FRCS Principles of Surgery & Wound Healing

Question 1

A patient is in Class III haemorrhagic shock. What is the estimated blood loss and the expected physiological response?

Accepted Answer

1500–2000 mL; marked tachycardia, decreased BP, decreased urine output

Answer

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?

Accepted Answer

Platelet-derived growth factor (PDGF)

Answer

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?

Accepted Answer

Type III collagen

Answer

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?

Accepted Answer

Healing by direct apposition of wound edges with sutures, clips, or glue

Answer

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?

Accepted Answer

Temperature 38.6°C, heart rate 102 bpm, RR 22 breaths/min, WBC 13.5 × 10⁹/L

Answer

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.

FRCS Part A Practice Test

FRCS Part A Practice Test

FRCS Principles of Surgery & Wound Healing