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Chapter 146: Antimicrobial Prophylaxis in Surgery SELF-ASSESSMENT QUESTIONS
Chapter 146: Antimicrobial Prophylaxis in Surgery SELF-ASSESSMENT QUESTIONS
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DiPiro: Pharmacotherapy A Pathophysiologic Approach, 12e
Chapter 146: Antimicrobial Prophylaxis in Surgery
SELFASSESSMENT QUESTIONS
1. A patient undergoing a cholecystectomy for acute cholecystitis requires:
A. No antibiotic therapy
B. Prophylactic antibiotic therapy
C. Presumptive antibiotic therapy
D. Therapeutic antibiotic therapy
2. According to the National Research Council classification of surgical site infection, antibiotic therapy is not required for:
A. Clean procedures
B. Clean–contaminated procedures
C. Contaminated procedures
D. A and B
3. Which of the following is not considered patientspecific risk factors for surgical site infections?
A. Smoking history
B. Preoperative nutritional status
C. Male gender
D. Diabetes
4. Which of the following statements about preoperative nutrition is true?
A. Preoperative dietary supplementation with glutamine reduces the risk of postoperative surgical site infections.
B. Preoperative dietary supplementation with arginine reduces the risk of postoperative surgical site infections.
C. Preoperative dietary supplementation with omega3 fatty acids reduces the risk of postoperative surgical site infections.
D. No dietary supplements have been shown to decrease postoperative surgical site infection.
5. According to the National Nosocomial Infection Surveillance System, which one of the following organisms is most often isolated from surgical site
infections?
A. Streptococcus pneumonia
B. Staphylococcus aureus
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C. Escherichia coli
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D. Enterococci sp.
5. According to the National Nosocomial Infection Surveillance System, which one of the following organisms is most often isolated from surgical site
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A. Streptococcus pneumonia
B. Staphylococcus aureus
C. Escherichia coli
D. Enterococci sp.
6. The Center for Disease Control recommends that vancomycin should be substituted for a cephalosporin for surgical prophylaxis when:
A. Methicillinresistant S. aureus is suspected
B. "Contaminated" and “dirty” procedures are expected
C. Patients with a documented history of a lifethreatening allergy to penicillins or cephalosporins.
D. The surgical procedure involves implantation of any prosthetic device.
E. A and C.
7. Which one of the following statements regarding prophylactic antimicrobial regimens is false?
A. Therapeutic antimicrobials for unrelated infections can be used in place of a prophylactic antimicrobial regimen, provided the antibiotic used
has appropriate antimicrobial activity.
B. Bactericidal concentrations of antibiotics must be delivered to the surgical site prior to the initial incision.
C. Bactericidal concentrations of antibiotics must be maintained throughout the duration of the surgery.
D. Antimicrobials should be administered with anesthesia or within 60 minutes prior to the initial incision.
8. Intraoperative redosing of antimicrobials are required for surgical procedures longer than:
A. 5 halflives of the antibiotic used for prophylaxis
B. 2 hours
C. 2.5 halflives of the antibiotic used for prophylaxis
D. 6 hours
9. With respect to gastrointestinal surgeries, thirdgeneration cephalosporins are considered to be effective prophylactic regimens for:
A. Cholecystectomies
B. Gastroduodenal surgeries
C. Colorectal surgeries
D. All of the above
10. Regarding colorectal surgery, which one of the following statements is true?
A. Mechanical bowel preparation (ie, with polyethylene glycol) is an effective way to reduce bacterial load in the colon.
B. Most surgeons report routinely using a mechanical bowel preparation in addition to antibiotics prior to elective colorectal surgery.
C. Mechanical bowel preparation (ie, with polyethylene glycol) is an effective way to reduce surgical site infection risk after elective colorectal
surgery.
D. All of the above.
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E. A and B only.
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11. Prophylactic antimicrobial therapy for gastrointestinal endoscopy is recommended for:
B. Most surgeons report routinely using a mechanical bowel preparation in addition to antibiotics prior to elective colorectal surgery.
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C. Mechanical bowel preparation (ie, with polyethylene glycol) is an effective way to reduce surgical site infection risk after elective colorectal
surgery.
D. All of the above.
E. A and B only.
11. Prophylactic antimicrobial therapy for gastrointestinal endoscopy is recommended for:
A. All patients as postprocedure bacteremia is common
B. No patient as the risk of postprocedure infection is low
C. Highrisk procedures including colonoscopy
D. Highrisk patients including those with prosthetic heart valves
12. Which one of the following statements about hysterectomies is false?
A. Cefazolin is the prophylactic drug of choice for vaginal hysterectomies.
B. Abdominal hysterectomies are associated with a higher rate of surgical site infections when compared to vaginal hysterectomies.
C. It is unnecessary to provide more than 24 hours of prophylactic antimicrobial coverage for abdominal hysterectomies.
D. Metronidazole is a reasonable alternative to a cephalosporin for penicillinallergic patients undergoing a hysterectomy.
13. Screening and preoperative eradication of S. aureus with intranasal mupirocin and chlorhexidine body wash has been shown to reduce surgical
site infections:
A. Only in cardiac surgery
B. Only in orthopedic surgery
C. Only in neurosurgery
D. Both cardiac and orthopedic surgeries
14. Patients suffering an open compound limb fracture:
A. Requires no more than 24 hours of prophylactic antibiotics
B. Requires no more than a single dose of prophylactic antibiotics
C. Requires a course of antibiotics for “presumptive” infection
D. None of the above
15. Nonantimicrobial strategies to reduce surgical site infections include all of the following, except:
A. Permissive hypothermia intraoperatively
B. High concentrations of oxygen administration intraoperatively
C. Protocolized aseptic technique
D. Perioperative normoglycemia
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