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|The following are common causes of urinary tract infections: |  |

| |

|A   | | |

|Proteus | | |

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|B   | | |

|Klebsiella | | |

| | | |

|C   | | |

|Enterobacter | | |

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|D   | | |

|Chlamydia | | |

| | | |

|E   | | |

|Candida | | |

| | | |

|Comments: | |

|Eschericha coli accounts for 80% of urinary tract infections. Enterobacter and Klebsiella spp. tend to be hospital acquired | |

|infections. Pseudomonas and Candida spp. are opportunistic infections, which affect immunosuppressed patients. Proteus spp. | |

|are often associated with urinary calculi. Chlamydia rarely causes UTI's but is associated with pelvic inflammatory disease.| |

|The following are examples of DNA viruses: |  |

|A   | | |

|herpes simplex virus | | |

| | | |

|B   | | |

|papilloma virus | | |

| | | |

|C   | | |

|influenza virus | | |

| | | |

|D   | | |

|enteroviruses | | |

| | | |

|E   | | |

|Epstein-Barr virus | | |

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|[pic] | |

|Comments: | |

|The Herpesviridae family of viruses are dsDNA viruses that include herpes simplex, varicella zoster, CMV and EBV. The | |

|papilloma virus, a member of the Papovavius, is a small dsDNA virus. The influenza virus belongs to the Othomyxoviridae | |

|family, and enteroviruses belong to the Picornaviridae family. Both are ssRNA viruses. | |

| |  |

|The germination of tetanus spores in a wound is inhibited by: | |

| |

|A   | | |

|Tissue trauma | | |

| | | |

|B   | | |

|Oxgen | | |

| | | |

|C   | | |

|Injection of anti-toxin | | |

| | | |

|D   | | |

|Injection of toxoid | | |

| | | |

|E   | | |

|Removal of devitalized tissue | | |

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|[pic] | |

|Comments: | |

|Germination occurs in damaged tissue where damage to the blood supply has reduced the supply of oxygen. Careful debridement | |

|of devitalised tissue and removal of foreign bodies is a useful preventative measure. Antitoxin should be promptly | |

|administered in all cases of suspected tetanus. It is ineffective when the toxin is already fixed in the CNS. Because spores| |

|of C. tetani are so widely distributed, the only effective way to control tetanus is by prophylactic immunisation with | |

|Tetanus toxoid. | |

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|Escherichia coli 0157 / H7: | |

| |

|A   | | |

|is a bowel commensal | | |

| | | |

|B   | | |

|causes haemorrhagic colitis | | |

| | | |

|C   | | |

|is an important cause of cholera-like illness | | |

| | | |

|D   | | |

|is a recognised cause of the haemolytic uraemic syndrome | | |

| | | |

|E   | | |

|can be prevented from causing clinical illness by vaccination | | |

| | | |

|[pic] | |

|Comments: | |

|Escherichia coli 0157 / H7 characteristically causes a haemorrhagic colitis with abdominal pain but little or no fever. An | |

|outbreak of 500 cases in the USA was described in 1993. This outbreak was associated with the consumption of hamburgers. | |

|There were over 50 cases of haemolytic uraemic syndrome and 4 fatalities. The source of an outbreak in Wishaw, Scotland in | |

|1996 was a butcher's. There were over 500 cases and 18 fatalities. | |

[pic]

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| | |

|Staphylococcus epidermidis: | |

| |

|A   |false    [pic]     | |

|is coagulase positive | | |

| | | |

|B   |false    [pic]     | |

|on microscopy are Gram positive cocci in chains | | |

| | | |

|C   |true    [pic]     | |

|are usually sensitive to penicillin | | |

| | | |

|D   |false    [pic]     | |

|grown in blood cultures are due to contamination and should be ignored | | |

| | | |

|E   |true    [pic]     | |

|are destroyed by povodine iodine | | |

| | | |

|[pic] | |

|Comments: | |

|Staph. epidermidis is part of the normal skin flora. As for Staph. aureus, Gram positive cocci in bunches are seen on | |

|microscopy. | |

|It is usually insensitive to penicillin. | |

|Although it is often a contaminant in blood cultures, it is associated with line infections. Central venous catheters are an| |

|especially likely site of infection even in the absence of overt exit site sepsis. They should not be ignored but | |

|interpreted in the clinical context, and usually the blood cultures should be repeated. In patients with central lines, | |

|blood cultures should be taken both peripherally and from the central line as semi-quantitative microbiological techniques | |

|are available that may point to the central line as the principle site of infection. | |

[pic]

|Blood cultures: |  |

| |

|A   |false    [pic]     | |

|Are usually negative. | | |

| | | |

|B   |true    [pic]     | |

|Are best obtained when the patient is febrile or complains of chills. | | |

| | | |

|C   |true    [pic]     | |

|Require two culture (aerobic and anaerobic) specimens obtained from the arm. | | |

| | | |

|D   |true    [pic]     | |

|Are unreliable if the patient has already been commenced on antibiotics. | | |

| | | |

|E   |false    [pic]     | |

|Grow and identify organisms within 24 hours. | | |

| | | |

|[pic] | |

|Comments: | |

|Blood cultures are frequently negative or grow commensal organisms. Bacteraemia can be intermittent and transient. Episodes | |

|of bacteraemia are usually associated with chills and fever. Two culture specimens (one aerobic one anaerobic) should be | |

|obtained from at least two different sites. Ideally, blood cultures should be obtained before commencing antibiotic therapy.| |

|A preliminary report can be issued at 24 hrs, however, 48 – 72 hrs are required for growth and identification of the | |

|organism. | |

[pic]

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|Bacterial capsules: | |

| |

|A   | | |

|are typical of pseudomonas aeroginose | | |

| | | |

|B   | | |

|can transfer antibiotic reisistance to other bacteria | | |

| | | |

|C   | | |

|enhance bacterial resistance to dehydration and phagocystosis | | |

| | | |

|D   | | |

|are associated with endotoxic shock | | |

| | | |

|E   | | |

|enhance bacterial resistance to antibiotics | | |

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|[pic] | |

|Comments: | |

|Bacterial capsules are usually composed of polysaccharide and may be associated with mucoid colonial morphology. The slimy | |

|material functions as an anti-phagocytic agent and also protects the bacterial cell from the environment, (eg dehydration), | |

|including antibiotics which may be present. However many important bacterial pathogens do NOT rely on capsules e.g. | |

|M.tuberculosis or Salmonella. Endotoxic shock is associated with the biological activity of lipopolysaccharide (LPS), not | |

|capsules. Endotoxic shock is associated with the biological activity of Gram negative cell wall lipopolysaccharide. | |

|Capsulated bacteria include Streptococcus pneumoniae and pseudomonas. Although capsule may help to protect against | |

|antibiotics they do not transfer antibiotic resistance. | |

[pic]

