Vascular Infection

Question 1

Vascular infection occurs with secondary:

Answer 1

vascular infection occurs with secondary subcutaneous necrosis.

Question 2

The difference between necrotizing fasciitis and cellulitis (late stage) is that:

Answer 2

Late stage necrotizing fasciitis presents with bullae.

Question 3

In necrotizing fasciitis, organisms spread from the

Answer 3

In necrotizing fasciitis, organisms spread from the subcutaneous tissue along the superficial and deep fascial planes.

Question 4

A deep necrotizing fasciitis infection can cause:

(1) Vascular occlusion
(2) ischemia
(3) Tissue necrosis

Answer 4

A deep necrotizing fasciitis infection can cause vascular occlusion, ischemia and tissue necrosis.

Question 5

T/F: Necrotizing fasciitis does not cause any damage to superficial nerves or local anesthesia.

Answer 5

False. Necrotizing fasciitis causes damage to superficial nerves and causes anesthesia.

Question 6

A patient has been recently diagnosed with necrotizing fasciitis of the medial thigh. The skin around the affected area MOST likely looks like:

Answer 6

dusky or purplish discoloration.

Question 7

A patient with non-clostridial necrotizing fasciitis presents with local creptiation. This finding is:

Answer 7

Occurs in more than 50% of patients; is specific but NOT sensitive.

Question 8

T/F: patients with necrotizing fasciitis present with lymphangitis or lymphadenopathy.

Answer 8

False.

Question 9

Which of the following regarding necrotizing fasciitis is TRUE?

(1) The causative bacteria are anaerobic.
(2) Type I is polymicrobial and causes clostridial myonecrosis.
(3) Type III is polymicrobial and caused by trauma or surgery.
(4) Type II is caused by group A streptococcus.

Answer 9

(4) Type II is caused by group A streptococcus.

Question 10

The speed of ascent of necrotizing fasciitis is proportional to:

Answer 10

The thickness of the subcutaneous tissue, and moves ALONG fascial planes.

Question 11

A seriously ill patient with necrotizing fasciitis and/or myonecrosis requires treatment of:

Answer 11

It is a surgical emergency with high mortality.

Question 12

Which of the following is a life threatening condition?

(1) Necrotizing fasciitis
(2) gas-forming myonecrosis

Answer 12

Both (1) necrotizing fasciitis and (2) gas-forming myonecrosis are life threatening.

Question 13

The prognosis of necrotizing fasciitis is:

Answer 13

20 - 80% mortality rate.

Question 14

The TWO most common pitfalls in management of of necrotizing fasciitis are:

Answer 14

(1) Failure of early diagnosis

(2) inadequate surgical debridement.

Question 15

Which of the following regarding treatment of necrotizing fasciitis is TRUE?

(1) Tissue gas is a universal finding in necrotizing soft tissue infections.
(2) I&D is an appropriate surgical strategy for necrotizing soft tissue infections.
(3) Excisional debridement is the appropriate surgical strategy for necrotizing soft tissue infections.

Answer 15

(3) Excisional debridement is the appropriate surgical strategy for necrotizing soft tissue infections.

Question 16

A patient presents with patches of purple discoloration on the skin, which turn into gangrenous tissue ascending up the leg. You diagnose the patient with necrotizing fasciitis and plan excisional debridement. The surgical incision should be:

Answer 16

Deep and extend beyond the areas of necrosis until viable tissue is reached.

Excise the entire necrotic area.

Irrigate the wound well.

Question 17

When planning excisional debridement for treatment of necrotizing fasciitis, you should take care to:

(1) Only incise the necrotic tissue.
(2) Excise the entire necrotic area.
(3) Avoid irrigating the wound.

Answer 17

(2) Excise the entire necrotic area.

Question 18

T/F: after excisional debridement of necrotic tissue, the incision site should be sutured.

Answer 18

False.

Question 19

A guillotine ankle amputation is indicated in the presence of:

(1) Mild infection or necrosis
(2) Necrosis in the forefoot only
(3) Severe infection or necrosis in the midfoot or hindfoot.

