ID surg Flashcards
How does a necrotising surgical site infection present?
Management?
Pain Edema erythema spreading beyond surgical site
Fever tachycardia or hypotension
Parenthesia or anaesthesia around wound edges
Cloudy gray discharge
Subcutaneous gas or crepitus
Parental antibiotics AND urgent surgical debridement
Amoebic abscess can cause fever RUQ and lesion in liver lobe. Elevated lfts is typical. Can also cause diarrhoea. Seen in resource limited settings. Not hepatitis as jaundice would be seen, aminotrabsferases >1000, abscess would not be seen. So UPSI was misleading
Wound developing erythematous streaks at site and regional lymphadenopathy. Fever Most likely diagnosis? Treatment
Cephalexin !!,
Acute infectious lymphangitis
Loss of skin grafts eg sloughing in a burns injury patient and confusion tachycardia fever is concerning for BW infection. Management?
Meropenem or pip Taz PLUS vancomycin!!
Need both gram positive and negative cover
What are the early signs of burn injury sepsis?
Low temp or greater than 39
Tachycardia or hypotension or tachypnea
Changes in CBC
Evidence of feeding intolerance = high gastric residual volumes, distended abdomen OR other signs of end organ dysfunction eg oliguria
Patient with pancreatic cancer has now had palliative biliary stenting to relive cancer obstruction. Now has fever, leukocytosis, elevated liver enzymes, RUQ pain and an associated pleural effusion. Most likely diagnosis?next step I’m managing after fluids and antibiotics?
Pyogenic liver abscess - may have spread from infected stent
CT scan
Signs of splenic abscess are Left sided chest and upper abdominal pain, fever, leukocytosis triad.
Left sided pleural effusion also seen and sometimes spleenomegaly
Infective endocarditis often associated = eg valve prolapse, weight loss fevers.
Splenic involvement not seen in TB and TB is more chronic
Splenic abscesses not seen in lung cancer
Immediate post op fever so within a day of operationmis likely due to tissue damage in procedure and is Managed how? Other causes of immediate post Op fever?
Symptomaticalky with acetaminophen and observation
Blood products so transfusion reaction
Malignant hyperthermia = muscle ridgidity
In patients with liver disease eg alcoholic cirrhosis viral hepatitis, hemachromatosis, an infection with vibrio vulnificus through a small cut in leg and exposure to infected water presents in what way?
Necrotising fasciitis
Hemorrhagic bullous lesions, shock
Radio graphic evidence of gas in deep tissues is in keeping with necrotising fasciitis. Rapid progression of wound occurs vs pyomyositis which doesn’t have gas and is confined to a muscle group. Systemic signs in nec fasc eg hypotension
When the bone can be palpated in a diabetic foot ulcer, risk of underlying osteomyelitis is increased. Next step in management?
Metatarsal/ bone biopsy and culture !! to confirm diagnosis of osteomyelitis
If osteomyelitis confirmed = surgical debridement and antibiotics
Amputation is last resort = ischemia, necrosis
Intubated patient with post op signs of pneumonia most likely has ventilator associated pneumonia. It develops from 48hrs post intubation. Next step in management following CXR?
Lower respiratory tract sampling with culture!!,
Antibiotics only given after
Which antibiotics should be avoided in a patient with a medical history of abdominal aortic aneurysm ?
Levofloxacin!! and other fluoroquinolones!!
Also associated with Achilles tendon rupture and retinal detachment
Knee pain 6 months after knee replacement. Most likely organism?
Staph epidermis!! - chronic signs can also include gait impairment, implant loosening
If more acute, so less than 3 months = staph aureus
Most effective way of reducing burns injury infection risk?
Early wound excision and grafting
Prophylactic antibiotics not used as they don’t prevent burn sepsis
Severe pain and decreased range of motion can point away from simple infection to septic arthritis. Management?
Surgical irrigation and debridement
And antibiotics
drooling dysphasia and tender submandibular region are all signs of Ludwig angina which is cause by infection of?
Teeth roots!!
After a splenectomy, what antibiotic should patient take immediately if they develop fever
Co amoxiclav
first line to prevent CA- UTI?
Clean intermittent catheterisation
A cystic hepatic lesion with eggshell calcification is concerning for hydatid cyst. Dogs are a hostb- can cause Ruq pain, nausea, hepatomegaly
Contrast to simple hepatic cyst that don’t cause calcification and are congenital
Patients with plantar puncture wounds through footwear are at risk of infection with which organism?
Pseudomonas
Treatment of osteomyelitis in sickle cell?
Clindamycin plus ceftriaxone
Compression injuries can occurs due to malpositkon during surgery and resolve on their own. Eg foot drop
