Anesthesia complications US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Anesthesia complications. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Anesthesia complications US Medical PG Question 1: A 16-year-old girl is brought to the emergency department by her friends who say that she took a whole bottle of her mom’s medication. They do not know which medication it was she ingested. The patient is slipping in and out of consciousness and is unable to offer any history. Her temperature is 39.6°C (103.2°F), the heart rate is 135/min, the blood pressure is 178/98 mm Hg, and the respiratory rate is 16/min. On physical examination, there is significant muscle rigidity without tremor or clonus. Which of the following is the best course of treatment for this patient?
- A. Cyproheptadine
- B. Dantrolene (Correct Answer)
- C. Flumazenil
- D. Fenoldopam
- E. Naloxone
Anesthesia complications Explanation: ***Dantrolene***
- The patient's presentation with **hyperthermia**, **tachycardia**, **hypertension**, and **severe muscle rigidity without tremor or clonus** is highly suggestive of **neuroleptic malignant syndrome (NMS)** or **malignant hyperthermia**.
- **Dantrolene** is a direct-acting **skeletal muscle relaxant** that reduces calcium release from the sarcoplasmic reticulum, effectively treating the muscle rigidity and hyperthermia in these conditions.
*Cyproheptadine*
- **Cyproheptadine** is an **antihistamine with serotonin antagonist properties** used to treat **serotonin syndrome**, which typically presents with **clonus** and **hyperreflexia**, not the rigidity seen here.
- While both NMS and serotonin syndrome involve hyperthermia, the distinct absence of clonus and presence of severe rigidity points away from serotonin syndrome.
*Flumazenil*
- **Flumazenil** is a **benzodiazepine receptor antagonist** used to reverse **benzodiazepine overdose**.
- Benzodiazepine overdose typically causes **CNS depression** (hypotension, bradycardia, respiratory depression), which is opposite to the patient's hyperdynamic state.
*Fenoldopam*
- **Fenoldopam** is a **D1 dopamine receptor agonist** used intravenously to treat **severe hypertension** and **hypertensive emergencies**.
- Although the patient has hypertension, fenoldopam would not address the underlying pathology of hyperthermia and muscle rigidity, which are the primary life-threatening issues.
*Naloxone*
- **Naloxone** is a **mu-opioid receptor antagonist** used to reverse **opioid overdose**.
- Opioid overdose typically causes **respiratory depression**, **miosis**, and **CNS depression**, which are not consistent with this patient's presentation.
Anesthesia complications US Medical PG Question 2: Six days after undergoing a left hemicolectomy for colorectal carcinoma, a 59-year-old man collapses in the hospital hallway and is unconscious for 30 seconds. Afterwards, he complains of shortness of breath and chest pain with deep inhalation. He has hypertension and hyperlipidemia. He smoked one pack of cigarettes daily for 35 years but quit prior to admission to the hospital. He does not drink alcohol. He is in distress and appears ill. His temperature is 36.5°C (97.7°F), blood pressure is 80/50 mm Hg, and pulse is 135/min and weak. Oxygen saturation is 88% on room air. Physical examination shows elevated jugular venous distention. Cardiac examination shows a regular, rapid heart rate and a holosystolic murmur that increases during inspiration. His abdomen is soft and mildly tender to palpation around the surgical site. Examination of his extremities shows pitting edema of the left leg. His skin is cold and clammy. Further examination is most likely to reveal which of the following findings?
- A. Reduced regional ventricular wall motion
- B. Rapid, aberrant contractions of the atria
- C. Stenosis of the carotid arteries
- D. Dilated right ventricular cavity (Correct Answer)
- E. Anechoic space between pericardium and epicardium
Anesthesia complications Explanation: ***Dilated right ventricular cavity***
- The patient's symptoms (shortness of breath, chest pain with deep inspiration, hypotension, tachycardia, hypoxemia, elevated JVD, holosystolic murmur increasing with inspiration, and leg edema) are highly suggestive of **acute pulmonary embolism (PE)**.
