Surgical Infections — MCQs

Surgical Infections Indian Medical PG Practice Questions and MCQs

Question 151: Index finger infection spreads to?

A. Hypothenar space
B. Flexion space
C. Thenar space
D. Mid palmar space (Correct Answer)

Explanation: ***Mid palmar space*** - Infections of the **index, middle, and ring fingers** predominantly spread to the **midpalmar space** due to the anatomical connections of their **flexor tendon sheaths**. - The flexor sheath of these fingers usually terminates just distal to the **carpal tunnel**, making the midpalmar space the most common site for proximal spread of infection. *Thenar space* - Infections of the **thumb** typically spread to the **thenar space** because its flexor tendon sheath extends directly into this space. - The thenar space is located between the **adductor pollicis muscle** and the **flexor tendons** of the other fingers. *Hypothenar space* - The **hypothenar space** is located on the ulnar side of the hand, overlying the hypothenar muscles. - While it is an anatomically defined space, it is not the primary site for spread of **index finger infections**, which follow the midpalmar route. *Flexion space* - "Flexion space" is not a recognized anatomical term for a fascial space in the hand where infections commonly spread. - Infections in the hand typically follow the **flexor tendon sheaths** and then extend into specific deep palmar spaces.

Question 152: A diabetic patient presents with sudden-onset perineal pain. On examination, foul-smelling discharge and necrotic tissue are noted. Which of the following is the most characteristic feature of this condition?

A. Mixed aerobic and anaerobic infection (Correct Answer)
B. Urinary diversion may be considered in severe cases
C. Bilateral orchidectomy is not routinely required
D. Anti-gas gangrene serum is indicated only in specific cases

Explanation: **Mixed aerobic and anaerobic infection** - Fournier's gangrene is a polymicrobial infection typically involving a **synergistic mixture of aerobic and anaerobic bacteria**. - This mixed infection contributes to the rapid progression and tissue destruction seen in this condition, leading to the **foul-smelling discharge** due to anaerobic metabolism. *Anti-gas gangrene serum is indicated only in specific cases.* - Anti-gas gangrene serum is specifically for **Clostridium perfringens** infections, which can cause gas gangrene but is usually a distinct clinical entity from Fournier's. - While Clostridium species can be present in Fournier's gangrene, it is not the sole causative agent, and **broader antimicrobial therapy** is the mainstay of treatment, not antitoxin serum. *Urinary diversion may be considered in severe cases.* - Urinary diversion, such as a **suprapubic catheter**, may be necessary when the urethra or perineum is extensively involved or to prevent ongoing contamination of the surgical site. - However, it's not a primary treatment for the infection itself but rather an **adjunctive measure** to manage complicated cases of Fournier's gangrene. *Bilateral orchidectomy is not routinely required.* - **Testicular involvement** in Fournier's gangrene is rare due to the separate blood supply of the testes. - **Orchidectomy** is only performed if the testes themselves are affected by necrosis, which is uncommon and occurs in critically severe cases; routine removal is not indicated.

Question 153: Identify the most common site of an intraperitoneal abscess.

A. Suprahepatic
B. Left subphrenic space
C. Pelvis (Pouch of Douglas) (Correct Answer)
D. Subhepatic

Explanation: ***Pelvis (Pouch of Douglas)*** - The **Pouch of Douglas** (rectouterine or rectovesical pouch) is the **most common site** for intraperitoneal abscesses. - It is the **most dependent (lowest) part** of the peritoneal cavity in both upright and supine positions, allowing gravity to facilitate collection of infected fluid. - Commonly results from **perforated appendicitis**, **diverticulitis**, **gynecological infections** (PID, tubo-ovarian abscess), or any source of peritoneal contamination where infected material flows downward. - **Clinical significance**: Pelvic abscesses can be drained via transrectal or transvaginal approaches, making them accessible for percutaneous drainage. *Subhepatic* - The **subhepatic space** (Morison's pouch on the right) is a **common but not the most common** site for intraperitoneal abscesses. - More specifically associated with **cholecystitis**, **perforated duodenal ulcers**, or hepatobiliary surgery complications. - While dependent in the supine position, it is less dependent than the pelvis in the upright position. *Suprahepatic* - Abscesses in the **suprahepatic space** are relatively uncommon. - May occur from direct extension of liver abscesses or as complications of upper abdominal surgery. - The presence of peritoneal attachments limits widespread fluid collection in this area. *Left subphrenic space* - The **left subphrenic space** is less commonly involved than the pelvis or right subphrenic spaces. - Typically arises from complications of **splenic injury**, **pancreatitis**, **gastric perforations**, or post-splenectomy infections.

