Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgical Recall > SR 27 - Surgical Infection > Flashcards

SR 27 - Surgical Infection Flashcards

1
Q

Define cellulitus

A

Blanching erythema from superficial dermal/epidermal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define a superinfection

A

New infection arising while a patient is receiving antibiotics for teh original infection at a different site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common nosocomial infection?

A

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common nosocomial infection leading to death?

A

Respiratory tract infection (pneumonia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What constitutes a positive urine analysis?

A

Positive nitrite
Positive leukocyte esterase
>10 WBC/HPF
Presence of bacteria (supportive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What number of CFU confirms the diagnosis of UTI?

A

100,000 (10^5) CFU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the common organisms for UTI?

A

E. coli, klebsiella, proteus

Enterococcus, staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment for UTIs?

A

Antibiotics with gram-negative spectrum (i.e. Bactrim, gentamicin, ciprofloxacin, aztreonam)
Check culture and sensitivity - adjust meds from there

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the treatment for bladder candidiasis?

A

Remove or change foley catheter

Administer systemic fluconazole or give amphotericin bladder washings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the signs of a central line infection?

A

Unexplained hyperglycemia
Fever, mental status change, hypotension, tachycardia
Shock
Pus and erythema at central line site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common cause of ‘catheter-related bloodstream infections’?

A

Coagulase-negative staphylococcus (33%)

Enterococci, Staphylococcus aureus, gram-negative rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When should central lines be changed?

A

When they are infected

There is NO advantage to changing them ever 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What central line infusion increases the risk of infection?

A

Hyperal (TPN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the treatmetn for central line infection?

A

Remove central line, send for culture
+/- IV antibiotics
Place new central line in a different place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should peripheral IV short angiocatheters be changed?

A

Every 72-96 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a surgical site infection?

When do they arise?

A

Infection in an operative wound

POD 5-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Signs and symptoms of surgical site infections?

A

Pain at incision site, erythema, drainage, induration, warm skin, fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the treatment for surgical site infections?

A 
Remove skin sutures/staples
Rule out fascial dehiscence
Pack wound open
Send wound culture
Administer antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the most common bacteria found in post-op wound infections?

A

Staph aureus (20%)
E. coli (10%)
Enterococcus (10%)
Others - staph epidermidids, pseudomonas, anaerobes, gram -, streptococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which bacteria cause fever and wound infection in the first 24 hours after surgery?

A

Streptococcus

Clostridium (bronze-brown weeping tender wound)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the definition of a ‘clean’ wound? Infection rate?

A

Elective, nontraumatic wound without acute inflammation

usually closes primarily without the use of drains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the definition of a ‘clean-contaminated’ wound? Infection rate?

A

Operation on GIT or RT withou unusual contamination or entry into the biliary or urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the definition of a ‘contaminated’ wound? Infection rate?

A

Acute inflammation, traumatic wound, GIT spillage, or a major break in sterile technique
5% infection rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the definition of a ‘dirty’ wound? Infection rate?

A

Pus present, perforated viscus or dirty traumatic would

33% infection rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the possible complications of wound infections?

A

Fistula, sinus tracts, sepsis, abscess, suppressed wound healing, superinfection, hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What factors influence the development of infections?

A

Foreign body (i.e. suture, drains, grafts)
Decreased blood flow (poor delivery of PMNs and antibiotics)
Strangulation of tissues with excessively tight sutures
Necrotic tissue or excessive local tissue destruction
Long operation (>2 hrs)
Hypothermia in OR
Hematomas or seromas
Dead space that prevvents the delivery of phagocytic cells to bacterial foci
Poor approximation of tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What patient factors influence the development of infections?

A 
Uremia
Hypovolemic shock
Vascular occlusive states
Advanced age
Distant area of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are examples of an immunosuppressed state?

A 
Immunosuppressant treatment
Chemotherapy
Systemic malignancy
Trauma or burn injury
Diabetes mellitus
Obesity
Malnutrition
AIDS
Uremia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What lab tests are indicated with a surgical wound infections?

