Surgical Infections

Question 1

Transferrin plays a role in host defense by

A. Sequestering iron, which is necessary for microbial growth
B. Increasing the ability of fibrinogen to trap microbes
C. Direct injury to the bacterial cell membrane
D. Direct injury to the bacterial mitochondria

Answer 1

A. Sequestering iron, which is necessary for microbial growth

Question 2

Which is NOT a component of systemic inflammatory response syndrome (SIRS)?

A. Temperature
B. White blood cell (WBC) count
C. Blood pressure
D. Heart rate

Answer 2

C. Blood pressure

Question 3

The best method for hair removal from an operative field is

A. Shaving the night before
B. Depilating the night before surgery
C. Shaving in the operating room
D. Using hair clippers in the operating room

Answer 3

D. Using hair clippers in the operating room

Question 4

A patient with necrotizing pancreatitis undergoes computed tomography (CT)-guided aspiration, which results in growth of Escherichia coli on culture. The most appropriate treatment is

A. Culture-appropriate antibiotic therapy
B. Endoscopic retrograde cholangiopancreatography with sphincterotomy
C. CT-guided placement of drain(s)
D. Exploratory laparotomy

Answer 4

D. Exploratory laparotomy

Question 5

Which factor does NOT influence the development of surgical site infections (SSIs)?

A. Duration of procedure
B. Degree of microbial contamination o the wound
C. Malnutrition
D. General anesthesia

Answer 5

D. General anesthesia

Question 6

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?

A. Class I (clean)
B. Class II (clean/contaminated)
C. Class III (contaminated)
D. Class IV (dirty)

Answer 6

C. Class III (contaminated)

Question 7

The most appropriate treatment of a 4-cm hepatic abscess is

A. Antibiotic therapy alone
B. Aspiration for culture and antibiotic therapy
C. Percutaneous drainage and antibiotic therapy
D. Operative exploration, open drainage of the abscess, and antibiotic therapy

Answer 7

C. Percutaneous drainage and antibiotic therapy

Question 8

Postoperative urinary tract infections (UTIs)

A. Are usually treated with a 7- to 10-day course of antibiotics.
B. Initial therapy should be directed by results of urine culture.
C. Are established by >104 CFU/mL of bacteria in urine culture in asymptomatic patients.
D. Can be reduced by irrigating indwelling Foley catheters daily.

Answer 8

B. Initial therapy should be directed by results of urine culture.

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 to the physical findings is

A. Obtain C-reactive protein
B. CT scan of the leg
C. Magnetic resonance imaging (MRI) of the leg
D. Operative exploration

Answer 9

D. Operative exploration

Question 10

What is FALSE regarding intravascular catheter infections?

A. Selected low-virulence infections can be treated with a prolonged course of antibiotics.
B. In high-risk patients, prophylactic antibiotics in used through the catheter can reduce rate of catheter infections.
C. Bacteremia with gram-negative bacteria or fungi should prompt catheter removal.
D. Many patients with intravascular catheter infections are asymptomatic.

Answer 10

B. In high-risk patients, prophylactic antibiotics in used through the catheter can reduce rate of catheter infections.

Question 11

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

A. Synthetic penicillins
B. Carbapenems
C. Cephalosporins
D. Monobactams

Answer 11

D. Monobactams

Question 12

What is the estimated risk of transmission of human immunodeficiency virus (HIV) from a needlestick from a source with HIV-infected blood?

A. <0.5%
B. 1%
C. 5%
D. 10%

Answer 12

A. <0.5%

Question 13

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?

A. 3–4%
B. 8–12%
C. 15–18%
D. 22–25%

Answer 13

A. 3–4%

Question 14

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

A. 90–99%
B. 75–80%
C. 50–60%
D. 10–30%

Answer 14

B. 75–80%

Question 15

Possible exposure to anthrax should be initially treated with

A. Colistin
B. Ciprofloxacin or doxycycline
C. Amoxicillin
D. Observation

Answer 15

B. Ciprofloxacin or doxycycline

Question 16

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

A. None (no effective treatment is known).
B. Two- or three-drug therapy started within hours of exposure.
C. Single drug therapy started within 24 hours of exposure.
D. Triple drug therapy started within 24 hours of exposure.

Answer 16

B. Two- or three-drug therapy started within hours of exposure.

Question 17

What is NOT an early goal in treatment of severe sepsis?

A. Mean arterial pressure >65 mm Hg
B. Central venous pressure 8 to 2 mmHg
C. Urine output >0.5 cc/kg/h
D. Serum lactate <2 mmol/L

Answer 17

D. Serum lactate <2 mmol/L

Question 18

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

A. Exchange endotracheal tube and change respiratory circuit.
B. Obtain bronchoalveolar lavage.
C. Start treatment with empiric penicillin G.
D. Obtain chest CT

Answer 18

B. Obtain bronchoalveolar lavage.

Question 19

Patients with severe, necrotizing pancreatitis should be treated with

A. No antibiotics unless CT-guided aspiration o f the area yields positive cultures
B. Empiric cefoxitin or cefotetan
C. Empiric cefuroxime plus gentamicin
D. Empiric carbapenems or fluoroquinolones

Answer 19

D. Empiric carbapenems or fluoroquinolones

Question 20

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

A. Antibiotics and warm soaks to the wound
B. Antibiotics alone
C. Antibiotics and opening the wound
D. Incision and drainage alone

Answer 20

D. Incision and drainage alone

Question 21

Which areas likely do  NOT contain resident microorganisms? 
A. Terminal ileum
B. Oropharynx 
C. Main pancreatic duct
D.  Nares

Answer 21

C. Main pancreatic duct