Inflammation and Wound Healing PDF

# INFLAMMATION AND WOUND HEALING ## INFLAMMATION 1. Severe generalized edema is called: - Myxedema - Pitting edema - Anasarca - Dependent edema **Explanation:** - When Edema is massive and generalized, it is called anasarca. It is caused by a variety of clinical conditions, like h...

# INFLAMMATION AND WOUND HEALING ## INFLAMMATION 1. Severe generalized edema is called: - Myxedema - Pitting edema - Anasarca - Dependent edema **Explanation:** - When Edema is massive and generalized, it is called anasarca. It is caused by a variety of clinical conditions, like heart failure, renal failure, liver failure, or problems with the lymphatic system. - The swelling is mainly caused by abnormal retention of body fluids in extracellular space and body tissues. Due to this, Anasarca is also known as dropsy, massive edema or generalized edema. In Anasarca the inflammation is widespread throughout the whole body. 2. Which of the following is NOT a plasma-derived chemical mediators? - Cytokines - Complement components - Kinins - Coagulation proteins 3. Cytokines are secreted by: - Neutrophils - B-Lymphocytes - Endothelial cells - All of the above 4. Which of the following increases vascular permeability during acute inflammation? - Histamine - Cytokines - AFP - Both A and B 6. The classical substances that increase the sensitivity of pain receptors by enhancing the pain-provoking effect of bradykinin is - Nociceptor - Endorphins - Prostaglandins - Encephalin **Explanation:** - High levels of prostaglandins are produced in response to injury or infection and cause inflammation, which is associated with the symptoms of redness, swelling, pain and fever. This is an important part of the body's normal healing process. - In contrast, Endorphins - causes analgesic effect. 7. Which of the following is a substance that decreases pain transmission and causes an inflammatory response? - Substance P - Endorphin - Prostaglandin - Histamine 8. All of the following are evidences of an infection, Except - Elevated WBC - Purulent drainage - Primary intention - Increased leukocytes 9. Hemorrhage with collection of blood in the soft tissue is called - Contusion - Purpura - Ecchymoses - Hematoma 10. Thick yellow drainage from the wound is known as: - Sanguineous - Serous-sanguineous - Serous - Purulent **Explanation:** - Clear and watery drainage is serous. Sanguineous drainage is fresh blood that is prevalent among deep wounds of full and partial thickness. Serous-sanguineous leakage is thin and watery, and it's pink in color. Purulent drainage is when the leakage from wound appears milky. It's generally gray, green or yellow. 11. Which of the following types of exudates contains fibrin? - Hemorrhagic exudate - Serous exudate - Fibrinous exudate - Purulent exudate ## WOUND HEALING 12. An opening of surgical wound edges is called: - Wound evisceration - Wound rupture - Wound approximation - Wound dehiscence **Explanation:** - Wound dehiscence is a surgical complication in which a wound ruptures along a surgical incision. It may be due to too tight suturing or loose improper suturing, sneezing, and coughing. - Wound evisceration - surgical incision opens (dehiscence) and the abdominal organs protrude or come out of the incision. 13. Diffuse, purulent inflammation of a tissue is called - Abscess - Cellulitis - Boils - Ulcers **Explanation:** - Cellulitis is a bacterial infection of underlying layers of the skin and the site of infection turns red with swelling and pain. It can be purulent (presence of pus) or non-purulent. - Key point: Cellulitis is diffused whereas abscess is localized. ## WOUND DEBRIDEMENT 35. Type of healing occurs in a decubitus ulcer which is treated with debridement and moist gauze dressing is: - Tertiary intention - Secondary intention - Regeneration of cells - Remodeling of tissues 36. Surgically creating an opening into an organ or space in the body by a sharp instrument is known as: - Laceration - Abrasion - Puncture - Incision 37. Removal of nonviable tissue from an open wound to promote healing is known as: - Debridement - Dressing - Cleansing - Excision 38. Sharp removal of tissue at the wound margin or at the wound base until viable tissue is removed is known as: - Selective debridement - Excisional debridement - Cleansing - Dressing 39. Components of granulation tissue is: - Angiogenesis - Fibroblasts - Chronic inflammatory cells - All of the above 40. Which of the following type of debridement involves introduction of live maggots into the soft tissue of the wound for the purpose of cleaning the necrotic tissue? - Autolytic debridement - Biologic debridement - Enzymatic debridement - Mechanical debridement **Explanation:** - Biological Debridement - Biological debridement (maggot therapy), also known as larval therapy, uses sterile larvae of the Lucilia sericata species of the green bottle fly. It is an effective mode of debridement, particularly appropriate in large wounds where a painless removal of necrotic tissue is needed. 