Surgical Infections — MCQs

Surgical Infections Indian Medical PG Practice Questions and MCQs

Question 101: Which of the following is shown in the image?

A. Fistula-in-Ano
B. Pilonidal sinus (Correct Answer)
C. Bowen disease
D. Hidradenitis suppurativa

Explanation: ***Pilonidal sinus*** - The image shows a **pilonidal sinus**, characterized by a small opening (pit) in the **natal cleft**, often with surrounding inflammation, redness, and discharge. - This condition is typically found at the top of the buttocks or near the coccyx, consistent with the image's appearance. - **Pilonidal disease** results from hair follicle obstruction in the natal cleft region, leading to cyst and sinus tract formation. *Fistula-in-Ano* - A fistula-in-ano is an **abnormal tract** connecting the anal canal or rectum to the perianal skin, often presenting as a perianal opening with discharge. - While it involves openings near the anus, its anatomical location is typically **closer to the anal margin**, not in the natal cleft as seen in the image. *Bowen disease* - Bowen disease (squamous cell carcinoma in situ) presents as a **red, scaly patch or plaque** on the skin, often in sun-exposed areas but can occur anywhere. - It is a **precancerous condition**, not typically presenting as a sinus or tract with discharge in the natal cleft region. *Hidradenitis suppurativa* - This chronic inflammatory skin condition primarily affects areas with **apocrine sweat glands** (e.g., axillae, groin, gluteal folds) and presents with painful nodules, abscesses, and sinus tracts. - While it can occur in the gluteal fold, it presents with **multiple recurring lesions and scarring**, unlike the typical single pit appearance of pilonidal sinus in the natal cleft.

Question 102: All are true about the image shown except:

A. Acute paronychia
B. Throbbing pain
C. Ring block with adrenaline used (Correct Answer)
D. I and D by incising the eponychium

Explanation: ***Ring block with adrenaline used*** ✓ Correct Answer (EXCEPT - This is FALSE) - **Adrenaline should NEVER be used in digital/ring blocks** for fingers, toes, penis, nose, or ears - Risk of **vasoconstriction-induced ischemia and tissue necrosis** in end-arterial circulation - This is the statement that is NOT true about proper management of the condition shown *Acute paronychia* (True statement) - Image shows classic features: swelling, erythema, and purulent collection around the nail fold - Acute infection of periungual tissues, typically caused by *Staphylococcus aureus* or *Streptococcus* - Most common hand infection *Throbbing pain* (True statement) - Characteristic symptom due to **pus accumulation under pressure** in the confined space of the nail fold - Pulsatile pain results from inflammation and pressure against inflamed tissues - Pain severity often correlates with abscess formation *I and D by incising the eponychium* (True statement) - **Standard treatment** for acute paronychia with abscess formation - Incision along the eponychium (proximal nail fold) allows drainage of collected pus - Relieves pressure and removes infected material - May require partial nail plate elevation if pus extends under the nail

Question 103: All are true about the image shown except:

A. Anti-gravity drainage
B. Cold abscess
C. Rubbery consistency of involved lymph nodes
D. Transillumination test is negative (Correct Answer)

Explanation: ***Transillumination test is negative*** - This is the **CORRECT ANSWER** because this statement is **FALSE** about tuberculous cold abscesses. - Transillumination test would actually be **positive** in cold abscesses because they contain fluid (pus) that allows light to pass through. - Cold abscesses are **cystic collections** filled with liquefied caseous material and pus, making them transilluminate similar to other fluid-filled structures like cysts. *Anti-gravity drainage* - This statement is **TRUE** - tuberculous abscesses characteristically spread along **fascial planes** rather than following gravity-dependent paths. - **Collar-stud abscesses** exemplify this pattern, where infection tracks through tissue planes in non-gravitational directions. - This anti-gravity spread is pathognomonic of TB and helps differentiate it from pyogenic abscesses. *Cold abscess* - This statement is **TRUE** - the image shows aspiration of a **cold abscess**, which is pathognomonic of **tuberculous lymphadenitis** (scrofula). - Called "cold" because it lacks classic inflammatory signs (**rubor, calor, dolor, tumor**) due to the **chronic granulomatous** nature of tuberculosis. - Contains thick, caseous pus rather than the thin, purulent discharge of pyogenic abscesses. *Rubbery consistency of involved lymph nodes* - This statement is **TRUE** - tuberculous lymph nodes characteristically feel **firm and matted** with a distinctive **rubbery texture**. - This consistency results from **granulomatous inflammation** and **caseous necrosis** that distinguishes it from other causes of lymphadenopathy. - Early nodes are discrete and rubbery; later they become matted and may undergo cold abscess formation.

