to the unconscious tendency to repeat past experiences, even if they are negative or harmful. In this case, the patient may be unconsciously seeking to recreate a familiar dynamic where he feels unheard and confronts his doctors. This pattern may stem from unresolved issues or traumas from his past, leading him to unconsciously seek out situations that mirror those experiences.

Explanation

The patient's pattern of repeatedly firing his physicians and finding new ones after feeling frustrated suggests a repetition-compulsion. This term refers to the unconscious tendency to repeat past experiences, even if they are negative or harmful. In this case, the patient may be unconsciously seeking to recreate a familiar dynamic where he feels unheard and confronts his doctors. This pattern may stem from unresolved issues or traumas from his past, leading him to unconsciously seek out situations that mirror those experiences.

3. A fourth year resident is working in the "burn unit" following a patient that received 3rd degree burns. The burns are healing and relatively mature scars have formed. As time goes by the scars seem to be getting a little smaller and undergo shape changes. He asks his attending what is responsible for this phenomenon. Which of the following is the most likely answer to his question?

Endothelial cells are synthesizing Thromboxane A2 which constricts blood vessels

Fibroblasts are converting collagen type 3 to collagen type 1

Metalloproteinases are acting upon the scars

Macrophages are synthesizing complement components

Neutrophils are releasing lysosomal enzymes

Metalloproteinases are enzymes that break down proteins, including collagen. In the context of scar formation, metalloproteinases play a role in remodeling the scar tissue by breaking down the excess collagen and allowing for the formation of new, healthier tissue. Therefore, it is likely that metalloproteinases are responsible for the observed phenomenon of the scars getting smaller and undergoing shape changes over time.

Explanation

Metalloproteinases are enzymes that break down proteins, including collagen. In the context of scar formation, metalloproteinases play a role in remodeling the scar tissue by breaking down the excess collagen and allowing for the formation of new, healthier tissue. Therefore, it is likely that metalloproteinases are responsible for the observed phenomenon of the scars getting smaller and undergoing shape changes over time.

4. This section of heart shown was taken during an autopsy from a 45 year old man with a history of familial hypercholesterolemia. Which of the following is most consistent with the section shown?

Healing by regeneration and repair

Healing by repair via secondary union

Healing by repair via primary intention

Healing by regeneration via primary union

Healing by regeneration via secondary intention

The section of the heart shown in the autopsy is consistent with healing by repair via secondary union. This is because secondary union refers to the healing process that occurs when there is a delay in wound closure or when the wound edges are not approximated. In this case, the section of the heart shows evidence of repair rather than regeneration, indicating that the healing process occurred without the wound edges being brought together. This is consistent with the concept of healing by repair via secondary union.

Explanation

The section of the heart shown in the autopsy is consistent with healing by repair via secondary union. This is because secondary union refers to the healing process that occurs when there is a delay in wound closure or when the wound edges are not approximated. In this case, the section of the heart shows evidence of repair rather than regeneration, indicating that the healing process occurred without the wound edges being brought together. This is consistent with the concept of healing by repair via secondary union.

5. During your surgery rotation, you are asked to re-suture a patient with dehiscence of his surgical incsion. Two days later the patient comes to the emergency room with wound dehiscence and profuse bleeding from his surgical incision. Which of the following proteins is most likely defective? (Wound dehiscence: is a surgical complication in which a wound breaks open along surgical suture.)

Collagen type 1

Collagen type 5

Elastin

Fibrillin

Collagen type 5 is most likely defective in this scenario. Collagen is an important protein that provides strength and stability to tissues, including in wound healing. Collagen type 5 is specifically involved in the formation of fibrils, which are essential for wound closure and tissue repair. If collagen type 5 is defective, it can lead to impaired wound healing and increased risk of wound dehiscence. This can explain why the patient experienced wound dehiscence and profuse bleeding from the surgical incision.

Explanation

Collagen type 5 is most likely defective in this scenario. Collagen is an important protein that provides strength and stability to tissues, including in wound healing. Collagen type 5 is specifically involved in the formation of fibrils, which are essential for wound closure and tissue repair. If collagen type 5 is defective, it can lead to impaired wound healing and increased risk of wound dehiscence. This can explain why the patient experienced wound dehiscence and profuse bleeding from the surgical incision.