- An acute PE can lead to increased pulmonary vascular resistance and **acute right ventricular (RV) overload**, causing RV dilation and dysfunction, which is often visible on echocardiography.
*Reduced regional ventricular wall motion*
- This finding is characteristic of **myocardial ischemia or infarction**, which typically presents with anginal chest pain and ECG changes; in this case, the chest pain is pleuritic and the overall picture points away from ischemia.
- While PE can cause RV dysfunction, the primary finding is RV overload and dilation, not necessarily isolated regional wall motion abnormalities often seen in left ventricular ischemia.
*Rapid, aberrant contractions of the atria*
- This describes **atrial fibrillation** or **atrial flutter**, which can occur in critically ill patients but is not the most direct consequence or expected finding from an acute pulmonary embolism in a previously stable patient.
- While atrial arrhythmias can be precipitated by acute stress, they are not the primary direct consequence of massive PE explaining these specific cardiovascular findings.
*Stenosis of the carotid arteries*
- **Carotid artery stenosis** is a risk factor for stroke but does not explain the acute cardiopulmonary collapse, hypoxemia, chest pain, and signs of right heart strain presented in the clinical scenario.
- This finding is unrelated to the acute presentation of shortness of breath, chest pain, and hemodynamic instability following surgery.
*Anechoic space between pericardium and epicardium*
- This finding represents a **pericardial effusion**, which can lead to cardiac tamponade if large and rapid in onset, but the associated holosystolic murmur increasing with inspiration and left leg edema are not typical for cardiac tamponade.
- While pericardial effusion can cause hypotension and shock, the specific constellation of symptoms, including pleuritic chest pain and signs of right heart strain, makes acute PE with RV dilation a more fitting diagnosis.
Anesthesia complications US Medical PG Question 3: An infant boy of unknown age and medical history is dropped off in the emergency department. The infant appears lethargic and has a large protruding tongue. Although the infant exhibits signs of neglect, he is in no apparent distress. The heart rate is 70/min, the respiratory rate is 30/min, and the temperature is 35.7°C (96.2°F). Which of the following is the most likely cause of the patient’s physical exam findings?
- A. Autosomal dominant mutation in the SERPING1 gene
- B. Genetic imprinting disorder affecting chromosome 11p15.5
- C. Type I hypersensitivity reaction
- D. Excess growth hormone secondary to pituitary gland tumor
- E. Congenital agenesis of an endocrine gland in the anterior neck (Correct Answer)
Anesthesia complications Explanation: ***Congenital agenesis of an endocrine gland in the anterior neck***
- This description is highly suggestive of **congenital hypothyroidism**, caused by **thyroid dysgenesis** (agenesis or hypoplasia of the thyroid gland).
- Symptoms include **lethargy**, **macroglossia** (large protruding tongue), **hypotonia**, **feeding difficulties**, **umbilical hernia**, and **hypothermia**, all consistent with the clinical picture.
*Autosomal dominant mutation in the SERPING1 gene*
- A mutation in the **SERPING1 gene** causes **hereditary angioedema**, characterized by recurrent episodes of unpredictable swelling in various body parts.
- While swelling can affect the tongue, it is typically episodic, painful, and often triggered, which is not suggested by the chronic lethargy and physical signs described.
*Genetic imprinting disorder affecting chromosome 11p15.5*
- This describes **Beckwith-Wiedemann syndrome**, an overgrowth disorder caused by imprinting defects involving genes like **IGF2**, **H19**, and **CDKN1C** on chromosome 11p15.5.
- Features include **macroglossia**, **macrosomia**, **umbilical hernia**, **hemihyperplasia**, and increased risk of embryonal tumors like **Wilms tumor**.
- However, Beckwith-Wiedemann syndrome does not typically present with profound **lethargy** and **hypothermia** as seen in congenital hypothyroidism.
*Type I hypersensitivity reaction*
- A **Type I hypersensitivity reaction** (e.g., anaphylaxis) could cause acute **angioedema** of the tongue, but this would be an acute, rapidly progressing, and life-threatening event.
- The infant's description of being "in no apparent distress" and exhibiting chronic signs like lethargy and hypothermia makes an acute allergic reaction unlikely.
