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Chapter 6: Surgical Infections

Transferrin plays a role in host defense by

A. Sequestering iron, which is necessary for microbial growth

B. Increasing the ability of fibrinogen to trap microbes

C. Direct injury to the bacterial cell membrane

D. Direct injury to the bacterial mitochondria

Answer: A

Once microbes enter a sterile body compartment (eg, pleural or peritoneal cavity) or tissue, additional host defenses act to limit and/or eliminate these pathogens. Initially, several primitive and relatively nonspecific host defenses act to contain the nidus of infection, which may include microbes as well as debris, devitalized tissue, and foreign bodies, depending on the nature of the injury. These defenses include the physical barrier of the tissue itself, as well as the capacity of proteins, such as lactoferrin and transferrin, to sequester the critical microbial growth factor iron, thereby limiting microbial growth. In addition, fibrinogen within the inflammatory fluid has the ability to trap large numbers of microbes during the process in which it polymerizes into fibrin. Within the peritoneal cavity, unique host defenses exist, including a diaphragmatic pumping mechanism whereby particles including microbes within peritoneal fluid are expunged from the abdominal cavity via specialized structures on the undersurface of the diaphragm. Concurrently, containment by the omentum, the so-called “gatekeeper” of the abdomen and intestinal ileus, serves to wall off infection. However, the latter processes and fibrin trapping have a high likelihood of contributing to the formation of an intra-abdominal abscess. (See Schwartz 10th ed., p. 138.)

Which is NOT a component of systemic inflammatory response syndrome (SIRS)?

A. Temperature

B. White blood cell (WBC) count

C. Blood pressure

D. Heart rate

Answer: C

Infection is defined by the presence of microorganisms in host tissue or the bloodstream. At the site of infection the classic findings of rubor, calor, and dolor in areas such as the skin or subcutaneous tissue are common. Most infections in normal individuals with intact host defenses are associated with these local manifestations, plus systemic manifestations such as elevated temperature, elevated white blood cell (WBC) count, tachycardia, or tachypnea. The systemic manifestations noted above comprise the systemic inflammatory response syndrome (SIRS). (See Schwartz 10th ed., p. 138.)

The best method for hair removal from an operative field is

A. Shaving the night before

B. Depilating the night before surgery


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