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SURGERY > Surgical Infections > Flashcards

Surgical Infections Flashcards

1
Q

Temperature

A

<36 C or >38 C

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2
Q

HR

A

> 90 beats per minute

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3
Q

RR

A

> 20 breaths per minute

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4
Q

PaCO2

A

< 32 mmHg

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5
Q

WBC Count

A

<4000 or >12000 cells/mm3 or >10% immature forms

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6
Q

UTI

A

3-5 days

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7
Q

Pneumonia

A

7-10 days

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8
Q

Bacteremia

A

7-14 days

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9
Q

Penetrating gastrointestinal trauma

A

12-24 hours

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10
Q

Perforated or gangrenous appendicitis

A

3-5 days

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11
Q

Peritoneal soilage secondary to perforated viscus with moderate contamination

A

5-7 days

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12
Q

Extensive peritoneal soilage (feculent peritonitis) in the immunocompromised host

A

7-14 days

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13
Q

Only skin microbiota

A

Class I: Clean

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14
Q

Opened w/o significant spillage

A

Class II: Clean contaminated

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15
Q

Open accidental wounds

A

Class III: Contaminated

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16
Q

Traumatic wound + significant treatment delay

A

Class IV: Dirty

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17
Q

Necrotic tissue, purulent discharge

A

Class IV: Dirty

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18
Q

Introduction of bacteria due to major breaks in sterile technique (open cardiac massage)

A

Class III: Contaminated

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19
Q

Perforated viscus high degree of contamination

A

Class IV: Dirty

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20
Q

Hernia repair

A

Class I: Clean

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21
Q

Perforated diverticulitis

A

Class IV: Dirty

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22
Q

Breast biopsy specimen P device (mesh, valve)

A

Class I: Clean

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23
Q

Cholecystectomy

A

Class II: Clean contaminated

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24
Q

Elective GI surgery (not colon)

A

Class II: Clean contaminated

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25
Q

Penetrating abdominal trauma

A

Class III: Contaminated

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26
Q

Necrotizing soft

tissue infections

A

Class IV: Dirty

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27
Q

Large tissue injury

A

Class III: Contaminated

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28
Q

Enterotomy during bowel obstruction

A

Class III: Contaminated

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29
Q

Occurs when microbes invade normally sterile peritoneal cavity via hematogenous dissemination from distant source of infection or direct inoculation

A

Primary microbial peritonitis

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30
Q

Common among patients who retain large amounts of peritoneal fluid due to ascites and those treated for renal failure via peritoneal dialysis

A

Primary microbial peritonitis

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31
Q

Diffuse tenderness

A

Primary microbial peritonitis

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32
Q

Guarding without localized findings

A

Primary microbial peritonitis

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33
Q

Absence of pneumoperitoneum

A

Primary microbial peritonitis

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34
Q

Occurs subsequent to contamination of the peritoneal cavity due to perforation or severe inflammation and infection of an intra-abdominal organ

A

Secondary microbial peritonitis

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35
Q

Poorly understood entity that is more common in immunosuppressed patients

A

Tertiary (Persistent) Peritonitis

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36
Q

Peritoneal host defences do not effectively clear or sequester the initial secondary microbial peritoneal infection

A

Tertiary (Persistent) Peritonitis

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37
Q

Develops in the absence of original visceral organ

A

Tertiary (Persistent) Peritonitis

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38
Q

Caused by manipulation of the biliary tract to treat a variety of diseases but nearly 50% of patients have no identifiable cause

A

Pyogenic liver abscess

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39
Q

Should be sampled and treated with a 4 to 6 week course of antibiotics

A

Small (< 1 cm), multiple abscesses

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40
Q

Parameters for antibiotic therapy and drain removal for larger abscesses:

A
  1. Clear evidence cavity collapse
  2. Output <10 - 20 mL/d
  3. No evidence of ongoing source of contamination
  4. Clinical condition improved
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41
Q

Dosage of metronidazole for amoebic liver abscess:

A

750 mg TID x 10 days

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42
Q

Current care includes staging with dynamic, contrast material enhanced helical CT scan to evaluate the extent of pancreatitis coupled with the use of one of several prognostic scoring systems.

A

Severe Acute Pancreatitis

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43
Q

Placed past the ligament of Treitz, associated with decreased development of infected necrosis → decreased gut translocation of bacteria

A

Nasojejunal feeding tubes

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44
Q

Dilation of the retroperitoneal drain tract

A

VARD (Video-Assisted Retroperitoneal Drainage)

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45
Q

Debridement of pancreatic bed

A

VARD (Video-Assisted Retroperitoneal Drainage)

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46
Q

Repeat debridement are performed as clinically indicated with most patients requiring multiple debridement.

A

VARD (Video-Assisted Retroperitoneal Drainage)

47
Q

Culture of postoperative UTI SYMPTOMATIC patients:

A

> 104 CFU/mL microbes

48
Q

Culture of postoperative UTI ASYMPTOMATIC patients:

A

> 105 CFU/mL microbes

49
Q

Due to prolonged mechanical ventilation

A

Nosocomial Pneumonia

50
Q

Infection associated with indwelling intravascular catheters

A

Bacteremia

51
Q

Selected catheter infections due to low-virulence microbes such as Staphylococcus epidermidis can be effectively treated in approximately 50% to 60% of patients with a __________ course of an antibiotic, which should be considered when no other vascular access site exists

A

14- to 21-day

52
Q

Central Venous Pressure (CVP)

A

8-12 mmHg

53
Q

Mean Arterial Pressure

MAP

A

≥ 65 mmHg

54
Q

Urine Output

A

≥ 0.5 mL/kg/h

55
Q

Mixed Venous Oxygen

Saturation

A

65%

56
Q

IV antibiotic therapy

A

1st hour after sepsis recognition

57
Q

Broad spectrum

A

Penetration into presumed

source

58
Q

Discontinue antibiotic

A

7-10 days

59
Q

1 L; CVP = 8-12 mmHg

A

Crystalloid

60
Q

First line of choice

A

Centrally administered

norepinephrine

61
Q

Setting of myocardial

dysfunction

A

Dobutamine

62
Q

Intravenous hydrocortisone dose

A

<300 mg/d

63
Q

Septic shock hypotension

A

Intravenous hydrocortisone

64
Q

Poor response to fluids and

vasopressors

A

Intravenous hydrocortisone

65
Q

Hgb < 7.0 g/dL

A

RBC

66
Q

Acute lung injury

A

VT 6 mL/kg body weight

Plateau pressure ≤ 30 cm H2O

67
Q

Avoid lung collapse

A

Positive end-expiratory

pressure

68
Q

Discontinue mechanical

ventilation

A

Weaning protocol

69
Q

Prevent stress ulcer

A

Proton pump inhibitor

H2 blocker

70
Q

Prevent DVT

A

Low does fractionated

heparin

71
Q

Hospital-associated infection

A

MRSA

72
Q

More common in chronically ill patients receiving multiple

courses of antibiotic

A

MRSA

73
Q

MRSA produce a toxin knowns as:

A

Panton-Valentin leukocidin

74
Q

make up an increasingly high percentage of surgical
site infections since they are resistant to commonly
employed prophylactic antimicrobial agents.

A

Panton-Valentin leukocidin

75
Q

Produce a plasmid-mediated inducible β-lactamase.

A

Extended spectrum β-lactamase (ESBL)

76
Q

Sensitive to first-, second-, or third- generation

cephalosporins with resistance to others

A

Extended spectrum β-lactamase (ESBL)

77
Q

Use of this seemingly active agent leads to rapid induction of
resistance and failure of antibiotic therapy.

A

Extended spectrum β-lactamase (ESBL)

78
Q

Treatment for ESBL:

A

Carbapenem

79
Q

Resistance is transposon-mediated

A

Vancomycin-resistant strain of Enterococcus (VRSE)

80
Q

Can transfer genetic material to S aureus in a host coinfected
with both organisms which can lead to

A

Vancomycin resistance in S aureus (VRSA)

81
Q

Needlestick from a source with HIV-infected blood

A

0.3% estimated risk of transmission

82
Q

Significantly decreased the risk of seroconversion

A

Antiretroviral Therapy (ART)

83
Q

2-3-drug regimen

A

Raltegavir

Tenofovir/emtricitabine

84
Q

develops in 75% to 80% of patients with

the infection

A

Chronic carrier state

85
Q

occurs in three-fourths of patients who

develop chronic infection

A

Chronic liver disease

86
Q

Seroconversion rate after accidental needlestick

A

1.8%

87
Q

Treatment for HCV:

A

Ribavirin + Pegylated gamma interferon

88
Q

United States halted BWA programs

A

Presidential Decree in 1971

89
Q

Inhalational anthrax develops after a _________________.

A

1- to 6-day incubation period

90
Q

Chest roentgenographic findings in Anthrax:

A

Widened mediastinum

Pleural effusions

91
Q

Post exposure prophylaxis for anthrax:

A

Ciprofloxacin
Doxycycline
Amoxicillin

92
Q

Treatment for anthrax:

A

ciprofloxacin, clindamycin, and

rifampin

93
Q

To block production of toxin

A

Clindamycin

94
Q

Penetrates into the central nervous system and

intracellular locations

A

Rifampin

95
Q

Epidemic pneumonia with blood-tinged sputum if aerosolized

bacteria are used

A

Plague

96
Q

Individuals who develop the following are suspected with

Bubonic plague:

A
  1. Painful enlarged lymph node lesions “bubo”
  2. Fever
  3. Severe malaise
  4. Exposure to fleas
97
Q

Post exposure prophylaxis for plague:

A

Doxycycline

98
Q

Treatment of the pneumonic or bubonic/septicemic form:

A
  1. Streptomycin
  2. Doxycycline
  3. Ciprofloxacin
  4. Levofloxacin
  5. Chloramphenicol
99
Q

Prolonged viability has been demonstrated in scabs up to

_______ after collection

A

13 years

100
Q

Incubation period for small pox:

A

10 to 12 days

101
Q

Postexposure prophylaxis for smallpox:

A

Cidofovir

102
Q

After inoculation, the organism proliferates within

macrophages

A

Tularemia

103
Q

Treatment of inhalational tularemia

A

Aminoglycoside

Doxycycline and ciprofloxacin (Second-line agents)

104
Q

Cardiovascular surgery

A

Cefazolin

Cefuroxime

105
Q

Gastroduodenal areal small intestinel nonobstructed

A

Cefazolin

106
Q

Biliary tract; open procedure, laparascopic high risk

A 
Cefazolin
Cefoxitin
Cefotetan
Ceftriaxone
Ampicillin-sulbactam
107
Q

Biliary tract; laparascopic low risk

A

None

108
Q

Appendectomy, uncomplicated

A

Cefoxitin
Cefotetan
Cefazolin + Metronidazole

109
Q

Colorectal surgery, obstructed small intestine

A 
Cefazolin or Ceftriaxone
Metronidazole
Ertapenem
Cefoxitin
Cefotetan
Ampicillin-Sulbactam
110
Q

Head and neck; clean contaminated

A

Cefazolin or cefuroxime
Metronidazole
Ampicilin-Sulbactam

111
Q

Neurosurgical procedures

A

Cefazolin

112
Q

Orthopedic surgery

A

Cefazolin

Ceftriaxone

113
Q

Breast, hernia

A

Cefazolin

SURGERY (1 decks)

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