Question 154: Vacuum assisted closure is contraindicated in which of the following conditions -

A. Chronic osteomyelitis
B. Large amount of necrotic tissue with eschar (Correct Answer)
C. Abdominal wound
D. Surgical wound dehiscence

Explanation: ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.

Question 155: What is the optimal timing for administering antibiotic prophylaxis before surgery?

A. Immediately before induction of anesthesia
B. 30-60 minutes before incision (Correct Answer)
C. 2-3 hours before surgery
D. Immediately after surgery

Explanation: ***30-60 minutes before incision*** - This is the **optimal timing** recommended by WHO, CDC, and major surgical guidelines for most commonly used prophylactic antibiotics (cefazolin, cefuroxime). - Ensures **peak tissue and serum concentrations** are achieved at the time of incision, providing maximum protection against surgical site infections. - Based on **pharmacokinetic principles**: the antibiotic must be present at bactericidal concentrations in tissues when bacterial contamination occurs. - Studies show this timing significantly reduces surgical site infection rates compared to other timings. *Immediately before induction of anesthesia* - While acceptable in some protocols, this may be too early if there is a delay between induction and incision. - Could result in **declining antibiotic levels** by the time the incision is made, especially for antibiotics with shorter half-lives. *2-3 hours before surgery* - This is **too early** for most antibiotics. - Tissue levels may have already **declined below therapeutic concentrations** by the time of incision. - Does not provide adequate protection during the critical period of bacterial contamination. *Immediately after surgery* - This is **treatment, not prophylaxis**. - Offers **no preventive benefit** against intraoperative contamination. - By this time, bacteria introduced during surgery have already adhered to tissues and begun forming biofilms.

Question 156: What is the best management for a human bite?

A. Ampicillin plus sulbactam (Correct Answer)
B. Clindamycin plus TMP-SMX
C. Fluoroquinolone
D. Doxycycline

Explanation: ***Ampicillin plus sulbactam*** - This combination is effective against the common **aerobic and anaerobic bacteria** found in human bite wounds, including **Eikenella corrodens** and oral streptococci. - The sulbactam component provides **beta-lactamase inhibition**, which is crucial as many oral bacteria produce these enzymes, rendering ampicillin alone ineffective. *Clindamycin plus TMP-SMX* - While clindamycin covers many anaerobes, it has **poor activity against Eikenella corrodens**, a key pathogen in human bites. - **TMP-SMX (trimethoprim-sulfamethoxazole)** also lacks reliable coverage against many oral anaerobes and Eikenella. *Fluoroquinolone* - **Fluoroquinolones** generally have good Gram-negative coverage but often possess **limited activity against oral anaerobes and streptococci** relevant to human bites. - There is a **growing concern for resistance** with fluoroquinolone monotherapy in these types of infections. *Doxycycline* - Doxycycline has a broad spectrum but is **not the first-line choice for human bites** due to inconsistent activity against common oral anaerobes and Eikenella corrodens. - It may be considered in specific cases, but **empiric coverage needs to be broader** for initial management of these **polymicrobial infections**.

Question 157: Most common organism involved in surgical site infections -

A. E. coli
B. Legionella
C. Streptococcus pneumoniae
D. Staphylococcus aureus (Correct Answer)

Explanation: ***Staphylococcus aureus*** - **Staphylococcus aureus** is a common commensal on human skin and mucous membranes, making it readily available to contaminate surgical wounds. - It produces various **virulence factors** that aid in adhesion, invasion, and evasion of host defenses, contributing to its high infectivity in surgical sites. - It is the **most common cause** of surgical site infections across all surgical specialties, accounting for 20-30% of all SSIs. *E. coli* - **Escherichia coli** is primarily associated with **gastrointestinal and urinary tract infections**, and is the second most common cause of SSIs (especially after GI/GU surgeries). - While it can cause infections, it's not the most frequent causative agent across all types of surgical procedures. *Legionella* - **Legionella species** are known to cause **Legionnaires' disease**, a severe form of pneumonia, and are typically acquired from contaminated water sources. - It is an **extremely rare cause** of surgical site infections and is not considered a primary pathogen in this context. *Streptococcus pneumoniae* - **Streptococcus pneumoniae** is a leading cause of **pneumonia, meningitis, and otitis media**. - While it can cause opportunistic infections, it is not a common cause of surgical site infections.

