FRCS Principles of Surgery & Wound Healing — Questions and Answers
Question 1: A patient is in Class III haemorrhagic shock. What is the estimated blood loss and the expected physiological response?
- 750–1500 mL; mild tachycardia, normal BP
- 1500–2000 mL; marked tachycardia, decreased BP, decreased urine output (Correct answer)
- 2000–2500 mL; tachycardia, normal BP, anxiety
- <750 mL; minimal tachycardia, normal BP
Correct answer: 1500–2000 mL; marked tachycardia, decreased BP, decreased urine output
ATLS Class III shock involves 1500–2000 mL blood loss (30–40% circulating volume), producing: HR >120, systolic BP decreased, pulse pressure narrowed, RR 30–40, urine output 5–15 mL/hr, and confusion/anxiety. Immediate fluid resuscitation and likely blood transfusion are required.
Question 2: Which growth factor is the primary driver of the proliferative phase of wound healing?
- TNF-alpha
- Platelet-derived growth factor (PDGF) (Correct answer)
- Transforming growth factor-beta (TGF-β)
- Vascular endothelial growth factor (VEGF) for fibroplasia
Correct answer: Platelet-derived growth factor (PDGF)
PDGF is released from platelets in the initial haemostatic phase and is one of the primary chemotactic and mitogenic signals for fibroblasts, initiating the proliferative phase. TGF-β drives fibrogenesis and scar formation. VEGF drives angiogenesis within the proliferative phase.
Question 3: What type of collagen is predominantly synthesised during the proliferative phase of wound healing and replaced in the remodelling phase?
- Type I collagen
- Type II collagen
- Type III collagen (Correct answer)
- Type IV collagen
Correct answer: Type III collagen
Type III collagen (fine, immature) is predominantly produced during the proliferative phase of wound healing. During the remodelling phase (weeks to months), Type III collagen is gradually replaced by the stronger Type I collagen as wound tensile strength increases. The wound never regains 100% pre-injury strength (maximum ~80%).
Question 4: What is primary intention wound healing?
- Healing that occurs without any surgical intervention
- Healing by direct apposition of wound edges with sutures, clips, or glue (Correct answer)
- Healing where the wound is left open to heal from the base
- Healing assisted by a vacuum-assisted closure device
Correct answer: Healing by direct apposition of wound edges with sutures, clips, or glue
Primary intention healing occurs when wound edges are brought together directly (sutures, staples, adhesive strips, or glue), allowing the wound to heal with minimal scar tissue. This is used for clean surgical incisions. Infection risk is low and healing is faster than secondary intention.
Question 5: Which sign indicates early systemic inflammatory response syndrome (SIRS) in a surgical patient?
- Temperature 38.2°C, heart rate 95 bpm, RR 19 breaths/min, WBC 9.5 × 10⁹/L
- Temperature 38.6°C, heart rate 102 bpm, RR 22 breaths/min, WBC 13.5 × 10⁹/L (Correct answer)
- Temperature 37.8°C, heart rate 88 bpm, RR 16 breaths/min, WBC 8 × 10⁹/L
- Temperature 36.8°C, heart rate 75 bpm, RR 14 breaths/min, WBC 10 × 10⁹/L
Correct answer: Temperature 38.6°C, heart rate 102 bpm, RR 22 breaths/min, WBC 13.5 × 10⁹/L
SIRS is diagnosed by two or more of: temperature >38°C or <36°C, heart rate >90 bpm, RR >20 breaths/min or PaCO2 <4.3 kPa, WBC >12 or <4 × 10⁹/L. Option B meets three criteria: temperature 38.6°C, HR 102, RR 22, and WBC 13.5 × 10⁹/L.
Question 6: Keloid scarring differs from hypertrophic scarring in which key way?
- Keloid scars remain within the original wound boundary; hypertrophic scars extend beyond it
- Hypertrophic scars remain within wound margins; keloid scars extend beyond the original wound boundary (Correct answer)
- Keloid scars regress spontaneously; hypertrophic scars do not
- Hypertrophic scars occur only in dark skin; keloid scars occur in any skin type
Correct answer: Hypertrophic scars remain within wound margins; keloid scars extend beyond the original wound boundary
Keloid scars grow beyond the original wound boundary and may continue to enlarge over time; they do not regress spontaneously and are more common in darker skin types and in certain anatomical sites (sternum, shoulders, earlobes). Hypertrophic scars remain within the wound margins and may regress with time.
FRCS Principles of Surgery & Wound Healing
A patient is in Class III haemorrhagic shock.
What is the estimated blood loss and the expected physiological response?