Surgical Infections — MCQs

Surgical Infections Indian Medical PG Practice Questions and MCQs

Question 131: Most common cause of death in burns is

A. Hypovolemic shock
B. Neurogenic shock
C. Haemorrhagic shock
D. Septicemic shock (Correct Answer)

Explanation: ***Septicemic shock*** - Among the types of shock listed, **septicemic shock** (sepsis-related mortality) is the most common cause of death in burn patients, particularly those who survive the initial resuscitation period. - In patients with **extensive burns**, the loss of the skin barrier makes them highly susceptible to **infections**, with damaged tissue providing an excellent medium for bacterial growth and translocation. - **Infection and sepsis** remain leading causes of mortality in burn patients despite advances in care, typically occurring days to weeks post-injury after the acute hypovolemic phase is managed. - Modern burn mortality is often multifactorial (infection, inhalation injury, multiorgan failure), but among shock-specific causes, septic shock predominates. *Hypovolemic shock* - While **hypovolemic shock** is a critical immediate concern due to massive fluid loss in extensive burns (fluid shifts into interstitium), it is usually manageable with prompt and aggressive **fluid resuscitation** (Parkland formula). - This causes early mortality (first 24-48 hours), but with proper fluid management, patients survive this phase, making it less common as an overall cause of death compared to later infectious complications. *Neurogenic shock* - **Neurogenic shock** results from severe injury to the **central nervous system** (spinal cord injury above T6), leading to loss of sympathetic tone. - This is **not a complication of burn injuries** unless there is concomitant spinal trauma from the initial accident. - It is characterized by **vasodilation**, **hypotension**, and **bradycardia**, features not seen in isolated burn patients. *Haemorrhagic shock* - **Haemorrhagic shock** is caused by significant **blood loss**, which is not the primary mechanism of circulatory compromise in burns. - While some blood loss can occur with deep full-thickness burns and surgical debridement, it is not extensive enough to be a major cause of death compared to fluid shifts and infection.

Question 132: Acute paronychia is commonly treated by:

A. Incision and drainage (Correct Answer)
B. Nail bed destruction
C. Partial nail avulsion
D. Total nail avulsion

Explanation: ***I & D*** - **Incision and drainage (I&D)** is the primary treatment for **acute paronychia** when an abscess has formed. - This procedure relieves pressure, drains pus, and promotes healing of the infection around the nail. *Nail bed destruction* - **Nail bed destruction** is typically performed for chronic or recurrent nail problems, such as **onychomycosis** or **ingrown toenails**, not for acute infections. - It involves removing or chemically destroying the nail matrix to prevent future nail growth. *Partial nail avulsion* - **Partial nail avulsion** involves removing only a portion of the nail, usually for **ingrown toenails** or local trauma, and is not the primary treatment for resolving the pus pocket of acute paronychia. - The focus is on removing the problematic nail edge, not draining an infection. *Total nail avulsion* - **Total nail avulsion** is the complete removal of the nail plate, generally reserved for severe infections, trauma, or certain fungal infections where the entire nail is involved, and it is considered a more aggressive procedure than needed for most uncomplicated acute paronychia. - This procedure leaves the nail bed exposed and can be painful with a longer recovery time.

Question 133: Which of the following is a PRIMARY indication for negative pressure wound therapy (NPWT)?

A. After amputation
B. Chronic osteomyelitis wound
C. Bed sore in sacrum after debridement (Correct Answer)
D. After split skin graft

Explanation: ***Bed sore in sacrum after debridement*** - **Negative pressure wound therapy (NPWT)** is a **primary, well-established indication** for pressure ulcers (bedsores) after debridement. - NPWT promotes **granulation tissue formation**, **wound contraction**, and prepares the wound bed for closure. - It effectively reduces **exudate** and bacterial load, making it a **first-line adjunctive therapy** for clean pressure ulcers. - **Strong evidence base** supports its use in this indication, particularly for Stage III-IV pressure ulcers post-debridement. *After amputation* - NPWT can be used in selected post-amputation cases to manage residual limb wounds or surgical site complications. - However, it is **not a primary or routine indication** but rather a **secondary/adjunctive option** for specific complications. - The main post-amputation focus is limb shaping, prosthetic preparation, and infection prevention. *Chronic osteomyelitis wound* - NPWT serves as **adjunctive therapy** for osteomyelitis wounds after surgical debridement to manage exudate. - The **primary treatment** for chronic osteomyelitis is aggressive **surgical debridement** and prolonged **antibiotic therapy**. - NPWT is supportive but **not the primary therapeutic modality** for this condition. *After split skin graft* - NPWT can be used post-grafting as a **graft bolster** to ensure adherence and optimal take. - While effective, this is a **specialized application** rather than a primary indication. - Traditional tie-over dressings remain standard in many settings, with NPWT reserved for complex cases.

