Surgical infections

Question 1

Role of transferrin in host defense

Answer 1

Sequestering iron which is necessary for microbial growth

Question 2

component of systemic inflamamtory response syndrome (SIRS)

Answer 2

• Elevated temperature
• Elevated WBC
• tachycardia
• tachypnea

Question 3

BEst method ofhair removal from an operative field

Answer 3

using hair clippers in the operating room

Question 4

Most appropriate treatment with a discrete, walled off purulent fluid collection (abscess)

Answer 4

Drainage viia percutaneous drain insertion or an operative approach.

The presence of an aggressive, rapidly spreading infection requires expedient, aggressive operative intervention, both to remove contaminated material and infected tissue

Question 5

3 factors related to the development of SSIs

Answer 5

• the degree of microbial contamination ofthe wound during surgery
• the duration of the procedure
• host factors such as diabetes, malnutrition, obesity,immune suppresionm and other diseases

Question 6

Surgical Wounds

Answer 6

Question 7

The most appropriate treatment of a 4cm hepatic abscess

Answer 7

PErcutaneous drainage and antibiotic therapy

• Small (<1cm), multiple abscess should be sampled and treaed with 4 to 6 week course of antibiotics
• Recurrent hepatic or splenic abscess may require operative intervention - unroofing and marsupialization

Question 8

Postoperative urinary tract infections

Answer 8

• Initial therapy should be directed by results of urine culture
• Diagnosis
  
  • >10⁴ CFU/ml for symptomatic patients
  • >10⁵ cFU/ml for asymptomatic
• Treatment for 3 to 5 days with a single antibiotic
• indwelling urinary catheters removed asap post operatively

Question 9

The first step in the evaluation and treatment of a patient with an infected bug bite on the leg with cellulitis, bullae, thin grayish fluid draining from the wound, and pain out of proportion

Answer 9

• Operative exploration

Question 10

Intravascular catheter infections

Answer 10

• Selected low virulence infections can be treated with a prolonged course of antibiotics (14-21 days)
• Bacteremia with gram negative bacteria orfungi should prompt catheter removal
• Many patients are asymptomatic

Question 11

Patients with penicillin allergy are LEAST likely to have a cross reaction with____

Answer 11

Monobactams

• Penicillin allergy ranges from 0.7 to 10%
• 5 to 7 % crossreactivity to cephalosporins
• 1% crossreactivity to carbapenems
• almost none to monobactams

Question 12

Estimated risk of transmission of HIV from needlestick from a source with HIV infected blood

Answer 12

<0.5%

(0.3%)

Question 13

Closure of appendectomyy wound in a oatient with perforated appendicitis who is receiving appropriate antibiotics will result in a wound infection in what percentage?

Answer 13

3-4%

Class IIand IV wounds is associated with 25-50%

Question 14

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

Answer 14

75-80%

• HCV is an RNA flavivirus
• not transmitted efficiently through occupational exposures to blood with a seronegative rate of 1.8%

Question 15

Possible exposure to anthrax should be inititaly treated with

Answer 15

Ciprofloxacin or doxycycline

• Inhalational anthrax develops after 1 to 6 day inubation period, with non specific symptoms including malaise, myalgia, and fever
• Widened mediastinum and PF
• Clindamycin is added to blocks production of toxin
• Rifampin penetrates into the CNS and intracellular locations

Question 16

The most effective postexposure prophylaxis for a surgeon stuck with a needle while operating on an HIV positive atient

Answer 16

2 to 3 drug therapy started within hours of exposure

Question 17

Earl goals in the treatment of severe sepsis

Answer 17

• MAP >65 mmHg
• Urine output > 0.5 cc/kg
• CVP of 8 to 12 mm Hg

Question 18

Firs step in managing intubated patients who develop new onset elevated WBC count, fever, and consolidation on xray

Answer 18

Obtain bronchoalveolar lavage

Question 19

Patients with severe necrotizing pancreatitis should be treated with

Answer 19

Empiric carbapenems or fluoroquinolones

Question 20

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

Answer 20

Incision and drainage

• The open wound is allowed to heal y secondary intention
• dressings being changed twice a day

Question 21

Areas who do not contain resident microorganisms

Answer 21

• Main pancreatic duct
• urogenital tract
• biliarty
• distal respiratory