Surgical Infections — MCQs

Surgical Infections Indian Medical PG Practice Questions and MCQs

Question 111: The indications for surgery in patients with pulmonary tuberculosis include all of the following except

A. Drug-resistant chronic tuberculous abscess
B. Severe life-threatening haemoptysis
C. AFB positive sputum with normal chest CT scan (Correct Answer)
D. Aspergilloma within a tuberculous cavity with recurrent haemoptysis

Explanation: ***AFB positive sputum with normal chest CT scan*** - This scenario typically indicates **early or uncomplicated pulmonary tuberculosis** that is responsive to standard antitubercular drug therapy. - A normal chest CT scan suggests the absence of significant cavitations, extensive lung damage, or other structural abnormalities that would necessitate surgical intervention. *Drug-resistant chronic tuberculous abscess* - **Drug resistance** and the presence of a **chronic tuberculous abscess** make medical management difficult and often ineffective. - Surgical resection can remove the source of infection, facilitate cure, and prevent further dissemination of drug-resistant organisms. *Severe life-threatening haemoptysis* - **Severe or life-threatening haemoptysis** in TB patients often arises from eroded pulmonary vessels within cavitary lesions. - Surgical intervention (e.g., lobectomy, pneumonectomy) is critical to control bleeding and prevent fatal outcomes when conservative measures fail. *Aspergilloma within a tuberculous cavity with recurrent haemoptysis* - An **aspergilloma (fungal ball)** developing in a pre-existing tuberculous cavity can cause **recurrent haemoptysis** due to erosion of blood vessels by the fungus. - Surgical resection is often the definitive treatment to remove the aspergilloma and prevent further bleeding.

Question 112: A 75 year old diabetic man had surgery for perforated colonic diverticulitis. In his post operative period he complained of severe wound pain and had signs of spreading inflammation with crepitus with subdermal spread of gangrene. He is likely to be suffering from

A. Abdominal wall cellulitis
B. Clostridial infection (Correct Answer)
C. Intra-peritoneal collection
D. Meleney synergistic gangrene

Explanation: ***Clostridial infection*** - The rapid onset of **severe wound pain**, **spreading inflammation**, **crepitus** (due to gas production), and **subdermal spread of gangrene** in a diabetic patient post-surgery for perforated diverticulitis is highly suggestive of **gas gangrene**, most commonly caused by **Clostridium** species. - **Diabetes** and a surgical wound involving the colon (a source of clostridia) are significant risk factors for such infections. *Abdominal wall cellulitis* - **Cellulitis** is a superficial infection of the skin and subcutaneous tissue, typically presenting with redness, warmth, and tenderness, but often lacks the rapid progression, **severe pain**, **crepitus**, and **gangrene**. - While an inflammatory process, it does not explain the presence of **crepitus** or the rapid, destructive tissue necrosis described. *Intra-peritoneal collection* - An **intra-peritoneal collection** (e.g., abscess) would primarily affect the abdominal cavity and usually present with localized abdominal pain, fever, and possibly ileus, but not typically with **crepitus** and **spreading gangrene** in the abdominal wall wound. - Such collections are often identified by imaging (CT scan) and do not directly cause the described severe wound infection signs. *Meleney synergistic gangrene* - **Meleney synergistic gangrene**, also known as progressive bacterial synergistic gangrene, is a chronic, progressive, and painful infection often seen around surgical incisions, characterized by a central area of necrosis and surrounding erythema. - While it involves gangrene and is painful, it typically has a **slower progression** and is caused by a synergy of aerobic and anaerobic bacteria, rather than the rapid, gas-producing destructive process characteristic of **clostridial infection**.

Question 113: Southampton wound grading system and ASEPSIS wound score is used for

A. Surgical scar
B. Severity of wound infections (Correct Answer)
C. Surgical site cosmesis
D. Severity of granulation tissue

Explanation: ***Severity of wound infections*** - The **Southampton wound grading system** assesses postsurgical wounds for complications like seroma, hematoma, and infection. - The **ASEPSIS wound score** is used for the objective assessment of **surgical site infections (SSI)**, considering factors like additional treatment, serous discharge, erythema, pus, separation of deep tissues, isolation of bacteria, and duration of hospital stay. *Surgical scar* - While wound healing can impact scars, these systems are primarily concerned with **acute wound complications and infection**, not the long-term cosmetic outcome of the scar itself. - Scar evaluation often uses different scales, such as the Manchester Scar Scale or the Vancouver Scar Scale, which focus on attributes like color, vascularity, pliability, and height. *Surgical site cosmesis* - This refers to the **aesthetic appearance** of the surgical site, which is a different aspect from infection status and complications. - Cosmesis is evaluated subjectively or using specific scar scales, not the Southampton or ASEPSIS scores. *Severity of granulation tissue* - Granulation tissue is a sign of **healing**; its severity is not the primary focus of these grading systems, which are designed to detect and quantify complications and infections. - While excessive or poor granulation can indicate issues, these systems broadly categorize wound issues rather than specifically grading granulation tissue.

