Surgical Infections Practice Questions

Q: All are true about the image shown except:

Ring block with adrenaline used. ***Ring block with adrenaline used*** - **Adrenaline** (epinephrine) is a vasoconstrictor and is **contraindicated** in digital blocks (ring blocks) due to the risk of **ischemia and necrosis** of the digits. - While a ring block is appropriate for anesthesia in finger procedures, adrenaline should **never be included** in the local anesthetic for this application. *Acute paronychia* - The image clearly depicts an **inflamed, swollen, and reddened nail fold** with pus accumulation, which is characteristic of **acute paronychia**. - This condition arises from bacterial infection, typically **Staphylococcus aureus**, entering via a break in the skin around the nail. *Throbbing pain* - **Throbbing pain** is a classic symptom associated with **acute inflammatory processes** with pus formation in confined spaces, such as an abscess or paronychia. - The increased pressure from the accumulating pus within the rigid nail fold causes pulsatile pain due to vascular pulsations. *I and D by incising the eponychium* - **Incision and drainage (I&D)** is the standard treatment for acute paronychia with pus collection, as seen in the image. - The incision is typically made along the **eponychium** (cuticle) or lateral nail fold to release the pus and relieve pressure.

Q: All are true about the image shown except:

Anti-gravity drainage. ***Anti-gravity drainage*** - The image shows aspiration of a cold abscess, which should be drained **with gravity** from a dependent position, not against it. - **Antigravity drainage is NOT a feature** of cold abscess management—proper drainage follows gravity to ensure complete evacuation. - This is the EXCEPT answer as the statement is FALSE. *Cold abscess* - A cold abscess is characterized by lack of classic inflammatory signs such as heat, redness, pain, and swelling. - Typically associated with **tuberculosis**, particularly tuberculous lymphadenitis. - The image depicts aspiration of pus from such an abscess, which is consistent with cold abscess management. *Transillumination test is negative* - Transillumination is used to differentiate fluid-filled cysts (which transilluminate) from solid or pus-filled masses (which do not). - An abscess containing **thick pus is opaque** and will not transilluminate. - A negative transillumination test is expected for a cold abscess. *Rubbery consistency of involved lymph nodes* - **Tuberculous lymphadenitis** classically presents with involved lymph nodes that feel rubbery or firm on palpation. - This is a characteristic clinical feature associated with cold abscess formation in TB lymphadenitis.

Q: All are true about the image shown except:

Ring block with adrenaline used. ***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

Q: All are true about the image shown except:

Transillumination test is negative. ***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.

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

Necrotizing fasciitis. ***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.

Q: "Collar-stud" abscess is seen in :

Tuberculosis. ***Tuberculosis*** - A "**collar-stud**" abscess is a classic presentation of **tuberculous lymphadenitis**, particularly in the neck. - This type of abscess forms when pus from an infected deep lymph node erodes through the deep fascia but is contained by the superficial fascia, creating a dumbbell or "collar-stud" shape. *Lymphomatous degeneration* - **Lymphomatous degeneration** refers to the transformation of a benign lymphoid process into lymphoma. - While lymph nodes are involved, it typically presents as **lymphadenopathy** (enlargement of lymph nodes) and does not characteristically form an abscess with this specific morphology. *Pseudomonas infection* - **Pseudomonas infections** can cause abscesses, especially in immunocompromised individuals or associated with contaminated wounds or medical devices. - However, they do not specifically form a "**collar-stud**" abscess, which is a hallmark of tuberculous infection of lymph nodes. *Streptococcal infection* - **Streptococcal infections** frequently cause cellulitis, erysipelas, and various forms of abscesses, such as peritonsillar or skin abscesses. - While streptococci can cause **suppurative lymphadenitis**, they do not typically produce the distinctive "**collar-stud**" morphology seen in tuberculosis.

Q: 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.

1, 2 and 4. ***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.

Q: The most common intraperitoneal abscess following peritonitis is

Pelvic. ***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.

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

Southampton grading system. ***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.

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

Acute pancreatitis. ***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 1

All are true about the image shown except:

Accepted Answer

Ring block with adrenaline used

Answer

Acute paronychia

Answer

Throbbing pain

Answer

I and D by incising the eponychium

Question 2

All are true about the image shown except:

Accepted Answer

Anti-gravity drainage

Answer

Cold abscess

Answer

Transillumination test is negative

Answer

Rubbery consistency of involved lymph nodes

Question 3

All are true about the image shown except:

Accepted Answer

Ring block with adrenaline used

Answer

Acute paronychia

Answer

Throbbing pain

Answer

I and D by incising the eponychium

Question 4

All are true about the image shown except:

Accepted Answer

Transillumination test is negative

Answer

Anti-gravity drainage

Answer

Cold abscess

Answer

Rubbery consistency of involved lymph nodes

Question 5

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

Accepted Answer

Necrotizing fasciitis

Answer

Trophic ulcer

Answer

Pyogenic granuloma

Answer

Martorell ulcer

Question 6

"Collar-stud" abscess is seen in :

Accepted Answer

Tuberculosis

Answer

Lymphomatous degeneration

Answer

Pseudomonas infection

Answer

Streptococcal infection

Question 7

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.

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 8

The most common intraperitoneal abscess following peritonitis is

Accepted Answer

Pelvic

Answer

Paracolic

Answer

Subphrenic

Answer

Interloop

Question 9

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

Accepted Answer

Southampton grading system

Answer

Apgar score

Answer

Glasgow scoring system

Answer

ASA classification

Question 10

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

Accepted Answer

Acute pancreatitis

Answer

Splenic abscess

Answer

Acute cholecystitis

Answer

Perforation peritonitis

Surgical Infections — MCQs

Surgical Infections — MCQs

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