SHOCK, SURGICAL INFECTIONS & TRAUMA

Choose the best answer:

1) More commonly, wound infections following surgery become evident on:

A. Between third and fifth day B. Between eight and eleventh day C. Between first and third day D. Between fourth and seventh day E. Between twelfth and sixteenth day

2) The following is an example of Class III surgical wound:

A. Urinary bladder surgery B. Herniorrhaphy C. Gastrectomy D. Resection of obstructed bowel E. Surgical drainage of pelvic abscess

3) A 70 yr old victim of an auto-pedestrian accident develops manifestation of severe sepsis 14 days after a Splenectomy. The organism most likely to be involved is:

A. Staph. aureus B. Strep. Pyogenes C. Hemophilus influenza D. E. coli E. Klebsiella sp.

4) The most reliable protection for the surgeon against Hepatitis B infection is by:

A. adherence to universal precautions B. administration of gamma globulins C. active immunization D. double gloving E. administration of interferons

5) Pro-inflammatory mediators in shock, EXCEPT:

A. IL-4 B. IL-2 C. TNF D. IL-6 E. IL-8

6) Hypotension occurs in healthy patients if blood volume is decreased by:

A. 15-30% B. More than 40% C. Up to 15 % D. 30 – 40% E. Any of the above

7) This type of shock is characterized by hypotension, decreased peripheral vascular resistance and bradycardia:

A. Traumatic shock B. High output septic shock C. Low output septic shock D. Hypovolemic shock E. Neurogenic shock

8) In a patient with swelling and paresthesia of the leg following trauma, the diagnosis of compartment syndrome is made and is best manage surgically if the compartmental pressure is:

A. more than 15mmHg B. more than 25mmHg C. more than 35mmHg D. more than 45 mmHg E. more than 55mmHg

9) A 27 yr old male was rushed to the Emergency Department unconscious with BP of 80/60mmHg, PR of 115/ min, RR of 40cpm after sustaining blunt trauma to the lower thorax. The trachea was deviated to the right with abrasions over the left lower chest at the area of 6th, 7th and 8th ribs. There was tympanism, with absent breath sounds over the left lung field. The most likely diagnosis is:

A. Hemothorax B. Tension Pneumothorax C. Flail Chest D. Open Pneumothorax E. Cardiac tamponade

10) Findings on Chest X-Ray suggestive of an aortic tear include the following, EXCEPT:

A. Tracheal shift B. Widened mediastinum C. Nasogastric tube shift D. Abnormal aortic contour E. None of the above

11) A 45 yr old male driver involved in a motor vehicular accident is brought to the Emergency Department in respiratory distress. He has no signs of chest/ thoracic cage injuries but he does have a Le Fort III fracture and mandibular fractures as well. In this patient, the best method o immediately securing his airway is:

A. Placement of oro-pharyngeal airway B. Hyperextending the neck C. Do a tracheostomy in the Emergency Department D. Performing a cricothyroidotomy E. Per oral endotracheal intubation

12) A 26 yr old male has a GSW to the right lower quadrant of the abdomen. On arrival minutes later, his vital signs are BP= 120/80mmHg, CR= 110bpm, and RR of 18cpm. He is alert and oriented. After placement of a large-bore IV access catheters, examination reveals an entrance wound in the right lower quadrant of the abdomen with no exit wound seen. Abdominal X-Ray shows the bullet slug overlying the right iliac fossa. Appropriate laboratory studies are drawn, he is given prophylactic antibiotics, and is taken to the operating room. Exploration reveals a through- and-through injury to the proximal portion of the ascending colon. The edges are clean and there is minimal fecal contamination of the abdomen. There are no other injuries noted. Management of this injury should be:

A. Resection of the colonic segment and colo-colonic anastomosis B. Primary repair with exteriorization of the repair C. Do a right hemicolectomy D. Primary repair leaving the repair intra-abdominally E. Resection of the colonic segment and double-barrel colostomy

13) On the fifth postoperative day, the patient (in #12) developed abbominal pain localized at the hypogastric area, diarrhea and low grade fever. Vital signs were: BP= 110/70mmHg, PR= 110bpm, RR= 26cpm and Temp of 38.2C. Pertinent PE revealed a slightly distended abdomen with direct and rebound tenderness at the hypogastric area. Laboratory and other diagnostics requested, pertinent results showed a WBC of 18, 000 and abdominal CT Scan finding of pelvic abscess. Best management approach at this time:

A. Surgical re-exploration with evacuation of abscess plus antibiotic(s) B. Antibiotic(s) only C. Transrectal drainage of abscess plus antibiotic(s) D. Percutaneous drainage of abscess plus antibiotic(s) E. None of the above

14) Appropriate antibiotic to be used in # 13:

A. Third- generation cephalosporins B. Fourth-generation cephalosporins C. Aminoglycosides D. Carbapenems E. Macrolides 15) Antibibiotic class that acts by alteration of cell membrane, bindinding and inhibition of 30S ribosomal unit:

A. Penicillin B. Cephalosporins C. Carbapenems D. Aminoglycosides E. Macrolides

Multiple Correct Response. Write: A – if option 1, 2 & 3 are correct B - if optios 1 & 3 are correct C - if options 2 & 4 are correct D - if options 4 is correct E - if all 4 options are correct

16) Components of the metabolic response in a 32yr old patient with polytrauma of severe magnitude include:

1. decrease in insulin secretion 2. decrease in glucocorticoids levels 3. increase in gluconeogenesis 4. increase in insulin secretion

17) A 65 yr old woman who is known diabetic develops a acute episode of right upper quadrant pain, fever and toxic manifestations. A plain abdominal X-ray study demonstrates air in the lumen and wall of the gallbladder. The organism most commonly identified in the causation of this problem include:

1. E. coli 2. Staph. aureus 3. Clostridium perfringens 4. Streptococcus pyogenes

18) The cornerstone(s) in the successful management of sepsis include:

1. comprehensive supportive care 2. source control 3. appropriate antibiotic therapy 4. massive doses of steroids

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