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General Surgery > Vascular Infection > Flashcards

Vascular Infection Flashcards

1
Q

Vascular infection occurs with secondary:

A

vascular infection occurs with secondary subcutaneous necrosis.

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2
Q

The difference between necrotizing fasciitis and cellulitis (late stage) is that:

A

Late stage necrotizing fasciitis presents with bullae.

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3
Q

In necrotizing fasciitis, organisms spread from the

A

In necrotizing fasciitis, organisms spread from the subcutaneous tissue along the superficial and deep fascial planes.

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4
Q

A deep necrotizing fasciitis infection can cause:

(1) Vascular occlusion
(2) ischemia
(3) Tissue necrosis

A

A deep necrotizing fasciitis infection can cause vascular occlusion, ischemia and tissue necrosis.

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5
Q

T/F: Necrotizing fasciitis does not cause any damage to superficial nerves or local anesthesia.

A

False. Necrotizing fasciitis causes damage to superficial nerves and causes anesthesia.

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6
Q

A patient has been recently diagnosed with necrotizing fasciitis of the medial thigh. The skin around the affected area MOST likely looks like:

A

dusky or purplish discoloration.

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7
Q

A patient with non-clostridial necrotizing fasciitis presents with local creptiation. This finding is:

A

Occurs in more than 50% of patients; is specific but NOT sensitive.

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8
Q

T/F: patients with necrotizing fasciitis present with lymphangitis or lymphadenopathy.

A

False.

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9
Q

Which of the following regarding necrotizing fasciitis is TRUE?

(1) The causative bacteria are anaerobic.
(2) Type I is polymicrobial and causes clostridial myonecrosis.
(3) Type III is polymicrobial and caused by trauma or surgery.
(4) Type II is caused by group A streptococcus.

A

(4) Type II is caused by group A streptococcus.

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10
Q

The speed of ascent of necrotizing fasciitis is proportional to:

A

The thickness of the subcutaneous tissue, and moves ALONG fascial planes.

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11
Q

A seriously ill patient with necrotizing fasciitis and/or myonecrosis requires treatment of:

A

It is a surgical emergency with high mortality.

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12
Q

Which of the following is a life threatening condition?

(1) Necrotizing fasciitis
(2) gas-forming myonecrosis

A

Both (1) necrotizing fasciitis and (2) gas-forming myonecrosis are life threatening.

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13
Q

The prognosis of necrotizing fasciitis is:

A

20 - 80% mortality rate.

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14
Q

The TWO most common pitfalls in management of of necrotizing fasciitis are:

A

(1) Failure of early diagnosis

(2) inadequate surgical debridement.

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15
Q

Which of the following regarding treatment of necrotizing fasciitis is TRUE?

(1) Tissue gas is a universal finding in necrotizing soft tissue infections.
(2) I&D is an appropriate surgical strategy for necrotizing soft tissue infections.
(3) Excisional debridement is the appropriate surgical strategy for necrotizing soft tissue infections.

A

(3) Excisional debridement is the appropriate surgical strategy for necrotizing soft tissue infections.

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16
Q

A patient presents with patches of purple discoloration on the skin, which turn into gangrenous tissue ascending up the leg. You diagnose the patient with necrotizing fasciitis and plan excisional debridement. The surgical incision should be:

A

Deep and extend beyond the areas of necrosis until viable tissue is reached.

Excise the entire necrotic area.

Irrigate the wound well.

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17
Q

When planning excisional debridement for treatment of necrotizing fasciitis, you should take care to:

(1) Only incise the necrotic tissue.
(2) Excise the entire necrotic area.
(3) Avoid irrigating the wound.

A

(2) Excise the entire necrotic area.

18
Q

T/F: after excisional debridement of necrotic tissue, the incision site should be sutured.

A

False.

19
Q

A guillotine ankle amputation is indicated in the presence of:

(1) Mild infection or necrosis
(2) Necrosis in the forefoot only
(3) Severe infection or necrosis in the midfoot or hindfoot.

