Test two (wound and infection)

1. Predisposing factors for the development of keloid scars include: a. patients of Afro-Carribean origin with dark complexion b. wound infection c. steroid therapy d. secondary wound closure  e. use of local bupivacaine answera.T   b.T   c.F   d.F   e.F The type of wound closure be it primary or secondary has no effect on keloid formation. The use of steroid decreases the incidence of keloid formation. Use of local bupivacaine does not affect keloid formation. 2. The following statements are true of wound infections: a. Staphylococcus aureus is the most common organism to infect the surgical wound b. MRSA wound infection is usually the result of wound contamination by hospital staff c. anaerobic organisms exert their lethal effects by producing endo- and exotoxins d. with opportunistic organisms, they are the result of a patient's reduced immune defence e. necrotizing fasciitis is commoner in carrier of MRSA answera.T   b.T   c.T   d.T   e.F Staphylococcus aureus is a common organism on the skin and commonly infects wound.  MRSA wound infection is usually caused by wound contamination through hospital staff who may be carriers of the organism. Anaerobic organisms exert their lethal effects by producing endo- and exotoxins. Infection with opportunistic organisms is a result of the patient's reduced immune defence.  The development of necrotizing fasciitis is not associated with MRSA.   3. Wound healing by secondary intention takes place: a. when the wound does not break apart b. when the wound edges are brought together c. when there is irreparable skin loss d. much more slowly than healing by first intention e. when the wound becomes infected answera.F   b.F   c.F   d.T   e.T Wound healing by secondary intention takes place when the wound breaks apart, when the wound edges are not brought together, and when there is irreparable skin loss. When the wound becomes infected and is laid open, healing is also by secondary intention. If the edges are opposed, for example in a sutured wound, the healing is by primary intention. Healing in this way is much slower compared with healing by first intention 4. Options for sterilization include: a. ethylene oxide b. gamma irradiation c. 1600  C dry heat for 30 minutes d. low temperature steam of 730 C for 20 minutes e. high temperature steam of 1340  C for 3 minutes answera.T   b.T   c.F   d.T   e.T For dry heat at 1600 C, the duration needs to be more than 120 minutes. 5. Clostridium tetani: a. causes gas gangrene b. produces an exotoxin c. has a terminal spore d. is an obligatory anaerobe e. is non-motile answera.F   b.T   c.T   d.T   e.F Clostridium tetani causes tetanus, and it produces a very powerful exotoxin which is neurotoxic. A characteristic feature of the spores is a terminal spore.  It is an obligatory anaerobe and is motile. 6. True statements concerning necrotizing fasciitis are correct: a. antibiotic therapy and hyperbaric oxygen do not limit the spread b. there is a severe infective process, but the skin initially appears normal c. conservative excision of the necrotic fascia and skin and muscle should be carried out      within 24 hours d. it is not common after minor trauma e. high doses benzylpenicillin (4 mega units) given intravenously are indicated answera.T   b.T   c.F   d.F   e.T It is caused by mixture of Staphylococci and Streptococci including anaerobic and microaerophilic cocci, therefore antibiotic therapy and hyperbaric oxygen do limit the spread of infection. The skin initially appears normal. Bold and wide surgical excision of the necrotic fascia, skin and muscle should be carried out immediately without delay. This condition is very common with i.v. drug abuse. High doses of benzylpenicillin intravenously are indicated. 7.Keloid scars: a. are distinguished from hypertrophic scars by their extent. b. extends beyond the original incisional scar c. are caused by the excess deposition of fibrin in the wound d. are common on the deltoid region e. may be prevented by pressure dressing answera.T   b.T   c.F   d.T   e.F The tendency to keloid formation is genetically pre-determined. Are distinguishable from hypertrophic scars in that keloid extends beyond the original scar It is caused by excessive deposition of collagen Not prevented by pressure dressing Commoner in sternum and deltoid regions. 8. Staphylococcus aureus is sensitive to: a. vancomycin b. cefuroxime c. flucloxacillin d. clindamycin e. methicillin answera.T   b.T   c.T   d.T   e.T Staphylococcus aureus that is not sensitive to methicillin is termed MRSA (methacillin resistant Staphylococcus aureus) 9. Lignocaine: a. inhibits the uptake of sodium into nerve cell membranes b. has a local vasodilatory effect c. toxicity should be suspected if the patient develops slurred speech d. is an alkaline solution e. 1% solution contains 1 g of lignocaine in 100 ml fluid answera.T   b.T   c.T   d.T   e.T Lignocaine blocks the uptake of sodium into nerves. The maximum safe dose for a 70 kg man is 150g. A 1% solution contains 100mg per 10ml (1g per 100ml). Lignocaine toxicity should be suspected if the patient complains of tingling around the mouth, followed by drowsiness and slurred speech which leads to convulsions and then coma.  10. Local anaesthetic injections are less painful if: a. the anaesthetic is cooled. b. they are combined with adrenaline c. they are given rapidly d. the pH is neutralized prior to administration e. a thinner needle is used. answera.F   b.F   c.F   d.T   e.T Reduction of pain can be achieved by: warning the patient before your inject the anaesthetic use the thinnest needle possible neutralize the pH warming the anaesthetic

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