Question 114: Hilton's method of Incision and drainage of abscess has the advantage of:

A. Avoids injury to underlying vessels and nerves (Correct Answer)
B. Complete drainage of pus
C. Heals without scar
D. Provides irrigation

Explanation: ***Avoids injury to underlying vessels and nerves*** - Hilton's method involves blunt dissection with an artery forceps once the skin incision is made, allowing the surgeon to **feel important structures** and push them aside. - This technique is particularly useful in areas with **numerous neurovascular bundles**, such as the axilla or neck, minimizing the risk of iatrogenic damage. *Complete drainage of pus* - While Hilton's method facilitates drainage, it doesn't inherently guarantee **complete drainage** more than other proper incision and drainage techniques. - The effectiveness of drainage primarily depends on the **size and location of the incision** relative to the abscess cavity. *Heals without scar* - Any surgical incision, including those made using Hilton's method, will result in some degree of **scar formation**. - The method prioritizes safety over cosmetic outcomes, and the nature of the scar depends on **wound healing** and **surgical closure**. *Provides irrigation* - Irrigation is a separate step often performed after the incision and drainage to **flush out debris** and reduce bacterial load. - Hilton's method itself is a technique for making the incision and gaining access to the abscess, not for **intraoperative irrigation**.

Question 115: Following are the factors for increased risk of wound infection EXCEPT:

A. Good blood supply (Correct Answer)
B. Metabolic diseases (diabetes, uraemia)
C. Immunosuppression
D. Malnutrition

Explanation: ***Good blood supply*** - A **robust blood supply** is crucial for wound healing as it delivers **oxygen, nutrients, and immune cells** to the injured site, actively preventing infection. - Good perfusion means that the tissues can effectively **clear bacteria** and support the local immune response, thereby **decreasing the risk** of wound infection. *Metabolic diseases (diabetes, uraemia)* - **Diabetes** impairs wound healing through mechanisms like **peripheral neuropathy**, **vasculopathy**, and compromised immune function, greatly increasing infection risk. - **Uraemia** in kidney failure leads to a buildup of toxins that can **suppress the immune system** and impair cellular function, making patients more susceptible to infections. *Immunosuppression* - **Immunosuppression**, whether due to chronic illness, medications (e.g., corticosteroids), or immunodeficiency, significantly **weakens the body's defense mechanisms**. - A compromised immune system is less able to **identify, target, and eliminate invading pathogens**, leading to a higher incidence of wound infections. *Malnutrition* - **Malnutrition**, particularly deficiencies in protein, vitamin C, and zinc, can severely **impair collagen synthesis**, immune function, and overall tissue repair. - Inadequate nutritional status hinders the body's ability to **mount an effective immune response** and regenerate tissues, creating an environment ripe for infection.

Question 116: A gentleman of 60 years presented with a brawny swelling of the submandibular region with inflammatory edema of mouth and putrid halitosis. Most likely he is suffering from

A. Ludwig's angina (Correct Answer)
B. Acute lymphadenitis
C. Tubercular adenitis
D. Chronic lymphadenitis

Explanation: ***Ludwig's angina*** - This is a **rapidly progressive cellulitis** of the submandibular, sublingual, and submental spaces, commonly originating from **odontogenic infections**. - The classic presentation includes **brawny edema** (firm, woody induration) of the submandibular region, inflammatory edema of the mouth, and **putrid halitosis** indicative of an anaerobic infection. *Acute lymphadenitis* - This involves inflammation of the lymph nodes, typically characterized by **tender, enlarged nodes**. - While it can be associated with infection, it usually does not present with the diffuse, *brawny* swelling of the floor of the mouth and submandibular area as described, nor the severe systemic symptoms often linked to Ludwig's angina. *Tubercular adenitis* - This is a **chronic granulomatous inflammation** of lymph nodes, typically presenting as slowly enlarging, **non-tender masses**. - It does not cause acute, rapidly spreading cellulitis or *brawny* edema with severe halitosis, which are hallmark features of Ludwig's angina. *Chronic lymphadenitis* - This refers to persistent or recurrent inflammation of lymph nodes, often due to protracted infection or inflammatory processes. - It usually manifests as **enlarged, firm, sometimes mobile lymph nodes**, but does not involve the acute, diffuse, and rapidly spreading *brawny* edema characteristic of a severe fascial space infection like Ludwig's angina.