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|Toxoplasma gondii: | |

| |

|A   | | |

|Is a rickettsia | | |

| | | |

|B   | | |

|Proliferates in the central nervous system | | |

| | | |

|C   | | |

|Is identified by Gram staining | | |

| | | |

|D   | | |

|Is a cause of congenital hydrocephalus | | |

| | | |

|E   | | |

|Is transmitted by ingestion of raw meat | | |

| | | |

|[pic] | |

|Comments: | |

|Toxoplasma gondii is an obligate intacellular parasite of the Apicomplexa family. The life cycle of the T. gondii parasite | |

|has three stages: cyst, oocyst, or tachyzoite. The latter can proliferate in the CNS forming cysts. This is particularly the| |

|case in the immunocompromised host and infection is a serious problem in pregnancy with fetal infection associated with | |

|stillbirth, prematurity, IUGR and neurological and ophthalmological abnormalities. The organism is identified with the | |

|Giemsa stain. It is usually transmitted through fecal contamination (most often cats) but can be acquired through consuming | |

|uncooked meats (this is how the cats get the disease). | |

[pic]

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|Proteolytic enzymes are released by the following organisms: | |

| |

|A   | | |

|Neisseria meningitides | | |

| | | |

|B   | | |

|Salmonella typhi | | |

| | | |

|C   | | |

|Streptococcus pyogenes | | |

| | | |

|D   | | |

|Mycobacterium tuberculosis | | |

| | | |

|E   | | |

|Clostridium perfringens (welchii) | | |

| | | |

|[pic] | |

|Comments: | |

|Virulence factors are important in the bacterial survival in vivo. In this sense bacterial extracellular proteolytic enzymes| |

|can be recognized as the legitimate target for this approach since they are involved either in direct or indirect | |

|destruction of an infected/colonized tissue and in dysregulation of many host defense pathways. The best example of the last| |

|is an effect of bacterial proteinases on fibrinolytic, kallikrein-kinin and complement cascades, as well as degradation of | |

|immunoglobulins, inactivation of endogenous proteinase inhibitors, and dysregulation of cytokine network system. Proteolytic| |

|enzymes are responsible for the virulence and activity of organisms such as Strep Pyogenes, Staphylococcus aureus, E coli | |

|and Clostridium welchii enabling the necrolytic effects on the skin in cellulitis and gangrene. | |

[pic]

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| | |

|Features of tetanus includes | |

| |

|A   | | |

|A rigid abdomen | | |

| | | |

|B   | | |

|Hypomagnesaemia | | |

| | | |

|C   | | |

|Hypocalcaemia | | |

| | | |

|D   | | |

|Carpopedal spasm | | |

| | | |

|E   | | |

|Clouding of conciousness | | |

| | | |

|[pic] | |

|Comments: | |

|Tetanus is caused by the gram positive bacillus Clostridium tetani and is associated with tetanic contractions due to | |

|neuromuscular blockade by the tetanus toxin. Tetanic contractions and respiratory arrest are seen but the level of | |

|conciousness is typically unimpaired. | |

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|Prevention of infection in joint replacement includes | |

| |

|A   | | |

|Covering all open wounds with an occlusive dressing | | |

| | | |

|B   | | |

|Cessation of smoking pre-operatively | | |

| | | |

|C   | | |

|The patient should shave the operation site the day before surgery | | |

| | | |

|D   | | |

|Laminar air flow in theatre | | |

| | | |

|E   | | |

|Antibiotic impregnated cement | | |

| | | |

|[pic] | |

|Comments: | |

|Joint replacement surgery should not be considered in patients with open wounds. Cessation of smoking at least 2 weeks | |

|before surgery reduces prosthesis and wound infection rates. The operation site should be shaved immediately before surgery,| |

|shaving the day before surgery causes an increased release of skin commensals. Laminar flow air hoods reduce the number of | |

|bacteria in the air above the wound. The antibiotic impregnated cement reduces the rate of deep infection. | |

[pic]

|The following are correctly paired |  |

| |

|A   | | |

|erythema nodosum tuberculosis | | |

| | | |

|B   | | |

|erythema marginatum Lyme disease | | |

| | | |

|C   | | |

|erythema multiforme orf | | |

| | | |

|D   | | |

|erythema induratum syphilis | | |

| | | |

|E   | | |

|erythema infectiosum parvovirus B19 | | |

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|[pic] | |

|Comments: | |

|Erythema nodosum. This is characterised by tender red swellings usually over the shins. The most common cause is | |

|streptococcal infection. Tuberculosis, sarcoidosis, leprosy, sulphonamides and inflammatory bowel disease are other | |

|important causes. | |

|Erythema marginatum. This is a non-itchy, pale red, macular eruption. It is a major criterion for the diagnosis of rheumatic| |

|fever but is also seen in acute glomerulonephritis and drug reactions. | |

|Erythema multiforme. This is characterised by cutaneous "target" lesions and mucosal involvement. Children and young adults | |

|are more commonly affected. Orf, mycoplasma, and herpes simplex are among the known causes. | |

|Erythema induratum. Cutaneous tuberculosis. Otherwise known as Bazin's disease. | |

|Erythema infectiosum. "Slapped cheeks", caused by parvovirus B19. | |

|Erythema chronicum migrans. An expanding annular lesion occurring in Lyme disease. | |

|Erythema gyratum repens. Erythema forming repeated concentric rings. Often there is an underlying malignancy. | |

|Clostridium tetani |  |

| |

|A   | | |

|causes gas gangrene | | |

| | | |

|B   | | |

|produces an exotoxin | | |

| | | |

|C   | | |

|has a terminal spore | | |

| | | |

|D   | | |

|is an obligatory anaerobe | | |

| | | |

|E   | | |

|is non-motile | | |

| | | |

|[pic] | |

|Comments: | |

|Gas gangrene is a Clostridium perfringens myositis. | |

|Clostridium tetani produces a potent neurotoxin called tetanospasmin. Tetanospasmin acts on both the motor systems at | |

|synapses, resulting in disinhibition. | |

|Most clostridia are normal commensals of human and animal gastrointestinal tracts, and are widely distributed in soil where,| |

|as spores, they may survive for years in adverse conditions. | |

|Clostridia are Gram-positive, spore-forming, obligatory anaerobic bacilli. | |

|Clostridium tetani is motile but non-invasive. | |

[pic]

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|Bacterial endotoxins: | |

| |

|A   | | |

|are proteins | | |

| | | |

|B   | | |

|are lipopolysaccharides | | |

| | | |

|C   | | |

|induce fever | | |

| | | |

|D   | | |

|are components of the cell wall in gram negative bacteria | | |

| | | |

|E   | | |

|are destroyed by heat such as boiling for 5 minutes | | |

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|[pic] | |

|Comments: | |

|Enodotoxins are lipopolysaccharides of the cell walls of gram negative bacteria and released following cell death. Typically| |

|larger amounts are required to produce effect compared with exotoxins. They are responsible for producing numerous effects | |

|of the infection (eg E Coli 0157) including fever, DIC, Myolysis etc. They are often heat resistant. | |

