Surgical Infections Practice Questions

Q: The intense pain associated with a felon occurs due to compression of which nerve in the finger?

Digital nerve compression. ***Digital nerve compression*** - A felon is a **closed-space infection** of the **distal pulp space** of the fingertip - The pulp is divided into compartments by **vertical fibrous septa** extending from periosteum to skin - As infection and pus accumulate in this tight, non-distensible compartment, **pressure increases dramatically** - The **digital nerves** (proper digital nerves) running through the pulp space are compressed by this increased pressure, causing **intense throbbing pain** - This is the direct anatomical cause of the characteristic severe pain of a felon *Median nerve involvement* - The median nerve does **not directly enter the finger** - It gives off **digital branches** (common and proper digital nerves) that supply specific fingers - A felon can occur in **any finger**, including those supplied by ulnar nerve branches (little finger, ulnar half of ring finger) - Therefore, attributing the pain specifically to "median nerve" is anatomically inaccurate *Nail bed involvement* - This describes **paronychia**, an infection of the **nail fold**, not the pulp space - Paronychia is a different clinical entity with different anatomy and treatment - While painful, it does not involve the closed compartment pressure dynamics of a felon *A closed space infection in the distal pulp* - This correctly describes the **pathophysiology** of a felon - However, this is the **underlying cause** rather than the direct mechanism of pain - The pain specifically results from **nerve compression secondary** to this closed-space infection - The question asks what causes the pain, and the answer is the nerve compression itself

Q: What is the first-line treatment for gas gangrene?

Debridement & antibiotics. ***Debridement & antibiotics*** - **Aggressive surgical debridement** to remove necrotic tissue and reduce bacterial load is the most critical initial step. - **Broad-spectrum antibiotics**, particularly penicillin G, are essential to target the causative *Clostridium perfringens* and prevent systemic spread. *Hyperbaric oxygen* - While **hyperbaric oxygen therapy** can be a useful adjunct by inhibiting bacterial growth and toxin production in anaerobic environments, it is not the *first-line* or sole treatment. - It should be used in conjunction with debridement and antibiotics, not as a standalone initial therapy. *Polyvalent gas gangrene antitoxin* - **Antitoxins** are generally not recommended due to their limited efficacy and potential for severe allergic reactions. - The primary treatment focuses on removing the source of infection and killing the bacteria, not neutralizing toxins alone. *Amputation* - **Amputation** is a drastic measure typically reserved for cases where the limb is irreversibly damaged, infection is uncontrollable by other means, or there is a threat to life. - It is not the initial treatment but may be necessary in advanced or complicated cases.

Question 1

The intense pain associated with a felon occurs due to compression of which nerve in the finger?

Accepted Answer

Digital nerve compression

Answer

Nail bed involvement

Answer

Median nerve involvement

Answer

A closed space infection in the distal pulp

Question 2

In a patient with suspected sepsis, which of the following is the MOST appropriate initial intervention?

Accepted Answer

Obtain blood cultures and start broad-spectrum antibiotics immediately

Answer

Start vasopressor support as first-line treatment

Answer

Begin aggressive fluid restriction to prevent organ dysfunction

Answer

Wait for culture results before starting any treatment

Question 3

What is the first-line treatment for gas gangrene?

Accepted Answer

Debridement & antibiotics

Answer

Hyperbaric oxygen

Answer

Polyvalent gas gangrene antitoxin

Answer

Amputation

Surgical Infections — MCQs

Surgical Infections — MCQs

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