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wound contraction percentage decrease wound size myofibroblasts

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I now have enough information to give a thorough answer. Here is the full analysis:

Yes - the marked answer has an error, and the app's correct answer also needs scrutiny

What the image shows

  • User selected (marked wrong - red border): "It may account for a maximum of 40% decrease in the size of wound"
  • App marked correct (green border): "It is the function of specialised fibroblasts that contain actin myofilaments"

Is the app's "correct" answer truly correct?

Partially - but the wording is imprecise.
Wound contraction is mediated by myofibroblasts, which are specialized fibroblasts containing actin filaments (specifically alpha-smooth muscle actin, or α-SMA, organized into stress fibers). So the answer is directionally correct.
However, the option says "actin myofilaments" - myofilaments are technically the individual protein filaments inside muscle cells. The more precise term used in surgery textbooks is actin stress fibers or α-smooth muscle actin. This is a minor semantic point, but the core concept is right.
As Schwartz's Principles of Surgery states: "The myofibroblast...possesses a cytoskeletal structure. Typically this cell contains α-smooth muscle actin in thick bundles called stress fibers, giving myofibroblasts contractile capability."

Is the user's answer (40%) wrong?

Yes - the figure is wrong, and wound contraction can actually reduce wound size by far more than 40%.
  • Wound contraction can reduce open wound area by up to 80-90% in wounds healing by secondary intention (not sutured wounds).
  • Research from Darby et al. found an 85.7% wound reduction in a rat model.
  • The commonly cited figure in surgery textbooks is that wound contraction can account for up to 40-80% of wound closure depending on location and wound type - but a "maximum of 40%" is too low and incorrect.
  • Schwartz's also notes: "Wounds contract at the rate of 0.75 mm to 1 mm daily," and the process continues for weeks.
The 40% figure is a significant underestimate. A "maximum of 40%" is simply not true - wound contraction routinely exceeds this in loose-skinned areas (e.g., perineum, axilla, neck).

Summary table

OptionVerdict
Primary process in sutured woundsFalse - sutured wounds close by primary intention; contraction is relevant to open/secondary intention wounds
Bacterial colonization slows contractionTrue in principle - infection delays all wound healing phases including contraction, but this is not the "best" single answer
Function of specialised fibroblasts (myofibroblasts) with actinTrue and best answer
Maximum 40% decrease in wound sizeFalse - wound contraction can reduce wound size by up to 80%+
The app's answer is correct. The user's chosen answer (40% maximum) is indeed wrong because wound contraction can account for up to 80-90% of wound area reduction in secondary-intention wounds - not a maximum of 40%.
Source: Schwartz's Principles of Surgery, 11th Edition - "Wound Contraction" section; wounds-uk.com review of fibroblast role in wound contraction (Darby et al., 1990 - 85.7% wound reduction)
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Is the answer correct

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Zollinger-Ellison syndrome gastrinoma cell type diarrhea percentage features

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The app's answer is incorrect. Here is a full breakdown:

What the image shows

  • User selected (marked wrong - red): "1, 2 and 3"
  • App marked correct (green): "1, 2 and 4"
The four statements:
  1. Aggressive and refractory peptic ulceration
  2. Unregulated gastrin release
  3. Beta islet cell tumour of pancreas
  4. Diarrhoea present in up to 50% cases

Analysis of each statement

Statement 1 - Aggressive and refractory peptic ulceration: TRUE ZES classically causes fulminating, refractory peptic ulceration in the stomach, duodenum, or atypical sites (e.g., jejunum). Over 90% of ZES patients have peptic ulcer disease.
Statement 2 - Unregulated gastrin release: TRUE The gastrinoma autonomously secretes gastrin without the normal feedback inhibition. This is the core pathophysiology of ZES.
Statement 3 - Beta islet cell tumour of pancreas: FALSE This is the critical error. ZES is caused by a non-beta (non-β) islet cell tumour - specifically a gastrinoma (a G-cell or delta/epsilon cell tumour). Beta cells produce insulin (causing insulinoma/hypoglycaemia), NOT gastrin. Bailey and Love's Surgery explicitly defines ZES as: "non-β islet cell tumours of the pancreas (gastrinoma)." So statement 3 is wrong to call it a beta cell tumour.
Statement 4 - Diarrhoea present in up to 50% cases: FALSE (it's much more common) This is where the app's answer is also wrong. Diarrhoea occurs in up to 73-75% of ZES patients, not just 50%. Multiple sources confirm this:
  • Gastroenterology Research: "Diarrhea (73%) are the most common clinical features of ZES"
  • PMC review: "up to 75% manifest diarrhea"
  • Bailey and Love's: describes diarrhoea as "another common symptom" without limiting it to 50%
So saying "diarrhoea in up to 50% cases" significantly underestimates the true frequency and is technically incorrect as well.

What the correct answer should be

The best answer is "1 and 2 only" if strict accuracy is applied, since:
  • Statement 3 is wrong (beta cell, not non-beta cell)
  • Statement 4 is wrong (diarrhoea occurs in ~73-75%, not just "up to 50%")
However, if the question is from an exam context where "up to 50%" is being used loosely to mean "at least 50% or more," then 1, 2, and 4 could be considered the intended answer - though even this is a poorly worded option because diarrhoea is actually closer to 73-75%.
The user's answer of "1, 2 and 3" is definitively wrong because statement 3 (beta cell tumour) is a classic exam trap - ZES involves non-beta (G-cell/gastrinoma) islet cell tumours, not beta cells.
The app's answer of "1, 2 and 4" is the intended correct answer, though statement 4 slightly underestimates the true diarrhoea prevalence. The most important take-home is that statement 3 is wrong - it is a non-β islet cell tumour, not a beta cell tumour.
Source: Bailey and Love's Short Practice of Surgery, 28th Ed. - "Zollinger-Ellison syndrome is...non-β islet cell tumours of the pancreas (gastrinoma)"
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