[pic]

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|Typical diseases caused by Haemophilus influezae include: | |

| |

|A   | | |

|Bronchopneumonia | | |

| | | |

|B   | | |

|Meningitis | | |

| | | |

|C   | | |

|Cellulitis | | |

| | | |

|D   | | |

|Septic arthritis | | |

| | | |

|E   | | |

|Epiglottitis | | |

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|[pic] | |

|Comments: | |

|H Influenzae may also cause osteomyelitis, pericarditis and sepsis. Appropraite therapy includes penicillin based antibiotic| |

|and third generation cephalosporins. | |

[pic]

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|Exotoxins: | |

| |

|A   | | |

|Are derived from Gram negative bacteria | | |

| | | |

|B   | | |

|Have a specific action | | |

| | | |

|C   | | |

|Are more toxic than endotoxins | | |

| | | |

|D   | | |

|Are neutralized by their homologous antitoxin | | |

| | | |

|E   | | |

|Can be converted to a toxoid | | |

| | | |

|[pic] | |

|Comments: | |

|Toxigenesis, or the ability to produce toxins, is an underlying mechanism by which many bacterial pathogens produce disease.| |

|At a chemical level, there are two types of bacterial toxins, lipopolysaccharides, which are associated with the cell walls | |

|of Gram-negative bacteria, and proteins, which are released from bacterial cells and may act at tissue sites removed from | |

|the site of bacterial growth. The lipoplysaccharide toxins are referred to as endotoxins and the extracellular diffusible | |

|toxins are referred to as exotoxins. Exotoxins are soluble proteins produced by the living bacteria and are generally | |

|specific for the pathogenic bacteria involved (Can be produced by both gram positive and gram negative bacteria -eg | |

|enterotoxigenic E coli). Bacterial protein toxins are the most powerful human poisons known and retain high activity at very| |

|high dilutions. Their effect may be neutralized by the antitoxin and this is used as a treatment (toxoid). | |

[pic]

|Micro-organisms that can cause latent infection include: |  |

| |

|A   | | |

|Mycobacterium tuberculosis | | |

| | | |

|B   | | |

|varicella-zoster virus | | |

| | | |

|C   | [pic]     | |

|cytomegalovirus (CMV) | | |

| | | |

|D   | | |

|hepatitis A | | |

| | | |

|E   | | |

|chlamydia trachoma | | |

| | | |

|[pic] | |

|Comments: | |

|Most commonly clinical tuberculosis represents delayed reactivation.Varicella-zoster virus remains dormant in the dorsal | |

|root ganglia and can cause latent infections such as shingles.Over 50% of the adult population have serological evidence of | |

|latent infection with CMV, although infection is generally symptomless.Hepatitis A is self-limiting and usually over in 3-6 | |

|weeks.Chlamydia trachomatis can remain latent for years but can later cause blindness, infertility, and ischaemic heart | |

|disease. | |

[pic]

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|Which of the following antibiotics are considered bactericidal? | |

| |

|A   | | |

|Clindamycin | | |

| | | |

|B   | | |

|Amoxicillin | | |

| | | |

|C   | | |

|Erythromycin | | |

| | | |

|D   | | |

|Tetracycline | | |

| | | |

|E   | | |

|Gentamicin | | |

| | | |

|[pic] | |

|Comments: | |

|Both penicillins and the aminoglycosides such as gentamicin are bactericidal whereas the others are bacteriostatic. | |

[pic]

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| | |

|Which of the following may constitute a vaccine? | |

| |

|A   | | |

|prion | | |

| | | |

|B   | | |

|live attenuated | | |

| | | |

|C   | | |

|toxoid | | |

| | | |

|D   |[pic]     | |

|inactivated | | |

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|E   |true    [pic]     | |

|DNA recombinant | | |

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|[pic] | |

|Comments: | |

|A prion is a proteinaceous infective material believed to be responsible for Creutzfeldt-Jacob Disease. You have probably | |

|received all of these yourself, with the possible exception of D. (B = polio, measles, BCG; C = diphtheria and tetanus | |

|toxoids; D = inactivated bacteria - pertussis[whooping cough], or viruses – hepatitis A, rabies; E = hepatitis B surface | |

|antigen, produced in yeasts ). | |

[pic]

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|Human immunodeficiency virus | |

| |

|A   | | |

|Is a single stranded DNA retrovirus | | |

| | | |

|B   | | |

|Induces a fall in CD4 lymphocytes, monocytes and antigen-presenting cells | | |

| | | |

|C   | | |

|Increases the risk of opportunistic infection | | |

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|D   | | |

|Patients can be infective prior to seroconversion illness at about three months | | |

| | | |

|E   | | |

|The median survival with AIDS is greater than 10 years | | |

| | | |

|[pic] | |

|Comments: | |

|HIV is a single stranded RNA retrovirus. It induces immunodeficeincy and increases the risk of opportunitsic infection (e.g.| |

|histoplasmosis, Pneumocystis carinii) and malignancy (e.g. Kaposi's sarcoma). Patients may have asymptomatic or symptomatic | |

|disease for several years before developing AIDS. The median survival with full AIDS is less than two years | |

[pic]

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|The following is true regarding Hydradenitis suppurativa: | |

| |

|A   | | |

|Represents an infection of the paracrine sweat glands | | |

| | | |

|B   | | |

|Due to an antigen-antibody reaction | | |

| | | |

|C   | | |

|Occurs more often in overweight women | | |

| | | |

|D   | | |

|Can result in sterile abscesses | | |

| | | |

|E   | | |

|Complete excision of the affected tissue down to the deep fascia can be curative | | |

| | | |

|[pic] | |

|Comments: | |

|This is a condition of the apocrine sweat glands. It is thought that it is an antigen-antibody complex clump that blocks | |

|excretion from the gland. The condition affects the axillae and perineum most often in overweight women. | |

|Abscesses are commonly sterile and when pathogens are present, they may represent commensal organisms. The surgery can often| |

|be extensive and debilitating. | |

[pic]

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|Regarding multiple organ dysfunction syndrome (MODS). | |

| |

|A   | | |

|The renal system often deteriorates first. | | |

| | | |

|B   | | |

|Sequence of organ dysfunction is not associated by the site of the original insult. | | |

| | | |

|C   | | |

|Mortality is up to 80%. | | |

| | | |

|D   | | |

|Is a reversible phenomenon. | | |

| | | |

|E   | | |

|Secondary MODS occurs when organ dysfunction is a consequence of the hosts response. | | |

| | | |

|[pic] | |

|Comments: | |

|The respiratory system often deteriorates first. The organs involved and the sequence of their dysfunction is determined by | |

|the original insult. Mortality increases with the number of organ systems affected and with the severity of physiological | |

|disturbance at onset. Prompt intervention can reverse organ dysfunction. Primary MODS is a direct consequence of a specific | |

|insult that causes early dysfunction of the organs involved. | |

[pic]

