PBL 2 WEEK 2 QUIZ

SKIN REVISION 1 List the five layers of the epidermis, the

two layers of the dermis and state what the hypodermis comprises:

What is the role of sebum?

What is the name of the antigen presenting cell (APC) found in the skin, and what MHC does it express?

SKIN REVISION 1 List the five layers of the epidermis, the two

layers of the dermis and state what the hypodermis comprises: Stratum cornium, lucidium, granulosm, spiousum,

basale Papillary and reticular dermis CT and Adipose

What is the role of sebum? Keeps skin soft/moisturised, ↓ bacterail growth by ↓ pH,

reduces evaporation What is the name of the antigen presenting cell

(APC) found in the skin, and what MHC does it express? Langerhan cell, MHC class II

SKIN REVISION 2 List three ‘natural flora’ of the skin

What is the active component in skin which creates vitamin D3 from sunlight?

Describe three ways in which thermoregulation is accomplished via the skin:

SKIN REVISION 2 List three ‘natural flora’ of the skin

Proprionibacterium acnes, Staphylococcus aureus, Staph. epidermidis

What is the active component in skin which creates vitamin D3 from sunlight?7 dehydrocholesterol

Describe three ways in which thermoregulation is accomplished via the skin:Sweating, insulation via subcutaneous fat

and hair, alteration of dermal blood vessels

ASSESSMENT OF BURNS 1 What percentage of burn TBSA equates to a

systemic inflammatory response? Which system does this pose the most immediate threat too?

An adult was admitted with burns to their right arm, forearm, thigh and leg, as well as half of their front and back. Approximately what %TBSA does this equate too?

List three factors which would lead you to suspect inhalation burns have been obtained:

ASSESSMENT OF BURNS 1 What percentage of burn TBSA equates to a

systemic inflammatory response? Which system does this pose the most immediate threat too? 20-25%. Respiratory system.

An adult was admitted with burns to their right arm, forearm, thigh and leg, as well as half of their front and back. Approximately what %TBSA does this equate too? ~45%

List three factors which would lead you to suspect inhalation burns have been obtained: Burns to face and neck or inside mouth and nose,

hoarseness, chest noises, hypoxia, carbonaceous sputum, env. factors: noxious gases/fumes, enclosed space.

ASSESSMENT OF BURNS 2 Describe the appearance of a superficial

burn and why it looks like this. Do you get necrosis?

What is one of the distinguishing features of a “2nd Degree”, partial thickness burn?

For a full thickness burn, list the three zones observed and state which of these can be saved and which of these can increase in size.

ASSESSMENT OF BURNS 2 Describe the appearance of a superficial burn and

why it looks like this. Do you get necrosis? Red – endothelial damage vasodilation and slight

oedema. No necrosis. What is one of the distinguishing features of a “2nd

Degree”, partial thickness burn? Blister – epidermal necrosis, dermal spared, separation

of layers. Blood redness – blood cells stuck out in the dermal layer

For a full thickness burn, list the three zones observed and state which of these can be saved and which of these can increase in size. Zone of Coagulation (could spread if

treatment/management is not sufficient), zone of stasis (can potentially be saved), zone of hyperaemia.

ACUTE MANAGEMENT OF BURNS 1 List three guiding principles for first aid

of burns:

When should IV line resuscitation be utilised?

What are the factors which determine the severity of a chemical burn? What is the difference between an acid and alkali burn?

ACUTE MANAGEMENT OF BURNS 1 List three guiding principles for first aid of

burns. Ice? Cool the burn/ stop the burning process. No ice! Reduce inflammatory mediator production Reduce tissue damage progression in first 24hrs.

When should IV line resuscitation be utilised? Partial thickness burns >15% in adult and 10% kid

What are the factors which determine the severity of a chemical burn? What is the difference between an acid and alkali burn? pH, length of contact, volume/concentration of

active agent, physical form of agent. Alkalis: protein denaturation and fat saponification

no barrier stopping further spread.

ACUTE MANAGEMENT OF BURNS 2 For what type of burns should silver

sulfadiazine be used? What are the contraindications for its use?

List three of the referral criteria to a special burns unit:

What is the mechanism behind the opioid- sparing powers of paracetamol?

ACUTE MANAGEMENT OF BURNS 2 For what type of burns should silver sulfadiazine be

used? What are the contraindications for its use? Small, superficial partial thickness Term pregnancy or newborn kernicterus

List three of the referral criteria to a special burns unit: Burns >10%TBSA for adult and 5% for kids, deep partial or full thickness burns >5%, inhalation or circumferential burns, burn across joint, hand, face, perenium Sig. associated injury or PMHx. Sig. chem or electrical burn

What is the mechanism behind the opioid- sparing powers of paracetamol? Who knows?

