Hand infection

Question 1

Patients who use tobacco should be expected to have slower
healing.

Answer 1

T

Question 2

The location of
wounds can influence decision-making.

Answer 2

T

Question 3

Signs of progressing infection

Answer 3

pain with passive ROM and
ascending lymphangitis,

Question 4

A critical step in the workup of hand infection is determining
whether a patient needs hospitalization versus outpatient management

Answer 4

T

Question 5

Hospitalization Indications

Answer 5

ascending lymphangitis,
a failed trial of oral antibiotics,
systemic symptoms,
elevated white blood cell (WBC) count,
needing operative intervention,
a high risk of not following-up.

Question 6

indications
for surgical management

Answer 6

Fluctuance, purulent drainage, and worsening pain

Question 7

MRSA infections tend to present with more skin
necrosis

Answer 7

T

Question 8

Immunocompromised
patients are more susceptible to fungal, mycobacteria

Answer 8

T

Question 9

Tissue culture will be
more reliable than culture swabs

Answer 9

T

Question 10

Elevation and rest are standard treatment adjuncts for infection
and are important components of pain management.

Answer 10

T

Question 11

position of function

Answer 11

wrist extended 30°, MCP flexed 90°, digits extended

Question 12

Hand soaks are commonly used in the acute setting and rehabilitation phase,

Answer 12

T

Question 13

report better pain
control and ability to perform ROM exercises when the hand is submerged in warm solution

Answer 13

T

Question 14

, treatment comprises hand soaks, oral antibiotics, and hand elevation. A first-generation cephalosporin of acute paronychia

Answer 14

T

Question 15

I + D is performed by incising the skin longitudinally

Answer 15

T

Question 16

Chronic paronychias present as longstanding induration, pain, erythema along the nail fold, nail plate ridges, elevation of the skin off the
nail plate, and occasional drainage

Answer 16

T

Question 17

The nail plate may be thickened and
discolored in chronic paronychia

Answer 17

F The nail plate may be thickened and
discolored due to concomitant onychomycosis

Question 18

antifungal coverage for Candida albicans with nystatin or itraconazole is generally required, along with marsupialization (excision of
semilunar patch of eponychial skin and subcutaneous tissue down to
the germinal matrix

Answer 18

T

Question 19

Topical gentian violet is a historic treatment for
chronic paronychia that is gaining popularity again

Answer 19

T

Question 20

Because of the
extensive septae within the pulp, infection remains localized within a
small compartment

Answer 20

T

Question 21

A felon can present without swelling

Answer 21

T throbbing
pain, often without visible external swelling until infection is advanced

Question 22

scars can become hypersensitive

Answer 22

T

Question 23

Delay in I + D of these abscesses can result in pulp necrosis,
osteomyelitis, or extension of infection into the flexor sheath.

Answer 23

T

Question 24

Untreated infectious tenosynovitis leads to

Answer 24

stiffness, chronic
pain, osteomyelitis, and ascending limb-threatening infection

Question 25

If caught within 24 to 48 hours with mild or equivocal Kanaval signs, treated with with IV antibiotics, rest, elevation, and inpatient monitoring alone

Answer 25

T

Question 26

Whom should undergo surgical decompression in the operating room

Answer 26

Anyone presenting with symptoms longer than 48 hours, Kanaval signs, or worsening symptoms with conservative management

Question 27

hand therapy can be started 24 to 48 hours after surgery

Answer 27

T

Question 28

indicators of a poor prognosis.in flexor tenosynovitistes

Answer 28

Subcutaneous purulence and digit ischemia on presentation

Question 29

the most common hand infection

Answer 29

Cellulitis

Question 30

Indication of admission with cellulitis

Answer 30

Ascending lymphangitis, elevated WBC, altered mental status, or lack of response to oral antibiotics warrant inpatient admission and IV antibiotics

Question 31

Surgery is not indicated for cellulitis

Answer 31

T

Question 32

X-rays should be performed if there is suspicion of a retained foreign body or fracture in case of fight bite fracture

Question 33

Fight bites require exploration of the wound to rule out jointspace infection, as the MCP joint is violated in 70% of cases.

Answer 33

T

Question 34

Percentage of deep space infection?

Answer 34

Deep-space infections comprise 5% to 15% of all hand infections

Question 35

abscess in the thenar region after a puncture wound will be blocked from moving ulnarly toward the small finger by the mid palmar septum

Answer 35

t

Question 36

collar button abscess can moved proximally through the parona space

Answer 36

F collar button abscess originating volar webspace and confined distally, because the strong palmar aponeurosis blocks infection from spreading proximally

Question 37

collar button abscess spreads dorsally into the dorsal subcutaneous tissues

Answer 37

T

Question 38

Collar button abscesses generally require volar and dorsal incisions for complete drainage;

Answer 38

T

Question 39

Thenar abscesses can be managed with a dorsal incision and dissection between the first dorsal interosseous and adductor pollicis muscles.

Answer 39

T

Question 40

transverse incisions within the webspace cause adduction contractures and should be avoided.

Answer 40

T

Question 41

There are two types of of necrotizing faciates

Answer 41

type 1, involving multiple anaerobic and aerobic bacteria, and type 2, involving group A Streptococcus and Staphylococcus sp

Question 42

MRSA has been isolated in up to 39% of cases

Answer 42

T

Question 43

Signs of hemodynamic instability, such as hypotension, tachycardia, and altered mental status are indicative of septic shock.

Answer 43

T

Question 44

A classic sign of necrotizing fasciitis is

Answer 44

cloudy dishwasher drainage, due to necrosis of the fascia.

Question 45

Amputation must be considered in the setting of advanced muscle necrosis and septic shock

Answer 45

T

Question 46

Patients should be placed in the intensive care unit if there is any concern of hemodynamic instability

Answer 46

T

Question 47

Patients will generally need extensive soft tissue reconstruction once infection is cleared

Answer 47

T

Question 48

Because joints are avascular immune privileged sites

Answer 48

T

Question 49

Haemophilus influenza (in children), and Neisseria gonorrhoeae are the most common pathogens in septic arthrites

Answer 49

T

Question 50

The wrist joint is opened via a longitudinal dorsal skin incision

Answer 50

T

Question 51

Automated pulse lavage is avoided, because the excessive pressure can damage cartilage

Answer 51

T

Question 52

Mycobacteria are notoriously difficult to culture; suspicion should be raised for mycobacteria when rice bodies are found at time of debridement or granulomas are found on pathology

Answer 52

T

Question 53

Sporotrichosis is a fungal infection more common in gardeners

Answer 53

T

Question 54

Herpetic whitlow causes a burning sensation for I or 2 days, followed by erythema and blistering around the thumb of fingers

Answer 54

T

Question 55

Tzanck smear confirms diagnosis.

Answer 55

T

Question 56

Aggressive debridement and unroofing of vesicles is ill-advised and can predispose patients to bacterial superinfection

Answer 56

T

Question 57

The standard for diagnosing osteomyelitis is bone biopsy

Answer 57

T

Question 58

The ideal time to treat a hand infection is within the first 24 hours

Answer 58

T

Question 59

Any wound present for longer than 6 months should be biopsied to rule out cancer,

Answer 59

T