Question 104: An HIV positive patient presents with symptoms of toxemia and foul smelling discharge from the lesion shown below. What is the diagnosis?

A. Trophic ulcer
B. Pyogenic granuloma
C. Martorell ulcer
D. Necrotizing fasciitis (Correct Answer)

Explanation: ***Necrotizing fasciitis*** - The image shows an extensive, deep soft tissue infection with a large area of **tissue necrosis**, which is characteristic of necrotizing fasciitis. - The patient's **HIV-positive status** puts them at higher risk for severe infections, and the symptoms of **toxemia** and **foul-smelling discharge** further support this aggressive, rapidly spreading bacterial infection. *Trophic ulcer* - Trophic ulcers are typically caused by **neuropathic or vascular insufficiency**, leading to chronic, poorly healing wounds, often located on the lower limbs. - They do not usually present with the rapid onset, extensive tissue destruction, toxemia, and foul-smelling discharge seen here. *Pyogenic granuloma* - A pyogenic granuloma is a **benign vascular lesion** that typically presents as a small, red, rapidly growing, pedunculated or sessile papule, prone to bleeding. - It does not involve widespread tissue destruction, toxemia, or a foul-smelling discharge. *Martorell ulcer* - A Martorell ulcer (or ischemic hypertensive leg ulcer) is a **painful, full-thickness ulcer** typically located on the lateral aspect of the lower leg, associated with poorly controlled **hypertension and peripheral arterial disease**. - While it is an ulcer, it doesn't typically present with the broad, necrotizing appearance, toxemia, or foul-smelling discharge indicative of such a severe, spreading infection.

Question 105: Which of the following are risk factors for wound infection? 1. Malnutrition 2. Poor perfusion 3. Antibodies 4. Foreign body material Select the correct answer using the code given below.

A. 1, 3 and 4
B. 1, 2 and 4 (Correct Answer)
C. 2, 3 and 4
D. 1, 2 and 3

Explanation: ***Correct: 1, 2 and 4*** The risk factors for wound infection include: - **Malnutrition** impairs the immune system and wound healing processes, making the patient more susceptible to infection - **Poor perfusion** (reduced blood supply) leads to decreased oxygen and nutrient delivery to the wound, hindering healing and immune cell function - **Foreign body material** within the wound creates a nidus for bacterial colonization and protects bacteria from immune defenses and antibiotics Antibodies are part of the body's immune defense system and **protect against infection** rather than being a risk factor for it. *Incorrect: 1, 3 and 4* While malnutrition (1) and foreign bodies (4) are risk factors, antibodies (3) are part of the immune defense and protect against infection, not increase its risk. *Incorrect: 2, 3 and 4* Poor perfusion (2) and foreign bodies (4) are risk factors, but antibodies (3) are protective components of the immune system. *Incorrect: 1, 2 and 3* Malnutrition (1) and poor perfusion (2) are significant risk factors, but antibodies (3) are a component of the host's defense mechanism against infection, not a risk factor.