Question 117: Pott's puffy tumour is a:

A. Tuberculosis of the skull bone
B. Subperiosteal abscess associated with osteomyelitis of frontal bone (Correct Answer)
C. Fungating scrotal malignancy
D. Squamous cell cancer of scalp

Explanation: ***Subperiosteal abscess associated with osteomyelitis of frontal bone*** - **Pott's puffy tumor** is a rare but serious complication of **frontal sinusitis**, characterized by an overlying edema and subperiosteal abscess. - It arises from **osteomyelitis of the frontal bone**, which can erode through the bone and lead to an intracranial abscess. *Tuberculosis of the skull bone* - While tuberculosis can affect bones, a **tuberculosis of the skull** would typically present with a more chronic course and different imaging findings, not the characteristic acute, localized swelling of Pott's puffy tumor. - **Pott's puffy tumor** is specifically associated with bacterial sinusitis, not mycobacterial infection. *Fungating scrotal malignancy* - This option refers to a **malignant tumor of the scrotum** and is entirely unrelated to skull pathology or infection. - The clinical presentation and location are completely different from Pott's puffy tumor. *Squamous cell cancer of scalp* - A **squamous cell cancer of the scalp** is a type of skin malignancy, which would present as a growing lesion and potentially ulcerate, but would not typically involve the deeper bone in the characteristic way of Pott's puffy tumor. - It does not involve a **subperiosteal abscess** or underlying osteomyelitis of the frontal bone.

Question 118: A 20-year-old patient underwent open hernia surgery four days ago. He has had fever for the last day and on local examination the operated site was wet with pus and surrounding redness and edema. The appropriate management would be:

A. Sending pus for C/S
B. Daily dressing
C. Change of antibiotics
D. Opening sutures and cleaning of wound (Correct Answer)

Explanation: ***Opening sutures and cleaning of wound*** - The presence of **fever**, **pus**, **redness**, and **edema** indicates a **surgical site infection (SSI)** with abscess formation, necessitating immediate **wound exploration** and **drainage**. - **Opening the sutures** allows for complete removal of pus, debridement of necrotic tissue, and proper irrigation, which are critical steps in managing a deep-seated infection. *Sending pus for C/S* - While **culture and sensitivity (C/S)** is important for guiding antibiotic therapy, it does not address the immediate mechanical problem of pus accumulation. - Delaying drainage for C/S results would allow the infection to spread, causing further tissue damage. *Daily dressing* - **Daily dressing** alone is insufficient for a wound with active infection and pus accumulation; it cannot effectively drain the infection. - Though necessary as part of wound care, it needs to be preceded by effective drainage. *Change of antibiotics* - Changing **antibiotics** without addressing the underlying source of infection (the pus collection) will likely be ineffective as antibiotics cannot penetrate well into an abscess. - Antibiotics are a crucial adjunct to surgical drainage, not a replacement.

Question 119: All of the following are risk factors for an increased risk of wound infection EXCEPT:

A. Hypertension (Correct Answer)
B. Cancer
C. Jaundice
D. Obesity

Explanation: ***Hypertension*** - **Hypertension** itself is not a direct risk factor for wound infection, unlike conditions that impair immunity, tissue perfusion, or healing. - While uncontrolled hypertension can contribute to broader cardiovascular issues, it does not inherently increase the likelihood of **bacterial contamination** or **impaired immune response** in a wound. *Cancer* - Patients with **cancer** often have compromised immune systems due to the disease itself or as a result of treatments like **chemotherapy** or **radiation**, increasing susceptibility to infections. - **Malnutrition** and overall debilitation associated with advanced cancer can also impair wound healing and immune function. *Jaundice* - **Jaundice** (hyperbilirubinemia) is associated with impaired immune function, particularly a reduction in phagocytic activity and cellular immunity, making patients more prone to infections. - High bilirubin levels can also interfere with **collagen synthesis** and wound tensile strength, contributing to delayed healing and increased infection risk. *Obesity* - **Obesity** is a significant risk factor for wound infection due to poor vascularity of adipose tissue, which leads to reduced oxygen delivery and antibiotic penetration to the wound site. - The presence of large skin folds can also create a **moist environment** conducive to bacterial growth, and increased tension on wound edges can impair healing.

Question 120: Which one of the following statements regarding Felon is NOT correct?

A. It is common in diabetics
B. It is a painless condition (Correct Answer)
C. Incision and drainage is the treatment of choice
D. There is infection of the finger tip between specialised fibrous septa

Explanation: ***It is a painless condition*** - A **felon** is an abscess within the distal phalanx (fingertip) confined by fibrous septa, making it an extremely **painful** and tense infection due to increased pressure. - The severe pain is a hallmark symptom, distinguishing it from a painless condition, and is caused by the pus accumulating in a confined space. *It is common in diabetics* - **Felons** (and other soft tissue infections) are indeed more common in individuals with **diabetes mellitus** due to impaired immune function and compromised circulation. - This makes diabetics more susceptible to infections and can also lead to more severe outcomes. *Incision and drainage is the treatment of choice* - For a **felon**, **surgical incision and drainage** is the primary treatment to relieve pressure, evacuate pus, and prevent serious complications like osteomyelitis or necrosis. - This procedure typically involves a longitudinal or hockey-stick incision to access the infected compartment. *There is infection of the finger tip between specialised fibrous septa* - A **felon** is an infection, typically bacterial, located in the closed compartments of the fingertip's distal pulp, which are separated by **fibrous septa**. - These septa connect the skin to the periosteum, creating multiple small, enclosed spaces that can become acutely infected and filled with pus.

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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