A

CBC - leukocytosis or leukopenia (an abscess may act as a WBC sink)
Blood cultures
Imaging studies (i.e. CT scan to locate an abscess)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the treatment for surgical wound infections?

A

Incision and drainage - an abscess must be drained

Antibiotics for deep abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the indications for antibiotic after drainage of a subcutaneous abscess?

A

DM, surrounding cellulitis, prosthetic heart valve or immunocompromised state
(flucuation is a sign of a subcutaneous abscess)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the causes of a peritoneal abscess?

A

Postoperative status after a laparotomy, ruptured appendix, peritonitis, any inflammatory intraperitoneal process, anastomotic leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the common sites for peritoneal abscesses?

A 
Pelvis
Morison's pouch
Subprenic
Paracolic gutters
Periappendiceal
lesser sac
34
Q

What are the signs/symptoms of a peritoneal abscess?

A

Fever (classifcally spiking)
Abdominal pain
Mass

35
Q

How is the diagnosis of peritoneal abscess made? When should you look?

A

Abdominal CT scan or ultrasound

POD 7

36
Q

What CT scan findings are associated with abscesses?

A

Fluid collection with fibrous rind

Gas in fluid collection

37
Q

What is the treatment for a peritoneal abscess?

A

Percutaneous CT-guided drainage

For pelvic abscess - transrectal/transvaginal drainage

38
Q

All abscesses must be drained except which type?

A

Amebiasis

Pre-treatment with surgical removal

39
Q

Define necrotizing fasciitis

A

Bacterial infection of underlying fascia

Spreads rapidly along fascial planes

40
Q

What are the causative agents for necrotizing fasciitis?

A

GAS (S. pyogenes)

But often polymicrobial with anaerobes/G- organisms

41
Q

What are the signs and symptoms of necrotizing fasciitis?

A

Fever, pain, crepitus, cellulitis, skin discoloration, blood blister, weeping skin, increased WBCs
Subcutaneous air on X-ray
Septic shock

42
Q

What is the treatment for necrotizing fasciitis?

A 
IVF
IV antibioitics
Aggressive early, extensive surgical debridement
Cultures
Tetanus prophylaxis
43
Q

What is clostridial myositis?

A

Clostridial muscle infection
AKA Gas gangrene
Due to Clostridium perfringens

44
Q

What are the signs and symptoms of clostridial myositis?

A

Pain, fever, shock, creptius
Foul-smelling brown fluid
Subcutaneous air on X-ray

45
Q

What is the treamtent of clostridial myositis?

A

IV antibiotics
Aggressive surgical debridement of involved muscle
Tetanus prophylaxis

46
Q

What is suppurative hidradenitis? Where do they occur?

A

Infection/abscess formation in apocrine sweat glands

Perineum/buttock, inguinal area, axillae (sites of aprocrine glands)

47
Q

What is the causative organisms in suppurative hidradenitis?

A

S. aureus

48
Q

What is the treatment for suppurative hidradenitis?

A

Antibiotics

Incision and drainage (excision of skin with glands for chronic infections)

49
Q

What is pseudomembranous colitis?

A

Antibiotic-induced colonic overgrowth of C. difficile, secondary to loss of competitive nonpathogenic bacteria that comprise the normal colonic flora
(Esp. penicillins, cephalosporins, clindamycin)
Caused by exoctoxin release by C. difficile

50
Q

What are the signs and symptoms of pseudomembranous colitis?

A

Diarrhea (10% bloody)

+/- fever, increased WBCs, abdominal cramps, abdominal distention

51
Q

How do you diagnose pseudomembranous colitis?

A

Stool assy for exotoxin titer
+/- fecal leukocytes
On colonoscopy, you see a membranous exudate

52
Q

What is the treatment of pseudomembranous colitis?

A

PO metronidazole or PO vancomycin
Discontinuation fo causative agents
NEVER give antiperistaltics

53
Q

What are hte indications for prophylactic IV antibiotics?

