MRSA infection

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Q) A 50-year-old male  with past history of MRSA presents to the emergency department 7 days after sigmoid colectomy with complaints of purulent drainage from his surgical incision 

Temp is 102 F

Vitals stable

Purulent drainage is easily expressed from the most inferior aspect of the incision.

Which of the following is the most appropriate management of this patient?

a) Open the incision, obtain a fluid culture, and start on an empiric course of IV Vancomycin and Piperacillin-Tazobactam

b) Open the incision, obtain a fluid culture and start on an empiric course of IV Vancomycin alone

c) Open the incision, obtain a fluid culture, and hold off on starting antimicrobial therapy until culture data returns

d) Discharge home on a 7-day course of oral Cephalexin

Gen Surgery Questions on Infection

Blunt colon injury

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Q) A 45-year-old male presents 24 hours after sustaining a blunt colonic injury. At laparotomy, there is a localized colonic injury with minimal fecal contamination and no other intra-abdominal injuries. The patient is hemodynamically stable and has received 3 units of packed red blood cells. What is the ideal surgical management?

Source: INI GI Surgery | Sabiston, p. 422

a) Resection and primary anastomosis
b) Resection with anastomosis and loop ileostomy
c) Resection with Hartmann’s procedure
d) Diverting ileostomy alone
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Distributive Shock

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Q) What is not seen in Distributive Shock?

a) High central venous pressure

b) High Cardiac output

c) High Base deficit

d) High Mixed Venous Saturation

MCQs on Shock and Body Response 

Ans a 

In Distributive shock Systemic vascular resistance and venous pressure are low ( because of vasodilation)

All other parameters are high

Distributive Shock Symptoms

Vasodilation

Warm peripheries

Hypotension

Causes of Distributive Shock are

  1. Anaphylaxis
  2. High spinal cord injury
  3. Septic shock
  4. Toxic Shock Syndrome
  5. The distributive shock from adrenal insufficiency occurs due to decreased alpha-1 receptor expression on arterioles secondary to cortisol deficiency, which results in vasodilation. This is seen in patients on chronic steroids that are stopped suddenly.

 

Thyroid storm

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Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks.

She presented in emergency with high grade fever and hypotension (Thyroid Storm).

What is not a part of further management?
a) Oxygen
b) Beta blockers
c) Radio active Iodine
d) Lugol's iodine

Staging in Adenocarcinoma lung

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Q) Patient with 2cm lung nodule, biopsy proven adenocarcinoma. CT shows hilar lymph node 1.5cm and left pleural effusion. Pleural fluid cytology is positive for malignant cells. What is the stage?

A. T1N1M0
B. T1N2M1
C. T4N1M0
D. T1N1M1
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