LONG TERM MANAGEMENT OF BURNS 1 List three professions involved in a

burns unit:

What three factors result in venous stasis and ischaemia, post-burn?

What is an eschar?

Why is Acticoat Absorbent used to dress escharotomy wounds?

LONG TERM MANAGEMENT OF BURNS 1 List three professions involved in a burns unit:

Nurse, physio, nutritionist, OT, social worker, mental health, orthotics, doctor/surgery.

What three factors result in venous stasis and ischaemia, post-burn? ↑ blood viscosity, localised oedema and ↓ circulatory

blood volume What is an eschar?

A dry scab/slough formed on the skin from protein denaturization.

Why is Acticoat Absorbent used to dress escharotomy wounds? Provides antimicrobial protection and absorbency.

LONG TERM MANAGEMENT OF BURNS 2 In what way do characteristics of a burn

influence infection?

What burn injury may prior alcohol consumption exacerbate?

What is an autogenous graft? What is the difference between a graft and a flap?

List the four factors influencing graft survival:

LONG TERM MANAGEMENT OF BURNS 2 In what way do characteristics of a burn influence

infection? The greater the severity and extent of the burn, the greater

the frequency of infection What burn injury may prior alcohol consumption

exacerbate? Why? Pulmonary issues. ?????

What is an autogenous graft? What is the difference between a graft and a flap? A graft taken from the recipient. Graft: no vascular pedicle, derives its blood flow from

recipient site revascularization. Flap: vascular network intact.

List the four factors influencing graft survival: Vascularity of recipient bed, level of contact b/n graft and

bed, immobilization of graft-bed unit, level of bacteria presence.

WOUND HEALING AND SCARS 1 What is the difference b/n resolution and

repair?

How does healing by second intention differ from first intention?

What does healing by tertiary intention involve?

WOUND HEALING AND SCARS 1 What is the difference b/n resolution and repair?

Resolution: destroyed tissues are capable of regeneration.

Repair: extensive tissue damage where regen. cant occur and collagenous scar tissue is used.

How does healing by second intention differ from first intention? First: no sig. tissue loss, clean wound, close edges. Second: sig. tissue loss. Longer epithelialisation,

scar formation and contraction What does healing by tertiary intention involve?

Debridement of the wound and may require skin grafts for full healing. Open wound for several days.

WOUND HEALING AND SCARS 2 What are the four stages of wound

healing and what occurs in each stage?

WOUND HEALING AND SCARS 2 What are the four stages of wound healing and

what occurs in each stage? Haemotoma: vasoconstriction, platelet

aggregation, fibrin clot formation. Inflammation: vasodilation, ↑ vasc. perm. Neutrophils,

Mᵠ and lymphocytes release GF to start wound healing Granulation tissue formation: presence of macrophages

and neutrophils, angiogenesis and the depsoition of Type III collagen by fibroblasts following fibrogenesis

Wound contraction/ECM deposition/remodelling: epithiliaization, fibroblasts require oxygenation to perform, whole wound contraction ~ day 10 from fibroblasts. Remodelling sees Type III collagen Type I, excess broken down, regression of vessels and granulation tissue.

INFECTIONS 1 List three issues and costs associated

with HAIs:

List three viral causes for HAIs:

Which infection sites are Staph epidermidis commonly responsible for?

What predisposes someone to vancomycin resistant enterococci (VRE)?

INFECTIONS 1 List three issues and costs associated with

HAIs: Morbidity and mortality, ↑ hospital stay, cost of

therapy, ↓ productivity, insurance claims, additional reservoir for infection

List three viral causes for HAIs: Norovirus, cytomeglavirus, rotavirus, herpes

simplex, respiratory syncytial virus Which infection sites are Staph epidermidis

commonly responsible for? IV lines, shunts and prosthetics

What predisposes someone to vancomycin resistant enterococci (VRE)? Use of a broad spectrum antibiotics

INFECTIONS 2 The most common cause of hospital

acquired diarrhoea is due to…

Provide characteristics of blood collection for an infected patient.

Provide some examples of ways to ‘break’ the infection chain.

INFECTIONS 2 The most common cause of hospital

acquired diarrhoea is due to… Clostridium difficle

Provide characteristics of blood collection for an infected patient. Take two samples, 30 mins apart from

separate sites. One anaerobic and one aerobic culture. Be wary of contamination

Provide some examples of ways to ‘break’ the infection chain. WASH YOUR HANDS!!! Face masks and other

PPE, cleaning, disinfection, sterile equipment

SEPSIS 1 What is the criteria for SIRS?

What two elements does the normal physiological response to inflammation consist of?