41. Which of the following type of debridement refers to the process of removal of damage tissue or foreign objects from a wound by physical force? - Sharp debridement - Mechanical debridement - Autolytic debridement - Enzymatic debridement **Explanation:** - Mechanical Debridement - Mechanical debridement is a nonselective devitalized type of debridement, meaning that it will remove both devitalized tissue and debris as well. Pulsatile lavage, or wound irrigation. It is indicated for both acute and chronic wounds with moderate to large amounts of necrotic tissue, regardless of the presence of an active infection. - It is carried using mechanical force: wet-to-dry, pulsatile lavage, or wound irrigation. ## GANGRENE 42. Characteristic of wet gangrene is: - Venous obstruction is there - It is invariably followed by bacterial infection - It is most commonly seen in the bowel - All of the above 43. Dry gangrene most commonly affects the - Bowel - Limbs - Lungs - Cervix 44. Dry gangrene commonly occurs due to: - Blockage of the venous supply - Arterial occlusion - Excessive blood supply to the limbs - Blockage of arterial supply 45. Meleney's synergistic gangrene is caused by: - Staphylococcus aureus - Streptococcus aureus - Streptococcus anginosus - Streptococcus bovis 46. Which of the following condition may lead to dry gangrene? - Buerger's disease - Diabetic foot ulcer - Bed sore - None of the above 47. Which of the following type of gangrene affects the genital region of the body? - wet gangrene - Dry gangrene - Fournier's gangrene - Meleney's gangrene ## PREVENTION & MANAGEMENT OF PRESSURE ULCER 48. All of the following scales are used to assess risk for pressures sore in patients; EXCEPT: - Waterlow scale - Broset scale - Norton scale - Braden's scale 49. The Braden Scale score of a client is 16. Most appropriate nursing action is: - Change position every 2 hours - High fowlers position - Apply moisturizer on the affected skin - Administer oxygen via mask 50. Decubitus ulcer on scapula measures 1 × 2 × 0.8 cm and pink subcutaneous tissue is completely visible on the wound bed, identify the stage: - Stage I - Stage II - Stage III - Stage IV 51. To properly stage a pressure ulcer: - The patient must be supine - The skin must be completely dry - Natural light must be used - Eschar must be removed **Explanation:** For assessment of stage of pressure ulcer, the eschar and slough must be removed before assessment. Position of the patient depends upon the site of pressure ulcer (not necessarily supine). A completely dry skin is not expected before assessing for staging. Day light may be preferred but not mandatory. ## Section A 52. The tool which is used for the risk assessment for pressure ulcer? - Waterlow scale - Wong baker scale - Brocet scale - Rule of nine 53. Loss of all tissue including bone and muscle is seen in which stage of pressure ulcer? - Stage 1 - Stage 2 - Stage 3 - Stage 4 54. Redness with intact skin is seen in which stage of pressure ulcer? - Stage 1 - Stage 2 - Stage 3 - Stage 4 55. Most important factor for healing of pressure ulcer is: - Tight packing of wound - wet dressing - Proper blood circulation - Proper nutrition 56. Partial thickness ulcer with red- pink color skin seen in which stage of pressure ulcer? - Stage 1 - Stage 2 - Stage 3 - Stage 4 57. How frequently the nurse need to change the position for the bed ridden clients? - Every 30 mins - Every 1 hr - Every 2 hrs - Every 6 hrs ## TYPES OF IMMUNITY 68. Humoral immunity is provided by: - T-lymphocytes - B- lymphocytes - Immunoglobulin - Interferon 69. Humoral immunity is also known as: - Cell mediated - Antibody mediated - Natural - Interferon mediated 70. T cell immunity is: - Cell mediated - Antibody mediated - Natural - Interferon mediated 71. Occurrence of certain disease or subclinical infection provides - Natural active - Natural passive - Active artificial - Passive artificial 72. Vaccination provides - Natural active - Natural passive - Active artificial - Passive artificial 73. Type of hypersensitivity reaction occurs during transfusion and erythroblastosis fetalis are: - Type I - Type II - Type III - Type IV 74. Lifelong immunity developed after the occurrence of disease is known as: - Natural passive immunity - Artificial passive immunity - Natural active immunity - Artificial active immunity 75. Cell mediated immunity is carried out by: - B lymphocytes - T lymphocytes - Monocytes - CD4 cells 76. Which of the following type of hypersensitivity is known as delayed