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|The following are true about Pseudomonas aeruginosa: | |

| |

|A   | | |

|it is the most common cause of contact lens acquired infection | | |

| | | |

|B   | | |

|it is a Gram negative bacteria | | |

| | | |

|C   | | |

|it can cause osteomyelitis | | |

| | | |

|D   | | |

|it is sensitive to chloramphenicol | | |

| | | |

|E   | | |

|it is sensitive to ciprofloxacin | | |

| | | |

|[pic] | |

|Comments: | |

|Infection rates can be reduced by wearing the contact lens for 10 hours or less.It is a gram-negative aerobic bacilli.The | |

|most common organisms that cause osteomyelitis are Staphylococcus, Haemophilus influenzae, and Salmonella, although | |

|P.Aeruginosa can cause osteomyelitis.Chloramphenicol has good activity against Haemophilus influenzae but not | |

|P.Aeruginosa.P.Aeruginosa is sensitive to quinolones, which inhibit DNA Topoisomerase. | |

[pic]

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|The following are suitable antibiotics for treating Escherichia coli: | |

| |

|A   |false    [pic]     | |

|Ampicillin | | |

| | | |

|B   |false    [pic]     | |

|Amoxicillin | | |

| | | |

|C   |true    [pic]     | |

|Ciprofloxacin | | |

| | | |

|D   |true    [pic]     | |

|Co-amoxiclav | | |

| | | |

|E   |true    [pic]     | |

|Cefuroxime | | |

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|[pic] | |

|Comments: | |

|Escherichia coli is a Gram-negative bacillus which produces penicillinases, but it remains sensitive to numerous | |

|antibiotics. Bacterial resistance to antibiotics is a major problem and where possible sensitivities should be checked | |

|before blind treatment of infections is commenced. Ampicillin and amoxicillin are broad spectrum antibiotics active against | |

|non-beta lactamase producing Gram-positive and Gram-negative organisms. They are inactivated by penicillinases and since up | |

|to 50% of Escherichia coli strains are now resistant, they would be an unsuitable choice. Co-amoxiclav consists of | |

|amoxicillin and the beta-lactamase inhibitor clavulanic acid. Thus it is active against beta-lactamase producing bacteria | |

|that are resistant to amoxicillin, including strains of Escherichia coli. Cefuroxime is a cephalosporin that is resistant to| |

|inactivation by bacterial beta-lactamases and so may be used against Escherichia coli. Ciprofloxacin has a 6-fluoro | |

|substituents which confers enhanced antibacterial potency against both Gram positive and Gram negative organisms, including | |

|Escherichia coli. | |

[pic]

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| | |

|The following definitions regarding the sepsis sequelae are correct. | |

| |

|A   | | |

|Systemic inflammatory response syndrome (SIRS) is the alteration of organ function in acute illness such | | |

|that homeostasis cannot be maintained without intervention. | | |

| | | |

|B   | | |

|Sepsis is an inflammatory response to microorganisms or their invasion of normal sterile host tissue. | | |

| | | |

|C   | | |

|Septicaemia is a clinically symptomatic endoxaemia or bacteraemia. | | |

| | | |

|D   | | |

|Septic shock is sepsis with hypotension and hypoperfusion despite adequate fluid resuscitation. | | |

| | | |

|E   | | |

|Severe sepsis is the systemic inflammatory response syndrome (SIRS) plus a confirmed infective process. | | |

| | | |

|[pic] | |

|Comments: | |

|SIRS is defined by the presence of 2 or more of the following; Temp > 38OC, or < 36OC. Pulse > 90 beats/min. Respiratory | |

|rate > 20 per min or an arterial partial pressure of oxygen (PaC02) 12, or < 4. B - The described definition | |

|is of infection. Sepsis is defined as SIRS plus a confirmed infective process. C - This is a dated term rarely used today. D| |

|- ie sepsis associated with a shocked state. Severe sepsis is defined as SIRS plus organ dysfunction, hypoperfusion or | |

|hypotension. | |

[pic]

|Sepsis |  |

| |

|A   | | |

|Systemic Inflammatory Response Syndrome (SIRS) is defined as three or more of the following; tachycardia, tachypnoea, pyrexia,| | |

|hypothermia, WCC >12 or 1.2mmol/l or systemic vascular resistance of 12 or 1.2mmol/l or a SVR of 38OC, or < 36OC. Pulse > 90 beats/min. Respiratory | |

|rate > 20 per min or an arterial partial pressure of oxygen (PaC02) 12, or < 4. B - The described definition | |

|is of infection. Sepsis is defined as SIRS plus a confirmed infective process. C - This is a dated term rarely used today. D| |

|- ie sepsis associated with a shocked state. Severe sepsis is defined as SIRS plus organ dysfunction, hypoperfusion or | |

|hypotension. | |

[pic]

| |  |

|Bacterial plasmids: | |

| |

|A   | | |

|may be transferred by conjugation between different strains | | |

| | | |

|B   | | |

|are responsible for endotoxaemic shock | | |

| | | |

|C   | | |

|always contain genes for enzymes that modify antibiotics | | |

| | | |

|D   | | |

|are responsible for transferring resistance to penicillins | | |

| | | |

|E   | | |

|may consist of a circular molecule of double-stranded RNA | | |

| | | |

|[pic] | |

|Comments: | |

|Plasmids comprise a group of extra-chromosomal, usually circular, molecules of double-stranded DNA, and may contain genetic | |

|information for various bacterial characteristics e.g. toxin production, adhesins etc as well as enzymes. They can replicate| |

|autonomously (ie independently from the bacterial chromosome), and larger plasmids are transferred naturally by conjugation | |

|between bacterial strains. DNA transferred between bacteria can be integrated into the recipient host chromosome or | |

|maintained as a plasmid. Plasmids may contain genetic information for various bacterial characteristics e.g. toxin | |

|production, adhesins etc. Plasmids comprise a circular molecule of double-stranded DNA. | |

