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Answers to Questions in the Book, Chapter 3, Inflammation and Tissue Repair
Answers to Exercises in Book: Stop and Consider Questions and Practice Exam Questions Short Answer (Stop and Consider Questions)
1. What can you do to improve or strengthen your first line of defense?
Answer: Avoid contact with injurious substances; maintain integrity of skin by avoiding excessive dryness or moisture.
2. What lines of defense are you enhancing by applying an antibiotic ointment and covering a laceration with a Band-Aid?
Answer: First and third.
3. Where have you heard the names of the various inflammatory mediators listed above? What do you already know about these
inflammatory mediators? Answer: Answers will vary.
4. Why would you want to block arachidonic acid production and inhibit the work of the inflammatory mediators?
Answer: Inflammatory response is often overzealous, and tissue damage occurs along with healing. Blocking the work of inflammatory mediators is an attempt to minimize surrounding tissue damage.
5. What does an elevation in leukocytes, erythrocyte sedimentation rate (ESR), or CRP levels tell you about the location of acute or chronic
inflammation? Answer: These laboratory values do not indicate location. These are nonspecific tests of inflammation or infection (leukocytes).
6. The RICE (rest, ice, compression, elevation) protocol is employed frequently in acute injury to minimize the effects of inflammation. How
does each of these components reduce inflammation? Answer: Rest decreases blood flow by limiting impact of muscle compression and gravity on the movement of blood through the vessels; ice vasoconstricts vessels; compression decreases blood flow and edema formation in the affected area by producing counterpressure; elevation decreases blood flow to the area by limiting the impact of gravity on the movement of blood through the vessels.
7. Why is it not a good idea to pick off a scab before a wound has healed?
Answer: This covering forms a protective barrier against further environmental exposures while the wound heals below the scab.
8. What did you eat and drink yesterday? What nutrients did you consume that would promote wound healing?
Answer: Answers will vary. Vitamins A and C along with protein are critical nutrients in healing.
9. How does the concept of healing by primary or secondary intention compare to the body’s three lines of defense?
Answer: Primary intention most resembles a first line of defense where the wound is minimally open to the environment.
10. Hematocrit is a laboratory test that indicates the percentage of RBCs in a designated volume of blood. Would an individual with partial-
thickness and full-thickness burns covering 20% body surface area have a decrease or increase in this laboratory value? What would be the impact of this change? Answer: An increased hematocrit would be noted as the blood becomes more concentrated. Fluids move out of the vessels as exudate leaving more viscous and concentrated blood with a reduction in blood pressure.
3. A wound is 6 cm × 6 cm × 4 cm. A wound with these dimensions needs to heal through:
a. secondary intention. b. primary intention. c. tertiary intention. d. scar tissue formation. Answer: a
4. A major difference between the acute and chronic inflammatory response is that in chronic inflammation:
a. inflammatory mediators are released.
b. neutrophils are much more prominent.
c. granulomas form around certain invaders.
d. granulation tissue is present.
Answer: c
5. Which is not a local manifestation of acute inflammation?
a. Edema
b. Redness
c. Loss of function
d. Leukocytosis
Answer: d
6. With burn injuries, it is important to determine the depth of injury. You are in the sun too long without sunscreen and develop redness
and blistering on your face, chest, and back. What depth of burn did you experience?
a. Superficial partial-thickness burn
b. Deep partial-thickness burn
c. Full-thickness burn
d. Dermal thickness burn
Answer: b
7.The hospitalized burn patient wants to know why you need to remove his dressings every day. It is painful and he wants to avoid
uncovering his burn injury. You explain that removing the dressings promotes:
a. debridement.
b. infection.
c. skin function.
d. drying the exudate.
Answer: a
8.What is the one definitive test to diagnose rheumatoid arthritis?
a. A positive rheumatoid factor (RF) b. An elevated erythrocyte sedimentation rate (ESR) c. A positive antinuclear antibody (ANA)
c. Increases blood flow to the tissues
d. Decreases scar formation
Answer: a
12. Which of the following is the most common cause of acute pancreatitis?
a. Cancer
b. Autoimmunity
c. Excess alcohol intake
d. Cystic fibrosis
Answer: c
13. Rheumatoid arthritis results in joint immobility as a result of:
a. synovial fluid loss.
b. pannus formation.
c. rheumatoid factor.
d. joint deviation.
