Surgical Infections

Question 1

“Gatekeeper” of the abdomen and intestinal ileus

Answer 1

Omentum
-serves to wall off infection
—however, this and fibrin trapping have a high like likelihood of contributing to the formation of an intra-abdominal abscess

Question 2

During a laparoscopic appendectomy, a large bowel injury was caused during trochar placement with spillage of bowel contents into the abdomen. What class of surgical wound is this?

Answer 2

Class III (contaminated)
-major breaks in sterile technique

Question 3

Open cardiac massage, what wound class?

Answer 3

Class III (contaminated)
-major breaks in sterile technique

Question 4

Remarks on the treatment of hepatic abscess

Answer 4

Small (<1cm), multiple abscesses should be sampled and treated with a 4-6 week course of antibiotics
Larger abscesses are amenable to percutaneous drainage

Question 5

Post-op UTI

Answer 5

> 10^4 CFU/mL in symptomatic
10^5 CFU/mL in asypmtomatic
TX: 3-5 DAYS of single antibiotics
*post-operative surgical patients should have indwelling urinary catheters removed as quickly as possible, typically within 1-2 days

Question 6

The estimated risk of transmissiosn from a needlestick from a source with HIV-infected blood is estimated at

Answer 6

0.3%

Question 7

Closure of an appendectomy wound in a patient with perforated appendicitis who is receiving appropriate antibiotics will result in a wound infection in what percentage of patients

Answer 7

3-4%

Question 8

Seroconversion rate after accidental needlestick with HCV is

Answer 8

1.8%

Question 9

A chronic carrier state occurs with hepatitis C infection in what percentage of patients?

Answer 9

75-80%

Question 10

Possible exposure to anthrax should be initially treated with

Answer 10

Ciprofloxacin or doxycycline

Question 11

Treatment for anthrax

Answer 11

Combination therapy with
Ciprofloxacin,
Clindamycin (blocks production of toxin), and
Rifampin (penetrates into the CNS and intracellular locations

Question 12

Incubation of anthrax

Answer 12

Cutaneous anthrax: 1-7 days
Inhalation anthrax:
1-6 days (schwartz absite)
Up to 6 weeks (Jawetz)

Question 13

Early goals in treatment of severe sepsis

Answer 13

MAP > 65 mmHg
CVP 8-12 mmHg
UO >0.5 cc/kg/h

Question 14

A patient in the ICU has been on ventilator support for 3 weeks. He has new onset elevated WBC count, fever, and consolidation seen on chest x-ray. What is an appropriate next step?

Answer 14

Obtain bronchoalveolar lavage

Question 15

Patients with severe, necrotizing pancreatitis should be treated with

Answer 15

Empiric carbapenems or fluoroquinolones

Exploratory laparotomy

Question 16

A patient with a localized wound infection after surgery should be treated with

Answer 16

Incision and drainage alone

*antibiotics are reserved for those with evidence of severe cellulitis, or who manifest concurrent sepsis syndrome

Question 17

Parts of the body with no resident microflora, as per Absite

Answer 17

Urogenital
Biliary
Pancreatic ductal
Distal respiratory tracts