Answer 19

Guillotine ankle amputations are indicated in the presence of severe infection or necrosis in the midfoot OR hindfoot.

Question 20

Which of the following is an indication for an ankle guillotine amputation?

(1) Wet gas gangrene
(2) Afebrile patient with absent bacteremia.
(3) Fulminant osteomyelitis

Answer 20

Both (1) Wet gas gangrene and (3) fulminant osteomyelitis are indications for a guillotine ankle amputation.

Question 21

T/F: An initial guillotine amputation helps control infection, eliminate bacteremia and provider a safer wound environment for a definitive amputation at a later date.

Answer 21

True.

Question 22

A patient with necrotizing fasciitis is febrile and presents with bacteremia. They require an amputation. The FIRST amputation that should be done is:

(1) Guillotine amputation
(2) Below knee amputation

Answer 22

(1) Guillotine amputation.

Question 23

An advantage of the guillotine amputation is that:

Answer 23

It can be rapidly performed, eliminating the need for anesthesia or prolonged surgery.

Question 24

Although a two-stage amputation, the guillotine amputation at the ankle is recommended as FIRST stage to deal with wet gangrene because it allows:

Answer 24

subsequent wound closure with a reduced chance of wound infection.

Question 25

In a study comparing guillotine + BKA and BKA alone for treatment of non-salvageable foot infections, the group that had higher rates of primary healing AND no revision surgeries required:

Answer 25

Guillotine + BKA had higher rates of primary healing and no revision surgeries were required.

Question 26

T/F: A Syme's articulation is the same as an ankle disarticulation.

Answer 26

False.

Question 27

T/F: An ankle disarticulation causes damage to the cortex of a bone.

Answer 27

False.

Question 28

Which of the following is an advantage to disarticulation of joints? (1) Minimal blood loss from marrow. (2) Minimal muscle coveragae (3) Easier identification and reduced number of major vessels.

Answer 28

(1) Minimal blood loss from marrow and (3) easier identification and reduced number of major vessels are advantages to joint disarticulations.

Question 29

T/F: Disarticulation avoids exposure to medullary bone and provides a natural barrier against desiccation.

Answer 29

True.

Question 30

The appropriate bandage dressings for a two-stage ankle disarticulation is:

Answer 30

Wet betadine, dankins or acetic acid.

Question 31

T/F: Xeroform is the most ideal dressing for necrotizing fasciitis or infected wounds.

Answer 31

Flase.

Question 32

Which of the following is the BEST dressing for an ankle disarticulation? (1) Wound vac (2) Xeroform (3) Wet betadine, dankins or acetic acid.

Answer 32

(3) Wet betadine, dankins and acetic acid are the best dressings for treatment of necrotizing fasciitis and ankle disarticulations.

Question 33

Which of the following surgeries is preferred? (1) Ankle disarticulation (2) BKA

Answer 33

(1) Ankle disarticulation is preferred over BKA.

Question 34

Which of the following surgeries is preferred? (1) Guillotine BKA (2) High BKA

Answer 34

(1) Guillotine BKA

Question 35

Which of the following procedures is preferred? (1) Knee disarticulation (2) Gritti Stokers or AKA

Answer 35

(1) Knee disarticulation.

Question 36

Which of the following procedures is preferred? (1) AKA (2) high AKA and possible hip disarticulation.

Answer 36

(1) AKA

Question 37

Out of these amputations (all are considered good for ambulation and function) which is the gold standard? (1) Toe amputation (2) Ray amputation (2 - 4) (3) BKA (4) Gritti stokes

Answer 37

(3) BKA

Question 38

The Gritti Stokes amputation has an advantage of maintaining muscle attachments and preserving patellar skin. However it is not used as much because:

Answer 38

There are few orthotics for it.

Question 39

Which of the following procedures requires special orthotics/shoes and has a high rate of breakdown? (1) AKA (2) TMA, Chopart, Lisfranc (3) Symes

Answer 39

(2) TMA, Chopart, Lisfranc

Question 40

Which of the following procedures provides little muscle coverage and doe snot have good orthotics availiable? (1) AKA (2) TMA, Chopart, Lisfranc (3) Symes

Answer 40

(3) Symes