Basically explain the pathophysiology behind SIRS

SEPSIS 1 What is the criteria for SIRS?

Two or more of: Temp >38 or <36 RR >20bpm (tachypnoea), Hyperventilation PaCO2 <32mmHg HR >90bpm Abnormal WCC (>12,000, <4,000) or 10% immature

neutrophils What two elements does the normal physiological

response to inflammation consist of? Acute proinflam. state from innate immunity system

recognition of toll receptor ligands, and anti-inflam. phase that modulates this.

Basically explain the pathophysiology behind SIRS Cytokines released proinflam compounds, which in turn

cause endothelial damage and initiate in and extrinsic coagulation. Microthrombi, ischaemia, microcirulatory damage.

SEPSIS 2 The most commonly recognised initiator of

SIRS is….which is released by….

What variations of circulation can exist with septic shock? How does this affect the patients clinical features?

What other CF classically present with septic shock?

What actions are required for septic shock treatment?

SEPSIS 2 The most commonly recognised initiator of SIRS

is….which is released by…. Endotoxin lipopolysaccharide (LPS), Gram -ve

What variations of circulation can exist with septic shock? How does this affect the patients clinical features? Hyperdynamic (normal/↑ CO with ↓ PR) – flushed and warm Hypodynamic (↓CO with ↑PR) – pale and cool, peripheral cyanosis.

What other CF classically present with septic shock? Abrupt onset of chills, nausea, fever, tachypnea, vomiting,

↓ mental status, hypotension and tachycardia What actions are required for septic shock treatment?

Remove the cause of infection, maintain perfusion measures (IV fluids, CVS meds) and supportive treatment for complications.

ANTIBIOTIC CHOICE 1 What is the first question to ask when

considering AB selection?

What factors influence antimicrobial choice?

When should prophylactic AB therapy be used?

ANTIBIOTIC CHOICE 1 What is the first question to ask when

considering AB selection? Is an antimicrobial essential for treatment?

What factors influence antimicrobial choice?Side effects, therapeutic drug monitoring, risk of

superinfection, adverse drug events/ hypersensitivity, spectrums of act. of microbes

When should prophylactic AB therapy be used? In situations proven to show benefit or when

consequences of infection would prove disastrous

ANTIBIOTIC CHOICE 2 What is empirical therapy and what

should its use be based on?

Is pathogen or sensitivity directed therapy more accurate? Why?

What elements of the AB dictate duration of therapy?

ANTIBIOTIC CHOICE 2 What is empirical therapy and what should its

use be based on? Use of ABs before the aetiology of infection is

known. Local epidemiology, potential pathogens and their potential resistance

Is pathogen or sensitivity directed therapy more accurate? Why? Sensitivity. Don’t need to consider potential

resistance, ABs pt. has previously used… What elements of the AB dictate duration of

therapy? Whether the AB’s killing power is concentration

dependant or time dependant. Side effects. Toxicity. Pharmodynamics

FLUID BALANCE 1 What ‘shocks’ make up burn shock and

how soon after the burn should IV fluid resus occur to avoid it?

Briefly describe burn shock pathophysiology.

Explain why cardiac function is impaired in burn shock.

FLUID BALANCE 1 What ‘shocks’ make up burn shock and how

soon after the burn should IV fluid resus occur to avoid it? Hypovolemic and distributive shock. Initiated within

2hrs. Delay ↑ mortality rate. Briefly describe burn shock pathophysiology.

Microvasculature is damaged. Fluid and protein leak into interstitium. Change in osmotic pressure pulls fluid out of vessels.

Explain why cardiac function is impaired in burn shock. ↑afterload (catecholamines, vasopressin, angiotensin

II, neuropeptide Y released after burn injury) ↓preload (drop in plasma volume) Myocardial impairment (gut-derived inflam factors.)

FLUID BALANCE 2 What is contained within Hartmann’s

solution and why is it preferred for burns pt.s?

A 27 year old female weighing 80kg is brought in suffering surface burns to 45% of her body. How much fluid should she receive in the first 8 hours?

What level of urine output are we aiming to maintain?

FLUID BALANCE 2 What is contained within Hartmann’s solution

and why is it preferred for burns pt.s? Na+, K+, Ca++, Cl-, lactate and fluid. Of the

crystalloid family, it most resembles body fluids; also increased death rate with colloids and concerns with plasma.

A 27 year old female weighing 80kg is brought in suffering surface burns to 45% of her body. How much fluid should she receive in the first 8 hours? 4 x 80 x 45 = 14,400 ml/24 hr, 7,200ml in 8hrs.

What level of urine output are we aiming to maintain with her? 0.5ml/kg/hr, 40ml/hr