Question 106: The most common intraperitoneal abscess following peritonitis is

A. Pelvic (Correct Answer)
B. Paracolic
C. Subphrenic
D. Interloop

Explanation: ***Pelvic*** - Due to **gravity**, inflammatory exudates and bacteria tend to accumulate in the lowest part of the peritoneal cavity, which is the **pelvis**. - The **pelvic peritoneum** has an excellent capacity for localizing infection, leading to a high incidence of abscess formation here. *Para colic* - While paracolic gutters can accumulate fluid, they are generally **less dependent** than the pelvis for universal collection of peritoneal fluid. - Abscesses in this region are common but not typically the *most common* overall compared to pelvic abscesses. *Subphrenic* - Subphrenic abscesses occur below the diaphragm, often associated with operations on the **upper abdomen** or liver/spleen injuries. - While a significant complication, they are less common than pelvic abscesses in general peritonitis. *Interloop* - Interloop abscesses form between loops of bowel, often due to localized inflammation and exudate. - These are common but tend to be **smaller** and **more scattered** than the large collections seen in the pelvis, making them less frequently the single most common site for a prominent abscess.

Question 107: Which of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?

A. Southampton grading system (Correct Answer)
B. Apgar score
C. Glasgow scoring system
D. ASA classification

Explanation: ***Southampton grading system*** - The **Southampton grading system** is specifically designed for the **severity of wound infection**, offering a clear framework for classification based on clinical signs. - Its utility in **surveillance and research** stems from its structured and reproducible assessment, allowing for consistent data collection on wound healing and infection rates. *Apgar score* - The **Apgar score** is a rapid assessment of a **newborn's health** immediately after birth, evaluating heart rate, respiratory effort, muscle tone, reflex irritability, and color. - It is not used for assessing wound infection severity. *Glasgow scoring system* - The **Glasgow Coma Scale (GCS)** is used to assess the **level of consciousness** in a person following a brain injury, comprising eye opening, verbal, and motor responses. - It is not relevant to wound infection assessment. *ASA classification* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is used to assess a patient's **overall health before surgery**, providing an indication of anesthetic risk. - It is not used for evaluating wound infection.

Question 108: Laparoscopic instruments are best sterilized by :

A. Autoclaving (Correct Answer)
B. Ethylene oxide
C. Hot air oven
D. 2% Glutaraldehyde

Explanation: ***Autoclaving*** - **Autoclaving** remains the gold standard for sterilizing **heat-stable** laparoscopic instruments (e.g., reusable trocars, simple graspers, scissors without delicate components). - Uses **moist heat** (steam at 121-134°C under pressure) to kill all microorganisms including spores, achieving complete sterilization. - **Advantages**: Rapid cycle time (15-30 minutes), cost-effective, no toxic residues, widely available. - **Limitation**: Many modern laparoscopic instruments contain heat-sensitive components (fiber optic cables, cameras, delicate optics) that may be damaged by repeated autoclaving. *Ethylene oxide* - **Ethylene oxide (EtO)** is the preferred method for **heat-sensitive** laparoscopic equipment including telescopes, cameras, and instruments with complex electronics. - Provides complete sterilization at low temperatures (37-63°C), making it ideal for delicate optics and plastics. - **Disadvantages**: Requires 8-12 hours for aeration to remove toxic residues, is a known **carcinogen**, needs special facilities and ventilation, and has longer cycle times (12-24 hours total). *Hot air oven* - Uses **dry heat** (160-180°C for 1-2 hours) suitable for glassware, oils, and powders. - **Not suitable** for laparoscopic instruments due to high temperatures damaging plastics, rubber, and optical components, and poor penetration into lumens. - Less efficient than moist heat sterilization. *2% Glutaraldehyde* - **2% Glutaraldehyde** provides **high-level disinfection** (20-30 minutes) or sterilization (10 hours contact time) for heat-sensitive instruments. - Commonly used for routine processing of laparoscopic equipment between cases when full sterilization is not required. - **Disadvantages**: Prolonged immersion time needed for sterilization, toxic fumes requiring ventilation, does not kill all spores reliably in short contact times, and is primarily a disinfectant rather than a practical sterilant. **Note**: Modern practice increasingly uses low-temperature sterilization methods (hydrogen peroxide plasma, peracetic acid systems) for heat-sensitive laparoscopic equipment, combining the benefits of complete sterilization with protection of delicate instruments.