[pic]

| |  |

| | |

| | |

| | |

| | |

| | |

|Regarding perianal abscesses: | |

| |

|A   | | |

|Abscess position is predicted by Goodsall's rule | | |

| | | |

|B   | | |

|The presence of aerobic bacteria in the pus implies a fistula | | |

| | | |

|C   | | |

|Are relatively common in children | | |

| | | |

|D   | | |

|Are more common in ulcerative colitis than in Crohn's disease | | |

| | | |

|E   | | |

|5% of patients presenting with a perianal abscess are diabetic | | |

| | | |

|[pic] | |

|Comments: | |

|Goodsall's rule predicts the position of the internal opening of a perianal fistula. The presence of bowel flora is | |

|associated with a fistula, aerobic bacteria would imply that the sepsis was derived from the skin. The incidence is less | |

|than 0.1% with boys less than 2 years being affected more often. Crohn's patients present more often with perianal sepsis | |

|and maybe the presenting symptom. All non-diabetic patients therefore need to be screened for diabetes. | |

[pic]

| |  |

| | |

| | |

| | |

|The following are true about Pseudomonas aeruginosa: | |

| |

|A   | | |

|it is the most common cause of contact lens acquired infection | | |

| | | |

|B   | | |

|it is a Gram negative bacteria | | |

| | | |

|C   | | |

|it can cause osteomyelitis | | |

| | | |

|D   | | |

|it is sensitive to chloramphenicol | | |

| | | |

|E   | | |

|it is sensitive to ciprofloxacin | | |

| | | |

|[pic] | |

|Comments: | |

|Infection rates can be reduced by wearing the contact lens for 10 hours or less.It is a gram-negative aerobic bacilli.The | |

|most common organisms that cause osteomyelitis are Staphylococcus, Haemophilus influenzae, and Salmonella, although | |

|P.Aeruginosa can cause osteomyelitis.Chloramphenicol has good activity against Haemophilus influenzae but not | |

|P.Aeruginosa.P.Aeruginosa is sensitive to quinolones, which inhibit DNA Topoisomerase. | |

[pic]

| |  |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|Pseudomonas infections are associated with: | |

| |

|A   | | |

|Urea - like odour | | |

| | | |

|B   | | |

|Grape - like odour | | |

| | | |

|C   | | |

|Faeculent - like odour | | |

| | | |

|D   | | |

|Sloughy exudate | | |

| | | |

|E   | | |

|Green exudate | | |

| | | |

|[pic] | |

|Comments: | |

|Pseudomonas spp. is a ubiquitous facultative anaerobe. Proteus infections are associated with urea-like odours. Bacteroides,| |

|Fusobacteria and Clostridia infections produce a faeculent odour. | |

[pic]

|Staphylococcus aureus |  |

| |

|A   | | |

|is a gram positive motile organism | | |

| | | |

|B   | | |

|produces a coagulase | | |

| | | |

|C   | | |

|produces enterotoxin | | |

| | | |

|D   | | |

|is typically anaerobic | | |

| | | |

|E   |   [pic]     | |

|is arranged in chains | | |

| | | |

|[pic] | |

|Comments: | |

|Staphylococcus aureus is a gram positive non-motile, aerobic coccus whose colonies are arranged in grape-like clusters. | |

|Strains are responsible for food poisoning through the production of an enterotoxin and pathogenicity is also associated | |

|with coagulase positivity. | |

[pic]

| |  |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|A 69-year-old smoker is to undergo a left fem-pop bypass due to atheromatous arterial disease. Which of | |

|the following would be regarded as appropriate antibacterial prophylaxis for this patient? | |

| |

|A   | | |

|Cefotaxime | | |

| | | |

|B   | | |

|Erythromycin | | |

| | | |

|C   | | |

|Gentamicin | | |

| | | |

|D   | | |

|Metronidazole | | |

| | | |

|E   | | |

|Flucloxacillin | | |

| | | |

|[pic] | |

|Comments: | |

|Appropriate prophylactic antibacterials for a relatively clean procedure such as arterial surgery includes 2nd or 3rd | |

|generation caphalosporins or Co-Amoxiclav as the drugs of choice for these procedures. Bacteriostatic agents such as | |

|erythromycin are inappropriate. Metronidazole would be effective where anaerobic agents would be considered problematic and | |

|would be used adjunctively in diabetic wounds etc. Flucloxacillin would not have a broad enough spectrum of activity to be | |

|considered appropriate. In those suspected high risk of MRSA - previous infection- or units where MRSA is a problem - | |

|vancomycin would be an appropriate agent. | |

[pic]

|The following are normal flora found in the particular anatomical site |  |

| |

|A   | | |

|Nasopharynx – Haemophilus spp | | |

| | | |

|B   | | |

|Skin – Propionbacteria | | |

| | | |

|C   | | |

|Stomach – sterile | | |

| | | |

|D   | | |

|Female genital tract – Enterococci | | |

| | | |

|E   | | |

|Urinary tract – Escherichia coli | | |

| | | |

|[pic] | |

|Comments: | |

|The normal flora found are | |

|Nasopharynx: Staphylococci, streptococci (including pneumococci), haemophilus spp., anaerobes | |

|Skin: Staphylococci, streptococci, propionbacteria | |

|Stomach: The acid content reduces the bacterial load, however, organisms can persist e.g. Helicobacter pylori | |

|Female genital tract: Flora of the large bowel plus staphylococci, streptococci, haemophilus spp. | |

|Urinary tract: Normally sterile | |

[pic]

| |  |

| | |

| | |

| | |

| | |

|Features of tetanus includes | |

| |

|A   | | |

|A rigid abdomen | | |

| | | |

|B   | | |

|Hypomagnesaemia | | |

| | | |

|C   | | |

|Hypocalcaemia | | |

| | | |

|D   | | |

|Carpopedal spasm | | |

| | | |

|E   | | |

|Clouding of conciousness | | |

| | | |

|[pic] | |

|Comments: | |

|Tetanus is caused by the gram positive bacillus Clostridium tetani and is associated with tetanic contractions due to | |

|neuromuscular blockade by the tetanus toxin. Tetanic contractions and respiratory arrest are seen but the level of | |

|conciousness is typically unimpaired. | |

[pic]

| |  |

| | |

| | |

|Pelvic abscesses | |

| |

|A   |false    [pic]     | |

|Are an uncommon cause of intra-abdominal abscess/ | | |

| | | |

|B   |true    [pic]     | |

|Can be associated with a perforated peptic ulcer | | |

| | | |

|C   |false    [pic]     | |

|Commonly present with nocturia | | |

| | | |

|D   |true    [pic]     | |

|Frequently drain spontaneously into the rectum | | |

| | | |

|E   |false    [pic]     | |

|Can only be identified on CT if there is a full bladder | | |

| | | |

|[pic] | |

|Comments: | |

|Pelvic abscess is the commonest variety of intraperitoneal abscess. Pus can track down the peritoneal cavity to form a | |

|pelvic abscess. The abscess can irritate the bladder causing urinary frequency/nocturia. If an abscess drains spontaneously | |

|via the rectum, they rarely require any further treatment. Ultrasound imaging requires a full urinary bladder to identify | |

|the pelvic organs and any abscesses present. | |

[pic]