Answer: b
14. Which of the following meals would you recommend to a patient who has a wound injury to promote healing?
a. Eggs and orange juice
b. Spaghetti and garlic toast
c. Steak and potatoes
d. Tomato soup and grilled cheese
Answer: a Additional Exercises for the Instructor’s Resource: Brownstone Test Generator (25-30 questions), Additional Case Studies (1-3), Additional Learning Activities (worksheets or other application exercises) Multiple Choice
1. Which characteristic best describes the inflammatory response?
a. Specific response to microorganisms
b. Initiated by certain types of injury
c. Hormone mediated
d. Regulated by chemical mediators
Answer: d
2. Which is not a major goal of the inflammatory response?
a. Increase blood flow to the site of injury
b. Form an antigen–antibody response
c. Dilute harmful substances at the site of injury
c. Blocks prostaglandins
d. The mechanism of action is unknown
Answer: c
6. The activation of complement induces all of the following except:
a. coagulation.
b. opsonization.
c. chemotaxis.
d. cell lysis.
Answer: a
7. Which of the following does not explain why multiple pathways are needed for the activation and suppression of chemical mediators?
a. Healing requires multiple chemical mediators.
b. The chemical mediators are so potent.
c. The response must be overzealous to be effective.
d. Autoimmunity can occur if unregulated.
Answer: c
8. Although against your better judgment, you squeezed an acne pustule on your face. Now you notice a clear fluid seeping from the
opening. What is this clear fluid?
a. Pus
b. Water
c. Exudate
d. Plasma
Answer: c
9. What is the role of the clear fluid referred to in the previous question?
a. Carries proteins and leukocytes
b. Promotes clotting
c. Replaces epithelial cells
d. Indicates edema in the underlying tissues
Answer: a
10. Which is not an essential step in the cellular response?
a. Cellular migration
b. Cellular adherence
c. Cellular chemotaxis
d. Cellular degranulation
Answer: d
14. How does the inflammatory response know when to retreat?
a. Feedback mechanisms regulated by plasma protein systems.
b. Multiple processes of cellular inhibition.
c. Inhibition is time dependent, the inflammatory response lasts 72 hours.
d. When all microorganisms have been destroyed.
Answer: a
15. You notice that after you sprained your ankle that the ankle became swollen, red, and hot. Why did the ankle get hot?
a. Exudate accumulated at the site.
b. Increased blood flow to the site.
c. The ankle became infected.
d. There was a thermal injury as well.
Answer: b
16. In chronic inflammation, extensive scarring is due to:
a. fibroblast activity.
b. degradation of collagen.
c. proteinase activity.
d. loss of labile cells.
Answer: a
17. Formation of these is a protective mechanism during some cases of chronic inflammation where an area is walled off in order
to protect surrounding unaffected tissues.
a. Adenomas
b. Granulomas
c. Basement membranes
d. Granulation tissues
Answer: b
18. Poor tissue perfusion can lead to this complication of chronic inflammation.
a. Keloid formation
b. Wound dehiscence
c. Adhesions
d. Ulceration
Answer: d
19. Which of the following types of burns can interrupt cardiac conduction and lead to sudden death?
a. Thermal
b. Chemical
c. Electrical
d. Radiation
c. Pannus
d. Nodular
Answer: c
23. What is the relationship between severe burns and the development of gastritis?
a. Burns shunt blood away from the stomach.
b. Eating spicy foods can burn the stomach.
c. Burns increase blood flow to the stomach.
d. Burns require the use of long-term analgesics, which irritate the stomach.
Answer: a
24. Which of the following is not a characteristic clinical manifestation of Crohn disease?
a. Weight loss
b. Constipation
c. Abdominal pain
d. Occult blood in stool
Answer: b
25. Which of the following statement is not true regarding ulcerative colitis?
a. It can occur anywhere in the gastrointestinal tract from the mouth to the anus.
b. It is associated with an increased risk of colon cancer.
c. It presents as a continuous friable intestinal lesion.
d. Perforation is a potential complication.
Answer: a Short Answer
26. Describe the rationale for each of the systemic manifestations: fever, leukocytosis, and increased circulating plasma proteins.
Answer: Fever is a result of chemical mediators acting directly on the hypothalamus. The hypothalamus is responsible for controlling temperature in the body. An elevated body temperature stimulates phagocytosis and can also inhibit the growth of certain microorganisms. Leukocytosis is an elevation in the white blood cell, or leukocyte, with a count usually above 10,000/mm^3. Typically, the individual has a white blood cell count of 5,000 to 10,000/mm^3. Leukocytosis demonstrates the increased circulation of white blood cells to aid in healing. Plasma proteins are also increased as a result of the three plasma protein systems (complement, kinin, and clotting). These proteins are called acute phase reactants and can be measured through the use of laboratory tests, such as C-reactive protein (CRP).