Question 109: The surgical complications of typhoid fever include all of the following except :

A. Acute pancreatitis (Correct Answer)
B. Splenic abscess
C. Acute cholecystitis
D. Perforation peritonitis

Explanation: ***Acute pancreatitis*** - While typhoid fever can rarely involve the pancreas, **acute pancreatitis** is **not** considered a typical *surgical complication* of typhoid fever. - Pancreatic involvement, when it occurs, is generally mild and does not require surgical intervention. - This is the correct answer as it is NOT a recognized surgical complication. *Splenic abscess* - **Splenic abscess** is a rare but recognized complication of typhoid fever, resulting from hematogenous spread. - When present, it may require **percutaneous drainage** or **splenectomy** due to the risk of rupture. - Note: More common splenic manifestation is splenomegaly, not abscess. *Acute cholecystitis* - **Acute cholecystitis** is a well-recognized surgical complication of typhoid fever. - The gallbladder can serve as a chronic reservoir for **Salmonella Typhi**, leading to inflammation and stone formation. - This may require **cholecystectomy** in severe or recurrent cases. *Perforation peritonitis* - **Intestinal perforation**, particularly of the **terminal ileum**, is the **most common and serious** surgical complication of typhoid fever. - Occurs in approximately **1-3%** of cases, typically in the 2nd-3rd week of illness. - This leads to **peritonitis**, a life-threatening condition requiring **urgent laparotomy and surgical repair**.

Question 110: A 25-year-old patient has 5 x 5 cm amoebic abscess in right lobe of liver. He is febrile and has pain in right hypochondrium. His primary management would include:

A. Laparotomy and drainage
B. Administration of antibiotic and observation
C. Ultra-sound guided aspiration
D. Ultra-sound guided placement of pigtail catheter (Correct Answer)

Explanation: ***Ultra-sound guided placement of pigtail catheter*** - For an **amoebic liver abscess** of 5x5 cm with **significant symptoms** (fever and pain), **catheter drainage combined with anti-amoebic therapy** is indicated. - While medical therapy alone may suffice for smaller or less symptomatic abscesses, this patient's **symptomatic presentation** warrants drainage to provide rapid relief, prevent complications, and ensure resolution. - **Pigtail catheter placement** allows for continuous drainage and is the preferred minimally invasive approach for abscesses requiring intervention. - This approach is safer than open surgery and more effective than single aspiration for complete evacuation. *Laparotomy and drainage* - **Open surgical drainage** is reserved for complicated cases such as **ruptured abscesses**, peritonitis, or failure of percutaneous drainage. - For an uncomplicated 5x5 cm abscess, laparotomy is overly invasive and carries higher morbidity compared to image-guided percutaneous techniques. *Administration of antibiotic and observation* - **Anti-amoebic medications** (metronidazole) are essential for treating amoebic liver abscesses and must be given in all cases. - However, for a **5x5 cm abscess with fever and pain**, medical therapy alone may be insufficient for rapid symptom resolution. - The size (at the threshold of 5 cm) combined with symptomatic presentation justifies **drainage in addition to medical therapy** to prevent complications like rupture or secondary infection. - Observation alone without drainage in a symptomatic patient of this size risks delayed resolution and potential complications. *Ultra-sound guided aspiration* - **Single aspiration** may be considered for diagnostic purposes or in selected cases. - However, for a 5x5 cm abscess, **aspiration may require multiple procedures** for complete evacuation, and there's risk of inadequate drainage. - **Pigtail catheter drainage** is preferred over aspiration as it allows **continuous drainage**, reduces the need for repeat procedures, and has higher success rates for abscesses of this size.

Practice by Chapter

Surgical Site Infections

Practice Questions

Intra-abdominal Infections

Practice Questions

Soft Tissue Infections

Practice Questions

Necrotizing Soft Tissue Infections

Practice Questions

Surgical Sepsis

Practice Questions

Tetanus Prophylaxis

Practice Questions

Antimicrobial Prophylaxis

Practice Questions

Antimicrobial Therapy in Surgical Infections

Practice Questions

Surgical Drainage Procedures

Practice Questions

Infection Control in Operating Room

Practice Questions

Biofilms and Implant-Related Infections

Practice Questions

Prevention Strategies

Practice Questions

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