infections, gynecology, dermatology

Question 1

Acute abdominal/pelvic in women

Answer 1

1. Mittelschmerz
2. ectopic pregn
3. Ovarian torion
4. Ruptured ovarian cyst
5. PID

Question 2

ruptured ovarian cysts can be presented as …. due to ….

Answer 2

acute abdomen due to hemoperitoneum

Question 3

Acute bacterial parotitis - presentation

Answer 3

painful swelling of the parotid gland that is aggravated by chewing
high fever and a tender swollen and erythematous parotid gland are common

Question 4

post-operative acute bacterial parotitis - how to prevent

Answer 4

adequate fluid hydration + oral hygiene

Question 5

acute bacterial parotitis - MC organism

Answer 5

S. aureus

Question 6

role of incentive spirometry in surgery

Answer 6

reduce post operative pulm complications

Question 7

necrotizing fasciitis - microbiology

Answer 7

1. strep pyog
2. Staph
3. Clostiridium perfringens
4. polymicrobial

Question 8

necrotizing fasciitis - pathogenesis

Answer 8

bacterai spread rapidly through subcutaneous tissue + deep fascia, undermining the sin
MC imvolves extremities + perineal region

Question 9

necrotizing fasciitis - clinical manifestation

Answer 9

• often antecedent history of minor trauma
• erythema of the overlying skin
• swelling + edema
• pain out of proportion to emanination findings
• systemic symptoms (FEVER + HYPOTENSION)

Question 10

necrotizing fasciitis - treatment

Answer 10

requires surgical debridement + broad spectrum antibiotics

Question 11

pyomyositis?

Answer 11

muscle abscess
similar presentation to necrotizing fasciitis, with fever, erythema, swelling + pain
limited to 1 muscle group and does not spread rapidly

Question 12

Prosthetic joint infection - time

Answer 12

early (less than 3 months)
delayed (3-12 months)
late more than 12 months

Question 13

Prosthetic joint infection - presentation regarding onset

Answer 13

early onset: acute pain, wound infection or breaskdown, fever

delayed: chronic joint pain, implant loosening, sinus tract formation
late: acute symptoms in prev asymptomaitc joints, recent infection at distant site

Question 14

prostetic joint infection - MC organisms

Answer 14

early: s. aures, gram (-) robs, anaerobes
delayed: coagulase (-) staph, enterococcim, propionibacerium species
late: staph aureus, gram (-) robs, beta hemolutic strep

Question 15

Most frequent caues of of nosocomial bloodstream infection in patients with IV devices

Answer 15

coagulase (-) staph

Question 16

factos that favor infection of contamination

Answer 16

1. systemic signs (hypotensioon, fever, leukocytosis)
2. erythema and tenderness at the catheter entry site (absence of local signs does not rule out infection)
3. culture growth within 48 h and in both aerobic and anaerobic bottles
4. 2 or more blood culture samples wit the same organism and drug susceptibility

Question 17

signs and symptoms suggestive of necrotizing surgical site infection

Answer 17

1. pain, edema, erythema spreading beyond the surgical site
2. systemic signs (fever, tachycardia, hypotension)
3. parestesia or anesthesia at the edges
4. subcut gas or crepitus
5. purulent cloudy gray discharge (dishwater drainage)

Question 18

postoperative fever - MNEMONIC

Answer 18

Wind (day 1-2) (lungs): Atelectasis, postoperative pneumonia
Water (day 3-5): UTI
Walk (day 5-7): DVT / PE + IV ACCESS LINES
Wound (day 7): surgical site infection
Weird (8-15): drug fever or deep abscess
Wonder (drugs/products): drug fever, blood products, IV lines

Question 19

Postoperative fever: immediately

Answer 19

prior infection, blood products, malignant hyperthermia

Question 20

which skin SCC are more aggressive

Answer 20

SCC arises from chronic wounds

Question 21

skin cancer arises from scar or burn

Answer 21

SCC (Marjolin ulcer)

Question 22

sepsis after burn - organisms

Answer 22

immediately after sever burn: gram (+) from hair follicles and sweat glands
after 5 or more daysL gram (-) of fungi

Question 23

wound infections are common after burns - highest risk

Answer 23

if large surface area (more than 20%)

Question 24

burn wound sepsis - manifestation

Answer 24

Q: more than 39 or les than 36. 5
2. tachycardia
3. tachypnea
4. Refractory hypotension
ALSO: oliguria, unexplained hyperglycemia, thrombocytopenia, mental status

Question 25

burn wound sepsis - diagnosis

Answer 25

quantitative wound culture and biopsy for histopathology.

Question 26

burn wound sepsis - treatment

Answer 26

empiric, broad spectrum IV antibiotcs (tazosin, carbapeneme) with the addition of potential coverage for MRSA or multi-resistant Pseudomonas (aminoglycoside)
local wound care and debridement are usually necessary

Question 27

compartment syndrome after burn?

Answer 27

the eschar results drom circumferential, full thickness (3rd degree) burn often leads to constriction of venous and lymphatic drainage, fluid accumulation –> acute compartment syndrome

Question 28

first sign og burn wound infection

Answer 28

change in burn wound appearance or loss of skin graft

Question 29

drug fever

Answer 29

diagnosis of exclusion
1-2 wls after medication administration
- rash and peripheral eosinophilia