| |  |

| | |

| | |

| | |

| | |

| | |

| | |

|Bacterial capsules: | |

| |

|A   |false    [pic]     | |

|are typical of pseudomonas aeroginose | | |

| | | |

|B   |false    [pic]     | |

|can transfer antibiotic reisistance to other bacteria | | |

| | | |

|C   |true    [pic]     | |

|enhance bacterial resistance to dehydration and phagocystosis | | |

| | | |

|D   |false    [pic]     | |

|are associated with endotoxic shock | | |

| | | |

|E   |true    [pic]     | |

|enhance bacterial resistance to antibiotics | | |

| | | |

|[pic] | |

|Comments: | |

|Bacterial capsules are usually composed of polysaccharide and may be associated with mucoid colonial morphology. The slimy | |

|material functions as an anti-phagocytic agent and also protects the bacterial cell from the environment, (eg dehydration), | |

|including antibiotics which may be present. However many important bacterial pathogens do NOT rely on capsules e.g. | |

|M.tuberculosis or Salmonella. Endotoxic shock is associated with the biological activity of lipopolysaccharide (LPS), not | |

|capsules. Endotoxic shock is associated with the biological activity of Gram negative cell wall lipopolysaccharide. | |

|Capsulated bacteria include Streptococcus pneumoniae and pseudomonas. Although capsule may help to protect against | |

|antibiotics they do not transfer antibiotic resistance. | |

[pic]

| |

| |

| |

| |

| |

| |

|A middle-aged woman presents with recent changes in bowel habit. She is investigated as a case of sporadic colonic carcinoma.|

|What is the mechanism of its tumorogenesis? |

|  |

| |

|1 ) |APC gene mutation |[pic] | | |

|2 ) |β-catenin suppression |[pic] | | |

|3 ) |Down-regulation of p27 |[pic] | | |

|4 ) |K-ras suppression |[pic] | | |

|5 ) |p53 upregulation |[pic] | | |

| |

|[pic] |

|Comments: |

|The cyclin-dependent kinase inhibitor p27 is a negative regulator of the cell cycle and a potential tumour suppressor gene. |

|Its down-regulation is associated with occurrence of sporadic colon cancer. β-catenin accumulation, not suppression, |

|initiates adenoma formation. p53 is a tumour suppressor gene. Activation of K-ras oncogene is seen in sporadic colon cancer. |

[pic]

| |

| |

| |

| |

|A 17-year-old girl underwent emergency splenectomy after a domestic accident. Which one of the following organisms is most |

|likely to cause life-threatening infection in the future? |

|  |

| |

|1 ) |Actinomycosis | | | |

|2 ) |Haemophilus influenzae | | | |

|3 ) |Pseudomonas aeruginosa | | | |

|4 ) |Staphylococcus aureus | | | |

|5 ) |Streptococcus pneumoniae | | | |

| |

|[pic] |

|Comments: |

|Following splenectomy a person is at risk of Streptococcus pneumoniae , Haemophilus influenzae, Nesseria meningitidis, |

|Escherichia coli and Pseudomonas aeruginosa. |

|By far the most common is Streptococcus pneumoniae- which can cause life threatening infection. |

[pic]

| |

| |

| |

| |

| |

| |

| |

| |

|A 33-year-old type 1 diabetic male presents with a two day history of pain in his left hand, fever and a rash. This began |

|after he pricked his finger in the garden whilst pruning a bush. His diabetic control has been quite reasonable with a HbA1c |

|of 7.1% on basal bolus insulin consisting of Lispro tds and Humulin I in the evenings. On examination he has a painful, red |

|and swollen middle finger with the redness extending to the metacaropophalangeal joint. He is diagnosed with cellulites and |

|is prescribed antibiotics. What is the most likely infective organism? |

|  |

| |

|1 ) |Escherichia coli |[pic] |  | |

|2 ) |Klebsiella |[pic] |  | |

|3 ) |MRSA |[pic] |  | |

|4 ) |Pseudomonas aeruginosa |[pic] |  | |

|5 ) |Streptococcus pyogenes |[pic] |[pic] | |

| |

|[pic] |

|Comments: |

|This patient has a community-acquired cellulitis which is most likely due to either strep or Staphylococcus aureus (not MRSA |

|which is more of a hospital pathogen and tends not to cause cellultis). Understanding the likely infective organism can |

|therefore dictate appropriate antibiotic therapy. In this case oral flucloxacillin and Pencillin V are appropriate. If the |

|cellultis does not quickly improve then intravenous antibiotics may be required. |

|Which of the following micro-organisms is the commonest cause of haematogenous osteomyelitis? |

|  |

| |

|1 ) |Streptococcus |[pic] |  | |

|2 ) |Salmonella |[pic] |  | |

|3 ) |H.influenza |[pic] |  | |

|4 ) |Staphylococcus aureus |[pic] |[pic] | |

| |

|[pic] |

|Comments: |

|In persons with haematogenous osteomyelitis, when infection penetrates the periosteal membrane, a cloaca may form and extend |

|into the adjacent soft tissues. Cortical sequestration can subsequently appear. In infants and young children, a suppurative |

|process of the metaphysis may extend into the epiphysis and also lead to involucrum formation. Other abnormalities include |

|single or multiple Brodies abscess usually of staphylococcal origin. On radiographs these abscesses appear as areas of |

|radiolucency with adjacent sclerosis. In the metaphysis, the lucent region may connect with the growth plate by a tortuous |

|channel (i.e. channel or tract sign); in the diaphysis, the radiolucent abscess cavity can be located in central or |

|subcortical areas or in the cortex itself and may contain a central sequestrum; in an epiphysis, a circular, well-defined |

|osteolytic lesion is seen. A cortical abscess simulates the appearance of an osteoid osteoma or a stress fracture. |

[pic]

|A 47-year-old man presents with progressive right hand swelling 2 days after being bitten by a dog. On examination there is a|

|punture wound with pus over the dorsum of the hand, cellulitis, ascending lymphangitis and tender axillary lymphadenopathy. |

|What is the most appropriate antibiotics therapy in this case? |

|  |

| |

|1 ) |Benzylpenicillin and flucloxacillin |[pic] | | |

|2 ) |Ceftriaxone |[pic] | | |

|3 ) |Ciprofloxacin |[pic] | | |

|4 ) |Co-amoxiclav |[pic] | | |

|5 ) |Erythromycin |[pic] | | |

| |

|[pic] |

|Comments: |

|Only 15-20% of dog bites become infected and providing the wound is appropriately cleaned and not considered at risk (eg |

|crush or deep wounds) then antibiotic prophylaxis may not be required. Hiwever, this patient has an infected wound and |

|infective organisms include pastuerella spp, Staph aureua and anaerobes like corynebacterium. The most appropriate antibiotic|

|therapy in dog bites associated with cellulites would be co-amoxiclav. |

[pic]

|A 21-year-old man with non-Hodgkin’s lymphoma and haemolytic anaemia is assessed for splenectomy. When should Pneumovax vaccine be administered? |

|  |

| |

|1 ) |one month before surgery |[pic] |[pic] | |

|2 ) |one week before surgery |[pic] |  | |

|3 ) |one week after surgery |[pic] |  | |

|4 ) |one month after surgery |[pic] |  | |

|5 ) |perioperatively |[pic] |  | |

| |

|[pic] |

|Comments: |

|The vaccine should be given a minimum of two weeks before elective splenectomy in order to ensure an optimal antibody response. In emergency splenectomy|

|the patient should be immunized as soon as possible after recovery from the operation and before discharge from hospital. Unvaccinated patients |

|splenectomized some time earlier should be vaccinated at the first opportunity. Vaccination is delayed for at least six months after immunosuppressive |

|chemotherapy or radiotherapy, during which time prophylactic antibiotics should be given. |