A

Guillotine ankle amputations are indicated in the presence of severe infection or necrosis in the midfoot OR hindfoot.

20
Q

Which of the following is an indication for an ankle guillotine amputation?

(1) Wet gas gangrene
(2) Afebrile patient with absent bacteremia.
(3) Fulminant osteomyelitis

A

Both (1) Wet gas gangrene and (3) fulminant osteomyelitis are indications for a guillotine ankle amputation.

21
Q

T/F: An initial guillotine amputation helps control infection, eliminate bacteremia and provider a safer wound environment for a definitive amputation at a later date.

A

True.

22
Q

A patient with necrotizing fasciitis is febrile and presents with bacteremia. They require an amputation. The FIRST amputation that should be done is:

(1) Guillotine amputation
(2) Below knee amputation

A

(1) Guillotine amputation.

23
Q

An advantage of the guillotine amputation is that:

A

It can be rapidly performed, eliminating the need for anesthesia or prolonged surgery.

24
Q

Although a two-stage amputation, the guillotine amputation at the ankle is recommended as FIRST stage to deal with wet gangrene because it allows:

A

subsequent wound closure with a reduced chance of wound infection.

25
Q

In a study comparing guillotine + BKA and BKA alone for treatment of non-salvageable foot infections, the group that had higher rates of primary healing AND no revision surgeries required:

A

Guillotine + BKA had higher rates of primary healing and no revision surgeries were required.

26
Q

T/F: A Syme’s articulation is the same as an ankle disarticulation.

A

False.

27
Q

T/F: An ankle disarticulation causes damage to the cortex of a bone.

A

False.

28
Q

Which of the following is an advantage to disarticulation of joints?

(1) Minimal blood loss from marrow.
(2) Minimal muscle coveragae
(3) Easier identification and reduced number of major vessels.

A

(1) Minimal blood loss from marrow and (3) easier identification and reduced number of major vessels are advantages to joint disarticulations.

29
Q

T/F: Disarticulation avoids exposure to medullary bone and provides a natural barrier against desiccation.

A

True.

30
Q

The appropriate bandage dressings for a two-stage ankle disarticulation is:

A

Wet betadine, dankins or acetic acid.

31
Q

T/F: Xeroform is the most ideal dressing for necrotizing fasciitis or infected wounds.

A

Flase.

32
Q

Which of the following is the BEST dressing for an ankle disarticulation?

(1) Wound vac
(2) Xeroform
(3) Wet betadine, dankins or acetic acid.

A

(3) Wet betadine, dankins and acetic acid are the best dressings for treatment of necrotizing fasciitis and ankle disarticulations.

33
Q

Which of the following surgeries is preferred?

(1) Ankle disarticulation
(2) BKA

A

(1) Ankle disarticulation is preferred over BKA.

34
Q

Which of the following surgeries is preferred?

(1) Guillotine BKA
(2) High BKA

A

(1) Guillotine BKA

35
Q

Which of the following procedures is preferred?

(1) Knee disarticulation
(2) Gritti Stokers or AKA

A

(1) Knee disarticulation.

36
Q

Which of the following procedures is preferred?

(1) AKA
(2) high AKA and possible hip disarticulation.

A

(1) AKA

37
Q

Out of these amputations (all are considered good for ambulation and function) which is the gold standard?

(1) Toe amputation
(2) Ray amputation (2 - 4)
(3) BKA
(4) Gritti stokes

A

(3) BKA

38
Q

The Gritti Stokes amputation has an advantage of maintaining muscle attachments and preserving patellar skin. However it is not used as much because:

A

There are few orthotics for it.

39
Q

Which of the following procedures requires special orthotics/shoes and has a high rate of breakdown?

(1) AKA
(2) TMA, Chopart, Lisfranc
(3) Symes

A

(2) TMA, Chopart, Lisfranc

40
Q

Which of the following procedures provides little muscle coverage and doe snot have good orthotics availiable?

(1) AKA
(2) TMA, Chopart, Lisfranc
(3) Symes

A

(3) Symes

General Surgery (12 decks)

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