Question 158: What is considered a poor prognostic indicator in Pott's paraplegia?

A. Healed disease
B. Chronic disease
C. Rapid progression of neurological deficits (Correct Answer)
D. Active disease

Explanation: ***Rapid progression of neurological deficits*** - **Rapid progression** implies severe spinal cord damage occurring quickly, which is less likely to fully recover even with treatment. - This indicates a more aggressive disease process or significant compression that can lead to irreversible neurological impairment. *Healed disease* - **Healed disease** (even if paraplegia existed previously) indicates that the infection is resolved and the destructive process has stopped, allowing for potential neurological recovery or stability. - While residual neurological deficits might remain, the absence of active inflammation improves the long-term prognosis compared to ongoing damage. *Chronic disease* - **Chronic disease** in the context of Pott's paraplegia often refers to established deficits after a prolonged course, but it doesn't necessarily imply ongoing active deterioration. - The chronicity itself, without rapid progression, suggests a more stable state where the damage has already occurred, and further deterioration might be slow or absent. *Active disease* - **Active disease** means the infection is still present and causing bone destruction, which is a concern. - However, if the neurological deficits are not rapidly progressing, there is still a window for treatment to stop the disease and potentially allow for some recovery, distinguishing it from an acute, rapidly deteriorating situation.

Question 159: Which of the following is an example of a clean surgery?

A. Hernia surgery (Correct Answer)
B. Cholecystectomy
C. Rectal surgery
D. Gastric surgery

Explanation: ***Hernia surgery*** - **Clean surgeries** involve no entry into hollow viscera (e.g., gastrointestinal, genitourinary, or respiratory tract) and are characterized by **no inflammation** or infection. Hernia repair typically fits this description. - The risk of **surgical site infection** (SSI) is usually less than 2% in clean cases, making it a benchmark for surgical infection control. *Gastric surgery* - This involves entry into the **gastrointestinal tract**, which is considered a **contaminated** or **clean-contaminated** procedure due to the presence of bacteria. - The risk of infection is higher than in clean surgeries, often requiring prophylactic antibiotics. *Cholecystectomy* - This procedure involves the **gallbladder**, which is part of the biliary system, often considered a **clean-contaminated** wound if bile spills or if there's no evidence of active infection. - If performed for **acute cholecystitis** (inflammation/infection), it would be classified as **contaminated** or **dirty**. *Rectal surgery* - This involves the **rectum**, which is part of the lower **gastrointestinal tract** and contains a high bacterial load. - Procedures involving the rectum are classified as **contaminated** or **dirty** due to the high risk of bacterial contamination.

Question 160: Most common organism causing infection after an open fracture?

A. Klebsiella
B. Pseudomonas
C. Gonococcus
D. Staphylococcus aureus (Correct Answer)

Explanation: ***Staphylococcus aureus*** - *Staphylococcus aureus* is the **most common organism** causing infection in **open fractures**, accounting for 30-40% of cases. - It is present on **skin flora** and readily contaminates traumatic wounds, making it the predominant pathogen in the immediate post-injury period. - **Antibiotic prophylaxis** for open fractures (cephalosporins) primarily targets *S. aureus*, reflecting its clinical importance. - It causes both **early and late infections** in open fractures and is the leading cause of **post-traumatic osteomyelitis**. *Pseudomonas* - *Pseudomonas aeruginosa* can cause infections in open fractures but is **not the most common** organism. - More frequently seen in **Type III open fractures** with extensive soft tissue damage, **nosocomial infections**, or **delayed infections** after hospitalization. - Associated with **contaminated water exposure** and **chronic wounds** rather than being the primary pathogen in acute open fractures. *Klebsiella* - *Klebsiella* species are typically associated with **nosocomial infections**, particularly **urinary tract infections** and **pneumonia**. - Rarely the primary pathogen in acute open fracture infections. - May be seen in **hospital-acquired** infections in patients with prolonged hospitalization. *Gonococcus* - **Gonococcus** (*Neisseria gonorrhoeae*) is primarily associated with **sexually transmitted infections** and can cause **septic arthritis** through hematogenous spread. - It does **not** cause infections in open fractures as it is not found in the environment or on skin. - The mode of transmission is completely unrelated to trauma or wound contamination.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free