[pic]

|A 12-year-old girl presents with left ear pain and fever, worsening over the past 3 days. Today mother has noted a whitish |

|creamy discharge from the ear canal. She was born at 38/40 gestation weighing 3.8kg and there were no neonatal problems. She |

|is fully immunised. She trains regularly in a swimming team. |

|On examination she has a temperature of 38.2°C and has a red left tragus. This is exquisitely tender, and examination of the |

|drum is impossible because of the pain and creamy thin discharge. She has shotty tender posterior cervical glands. |

|What is the most likely diagnosis? |

|  |

| |

|1 ) |Group A streptococcal pharyngitis |[pic] |  | |

|2 ) |Mastoiditis |[pic] |  | |

|3 ) |Otitis externa |[pic] |  | |

|4 ) |Otitis media, acute |[pic] |[pic] | |

|5 ) |Otitis media, recurrent |[pic] |  | |

| |

|[pic] |

|Comments: |

|The history suggests an acute otitis externa. The tight adherance of skin to the underlying perichondrium and periostium make|

|the pain worse than the degree of inflammation would suggest. An ear swab culture should be sent and neomycin and |

|colistin/polymixin ear drops commenced. This covers the common gram positive and gram negative usually responsible. |

[pic]

|A 5-year-old boy presents to Accident and Emergency complaining of acute pain over his upper tibia. He is febrile and he |

|refuses to move his leg. A diagnosis of osteomyelitis is suspected |

|The likely infecting organism is? |

|  |

| |

|1 ) |Clostridium difficile | | | |

|2 ) |Haemophilus influenzae | | | |

|3 ) |Pseudomonas | | | |

|4 ) |Salmonella | | | |

|5 ) |Staphylococcus aureus | | | |

| |

|[pic] |

|Comments: |

|The commonest infecting organism in acute osteomyelitis in children over the age of 4 years is Staphilococcus aureus. With |

|immuniozation cases of haemtogenous osteomyelitis due to Haemophilus influenzae have almost been eradicated. Salmonella is |

|the characteristic organism inm sickle cell anaemia. Pseudomonas infection is a common organism in haemodyalisis patients and|

|intravenous drug addicts. |

[pic]

|A 7-year-old girl presents with right ear pain and fever, worsening over the past few days. Symptoms began 7d ago with severe|

|ear pain and fever, which was treated with paracetamol. The following morning the pain resolved and a purulent discharge |

|mixed with blood was noted on her pillow. 4d later the pain is throbbing and her ear is tender. She was born at term weighing|

|3.68kg and there were no neonatal problems. She is fully immunised, and there is no FH/SH of note. |

|On examination she has a fever to 39.7C, and her right ear is displaced downwards and forwards. She is extremely tender |

|behind the right ear, and has a purulent discharge from the ear canal. Her pulse is 100/min and respiratory rate is 15/min. |

|What is the most likely diagnosis? |

|  |

| |

|1 ) |Cholesteatoma |[pic] | | |

|2 ) |Mastoiditis |[pic] | | |

|3 ) |Otitis media with effusion |[pic] | | |

|4 ) |Otitis media, acute |[pic] | | |

|5 ) |Otitis media, recurrent |[pic] | | |

| |

|[pic] |

|Comments: |

|The history suggests acute otitis media with perforation, followed by acute mastoiditis (acute mastoid osteitis). This can be|

|confirmed by CT scan of the mastoid. Pneumococcus and H. influenzae are the commonest cause. Most resolve with antibiotics, |

|but some require surgical drainage. |

|Regarding antibiotic prophylaxis: |  |

| |

|A   | | |

|The dose of antibiotic should reflect the degree of sepsis found | | |

| | | |

|B   | | |

|Requires a second dose if the procedure exceeds 4 hrs | | |

| | | |

|C   | | |

|Should only be given on induction of anaesthetic | | |

| | | |

|D   | | |

|Usually only require a single dose | | |

| | | |

|E   | | |

|Are not required in 'clean' procedures | | |

| | | |

|[pic] | |

|Comments: | |

|In adults, the full dose of the chosen antibiotic should be administered unless there is a concern regarding excretion e.g. | |

|renal failure. In prolonged procedures, a second dose is advised. Otherwise, single-dose prophylaxis is effective in most | |

|clinical situations. Clean procedures were synthetic material is implanted require antibiotic prophylaxis. | |

[pic]

| |  |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|The following statements regarding anastomotic leakage are correct: | |

| |

|A   | | |

|Colorectal anastomotic leakage results in a three-fold increase in post-operative mortality. | | |

| | | |

|B   | | |

|Anastomoses below the peritoneal reflection have a reduced risk of leakage. | | |

| | | |

|C   | | |

|Clinically detected leaks are roughly equal to radiologically detected leaks. | | |

| | | |

|D   | | |

|Excessive tension in the ligatures reduces the leak rate. | | |

| | | |

|E   | | |

|Barium enema is the investigation of choice to confirm the diagnosis. | | |

| | | |

|[pic] | |

|Comments: | |

|Most colorectal anastomotic leaks present late (after the patient has recommenced oral feeding). Low anastomoses have a | |

|higher leak rate therefore, most surgeons divert the faecal flow with a temporary proximal stoma. | |

|The clinical leak rate underestimates the true incidence of leakage. Excessive tension leads to tissue necrosis and leakage | |

|of the anastomosis. | |

|Barium is toxic in the peritoneal cavity therefore the investigation of choice is a gastrograffin enema. | |