type hypersensitivity and is carried out by T-lymphocytes? - Type I - Type II - Type III - Type IV 77. Identify the correct statement related to type I hypersensitivity: - Immunoglobulin responsible for type I hypersensitivity reaction is IgE - Mast cells are important cells in type I hypersensitivity - Immunoglobulin responsible for type I hypersensitivity reaction is IgG - Both A and B 78. Immediate treatment of Anaphylaxis is: - Adrenaline - Benzyl penicillin - Hydrocortisone - Atropine **Explanation:** Adrenaline or epinephrine is the immediate treatment of anaphylaxis. Adrenaline stimulates the alpha adrenoceptors and thereby it increases peripheral vascular resistance that leads to the improvement of blood pressure, reversing of peripheral vasodilation, coronary perfusion and it decreases angioedema. 79. During blood transfusion therapy, patient developed wheezing and her skin becomes flushed with hives. These are the characteristics of: - Hemolytic reaction - Allergic reaction - Transfusion - Thrombotic crisis 80. Identify the transfusion reactions among the following: - Hemolytic transfusion reactions-immediate or delayed - Infections - Allergic reactions - All of the above 81. Identify autoimmune diseases among the following: - SLE - Grave's disease - Myasthenia gravis - All of the above 82. The nurse is caring for a child who is taking corticosteroids for systemic lupus erythematosus. The nurse carefully monitors child's condition because the nurse is aware that corticosteroids can have what major action? - They increase liver enzymes - They can mask signs of infection - They cause bone marrow suppression - They decrease renal function **Explanation:** Corticosteroids suppress the immune system, so the immune response to infection is diminished. It may mask or hide some signs and symptoms of infection. 83. HLA elevates in `______ `condition. - Congenital malformation - Malignant tumor - Hepatic disorders - Autoimmune disorders 84. A rise of an existing antibody level in response to irrelevant stimulus is called: - Anaphylactic reaction - Anamnestic reaction - Agglutination reaction - Precipitation reaction **Explanation:** Anamnestic reaction, also known as booster response, is a delayed immunologic response. Exposure to antigen in a sensitized individual results in massive production of existing antibody. Agglutination reaction is the process that occurs if an antigen is mixed with corresponding antibody. Anaphylactic reaction are life threatening reactions which exhibit symptoms such as generalized itching and hives, swelling, wheezing and difficulty breathing, fainting, and/or other allergy symptoms. Precipitation reaction refers to the formation of an insoluble salt when two solutions containing soluble salts are combined. 85. Which of the following is a priority in planning care for a client with a diagnosis of immune deficiency? - Providing emotional support to decrease anxiety - Identifying factors that decreased the immune function - Encouraging discussion about lifestyle changes - Protecting the client from infection **Explanation:** Immunodeficiency is state of diminished or absence of immune response that increases susceptibility to infection. Protecting the client from the infection is the priority while planning the care of patient with compromised immunity. 86. Delayed hypersensitivity reaction can be managed with: - Adrenaline - Dopamine - IV fluid - Corticosteroids 87. The aim of immunosuppressive therapy is to: - Stimulate the antibody production against foreign antigens - Suppress the production of antibodies against foreign antigens - Promote phagocytosis - All of the above **Explanation:** The purpose of immunosuppressive therapy is to reduce the immune response to foreign antigens (infections) by suppressing the production of antibodies against it. ## Multiple Choice Questions 100. Which of the following immunoglobulin is very important in fighting bacterial and viral infections? - IgA - IgM - IgE - IgG 101. Which type of immunoglobulin is associated with allergic reaction? - IgA - IgM - IgE - IgG 102. Which of the following immunoglobulin is the most abundant isotype in the blood? - IgA - IgM - IgE - IgG 103. Immunoglobulins are proteins that are produced by `______ ` - B cells - T cells - Chief cells - Parietal cells 104. Which immunoglobulin is present in the mucus and helps in protecting against bacteria and virus? - IgA - IgM - IgE - IgG ## HIV & AIDS 105. Which immunity is affected by HIV infection? - Natural immunity - Active immunity - Cellular immunity - Humoral immunity **Explanation:** HIV attacks and destroys the T helper lymphocytes or T-cells, which are crucial to the immune system and immune response. CD4 T cells will be affected which is responsible for cellular immunity. 