27. Erythrocyte sedimentation rate (ESR) is a nonspecific test for inflammation. What does this mean? What happens during the ESR test?
Answer: The erythrocyte sedimentation rate (also referred to as a sed rate or ESR) is a nonspecific method of testing for inflammation. This means that, when elevated, inflammation is occurring somewhere in the body, but the exact source or location is not identified by the test. During the inflammatory process, the coagulation cascade results in increased circulating levels of fibrinogen, which causes cells to stick together. When measured in a tube in the lab, RBCs exposed to the inflammatory process will fall faster and will clump together. The ESR test then measures (in mm/hr) the level of RBC stacking. The test takes about 45 minutes. Typically, a higher result
Answer: The basement membrane is a critical component of tissue healing and serves to provide a supportive architectural structure, support reepithelialization, or the movement of epithelial cells to form a covering over the wound, store growth factors, restore neuromuscular function at the site, and support the development of parenchymal tissues, that is, those tissues made up of cells with a specific function, such as neurons, myocardial cells, and epithelial cells, at the site.
31. Differentiate labile, stable, and permanent cells.
Answer: Labile cells constantly regenerate through mitosis, particularly epithelial cells of the skin, gastrointestinal tract, and urinary tract, and blood cells in the bone marrow. Stable cells stop regenerating when growth is complete but can resume regeneration if injured. Permanent cells, such as neurons, cardiac myocytes, and the lens of the eye, do not undergo mitosis and are unable to regenerate. Case Study 3-3 (only in instructor resource) Bill is a 54-year-old Asian male who sustained a full-thickness burn to 20% of his body while at work 3 days ago. He was exposed to a hot liquid at temperatures exceeding 180°F. The burn occurred primarily on his right arm, hand, and right side of his chest. He is currently hospitalized on a burn unit and is in stable condition.
1. How do thermal burns induce irreversible cellular injury?
Answer: In thermal injuries, a higher temperature and increased length of exposure will increase burn severity. Irreversible cellular damage occurs as proteins denature in the body at temperatures exceeding 45°C (113°F).
2. What is the impact of this degree and extent of burn on Bill’s cardiovascular system?
Answer: In widespread inflammation, as capillaries at the site of injury become more permeable, local fluid is allowed to shift out of the
blood vessels and into the tissues. There is less fluid in the blood vessels, and the circulating blood volume is reduced. In those with full- thickness burns, approximately 0.3 mL of body water per square centimeter is lost per day. When full-thickness burns cover 70% of the body, extensive fluid shifts out of the blood vessels and into the tissues resulting in severe hypovolemia (low fluid volume in the blood vessels). Systemically, the blood becomes viscous (thick) and heat converts red blood cells from a concave to a spherical shape, and the flow of blood is altered. An inadequate amount of blood in the circulation leads to shock, a state of inadequate perfusion (oxygenated blood flow) to peripheral tissues. Poor perfusion is particularly problematic in vital organs, which require a constant flow of oxygen to survive.
3. What is the role of eschar formation in a full-thickness burn?
Answer: At the local site of the burn, thrombi (clots) can develop, oxygenated blood flow is restricted, and necrosis can develop as the burned tissue becomes hypoxic. In full-thickness burns, this dead tissue and exudate convert into an eschar, which is a thick, coagulated crust. The eschar must be surgically removed in order to prevent extensive microorganism growth.
4. How are full-thickness burns different than partial-thickness burns with regard to clinical manifestations?
Answer: Superficial partial-thickness burns result in erythema, warmth, pain, swelling, and loss of function of affected areas. Deep partial- thickness burns lead to blistering, along with erythema, warmth, pain, edema, and serous exudate, which is a clear fluid that seeps out of the tissues. Erythema, eschar formation, edema, and exudate characterize full-thickness burns. Full-thickness burns destroy nerve endings, sweat glands, and hair follicles. Destruction of nerve endings inhibits the pain response in areas where the burn has penetrated all skin layers. The individual with a full- thickness burn is not pain free, however. Areas of deep and superficial thickness burns, like a bull’s-eye, often surround full-thickness burns. Pain is notable in these surrounding tissues.
5. What complications are likely given the severity of Bill’s burn injury?