[pic]

| |  |

| | |

| | |

| | |

|Regarding surgical infection: | |

| |

|A   | | |

|Primary refers to a planned surgical trauma. | | |

| | | |

|B   | | |

|Always have a focus of infection. | | |

| | | |

|C   | | |

|Are always associated with tissue necrosis. | | |

| | | |

|D   | | |

|Inflammation is the response to tissue necrosis. | | |

| | | |

|E   | | |

|Antibiotics are advised once a septic focus has been drained. | | |

| | | |

|[pic] | |

|Comments: | |

|Primary surgical infections refer to surgical wounds which appear spontaneously e.g. a skin abscess. | |

|Surgical wounds differ from non-surgical wounds in that they always have a source of infection, which can be drained | |

|surgically. | |

|Tissue necrosis results from trauma or through a pathophysiological process. Inflammation leads to the events visible at the| |

|surface. Once the source of infection has been drained, antibiotics are usually unnecessary unless the surrounding tissues | |

|are infected. | |

[pic]

| |  |

| | |

| | |

| | |

| | |

| | |

| | |

|The following can be used for skin disinfection: | |

| |

|A   | | |

|quaternary ammonium compounds | | |

| | | |

|B   | | |

|phenol | | |

| | | |

|C   | | |

|glutaraldehyde | | |

| | | |

|D   | | |

|alcoholic solution of chlorhexidine | | |

| | | |

|E   | | |

|povidone-iodine solution | | |

| | | |

|[pic] | |

|Comments: | |

|Quaternary ammonium compounds are powerful disinfectants with additional detergent action, not to be used on skin. Phenol is| |

|famous as the disinfectant first used by Joseph Lister in the l880's in antiseptic surgery. It is however very corrosive to | |

|human tissues and today is usually the starting point for the synthesis of derivatives. Glutaraldehyde is a compound used | |

|especially in tanning leather and in the fixation of biological tissues. Although not a phenol compound, chlorohexidine is | |

|similar in structure and function and has no reported toxic effects. It is often used as an alternative in soaps, and on | |

|skin and mucous membranes. Iodine is most commonly used in alcoholic solution known as tinctures of iodine. It is a common | |

|skin disinfectant used for cuts and abrasions as well as a skin preparation in surgery. | |

[pic]

| |  |

| | |

| | |

| | |

| | |

|The following are recognised cause of toxic megacolon: | |

| |

|A   | | |

|pneumatosis cystoides intestinalis | | |

| | | |

|B   | | |

|amoebic dysentry | | |

| | | |

|C   | | |

|salmonella gastroenteritis | | |

| | | |

|D   | | |

|Strongyloides infection | | |

| | | |

|E   | | |

|pseudomembranous colitis | | |

| | | |

|[pic] | |

|Comments: | |

|Complications of amoebiasis include fulminant colitis, stricture formation, haemorrahge, amoeboma and amoebic liver abscess.| |

|Pseudomembranous colitis caused by Clostridium difficile and associated with antibiotic use. Symptoms vary from mild | |

|diarrhoea to fulminating toxic megacolon. Samonella is also a recognised cause, particularly in children. Pneumatosis | |

|cystoides intestinalis associated with chronic bronchitis - multiple gas filled cysts in sub-mucosa of colon. Mainly | |

|asymptomatic, but can cause abdominal pain, diarrhoea and rupture to produce pneumoperitoneum. Salmonella enterocolitis | |

|produces colitis, acute appendicitis in young and mesenteric thrombosis in the elderly. Strongyloides stercoralis causes | |

|malabsorption with steatorrhoea. | |

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| | |

|In a young man with a four day history of bloody diarrhoea: | |

| |

|A   | | |

|shigellosis is a likely diagnosis | | |

| | | |

|B   | | |

|the finding of cysts to Entamoeba histolytica in the stools confirms a diagnosis of acute amoebic | | |

|dysentry | | |

| | | |

|C   | | |

|cholera is a likely diagnosis | | |

| | | |

|D   | | |

|a negative amoebic fluorescent antibody test excludes a diagnosis of acute amoebic dysentry | | |

| | | |

|E   | | |

|giardiasis is a likely diagnosis | | |

| | | |

|[pic] | |

|Comments: | |

|Infective causes plus inflammatory bowel disease should be considered in the differential diagnosis of a young man with | |

|bloody diarrhoea. Shigellosis is a possible cause. b-trophozoites seen in acute dysentry. Cysts for E. Histolitica are not | |

|100% sensitive for amoebic dysentery. c+e-watery diarrhoea | |

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| | |

|Sterilization: | |

| |

|A   | | |

|Hot air sterilization is the preferred method to treat surgical instruments with fine cutting edges. | | |

| | | |

|B   | | |

|Sterilization by ethylene oxide has a broad-spectrum static action against bacteria, spores and viruses. | | |

| | | |

|C   | | |

|Ethylene oxide should only be used when heat sterilization of an item is not possible. | | |

| | | |

|D   | | |

|Flash autoclaving at 147°C and 40 lb/square inch is the preferred method of sterilization by steam. | | |

| | | |

|E   | | |

|Unwrapped instruments may be sterilized in theatre using a portable steam sterilizer. | | |

| | | |

|[pic] | |

|Comments: | |

|Hot-air ovens have the benefit of not causing corrosion in non-stainless metals and not damaging fine cutting edges in | |

|delicate instruments. | |

|Under optimal conditions of concentration, temperature and exposure time, ethylene oxide has a broad spectrum cidal action. | |

|Ethylene oxide is toxic, irritant, mutagenic and carcinogenic, therefore its use requires extreme caution. | |

|Flash autoclaving is no longer recommended or available for safety reasons, the preferred setting is 132°C (30 lb in-2) held| |

|for 3 minutes. This method is a convenient way to deal with dropped instruments. | |

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|The following wound classification are correct: | |

| |

|A   | | |

|Emergency femoral hernia repair – clean | | |

| | | |

|B   | | |

|Open cholecystectomy for a mucocele of the gallbladder – potentially contaminated. | | |

| | | |

|C   | | |

|Emergency abdominal aortic aneurysm repair – contaminated. | | |

| | | |

|D   | | |

|Girdlestone's procedure – clean. | | |

| | | |

|E   | | |

|Hartmann's procedure performed for peritonitis - dirty. | | |

| | | |

|[pic] | |

|Comments: | |

|While the femoral hernia repair is being performed, as an emergency there is a high risk of strangulation and possible perforation; therefore, this| |

|wound should be considered as potentially contaminated. | |

|There is always a risk of bile/mucus spillage during the procedure. | |

|Emergency and elective abdominal aortic aneurysm should be considered clean procedures. | |

|Girdlestone's procedure (excision of the femoral head and arthrodesis) is usually performed for infection and should be considered to be | |

|potentially contaminated. | |

|An emergency Hartmann's procedure is usually performed for a sigmoid colon perforation or secondary to diverticular disease or cancer. | |

[pic]

|T |  |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|he following is/are true of the Hepatitis C virus | |

| |

|A   | | |

|Can be prevented by vaccination | | |

| | | |

|B   | | |

|Usually resolves following an acute illness | | |

| | | |

|C   | | |

|The prevalence in the UK is ................
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