*Excess growth hormone secondary to pituitary gland tumor*
- **Excess growth hormone** (gigantism in children, acromegaly in adults) can cause **macroglossia** and coarse facial features in the long term.
- However, it does not explain the associated **lethargia**, **hypothermia**, and profound developmental delay seen in congenital hypothyroidism in an infant.
Anesthesia complications US Medical PG Question 4: A 22-year-old woman is brought to the emergency department after being struck by a car while crossing the street. She has major depressive disorder with psychosis. Current medications include sertraline and haloperidol. Vital signs are within normal limits. X-ray of the lower extremity shows a mid-shaft femur fracture. The patient is taken to the operating room for surgical repair of the fracture. As the surgeon begins the internal fixation, the patient shows muscle rigidity and profuse diaphoresis. Her temperature is 39°C (102.2°F), pulse is 130/min, respirations are 24/min, and blood pressure is 146/70 mm Hg. The pupils are equal and reactive to light. The end tidal CO2 is 85 mm Hg. Which of the following is the most appropriate treatment for this patient's condition?
- A. Fat embolectomy
- B. Bromocriptine therapy
- C. Propranolol therapy
- D. Dantrolene therapy (Correct Answer)
- E. Cyproheptadine therapy
Anesthesia complications Explanation: ***Dantrolene therapy***
- The patient's presentation with **muscle rigidity**, **hyperthermia** (39°C), **tachycardia**, **tachypnea**, **hypertension**, and **markedly elevated end-tidal CO2 (85 mm Hg)** developing acutely **during surgery** is diagnostic of **malignant hyperthermia (MH)**.
- MH is a life-threatening hypermetabolic crisis triggered by **volatile anesthetic agents** (e.g., sevoflurane, isoflurane) or **succinylcholine** in genetically susceptible individuals with mutations in the ryanodine receptor (RYR1).
- **Dantrolene** is the specific antidote for MH, working by inhibiting calcium release from the sarcoplasmic reticulum, thereby reducing muscle contractility and heat production.
- The **extremely elevated end-tidal CO2** reflects the hypermetabolic state and is a key diagnostic feature distinguishing MH from other conditions.
*Fat embolectomy*
- **Fat embolism syndrome** can occur 24-72 hours after long bone fractures and presents with **respiratory insufficiency**, **neurologic dysfunction** (confusion, altered mental status), and a **petechial rash** (classic triad).
- While the patient has a femur fracture, the **acute intraoperative onset**, **muscle rigidity**, and **markedly elevated end-tidal CO2** are not consistent with fat embolism syndrome.
*Bromocriptine therapy*
- **Bromocriptine**, a dopamine agonist, is used in the treatment of **neuroleptic malignant syndrome (NMS)**, which shares features with MH (rigidity, hyperthermia, autonomic instability).
- However, NMS typically develops over **days to weeks** after antipsychotic exposure or dose changes, not acutely during surgery.
- The **intraoperative timing** and **extremely elevated end-tidal CO2** point to malignant hyperthermia triggered by anesthetic agents, not NMS.
*Propranolol therapy*
- **Propranolol**, a non-selective beta-blocker, may help manage **tachycardia** and **hypertension** symptomatically.
- However, it does not address the underlying pathophysiology of MH (**uncontrolled calcium release** and **hypermetabolic crisis**) and is not a primary treatment.
- Dantrolene is the specific and life-saving therapy for MH.
*Cyproheptadine therapy*
- **Cyproheptadine**, a serotonin antagonist, is the treatment for **serotonin syndrome**, which can present with hyperthermia, rigidity, and autonomic instability.
- However, serotonin syndrome typically features **hyperreflexia** and **clonus** rather than the **lead-pipe rigidity** seen here, and develops after serotonergic drug exposure or interactions.
- The **intraoperative timing**, **muscle rigidity**, and **markedly elevated end-tidal CO2** are pathognomonic for **malignant hyperthermia**, not serotonin syndrome.
