Test yourself

MCQ and extended

matching
The MCQ and extended matching section in Surgery is designed to test
your knowledge of selected topics in this issue of the journal.
Michael G Wyatt MSc MD FRCS, Consultant Surgeon, Freeman Hospital,
Newcastle upon Tyne, UK. Editorial Secretary for ASGBI, Member of
SAC in General Surgery and Court of Examiners for the intercollegiate
MRCS.
For questions 1e4, select the statements which are true and
which are false. The correct answers are given below.
1 Organisms of importance to the general surgeon
In patients with hospital-acquired infections (HAIs):
A The majority of HAIs are caused by the patients
own commensal microbial ora.
B The 2006 UK Prevalence Study found that the
overall prevalence of HAIs in the UK and Northern
Ireland (excluding Scotland) was 7.6% of adult
patients in acute hospitals.
C Surgical-site infection (SSI) is the third most
common HAI in the UK and is preventable.
D Clostridium difcile enteritis, which can present as
a surgical emergency requiring operative interven-
tion, is now a major cause of HAI, with cases also
occurring in the community.
E Clostridium difcile diarrhoea is caused by the
production of toxin-A (an enterotoxin) and toxin-B
(a cytolytic toxin).
2 Rational antibiotic use in surgery
When considering rational antibiotic use after surgery:
A Between 2000 and 2007, the UK has seen increasing
resistance, through extended-spectrum b lacta-
mases, of Escherichia coli to cephalosporins (12-fold
increase), quinolones (5-fold increase) and amino-
glycosides (3-fold increase).
B Quinolones, fusidic acid, linezolid, clindamycin and
metronidazole have poor oral bioavailability and
should be given via an intravenous route.
C Antibiotics should be given for the shortest duration
possible, but many infections can be effectively treated
with short-duration therapy (one week or less) e
particularly when an infective focus has been drained.
D Ten days of antibiotic therapy is adequate for most
post-operative chest infections, and ve days for
uncomplicated urinary tract infections.
E In patients with IgE-mediated reactions to
penicillin, cephalosporins and other beta-lactams
(e.g. carbapenems and aztreonam) may be used
with caution.
3 Decontamination and sterilization
When considering decontamination and sterilization:
A Sterilization is the elimination or reduction in the level
of vegetative micro-organisms and other unwanted
material from medical devices, equipment and
surfaces so that they cannot reach a susceptible site in
sufcient quantity to cause infection or other harmful
response.
B Cleaning is the physical removal of contamination
(e.g. blood, tissue and body uid residues, degradation
products, pyrogens, soil and dust) from reusable
medical devices and equipment. However, it does not
necessarily destroy micro-organisms.
C Disinfection is a process which kills or inactivates most
viable micro-organisms, but does not necessarily
destroy certain viruses and bacterial spores.
D Decontamination is the complete removal of all viable
micro-organisms including spores and viruses. Sterili-
zation can be performed only on inanimate objects
because it can cause severe damage to living tissues.
E Autoclaving involves maintaining saturated steam at
high temperature in a vacuum. It is used to eliminate
all microbes including tubercle bacilli, viruses and
heat-resistant spores, but requires direct contact of
instruments with moist steam.
4 Surgery in carriers of HIV and hepatitis
When considering surgery in carriers of HIV and
hepatitis
A The chance of developing HIV after occupational
exposure in the UK is around one in 3000.
B There have been three documented UK-acquired HIV
infections in surgeons practising in the UK, but 10
further cases may have been acquired through work in
Africa, India and the Indian subcontinent.
C HIV is 50e100 times more infectious than hepatitis B,
and 10 times more infectious than the hepatitis C virus.
D The commonest outcome after infection with hepatitis
B is progression to chronic carrier status, and 15e20
years to cirrhosis development.
E There is no vaccine against hepatitis B, or any active
treatment post exposure.
MULTIPLE CHOICE QUESTIONS
see next page
SURGERY 27:10 456 2009 Published by Elsevier Ltd.
Questions cont.
5 Sepsis, SIRS and MODS
Theme: Sepsis, SIRS and MODS
A The failure of two, or more, organs which are
unable to maintain homeostasis without
intervention.
B Can be diagnosed when any two of the following
criteria exist: body temperature <36

C or >38

C,
heart rate >90 beats/min, respiratory rate >20
breaths/min or PCO
2
<4.3 kPa (32 mmHg), white
cell count <4 or >12 10
9
/l or the presence of
greater than 10% immature neutrophils.
C Evidence-based care bundles which should be
delivered expediently to septic.
D SIRS in the presence of infection, either proven or
suspected.
E Used in patients with severe sepsis and multiple
organ dysfunction in addition to standard care. Its
anticoagulant action means it is contraindicated in
patients with a risk of signicant bleeding.
F Recommended in patients with septic shock who
despite adequate uid replacement, require
vasopressor therapy to maintain adequate blood
pressure.
G Sepsis-induced hypotension which persists despite
adequate uid resuscitation.
H Sepsis with evidence of organ dysfunction or tissue
hypoperfusion.
For each of the terms listed below select the single most
likely true statement from the list above. Each option
may be used only once, more than once or not at all.
1 Sepsis
2 Activated protein C (APC)
3 Multiple Organ Dysfunction Syndrome (MODS)
4 Septic shock
5 Systemic Inammatory Response Syndrome (SIRS)
6 Sepsis Campaign (international consensus group)
guidelines
7 Severe sepsis
8 Intravenous corticosteroids
Answers
1 All
2 A, C
3 B, C, E
4 None
5 1-D, 2-E, 3-A, 4-G, 5-B, 6-C, 7-H, 8-F
Answers to incorrect statements
Question 2
B Quinolones, fusidic acid, linezolid, clindamycin and
metronidazole have good oral bioavailability and the
intravenous route offers little advantage in administration.
D Five days of antibiotic therapy is adequate for most
post-operative chest infections, and three days for
uncomplicated urinary tract infections.
E In patients without IgE-mediated reactions to penicillin,
cephalosporins and other beta-lactams (e.g. carbapenems
and aztreonam) may be used with caution.
Question 3
A Decontamination is the elimination of or reduction in, the
level of vegetative micro-organisms and other unwanted
material from medical devices, equipment and surfaces so
that they cannot reach a susceptible site in sufcient
quantity to cause infection or other harmful response.
D Sterilization is the complete removal of all viable micro-
organisms including spores and viruses. Sterilization can
be performed only on inanimate objects because it can
cause severe damage to living tissues.
Question 4
A The chance of developing HIV after occupational exposure
in the UK is around one in 300.
B There have been no documented infections in UK
surgeons practising in the UK, but in three possible cases
they may have acquired the infection through work in
Africa, India and the Indian subcontinent.
C The hepatitis B virus is 50e100 times more infectious than
HIV, and 10 times more infectious than the hepatitis Cvirus.
D The commonest outcome after infection with hepatitis C is
progression to chronic carrier status, and 15e20 years to
cirrhosis development.
E There is no vaccine against hepatitis C, or any active
treatment post exposure.
MULTIPLE CHOICE QUESTIONS
SURGERY 27:10 457 2009 Published by Elsevier Ltd.