106. HIV affects: - B-cells - Helper T cells - Neutrophil - Lymphocyte 107. While screening for HIV, blood is tested for: - P24 antigen - HIV DNA plasma - HIV antibodies - Presence of HIV RNA 108. Which of the following diagnostic test is considered as a gold standard for confirmation of HIV infection? - ELISA test - Tri-dot test - Western blot test - Polymerase Chain Reaction (PCR test) **Explanation:** Western blot is often used as a follow-up test to confirm the presence of an antibody of HIV virus. This test is considered to be the gold standard for confirmation of HIV infection. 109. Which among the following is the most appropriate intervention to prevent the progression of HIV to AIDS? - Monthly plasmapheresis - Abstinence - Compliance with complete therapeutic regimen - Monthly blood test 110. Risk for vertical transmission of HIV is more during: - Antenatal period - Intranatal period - Postnatal period - Breast feeding 111. Which of the following statement is false? - Untreated HIV infection can remain in the early chronic stage for a decade or more - Infection with HIV results in a chronic disease with acute exacerbations - Late stage detection is called AIDS - Opportunistic disease occurs more often when the CD4 T cells count is high and viral load is low 112. The diagnosis of HIV AIDS is made based on: - CD4+ T cell count - Sudden weight loss - Diarrhea - Persistent fever 113. Which of the following is an indicator of AIDS? - CD4 count lower than 1000 cells/mm³ - CD4 count lower than 600 cells/mm³ - CD4 count lower than 400 cells/mm³ - CD4 count less than 200 cells/mm³ **Explanation:** According to the CDC disease staging system, the definition of AIDS includes all HIV-infected individuals with CD4 counts of <200 cells/µL (or CD4 percentage <14%) as well as those with certain HIV-related conditions and symptoms. 114. The clinical symptoms of wasting syndrome in AIDS include: - Involuntary weight loss - Chronic diarrhea - Protein - energy malnutrition - Oesophageal candidiasis - A, B, C - B, C, D - A, B, D - A, B, C, D **Explanation:** The symptoms of wasting syndrome in AIDS include involuntary weight loss, diarrhea for at least a month, protein energy malnutrition, extreme weakness and fever that's not related to infection. Esophageal candidiasis is an opportunistic infection of oesophagus by candida albicans. 115. Organism responsible for pneumonia in AIDS patient is: - Cytomegalo virus - Fungi - Pneumocystis carinii - Mycoplasma 116. Which of the following condition is associated with AIDS? - Invasive cervical cancer - Kaposi's sarcoma - Burkitt's lymphoma - All of the above 117. Find out the malignancies associated with HIV AIDS: - Kaposi's Sarcoma - Non Hodgkin's lymphoma - Cervical cancer - All of the above 118. Which is the most common cancer associated with AIDS? - Leukemia - Adenocarcinoma - Osteosarcoma - Kaposi's sarcoma **Explanation:** Kaposi's sarcoma is most common cancer associated with the AIDS. 119. While providing oral care to a retro positive client, nurse should: - Use special mouth care solution - Use soft tooth brush - Isolate the client - Wear gloves 120. While taking temperature of HIV positive client nurse should: - Wear all PPE - Wear mask and gloves - Use 1% hypochlorite solution - Wash hands before and after the procedure 121. Which among the following food item need to be avoided by an immunocompromised person who is experiencing frequent diarrhea? - Milk - Rice water - Fruits - Curd **Explanation:** Parasites may be the most common etiology for enteritis, especially in patients who are greatly immunosuppressed. Feed intolerance is common in immunosuppressed patients and is usually manifested by vomiting and diarrhea. In these patients, bulking agents, lactose-free diets, and antidiarrheal medications like diphenoxylate with atropine or loperamide are beneficial in treating diarrheal symptoms. 122. Opportunistic diseases: - Can be sudden in onset - Can occur at any point of time - Occur during immunosuppression - Can be treated with oral antibiotics 123. Rapidly progressive dementia is seen in: - Alzheimer's disease - Vascular dementia - HIV Dementia - Parkinson's disease ## ANTIRETROVIRAL THERAPY 124. ART stands for: - Antiretroviral Therapy - Antiretroviral Treatment - Anti rhesus Treatment - All retroviral Therapy 125. Antiretroviral drugs help to: - Treat HIV infection - Decrease viral RNA levels - Control pneumocystis carinii pneumonia - Decrease pain and diarrhea 126. Which of the following anti-retroviral drug is newly introduced by NACO for the treatment of HIV positive patients? - Tenofovir Disoproxil fumarate - Lopinavir - Lamivudine - Dolutegravir **Explanation:** Dolutegravir is a new drug used for the treatment of HIV positive individuals.