Surgical Infections Practice Questions

Q: What is the most effective treatment for gas gangrene?

Antibiotics with surgical debridement. **Explanation:** Gas gangrene (Clostridial Myonecrosis) is a life-threatening infection caused primarily by *Clostridium perfringens*. The pathophysiology involves a rapidly spreading necrotizing infection of the muscle, where exotoxins (Alpha-toxin) cause tissue destruction and systemic toxicity. **Why Option D is Correct:** The cornerstone of management is **emergency surgical debridement** and **high-dose antibiotics**. Surgery is the most critical step; it involves wide excision of all necrotic tissue and "fasciotomy" to relieve pressure and remove the anaerobic environment. Antibiotics (typically Penicillin G combined with Clindamycin to inhibit toxin production) are essential to control the systemic spread. **Why Other Options are Incorrect:** * **A. Hyperbaric Oxygen (HBO):** While HBO can inhibit clostridial growth and toxin production, it is an **adjunct** therapy. It should never delay definitive surgical intervention. * **B. Polyvalent Antitoxin:** This is largely of historical interest. It has no proven clinical benefit in improving survival and is not recommended in modern protocols. * **C. Amputation:** While amputation may be necessary if a limb is non-viable or life-threateningly infected, it is not the "standard" treatment for all cases. The goal is limb-sparing debridement whenever possible. **High-Yield Clinical Pearls for NEET-PG:** * **Incubation Period:** Very short (usually <24 hours). * **Clinical Sign:** "Dishwater" discharge, crepitus (gas in tissues), and pain out of proportion to clinical findings. * **X-ray:** Shows "feathering" or gas patterns along muscle planes. * **Drug of Choice:** Penicillin G + Clindamycin (Clindamycin is superior for suppressing toxin synthesis).

Q: Which of the following is false regarding cellulitis?

Abscesses, if present, should be managed conservatively.. **Explanation:** **1. Why Option A is the correct (False) statement:** The fundamental surgical principle for any collection of pus is **"Ubi pus, ibi evacua"** (Where there is pus, evacuate it). While uncomplicated cellulitis is managed medically with antibiotics and limb elevation, the presence of an **abscess** is a definitive indication for **Incision and Drainage (I&D)**. Managing an abscess conservatively (with antibiotics alone) often leads to treatment failure, as antibiotics cannot effectively penetrate the walled-off necrotic core of an abscess. **2. Analysis of other options:** * **Option B:** Cellulitis is a spreading infection that can lead to bacteremia. This triggers a systemic immune response, manifesting as **SIRS** (tachycardia, tachypnea, fever, and leukocytosis). * **Option C:** By definition, cellulitis is a non-necrotizing inflammation of the **skin and subcutaneous tissues**. It primarily involves the deep dermis and underlying fat. * **Option D:** **Streptococcus pyogenes** (Group A Strep) and *Staphylococcus aureus* are the most common causative organisms. S. pyogenes is particularly known for its production of hyaluronidase, which facilitates the rapid, "spreading" nature of cellulitis. **Clinical Pearls for NEET-PG:** * **Erysipelas vs. Cellulitis:** Erysipelas is more superficial (upper dermis/lymphatics) and has **sharply demarcated borders**, whereas cellulitis has ill-defined borders. * **Eron Classification:** Used to assess the severity of skin and soft tissue infections (SSTIs) to decide between oral vs. IV antibiotics. * **Red Flag:** If pain is out of proportion to clinical findings or there is "woody" induration, suspect **Necrotizing Fasciitis**—a surgical emergency. * **Management:** Elevation of the affected limb is crucial to reduce edema and improve antibiotic delivery.

Question 1

What is true about gas gangrene?

Accepted Answer

The most common organism implicated is Clostridium perfringens.

Answer

Underlying skin and muscle are normal.

Answer

It is caused by tetanospasmin toxin.

Answer

Muscle rigidity and spasm are characteristic.

Question 2

What are the most common agents responsible for human bite infections?

Accepted Answer

Anaerobic streptococci

Answer

Gram-negative bacilli

Answer

Gram-positive bacilli

Answer

Spirochetes

Question 3

What is the most effective treatment for gas gangrene?

Accepted Answer

Antibiotics with surgical debridement

Answer

Hyperbaric oxygen

Answer

Polyvalent gas gangrene antitoxin

Answer

Amputation of the involved limb

Question 4

Surgical wound of trans-alveolar extraction mostly falls under which of these categories?

Accepted Answer

Clean-contaminated

Answer

Clean

Answer

Dirty-infected

Answer

None of the above

Question 5

What is the recommended treatment for streptococcal necrotizing fasciitis?

Accepted Answer

Metronidazole

Answer

Surgical debridement

Answer

Penicillin

Answer

Clindamycin

Question 6

Which of the following is false regarding cellulitis?

Accepted Answer

Abscesses, if present, should be managed conservatively.

Answer

Cellulitis can cause Systemic Inflammatory Response Syndrome (SIRS).

Answer

Cellulitis is an infection of the subcutaneous tissue.

Answer

Cellulitis can be caused by Streptococcus pyogenes.

Question 7

Which of the following is a method for the prevention of surgical wound infection?

Accepted Answer

Pre-operative antibiotic therapy

Answer

Pre-operative shaving

Answer

Monofilament sutures

Answer

Wound apposition

Question 8

Which of the following statements regarding surgical wounds are TRUE or FALSE?
1. No antibiotics are required in clean surgery.
2. Incision of an abscess is performed in contaminated wounds.
3. Spillage of stomach contents converts a clean/contaminated wound case to a contaminated case.
4. In clean/contaminated wounds, the infection rate is 10%.
5. Hernial repair is considered a contaminated wound.

Accepted Answer

Statements 1, 3, and 4 are true; statements 2 and 5 are false.

Answer

Statements 1, 2, and 3 are true; statements 4 and 5 are false.

Answer

Statements 3, 4, and 5 are true; statements 1 and 2 are false.

Answer

All statements are true.

Question 9

A patient developed a wound infection post laparotomy for pyoperitoneum and was treated conservatively. Granulation tissue is now seen in the wound. What is the next step in management?

Accepted Answer

Resuturing with interrupted stitches

Answer

Daily dressing

Answer

Mesh repair

Answer

Incision and drainage

Question 10

Which of the following statements regarding cellulitis are true?
1. It is commonly caused by Streptococcus pyogenes.
2. It can lead to Systemic Inflammatory Response Syndrome (SIRS).
3. It is a localized infection.
4. Any associated abscess should be drained.
5. Incision and drainage (I&D) should not be performed.

Accepted Answer

Statements 3 and 5 are false, and statements 1, 2, and 4 are true.

Answer

Statements 1, 2, and 3 are true, and statements 4 and 5 are false.

Answer

Statements 1, 3, and 5 are true, and statements 2 and 4 are false.

Answer

Statements 1 and 2 are false, and statements 3, 4, and 5 are true.

Surgical Infections — MCQs

Surgical Infections — MCQs

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