Question 134: Not true about gas gangrene:

A. Metronidazole is the drug of choice
B. Cl perfringens produce heat-labile spores (Correct Answer)
C. Most common cause is Cl perfringens
D. Extensive necrosis of muscles

Explanation: ***Cl perfringens produce heat-labile spores*** - *Clostridium perfringens* spores are, in fact, **heat-resistant**, allowing them to survive harsh conditions and subsequently germinate into vegetative cells causing infection. - This heat resistance is a crucial factor in food poisoning outbreaks and wound infections, as spores can survive cooking temperatures. *Metronidazole is the drug of choice* - While metronidazole can be used as an adjunct, **penicillin G** is generally the primary antibiotic of choice for gas gangrene, often in combination with other agents like clindamycin. - **Surgical debridement** and **hyperbaric oxygen therapy** are also critical components of treatment, as antibiotics alone are often insufficient. *Most common cause is Cl perfringens* - **_Clostridium perfringens_** is indeed the most frequent cause of gas gangrene (clostridial myonecrosis), accounting for approximately 80-95% of cases. - This bacterium produces potent **exotoxins** that cause rapid tissue destruction and gas formation, leading to the characteristic symptoms. *Extensive necrosis of muscles* - Gas gangrene is characterized by **rapid and extensive necrosis of muscle tissue**, which is caused by the potent toxins produced by clostridial species, particularly alpha-toxin. - This muscle destruction leads to systemic toxicity, pain, and the production of gas within the tissues.

Question 135: Which of the following is true regarding prophylactic antibiotic use in surgical practice?

A. is given orally
B. continued for a minimum of 7 days
C. first dose is given before induction of anesthesia (Correct Answer)
D. depends on individual preference

Explanation: ***First dose is given before induction of anesthesia*** - **Prophylactic antibiotics** are most effective when present in adequate concentrations in tissue **before the surgical incision** is made - Administering the first dose **within 60 minutes before incision** (typically before induction of anesthesia) ensures optimal tissue levels at the time of potential bacterial contamination - This timing is a **key principle** of effective surgical antibiotic prophylaxis *Is given orally* - Surgical prophylaxis requires **intravenous administration** for rapid and reliable tissue levels - IV route ensures predictable bioavailability and adequate drug concentration at the surgical site - Oral route may be used in specific outpatient scenarios but is **not standard** for surgical prophylaxis *Continued for a minimum of 7 days* - Prophylactic antibiotics are given for **short duration**: typically a **single dose** or continued for less than 24 hours post-operatively - Extended courses (≥7 days) are reserved for **treating established infections**, not prophylaxis - Prolonged use increases risk of **antibiotic resistance**, adverse effects, and *Clostridioides difficile* infection *Depends on individual preference* - Prophylactic antibiotic use follows **evidence-based guidelines** and institutional protocols, not individual preference - Guidelines consider surgery type, patient risk factors, local **antibiogram data**, and established efficacy - Standardized protocols improve outcomes and reduce surgical site infections

Question 136: Late deaths in burns are due to -

A. Neurogenic
B. Hypovolemia
C. Sepsis (Correct Answer)
D. Contractures

Explanation: ***Sepsis*** - **Sepsis** is the leading cause of **late deaths** in burn patients, often due to infection of the burn wound or other sites. - The extensive tissue damage and compromised skin barrier in burn injuries predispose patients to severe infections and a subsequent **systemic inflammatory response**. *Neurogenic* - While psychological and neurological issues can arise in burn patients, **neurogenic causes** are not a primary direct cause of late mortality. - Acute neurogenic shock can occur early, but long-term neurogenic complications rarely lead directly to death. *Hypovolemia* - **Hypovolemia** is a major concern in the **immediate post-burn period** due to plasma leakage from damaged capillaries. - With proper fluid resuscitation, hypovolemia is usually managed within the first 24-48 hours and is not a significant cause of **late death**. *Contractures* - **Contractures** are a common long-term complication of burns, leading to functional impairment and disfigurement. - While they significantly impact quality of life, **contractures themselves are not a direct cause of mortality**.

Question 137: Which of the following is false about hydatid cyst:

A. Most commonly involves lung (Correct Answer)
B. 20% saline is scolicidal
C. PAIR is employed for hepatic hydatid cysts
D. Ideally should be managed by pre-operative albendazole followed by surgery

Explanation: ***Most commonly involves lung*** - This statement is **false** because the **liver** is the most commonly involved organ in hydatid cyst disease (Echinococcosis), accounting for 60-70% of cases. - The lungs are the second most common site, seen in about 20-25% of cases. *20% saline is scolicidal* - This statement is **true** as hypertonic saline (typically 20-30%) is an effective **scolicidal agent** used during surgery or PAIR procedures. - It helps to kill the protoscolices within the cyst, reducing the risk of recurrence and anaphylaxis if spillage occurs. *PAIR is employed for hepatic hydatid cysts* - **PAIR (Puncture, Aspiration, Injection, Re-aspiration)** is a well-established and effective minimally invasive procedure for treating **hepatic hydatid cysts**. - It involves aspirating cyst fluid, injecting a scolicidal agent (like hypertonic saline or ethanol), and then re-aspirating the contents. *Ideally should be managed by pre-operative albendazole followed by surgery* - **Albendazole** is often given **pre-operatively** for several weeks (typically 4-6 weeks) to decrease cyst viability and reduce the risk of secondary hydatidosis if spillage occurs during surgery. - This combined approach of medical therapy followed by surgical excision is considered a standard for managing many hydatid cysts, particularly large or complicated ones.