A

Accidental wounds with heavy contamination and tissue damage
Accidental wounds requring surgical therapy that has had to be delayed
Prosthetic heart valve or valve disease
Penetrating injuries of hollow intra-abdominal organs
Large bowel resections and anastomosis
Cardiovascular surgery with the use of a prosthesis/vascular procedures
Patients with open fractures (start in ER)
Traumatic woudns occuring >8 hours prior to medical ttention

54
Q

What must a prophylactic antibotic cover for procedures on teh large bowel/abdominal trauma/appendicitis?

A

Anaerobes

55
Q

What commonly used antibiotics offer anaerobic coverage?

A 
Cefoxitin (Mefoxin)
Clindamycin
Metronidazole (Flagyl)
Cefotetan
Ampicillin-sulbactum (Unasyn)
Zosyn
Timentin
Imipenem
56
Q

What antibiotic is used prophylactically for vascular surgery?

A

Ancef

significant PCN allergy - erythromycin or clindamycin

57
Q

When is the appropriate time to administer prophylactic antibiotics?

A

Adequate blood levels prior to surgical incision

58
Q

What is parotitis? Bug?

A

Infection of the parotid gland

Staphylococcus

59
Q

Factors associated with increased risk for parotitis?

A 
>65yo
Malnutrition
Poor oral hygiene
Presence of NG tube
NPO dehydration
60
Q

When does parotitis most commonly occur?

A

2 weeks postoperatively

61
Q

Signs of parotitis?

A

Hot, red, tender parotid gland

Increased WBCs

62
Q

What is the treatment of parotitis?

A

Antibiotics

Operative drainage, as necessary

63
Q

What is a ‘stitch’ abscess?

A

Subcutaneous abcess centered around a subcutaneous stitch, which is a foreign body
Treat with drainage and stitch removal

64
Q

What bacteria to be found in the colon?

A

Anaerobic - bacteroides fragilis

Aerobic - E. coli

65
Q

Which bacteria are found in infections from human bites?

A

Strep viridans, S. aureus, Peptococcus, Eikenella

Treat with Augmentin

66
Q

What is the most common ICU pneumonia bacteria?

A

Gram-negative organisms

67
Q

What is Fournier’s gangrene?

A

Perineal infection starting classifcally in the scrotum in patients with diabetes
Treat with triple antibiotics adn wide debridement - surgical emergency

68
Q

Does adding antibiotics to peritoneal lavage solution lower the risk of abscess formation?

A

No

69
Q

What are the classic antibiotics for ‘triple’ antibiotics?

A

Ampicillin, gentamycin, metronidazole (Flagyl)

70
Q

What antibiotic is used to treat amoeba infection?

A

Metronidazole (Flagyl)

71
Q

What bacteria commonly infect prosthetic material and central lines?

A

Staphylococcus epidermis

72
Q

What is the antibiotic of choice for Actinomyces?

A

Penicillin G

73
Q

What is a furnucle?

A

Staph abscess that forms in a hair follicle

74
Q

What is a carbuncle

A

Subcutaneous staph abscess, suusally an extension of a furuncle
Most commonly seen in patients with diabetes

75
Q

what is a felon

A

Infection of the finger pad

76
Q

What are the signs of tetanus?

A

Lockjaw, muscle spasm, laryngospasm, convulsions, respiratory failure

77
Q

What are the appropriate prophylactic steps in tetanus-prone injury in patients who have three previous immunizations

A

None

Tetanus toxid only if >5 years since last toxoid

78
Q

What are the appropriate prophylactic steps in tetanus-prone injury in patients who have two previous immunizations?

A

Tetanus toxoid

79
Q

What are the appropriate prophylactic steps in tetanus-prone injury in patients who have one previous immunization?

A

Tetanus immunoglobulin IM and tetanus toxoid IM (different sites)

80
Q

What are the appropriate prophylactic steps in tetanus-prone injury in patients who have no previous immunizations?

A

Tetanus immunoglobulin IM and tetanus toxoid IM (different sites)

Surgical Recall (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions