Surgical Infections Practice Questions

Q: What is the most appropriate treatment for acute paronychia?

Partial nail removal. **Explanation:** Acute paronychia is a localized infection of the nail fold, most commonly caused by *Staphylococcus aureus*. The management depends on the stage of the infection and the presence of an underlying abscess. **Why Partial Nail Removal is Correct:** In cases of acute paronychia where an abscess has formed beneath the nail plate (subungual extension), simple incision of the soft tissue is insufficient. **Partial nail removal** (specifically of the lateral edge of the nail) is the most effective treatment because it ensures complete decompression of the subungual space and allows for adequate drainage of the infected pocket. This approach prevents recurrence and promotes faster healing compared to simple soft tissue drainage. **Analysis of Incorrect Options:** * **B. Nail Removal:** Complete nail avulsion is overly aggressive for a localized paronychia and is generally reserved for severe fungal infections (onychomycosis) or extensive subungual trauma. * **C. Lifting of the Eponychium:** This technique (using a flat probe or elevator) is used for very early, superficial paronychia. However, it is often inadequate if the pus has already tracked under the nail plate. * **D. Incision and Drainage:** While I&D is standard for most abscesses, in paronychia, a simple skin incision often fails to drain the subungual component, leading to treatment failure. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organism:** *Staphylococcus aureus* (Acute); *Candida albicans* (Chronic). * **Chronic Paronychia:** Defined as lasting >6 weeks; treatment involves avoiding moisture and topical steroids/antifungals (Marsupialization is the surgical option). * **Felon:** An infection of the pulp space of the finger; requires a lateral longitudinal incision to avoid damaging the digital nerves and vessels.

Q: Crepitus over the skin of a swollen limb should alert on the possibility of:

Gas gangrene. **Explanation:** **Gas gangrene** (Clostridial Myonecrosis) is the correct answer because it is a life-threatening necrotizing infection caused primarily by *Clostridium perfringens*. These anaerobic, spore-forming bacteria produce alpha-toxins that cause tissue necrosis and ferment carbohydrates, leading to the production of gas within the soft tissues. This trapped gas manifests clinically as **crepitus** (a crackling sensation) upon palpation of the swollen limb. **Analysis of Incorrect Options:** * **Air embolism:** This occurs when air enters the venous or arterial circulation (e.g., via central line insertion). While it involves "air," it is intravascular and does not present with subcutaneous crepitus. * **Fat embolism:** This typically follows long bone fractures. It presents with a clinical triad of hypoxemia, neurological abnormalities, and petechial rashes, but not localized tissue crepitus. * **DIC:** This is a systemic hematological disorder characterized by widespread activation of the coagulation cascade, leading to simultaneous bleeding and clotting. It does not produce gas in tissues. **Clinical Pearls for NEET-PG:** * **Causative Agent:** *Clostridium perfringens* (Type A) is the most common. * **X-ray Finding:** Shows "feathering" or gas shadows along muscle planes. * **Incubation Period:** Very short (typically 1–6 hours to 3 days). * **Management:** Emergency surgical debridement (most important), high-dose Penicillin G, and Hyperbaric Oxygen (HBO) therapy. * **Differential:** Non-clostridial crepitant cellulitis (often caused by *E. coli* or *Klebsiella*) can also cause crepitus but is generally less toxic than gas gangrene.

Q: Which of the following is not a component of SIRS criteria?