Anesthesia complications US Medical PG Question 5: A 16-year-old male presents to the emergency department complaining of episodes of pounding headache, chest fluttering, and excessive sweating. He has a past history of kidney stones that are composed of calcium oxalate. He does not smoke or drink alcohol. Family history reveals that his mother died of thyroid cancer. Vital signs reveal a temperature of 37.1°C (98.7°F), blood pressure of 200/110 mm Hg and pulse of 120/min. His 24-hour urine calcium, serum metanephrines, and serum normetanephrines levels are all elevated. Mutation of which of the following genes is responsible for this patient's condition?
- A. RET proto-oncogene (Correct Answer)
- B. BCL2
- C. BRAF
- D. BCR-ABL
- E. HER-2/neu (C-erbB2)
Anesthesia complications Explanation: ***RET proto-oncogene***
- The patient's symptoms (pounding headache, chest fluttering, sweating, hypertension, tachycardia), elevated metanephrines, and a history of kidney stones (suggesting **hyperparathyroidism**) combined with a family history of **thyroid cancer** are classic for **Multiple Endocrine Neoplasia type 2A (MEN2A)**.
- **MEN2A** is caused by a germline mutation in the **RET proto-oncogene** and typically involves **medullary thyroid carcinoma**, **pheochromocytoma** (explaining the adrenal symptoms), and **primary hyperparathyroidism**.
*BCL2*
- The **BCL2 gene** is an **anti-apoptotic gene** primarily associated with lymphomas, particularly **follicular lymphoma**, where its overexpression promotes cell survival.
- Mutations or translocations involving BCL2 are not linked to endocrine disorders like MEN2A or the specific combination of symptoms seen in this patient.
*BRAF*
- The **BRAF gene** encodes a protein involved in cell growth signaling and is commonly mutated in various cancers, most notably **melanoma** and **papillary thyroid carcinoma**.
- While associated with thyroid cancer, a BRAF mutation does not explain the pheochromocytoma, hyperparathyroidism, or the specific family history indicative of MEN2A.
*BCR-ABL*
- The **BCR-ABL fusion gene** results from the **Philadelphia chromosome translocation (t(9;22))** and is the hallmark of **chronic myeloid leukemia (CML)** and some cases of acute lymphoblastic leukemia.
- This gene is a potent oncogene in hematopoietic malignancies and has no association with the endocrine tumors or symptoms described in the patient.
*HER-2/neu (C-erbB2)*
- **HER-2/neu (C-erbB2)** is an oncogene that encodes a receptor tyrosine kinase and is primarily associated with **breast cancer** and some **gastric cancers**, where its overexpression indicates a more aggressive tumor and guides targeted therapy.
- This gene is not implicated in the pathogenesis of MEN2A or the constellation of symptoms observed in this patient.
Anesthesia complications US Medical PG Question 6: A 37-year-old-woman presents to the emergency room with complaints of fever and abdominal pain. Her blood pressure is 130/74 mmHg, pulse is 98/min, temperature is 101.5°F (38.6°C), and respirations are 23/min. The patient reports that she had a laparoscopic cholecystectomy 4 days ago but has otherwise been healthy. She is visiting her family from Nebraska and just arrived this morning from a 12-hour drive. Physical examination revealed erythema and white discharge from abdominal incisions and tenderness upon palpations at the right upper quadrant. What is the most probable cause of the patient’s fever?
- A. Pulmonary atelectasis
- B. Residual gallstones
- C. Urinary tract infection
- D. Wound infection (Correct Answer)
- E. Pulmonary embolism
Anesthesia complications Explanation: ***Wound infection***
- The presence of **erythema**, **white discharge from abdominal incisions**, and **fever** 4 days post-laparoscopic cholecystectomy strongly indicates a surgical site infection.
- This is a common complication after surgery, especially with visible signs of local inflammation and purulent discharge.
*Pulmonary atelectasis*
- **Atelectasis** typically presents within **24-48 hours post-op** and usually resolves spontaneously.
- While it can cause fever, the prominent local wound signs and the timing (4 days post-op) make it less likely to be the primary cause of fever.
*Residual gallstones*
- **Residual gallstones** would typically present with symptoms resembling acute cholecystitis or cholangitis, such as **right upper quadrant pain**, **jaundice**, or **elevated liver enzymes**, without direct signs of wound infection.
- These do not account for the **erythema and discharge from the incision sites**.
*Urinary tract infection*
- A **urinary tract infection (UTI)** would present with **dysuria**, **frequency**, **urgency**, or **suprapubic pain**, and would not explain the local wound findings.
- While surgery can increase the risk of nosocomial UTIs, the clinical presentation is primarily focused on the surgical site.
*Pulmonary embolism*
- A **pulmonary embolism (PE)** would likely cause **dyspnea**, **tachycardia**, **hypoxia**, and **pleuritic chest pain**, which are not reported in this case.
- Though prolonged immobility (e.g., long drive) is a risk factor, the specific local signs of infection are not consistent with PE.
Anesthesia complications US Medical PG Question 7: Three days after undergoing an open cholecystectomy, a 73-year-old man has fever and abdominal pain. He has hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. He had smoked one pack of cigarettes daily for 40 years but quit 1 year ago. He does not drink alcohol. Prior to admission to the hospital, his medications included lisinopril, metformin, ipratropium, and tamsulosin. He appears acutely ill and lethargic. His temperature is 39.5°C (103.1°F), pulse is 108/min, respirations are 18/min, and blood pressure is 110/84 mm Hg. He is oriented only to person. Examination shows a 10-cm subcostal incision that appears dry and non-erythematous. Scattered expiratory wheezing is heard throughout both lung fields. His abdomen is distended with tenderness to palpation over the lower quadrants. Laboratory studies show:
Hemoglobin 10.1 g/dl
Leukocyte count 19,000/mm3
Serum
Glucose 180 mg/dl
Urea Nitrogen 25 mg/dl
Creatinine 1.2 mg/dl
Lactic acid 2.5 mEq/L (N = 0.5 - 2.2 mEq/L)
Urine
Protein 1+
RBC 1–2/hpf
WBC 32–38/hpf
Which of the following is the most likely underlying mechanism of this patient's current condition?
- A. Wound contamination
- B. Peritoneal inflammation
- C. Impaired alveolar ventilation
- D. Intraabdominal abscess formation (Correct Answer)
- E. Bladder outlet obstruction
Anesthesia complications Explanation: ***Intraabdominal abscess formation***
- The patient presents with **fever**, **leukocytosis**, **abdominal pain** and **distension** three days post-cholecystectomy. These symptoms, coupled with signs of systemic illness (lethargy, altered mental status, tachycardia, elevated lactic acid), are highly suggestive of an **intraabdominal infection** such as an abscess.
- The surgical site incision appears dry and non-erythematous, making a superficial wound infection less likely to explain the systemic symptoms and deep abdominal pain.
*Wound contamination*
- While wound contamination can cause infection, the incision site is described as **dry and non-erythematous**, suggesting that a superficial surgical site infection is not the primary cause of the patient's systemic illness and deep abdominal pain.
- A simple wound infection generally would not lead to such significant systemic symptoms, including **lethargy** and **altered mental status**, within three days post-surgery, especially without local signs of inflammation.
*Peritoneal inflammation*
- Peritoneal inflammation (peritonitis) is a consequence of an intraabdominal process like an abscess or anastomotic leak, rather than the primary underlying mechanism itself.
- The symptoms of **localized tenderness** and **distension** are more indicative of a contained process like an abscess rather than diffuse peritoneal inflammation as the initial cause.
*Impaired alveolar ventilation*
- While the patient has COPD and scattered expiratory wheezing, suggesting some degree of respiratory compromise, **impaired alveolar ventilation** alone does not explain the fever, elevated leukocyte count, abdominal pain, and an elevated lactic acid (though respiratory distress can contribute to lactic acidemia, an infection is a more direct cause here).
- Post-operative pulmonary complications are common, but the abdominal findings and systemic signs of infection point away from a purely respiratory origin for this acute deterioration.
