PATH MIDTERM 2 EXAM QUESTIONS AND CORRECT DETAILED / VERIFIED ANSWERS LATEST UPDATE

A patient visits his primary care physician with a 2-inch cut on the anterior aspect of his right hand. He lacerated his hand while fixing a barbed wire fence 5 days ago. He told his wife that he did not have time to go to the doctor for such a small cut. The NP instructed her nurse to clean the wound, apply a clean dressing, and call in a prescription for 10 days of antibiotics. Why didn't the NP stitch the wound to minimize scarring and allow the wound to heal by primary intention? How will the patient's wound have to heal? - ANS The patient waited too long. By waiting, the wound is likely contaminated with various bacterial species that would cause a severe wound infection. The wound also lacks good viable tissue at the wound borders. Stitching the wound would also allow the superficial bacteria to invade deeper tissue. This wound will have to heal by secondary intention. The individuals in room 234 had appendectomies. The person in bed 1 is 22 years old, and the person in bed 2 is 66 years old. Which one is at risk for poor wound healing? Why? - ANS The older person may be at higher risk for poor wound healing, although there is no concrete evidence that impaired wound healing is a function of aging. Older adults frequently have chronic conditions that impede wound healing; they often take medications that affect wound healing; they have a diminished immune system that may interfere with healing; and they have age-related physiologic changes in the skin that include decreased capillary perfusion that may affect wound healing. What is considered to be the second line of defense? - ANS The inflammatory response is the second line of defense. It occurs at the site of tissue injury and generates a nonspecific response that involves cellular and chemical components. the largest blood cells and are granular - ANS Monocytes Which cells are the predominant phagocytes of early inflammation? - ANS Neutrophils are the predominant phagocytes of early inflammation. They arrive before lymphocytes and macrophages. What are antigens? - ANS Antigens are recognized as foreign and initiate the immune response. Immunoglobulins and antibodies are part of the ______; they attack the antigen. - ANS adaptive immune response _____are a type of blood cell that is part of the adaptive response - ANS Lymphocytes Explain how macrophages assist in wound healing. - ANS The major role of macrophages in wound healing is to keep the wound free of extraneous debris. For healing to progress, the fibrin clot over the wound must be dissolved and replaced with normal tissue or scar tissue. As the clot is dissolved, macrophages invade the area and clear away debris. Macrophages are the primary phagocyte of débridement. They secrete collagenase, which promotes repair of injured collagen fibers in the wound. They also secrete the following substances that aid in wound healing: fibroblast-activating factor (which stimulates fibroblasts to enter a lesion and synthesize and secrete the collagen precursor procollagen); angiogenesis factor (which stimulates vascular endothelial cells to form capillary buds that grow into the lesion); and an unidentified factor that stimulates epithelial cells to grow over and seal the wound surface. As new capillaries grow into the wound, erythrocytes leak into the wound bed. Macrophages engulf and phagocytize them as the scar matures and repair becomes complete.