Heart rate > 90 beats per minute. The **Systemic Inflammatory Response Syndrome (SIRS)** criteria were established to identify the body's generalized inflammatory response to various insults (infection, trauma, burns, or pancreatitis). To meet the definition of SIRS, a patient must fulfill **at least two** of the following four criteria: 1. **Temperature:** > 38.0°C (100.4°F) or 90 beats per minute. 3. **Respiratory Rate:** > 20 breaths per minute OR PaCO₂ 12,000/mm³, 10% immature (band) forms. **Analysis of Options:** * **Option A (Correct Answer):** The threshold for fever in SIRS is **> 38.0°C**, not > 38.3°C. While 38.3°C is often used in the definition of "Fever of Unknown Origin" (FUO), it is technically incorrect for the standardized SIRS criteria. * **Option B:** This is a standard SIRS criterion (Tachycardia > 90 bpm). * **Option C:** This is a standard SIRS criterion (Tachypnea > 20 bpm). * **Option D:** This is a standard SIRS criterion regarding leukocytosis or leukopenia. **NEET-PG High-Yield Pearls:** * **Sepsis-3 Definition:** Modern guidelines have shifted away from SIRS toward the **qSOFA score** (Altered mental status, Systolic BP ≤ 100 mmHg, and RR ≥ 22) and the **SOFA score** to define sepsis. * **Sepsis vs. SIRS:** Sepsis is now defined as life-threatening organ dysfunction caused by a dysregulated host response to **infection** (SOFA score increase ≥ 2). * **SIRS is non-specific:** It can occur in non-infectious conditions like acute pancreatitis or major surgery.

Q: All of the following are signs of sepsis, except:

Induration. **Explanation:** In the context of surgical infections, the question asks to identify which sign is **not** a characteristic feature of **sepsis** (systemic or spreading infection) compared to localized inflammation or a localized abscess. **Why Induration is the Correct Answer:** **Induration** (Option C) refers to the hardening of soft tissue, typically due to localized inflammation, edema, or cellular infiltration. In surgical practice, induration is a hallmark sign of a **localized abscess** or a phlegmon. While it indicates inflammation, it is a physical finding of a "walled-off" or focal process rather than a sign of spreading sepsis or systemic infection. **Analysis of Incorrect Options:** * **Serous discharge (Option A):** While often associated with healing, a change in the nature of discharge (from serous to serosanguinous or cloudy) can be an early sign of surgical site infection and impending sepsis. * **Purulent exudate (Option B):** The presence of pus is a definitive sign of infection (suppuration). If the infection is not contained, it leads to systemic inflammatory response syndrome (SIRS) and sepsis. * **Erythema (Option C):** Spreading redness (erythema) or lymphangitis is a classic sign of invasive infection and cellulitis, which are precursors to or components of clinical sepsis. **Clinical Pearls for NEET-PG:** * **Sepsis Definition:** Sepsis is now defined (Sepsis-3) as life-threatening organ dysfunction caused by a dysregulated host response to infection. * **Local vs. Systemic:** Induration, fluctuance, and localized pain suggest an **abscess** (requires incision and drainage). Erythema, warmth, and systemic fever suggest **cellulitis/sepsis** (requires antibiotics). * **Cardinal Signs of Inflammation:** Remember Celsus’ tetrad: *Rubor* (redness), *Calor* (heat), *Tumor* (swelling), and *Dolor* (pain). Induration is a subset of *Tumor*.

Question 1

What is the most appropriate treatment for acute paronychia?

Accepted Answer

Partial nail removal

Answer

Nail removal

Answer

Lifting of the eponychium

Answer

Incision and drainage

Question 2

Crepitus over the skin of a swollen limb should alert on the possibility of:

Accepted Answer

Gas gangrene

Answer

Air embolism

Answer

Fat embolism

Answer

Disseminated intravascular coagulation (DIC)

Question 3

Which of the following is not a component of SIRS criteria?

Accepted Answer

Heart rate > 90 beats per minute

Answer

Core body temperature > 38.3°C

Answer

Respiratory rate > 20 breaths per minute

Answer

White blood cell count > 12,000/mm³ or < 4,000/mm³

Question 4

Which one of the following organisms is not associated with synergistic gangrene?

Accepted Answer

Escherichia

Answer

Staphylococcus

Answer

Clostridium

Answer

Streptococcus

Question 5

All of the following are signs of sepsis, except:

Accepted Answer

Induration

Answer

Serous discharge

Answer

Purulent exudate

Answer

Erythema

Surgical Infections — MCQs

Surgical Infections — MCQs

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