*Bladder outlet obstruction*
- The patient has BPH and is on tamsulosin, but his current symptoms of fever, leukocytosis, abdominal pain, and elevated lactic acid are not typical for **bladder outlet obstruction**.
- Although the urine analysis shows pyuria (WBC 32-38/hpf), which could suggest a urinary tract infection (UTI), a UTI alone is less likely to cause this degree of systemic illness with **significant abdominal distension** and **tenderness** in the lower quadrants shortly after abdominal surgery; it's more probable that the pyuria is a secondary finding or contributing factor in a patient with a more severe intraabdominal process.
Anesthesia complications US Medical PG Question 8: A 19-year-old man is brought to the emergency department 35 minutes after being involved in a high-speed motor vehicle collision. On arrival, he is alert, has mild chest pain, and minimal shortness of breath. He has one episode of vomiting in the hospital. His temperature is 37.3°C (99.1°F), pulse is 108/min, respirations are 23/min, and blood pressure is 90/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination shows multiple abrasions over his trunk and right upper extremity. There are coarse breath sounds over the right lung base. Cardiac examination shows no murmurs, rubs, or gallop. Infusion of 0.9% saline is begun. He subsequently develops increasing shortness of breath. Arterial blood gas analysis on 60% oxygen shows:
pH 7.36
pCO2 39 mm Hg
pO2 68 mm Hg
HCO3- 18 mEq/L
O2 saturation 81%
An x-ray of the chest shows patchy, irregular infiltrates over the right lung fields. Which of the following is the most likely diagnosis?
- A. Pneumothorax
- B. Pulmonary contusion (Correct Answer)
- C. Aspiration pneumonia
- D. Acute respiratory distress syndrome
- E. Pulmonary embolism
Anesthesia complications Explanation: ***Pulmonary contusion***
- The patient's presentation with **hypoxia**, increasing shortness of breath after a high-speed motor vehicle collision, and **patchy, irregular infiltrates** on chest x-ray despite initial hydration, are highly suggestive of **pulmonary contusion**.
- The coarse breath sounds over the right lung base further support the presence of parenchymal injury and hemorrhage in the lung tissue.
*Pneumothorax*
- While a pneumothorax is common after trauma, the chest x-ray would typically show a **collapsed lung** and **absence of lung markings** in the affected area, which is not described.
- The presence of coarse breath sounds suggests air entry, not a complete absence due to collapsed lung.
*Aspiration pneumonia*
- Although the patient had one episode of vomiting, **aspiration pneumonia** typically develops hours to days after aspiration, presenting with fever and signs of infection.
- The acute onset of symptoms within minutes of trauma and the lack of fever make aspiration pneumonia less likely as the primary diagnosis immediately following the accident.
*Acute respiratory distress syndrome*
- **Acute respiratory distress syndrome (ARDS)** is a severe inflammatory lung injury that typically develops **24 to 72 hours** after an initial insult, not immediately.
- While the patient has hypoxia, the diffuse bilateral infiltrates characteristic of ARDS are not seen, and his symptoms are too acute for ARDS to be the primary cause at 35 minutes post-injury.
*Pulmonary embolism*
- A **pulmonary embolism** would typically present with sudden onset of shortness of breath and pleuritic chest pain, often without significant findings on chest x-ray or presenting with a **wedge-shaped infiltrate**.
- Given the direct chest trauma and immediate onset of respiratory compromise, a pulmonary contusion is a more direct and acute consequence.
Anesthesia complications US Medical PG Question 9: Five days after undergoing right knee arthroplasty for osteoarthritis, a 68-year-old man has severe pain in his right knee preventing him from participating in physical therapy. On the third postoperative day when the dressing was changed, the surgical wound appeared to be intact, slightly swollen, and had a clear secretion. He has a history of diabetes, hyperlipidemia, and hypertension. Current medications include metformin, enalapril, and simvastatin. His temperature is 37.3°C (99.1°F), pulse is 94/min, and blood pressure is 130/88 mm Hg. His right knee is swollen, erythematous, and tender to palpation. There is pain on movement of the joint. The medial parapatellar skin incision appears superficially opened in its proximal and distal part with yellow-green discharge. There is blackening of the skin on both sides of the incision. Which of the following is the next best step in the management of this patient?
