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  #1  
Old 08-24-2011
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Default post op infection

A 24-year-old man, an automobile accident victim, was brought to the hospital with a compound fracture of the distal left tibia and fibula. Within 6 hours of the accident, the patient was taken to surgery where the wound was debrided, the leg was immobilized, and therapy was begun (cephalothin sodium IV, 1 g/4 hr). The patient was afebrile. The hematocrit reading was 41%, the WBC count 10,900/mm3, and blood pressure and pulse rate within normal limits. He did well until the fourth postoperative day when he was noted to have a temperature of 38.3C orally, a tachycardia rate of 120 bpm, a painful left leg, and a sense of impending doom.

The cast was opened and the entire lower leg was found to be swollen and reddish-brown, and was exuding a serosanguineous foul-smelling discharge. Crepitations were palpable over the anterior tibial and entire gastrocnemius areas. His blood pressure became unstable and then dropped to 70/20 mm Hg. Gram stain of an aspirate from the gastrocnemius demonstrated both Gram-negative and Gram-positive rods, but no spores were seen. At this time, the hematocrit reading had decreased to 35%, and WBC count was 12,000/mm3, with 85% polymorphonuclear leukocytes.

Therapy was begun with IV penicillin G aqueous, 5 million units every 6 hours. The man was taken to surgery, where an above-knee amputation was performed. While the patient was receiving cephalothin, cultures of the necrotic muscle grew Escherichia coli and Clostridium perfringens. Within 3 hours after amputation, the patient had a sense of well-being, and complete recovery followed.

The injury in the tissue is produced by which of the following:

A. ADP-ribosylating toxin
B. Lecithinase -toxin
C. Pore-forming -toxin
D. Enterotoxin
E. Spores
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dr_lizard (08-24-2011), patelMD (08-24-2011), star123 (08-24-2011)



  #2  
Old 08-24-2011
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Default

Quote:
Originally Posted by ricko335 View Post
A 24-year-old man, an automobile accident victim, was brought to the hospital with a compound fracture of the distal left tibia and fibula. Within 6 hours of the accident, the patient was taken to surgery where the wound was debrided, the leg was immobilized, and therapy was begun (cephalothin sodium IV, 1 g/4 hr). The patient was afebrile. The hematocrit reading was 41%, the WBC count 10,900/mm3, and blood pressure and pulse rate within normal limits. He did well until the fourth postoperative day when he was noted to have a temperature of 38.3C orally, a tachycardia rate of 120 bpm, a painful left leg, and a sense of impending doom.

The cast was opened and the entire lower leg was found to be swollen and reddish-brown, and was exuding a serosanguineous foul-smelling discharge. Crepitations were palpable over the anterior tibial and entire gastrocnemius areas. His blood pressure became unstable and then dropped to 70/20 mm Hg. Gram stain of an aspirate from the gastrocnemius demonstrated both Gram-negative and Gram-positive rods, but no spores were seen. At this time, the hematocrit reading had decreased to 35%, and WBC count was 12,000/mm3, with 85% polymorphonuclear leukocytes.

Therapy was begun with IV penicillin G aqueous, 5 million units every 6 hours. The man was taken to surgery, where an above-knee amputation was performed. While the patient was receiving cephalothin, cultures of the necrotic muscle grew Escherichia coli and Clostridium perfringens. Within 3 hours after amputation, the patient had a sense of well-being, and complete recovery followed.

The injury in the tissue is produced by which of the following:

A. ADP-ribosylating toxin
B. Lecithinase -toxin
C. Pore-forming -toxin
D. Enterotoxin
E. Spores
C. Perfringens has Lecithanse Toxin

Answer: B.
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  #3  
Old 08-24-2011
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agreeing with option b
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  #4  
Old 08-24-2011
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yea gas gangrene, choice b.
what the hell ! who would read that long question! i just read last sentence of each paragraph!
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  #5  
Old 08-24-2011
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lecithinase....dat was a long story btw...
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  #6  
Old 08-25-2011
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the correct answer is b
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  #7  
Old 08-25-2011
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Default B

lecithinase by perfringes

Quote:
Originally Posted by ricko335 View Post
A 24-year-old man, an automobile accident victim, was brought to the hospital with a compound fracture of the distal left tibia and fibula. Within 6 hours of the accident, the patient was taken to surgery where the wound was debrided, the leg was immobilized, and therapy was begun (cephalothin sodium IV, 1 g/4 hr). The patient was afebrile. The hematocrit reading was 41%, the WBC count 10,900/mm3, and blood pressure and pulse rate within normal limits. He did well until the fourth postoperative day when he was noted to have a temperature of 38.3C orally, a tachycardia rate of 120 bpm, a painful left leg, and a sense of impending doom.

The cast was opened and the entire lower leg was found to be swollen and reddish-brown, and was exuding a serosanguineous foul-smelling discharge. Crepitations were palpable over the anterior tibial and entire gastrocnemius areas. His blood pressure became unstable and then dropped to 70/20 mm Hg. Gram stain of an aspirate from the gastrocnemius demonstrated both Gram-negative and Gram-positive rods, but no spores were seen. At this time, the hematocrit reading had decreased to 35%, and WBC count was 12,000/mm3, with 85% polymorphonuclear leukocytes.

Therapy was begun with IV penicillin G aqueous, 5 million units every 6 hours. The man was taken to surgery, where an above-knee amputation was performed. While the patient was receiving cephalothin, cultures of the necrotic muscle grew Escherichia coli and Clostridium perfringens. Within 3 hours after amputation, the patient had a sense of well-being, and complete recovery followed.

The injury in the tissue is produced by which of the following:

A. ADP-ribosylating toxin
B. Lecithinase -toxin
C. Pore-forming -toxin
D. Enterotoxin
E. Spores
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