Question 138: Which of the following is a risk factor for postoperative infection after hysterectomy?

A. Use of prophylactic antibiotics
B. Surgery for malignancy (Correct Answer)
C. Age > 50 yrs
D. Urinary catheterization > 7 days

Explanation: ***Surgery for malignancy*** - **Surgery for malignancy** is a significant risk factor for postoperative infection after hysterectomy due to multiple factors: - **Longer operative duration** and more extensive dissection increase tissue trauma and infection risk - **Radical hysterectomy** for cancer involves wider resection margins and lymph node dissection, creating larger surgical fields - Cancer patients often have **underlying immunocompromise** from the malignancy itself - **Greater blood loss** may necessitate transfusions, which can impact immune function - **Compromised tissue perfusion** in the surgical field due to tumor involvement - Studies consistently show **higher surgical site infection rates** in cancer surgeries compared to benign indications *Urinary catheterization > 7 days* - While prolonged catheterization does increase UTI risk, standard practice involves **catheter removal within 24-48 hours** after uncomplicated hysterectomy - Catheterization beyond 7 days is **uncommon** in routine hysterectomy and would typically indicate complications already present - Though a risk factor when it occurs, it's not the primary established risk factor in standard hysterectomy practice *Use of prophylactic antibiotics* - **Prophylactic antibiotics** are a protective measure that **reduces infection risk** by 50-75% - Standard perioperative protocol specifically designed to prevent surgical site infections - Their use is recommended by all major surgical guidelines (ACOG, WHO, CDC) *Age > 50 yrs* - Age alone is **not an independent risk factor** for postoperative infection - While older patients may have more comorbidities, **age per se** does not significantly increase infection risk - The presence of specific comorbidities (diabetes, immunosuppression) rather than chronological age determines risk

Question 139: Which of the following is true about tenosynovitis of the finger?

A. Treatment is conservative.
B. Fingers held in mild extension / Extension deformity at the involved fingers.
C. With involvement of little finger the infection can spread to the ring finger.
D. Tenosynovitis of little finger will spread to thumb rather than ring finger. (Correct Answer)

Explanation: ***Tenosynovitis of little finger will spread to thumb rather than ring finger.*** - The **little finger's flexor tendon sheath** connects directly to the **ulnar bursa**, which communicates with the **radial bursa** (thumb's sheath) in approximately **80% of individuals** through the space of Parona. - This **bursal communication** creates a direct pathway for infection spread from the little finger to the thumb, making it the most common route of propagation in flexor tenosynovitis. *With involvement of little finger the infection can spread to the ring finger.* - While anatomically possible through **fascial plane connections**, direct spread to the ring finger is **less common** than spread to the thumb via established bursal pathways. - The **ulnar bursa-radial bursa connection** provides a more direct and frequently utilized route for infection propagation than lateral spread to adjacent digits. *Treatment is conservative.* - **Purulent flexor tenosynovitis** requires urgent **surgical incision and drainage** to prevent irreversible tendon damage and loss of function. - Conservative treatment with antibiotics alone is inadequate for established infections and may lead to **tendon necrosis** and permanent disability. *Fingers held in mild extension / Extension deformity at the involved fingers.* - Patients with tenosynovitis characteristically hold the affected finger in **mild flexion** as part of **Kanavel's four cardinal signs**. - **Extension** of the finger causes severe pain due to stretching of the inflamed tendon sheath, so patients avoid this position naturally.

Question 140: Primary closure of incised wounds must be done within

A. 12 hrs
B. 2 hrs
C. 6 hrs (Correct Answer)
D. 4 hrs

Explanation: ***6 hrs*** - **Primary closure** of incised wounds is generally recommended within **6 hours** of injury to minimize the risk of infection. - This timeframe allows for wound cleaning and closure before significant bacterial colonization occurs. *12 hrs* - Closing wounds at **12 hours** or later significantly increases the risk of **wound infection** due to bacterial proliferation. - Delayed closure beyond this period is often managed with **delayed primary closure** or secondary intention healing. *2 hrs* - While closure within **2 hours** is ideal, a slightly longer window of up to 6 hours is still considered safe for primary closure. - The 2-hour mark is not a strict upper limit for all wounds. *4 hrs* - **4 hours** is within the acceptable window for primary closure, but the more commonly cited and safe upper limit for most clean wounds is 6 hours. - There is no significant clinical benefit of closing strictly within 4 hours compared to 6 hours for most healthy individuals and clean wounds.

Practice by Chapter

Surgical Site Infections

Practice Questions

Intra-abdominal Infections

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Soft Tissue Infections

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Necrotizing Soft Tissue Infections

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Surgical Sepsis

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Tetanus Prophylaxis

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Antimicrobial Prophylaxis

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Antimicrobial Therapy in Surgical Infections

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Surgical Drainage Procedures

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Infection Control in Operating Room

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Biofilms and Implant-Related Infections

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Prevention Strategies

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