- A. Vacuum dressing
- B. Antiseptic dressing
- C. Nafcillin therapy
- D. Removal of prostheses
- E. Surgical debridement (Correct Answer)
Anesthesia complications Explanation: ***Surgical debridement***
- The patient presents with classic signs of **necrotizing fasciitis** or a severe wound infection: rapidly worsening pain, erythema, swelling, **yellow-green discharge**, and crucially, **blackening of the skin** (indicating tissue necrosis).
- Immediate **surgical debridement** is critical for source control, removal of necrotic tissue, and preventing further spread of infection, which can be life-threatening.
*Vacuum dressing*
- A vacuum-assisted closure (VAC) dressing is used for wound management after adequate debridement or for wounds without signs of aggressive infection to promote healing.
- Applying a VAC dressing to a wound with widespread necrosis and active infection, especially necrotizing fasciitis, without prior debridement would be ineffective and potentially harmful.
*Antiseptic dressing*
- While antiseptic dressings can help reduce bacterial load in some superficial wounds, they are entirely insufficient for deep-seated, rapidly spreading infections with tissue necrosis.
- This approach fails to address the underlying necrotic tissue and the extent of the infection, leading to rapid deterioration.
*Nafcillin therapy*
- **Antibiotic therapy** is essential for treating severe infections; however, it must be combined with source control, especially when necrosis is present.
- Giving antibiotics alone without **surgical debridement** in cases of necrotizing fasciitis is inadequate and will not prevent progression of the infection or improve patient outcomes.
*Removal of prostheses*
- While **prosthesis removal** may be necessary in some cases of established periprosthetic joint infection, it is a definitive and often late measure.
- The immediate priority in a rapidly progressing, necrotic wound infection is **surgical debridement** to remove devitalized tissue and control the local infection, prior to considering implant removal unless the infection is directly on the implant.
Anesthesia complications US Medical PG Question 10: A 56-year-old man presents to the emergency department with severe chest pain and a burning sensation. He accidentally drank a cup of fluid at his construction site 2 hours ago. The liquid was later found to contain lye. On physical examination, his blood pressure is 100/57 mm Hg, respiratory rate is 21/min, pulse is 84/min, and temperature is 37.7°C (99.9°F). The patient is sent immediately to the radiology department. The CT scan shows air in the mediastinum, and a contrast swallow study confirms the likely diagnosis. Which of the following is the best next step in the management of this patient’s condition?
- A. Ceftriaxone
- B. Oral antidote
- C. Dexamethasone
- D. Surgical repair (Correct Answer)
- E. Nasogastric lavage
Anesthesia complications Explanation: ***Surgical repair***
- The presence of **mediastinal air** on CT scan and confirmation of **esophageal perforation** by contrast swallow study indicate a surgical emergency.
- **Emergency surgical repair** is crucial to prevent widespread mediastinitis, sepsis, and potential mortality from corrosive ingestion.
*Ceftriaxone*
- While **antibiotics** like Ceftriaxone might be used as adjuncts to prevent infection, they are not the primary treatment for an established esophageal perforation.
- Antibiotics alone will not address the structural defect or contain the leakage of corrosive material into the mediastinum.
*Oral antidote*
- For corrosive ingestions, administering an **oral antidote** is contraindicated as it can worsen tissue damage or induce vomiting, leading to further esophageal injury.
- The immediate priority is managing the perforation, not neutralizing the corrosive agent internally.
*Dexamethasone*
- **Corticosteroids** like dexamethasone are sometimes considered in the management of corrosive ingestions to reduce stricture formation, but their role is controversial and they are not the initial treatment for an acute perforation.
- In an active perforation, corticosteroids would not address the immediate life-threatening issue of mediastinal contamination.
*Nasogastric lavage*
- **Nasogastric lavage** is contraindicated in corrosive ingestions, especially with suspected or confirmed perforation.
- Passing a tube could further injure the already damaged tissue and increase the risk of perforation or exacerbate an existing one.
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