Chapter 8: Surgical Infections Flashcards
A variety of patients were evaluated for surgery. For which one of the following are periprocedural prophylactic antibiotics considered standard care of issue?
A patient who requires open repair of an abdrominal aortic aneurysm***
A 48-year-old retired army veteran of the Iraw War has profuse diarrhea 10 days after a sigmoid colon resection and reanastomosis for perforate diverticulitis. He is on a regular diet and is afebrile and has mild diffuse abdominal tenderness but no indication of peritonitis. His stool specimen is bloody and C. Difficle toxin is detected. Initial management should be:
Oral Vancomycin Therapy (Vanc-can drink IV, but I think they use metronidazole first b/c vanc selects for resistance)
A 56-year-old man is seen in clinic preoperatively before a right hemicolectomy for a large sessile polyp locate in the cecum. He has hypertension controlled with hydrochlorothiazide, and lisinopril, and type-2 diabetes mellitus controlled with insulin. In order to be effective for this patient, intravenous prophylactic antibiotic therapy should be:
Administered one hour prior to operation
A 64-year-old man is on surgical ward recovering from a gastric resection for a large duodenal ulcer complicated by a duodenal stump leak, pneumonia and catheter related sepsis. A nasal swab was positive for MRSA. He was in the intensive care unit for 5 weeks and received a variety of intravenous antibiotics including clindamycin, a third generation cephalosporin, metronizable, and clindamycin. Neomycin irrigant was used to irrigate his peritoneal cavity at the initial surgery. He is now noted to have a decrease in hearing acuity. The most likely antimicrobial agent for this toxicity is:
Vancomycin (recall: the AGs as well-peaks and troughs (kidneys))
A 52-year-old man is in the surgical ward has a temperature of 102.5 degress Celsius four days after a laparotomy and lysis of adhesions for intestinal obstruction. Prior to surgery he was tread with an NG tube and IV fluids for 5 days but his obstruction failed to resolve. His prior surgical history include an appendectomy (age 10) and traumatic splenectomy (age 24). He has had an uneventful postoperative course, has regained bowel function, and his only oral medication is for incisional pain. His PE is unremarkable except for a swollen right FA w/ a small amt of purulent drainage noted from an old IV site. What is the next best step in management?
Excision of the IV site
A 35-year-old man is declared brain dead following an isolated gunshot wound. His family agrees to solid organ donation but his in depth medical and social history obtained by the organ donor staff details multiple heterosexual encounters and IV drug use. This drug activity occurred within the previous week. Which of the following best assesses his acceptability for organ donation?
The latent HTLV virus status in this patient is documented by enzyme-linked Immunosorbent assay (ELISA) and confirmed by nucleic acid testing (NAT)
A 54-year-old man comes to the Emergency Department because of diffuse abdominal pain for three days. He has cirrhosis secondary to hepatitis C and a history of GERD. His temperature is 38 degrees Celsius, BP-110/60 mm Hg, P-100 bpm, and R-18/min. There is mild scleral icterus. His chest is clear bilaterally and heart is regulat. His abdomen is distended and there is diffuse tenderness. An abdominal CT scan shows diffuse ascites and no free peritoneal air. A gallstone is also noted as well as sigmoid diverticulosis. A peritoneal tap shows 500leukocytes/mLandgramstainshowsG+cocci. Whatisthebestmanagementforthispt?
Admit to the hospital for intravenous antibiotic therapy
A 22 year-old man is in the hospital three weeks after and abdominal gunshot wound that penetrated the spleen, stomach, and proximal small bowel. The internal injuries had been repaired primary and the spleen removed. He has been eating a soft food diet. He now has intermittent fevers associated with chills and sweats and uniculated right subhepatic abscess is noted on CT scan. Vital signs are stable. In addition
Image-guided percutaneous drainage
A 64-year-old man is scheduled for an elective sigmoid colon resection for biopsy-proven adenocarcinoma. His
medical history includes a vessel coronary artery bypass graft and insulin-dependent diabetes mellitus. What is the most appropriate antibiotic management for this patient?
Should be administered one hour prior to the incision
A 79-year-old woman has been in the ICU on a ventilator for exacerbation of COPD for 6 days. Her past medical history includes an endovascular graft for an abdominal aortic aneurysm. She has a central venous line for fluid and medication administration because of lack of peripheral IV access. Blood cultures obtained in response to a 102.7 degree Celsius temperature are positive for E. Coli. The most likely source for the infection?
Urinary Tract
A 24-year-old man who works as a carpenter is seen in the Emergency Department because of a deep rusty nail puncture wound to the dorsal surface of the foot. He had a tetatnus booster shot six years ago. What is the recommended treatment protocol to prevent tetanus in this man?
Administration of 0.5 mL absorbed tetanus toxin. **
A 48-year-old man comes in the Emergency Department because of a painful left index finger for 3 days. He works as a short order cook at a local diner where he works the breakfast shit. He has a history of type-2 diabetes treated with oral medications. He smokes a pack of cigarettes daily. On Exam, there is erythema and swelling involving the soft tissue adjacent to the nail on the ulnar aspect of his left index finger. The swelling and erythema surround the base of the nail but does not extend beyond the DIP joint. It is very tender but there is no increased pain with active flexion or extension of the distal phalanx. There is no tenderness of the pulp of the distal phalanx. What ist eh best management for this patient?
Excision of the overlying nail plate
