Gas gangrene is a rapid spreading infective gangrene of the muscles characterized by collection of gas in the muscles and subcutaneous tissue. It is also called "Clostridial myonecrosis".
Gas Gangrene is most likely to develop in wounds where there has been extensive laceration or devitalization of muscle mass with gross contamination of the wound by soil and other foreign bodies.
Clostridial organisms can be divided into two groups - namely Saccharolytic and Proteolytic. Of the Saccharolytic group of anaerobes, Clostridium perfringes (Cl. welchii) plays the main part in gas gangrene.
Other organisms that cause gas gangrene are Clostridium oedematiens, Clostridium septicum, Clostridium histolyticum, and Clostridium bifermentans.
Two important factors necessary for the formation of gas gangrene include :
Entry of Clostridial organisms, particularly Clostridium perfringes (Cl. welchii), and
Anaerobic conditions within the wound
Diabetes and other occlusive arterial diseases predispose to gas gangrene.
The various exotoxins produced by these organisms (particularly Clostridium welchii) are:
Alpha toxin (Lecithinase)
Is hemolytic, and splits lecithin to phosphocholine and diglyceride.
Collagenase
Is a proteinase and breaks down collagen
Hyaluronidase
Breaks down hyaluronic acid
Theta toxin
Is hemolytic, lethal and necrotic
Leucocidin
Kills the leucocytes
Clostridial invasion affects the whole of the involved muscle from origin to insertion producing a foul smelling necrosis of the muscle which becomes dull red to green and ultimately black in appearance.
The muscle becomes green to black due to the action of the sulphurated hydrogen on iron liberated from broken down muscle hemoglobin. The gas is chiefly hydrogen, being odorless in the beginning, but soon it becomes fetid due to the liberation of sulphurated hydrogen (H2S), ammonia and volatile gases.
TYPES OF GAS GANGRENE
Clostridial cellulitis
Crepitant infection involving necrotic tissue, but healthy muscle is not involved and is characterized by foul smelling, seropurulent infection of a wound.
Single muscle type
Limited to one muscle only
Group type
Limited to one group of muscles, eg. extensors of the thigh
Massive type
Involves almost whole muscle mass of one limb
Fulminating type
Spreads very rapidly even beyond the limb, associated with intense toxemia
The most characteristic feature of gas gangrene is profuse discharge of brownish, foul smelling fluid between the sutures and the presence of crepitus due to presence of gas in the muscle and subcutaneous tissue.
The first prophylactic step in the prevention of gas gangrene wound is excision or debridement in which all the devitalized tissues, blood clots, dead and damaged muscles and foreign bodies should be removed.
Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Gastric lavage involves the passage of a tube (such as an Ewald tube) via the mouth or nose down into the stomach followed by sequential administration and removal of small volumes of liquid. - Useful within three hours after ingestion of the poison PROCEDURE FOR GASTRIC LAVAGE
A stomach tube (Ewald's tube or Boa's tube) or ordinary, soft, noncollapsible rubber tube of length 1.5 meter and diameter 1 cm with a glass funnel attached on one end and a mark at 50 cm from the other end (which should be rounded with lateral openings) is used
Denture must be removed and mouth gag should be placed
Patient should be in left lateral position or head hanging over the edge of the bed and face supported by assistant.
The end is lubricated with olive oil or glycerine and is slowly passed into mouth and through the pharynx and oesophagus into the stomach till the 50 cm marking.
About 1/4th liter of lukewarm water should be passed through the funnel held high above the patient's head
When funnel is empty, compress the tube below the funnel between finger and thumb and lower it below the level of stomach. the contents will be emptied by siphoning action when the pressure is released.
This first stomach contents should be preserved for chemical analysis.
Gastric lavage can be done with: - water - 1:5000 Potassium Permanganate (KMnO4) - 5 % Sodium Bicarbonate (NaHCO3) - 4 % Tannic acid - 1 % Sodium or potassium iodide - 0.9 % saline
Repeat the wash with 1/2 liter suitable solution till clear and odorless fluid comes out. CONTRAINDICATIONS OF GASTRIC LAVAGE: Absolute Contraindication: Corrosive poisoning except for carbolic acid Relative Contraindication: i. Convulsant poisoning ii. Comatose patient iii. Volatile poison iv. upper GIT disease v. Patient with marked hypothermia and hemorrhagic diathesis
# What is Ranula ?
A. Retention cyst of sublingual gland
B. Retention cyst of submandibular gland
C. Extravasation cyst of sublingual glands
D. Extravasation cyst of submandibular glands
# The parotid duct is known as:
A. Wharton's duct
B. Stenson's duct
C. Duct of Santorini
D. Duct of Wirsung
# Nerve, which lies in association to Wharton's duct is:
A. Hypoglossal
B. Lingual
C. Facial
D. Spinal Accessory
# During parotid surgery, injury to the nerve, which results in Frey's syndrome is :
A. Auriculotemporal nerve
B. Great auricular nerve
C. Mandibular nerve
D. Buccal nerve
# The nerve sacrificed in parotid surgery is:
A. Auriculotemporal
B. Facial
C. Buccal
D. Cervicofacial
# In a 3 year old child, which of the following is the most common cyst located in the midline of the neck ?
A. Thyroglossal cyst
B. Bronchial cyst
C. Lymphangiocele
D. Cystic Hygroma
# Chronic lymphocytic thyroiditis refers to:
A. Tuberculous Thyroiditis
B. Hashimoto's thyroiditis
C. Dequervein's theme
D. Riedel's pharmoaclogy
# In Hashimoto's disease, serum antibodies are mainly against:
A. Thyroid Follicles
B. Thyronine
C. Thyroglobulin
D. Iodine
# Thyroglossal cyst may occasionally give rise to _________ carcinoma.
A. papillary
B. Medullary
C. Anaplastic
D. Follicular
# The folowing statements about thyroglossal cysts are true, EXCEPT :
A. Frequent cause of anterior midline neck masses in the first decade of life
B. The cyst is located within 2 cm of the midline
C. Incision and drainage is the treatment of choice
D. The swelling moves upwards on protrusion of the tongue
# Prophylactic thyroidectomy is indicated in:
A. Papillary carcinoma of thyroid
B. Follicular carcinoma of thyroid
C. Medullary carcinoma of thyroid
D. Malignant lymphoma
# A patient has wide eyes, nervousness, raised systolic BP and weight loss. Most probable diagnosis is:
A. Hypothyroidism
B. Hyperthyroidism
C. Hyperparathyroidism
D. Hypoparathyroidism
# Thyroglossal fistula is :
A. Congenital
B. Acquired
C. Hereditary
D. Discharges blood
# The most common cause of hypoparathroidism after thyroidectomy is :
A. Removal
B. Vascular injury
C. Hypertrophy
D. Malignancy
# The commonest cause of hypercalcemia in a patient with known cancer is:
A. Ectopic parathormone production
B. Direct destruction of the bone by tumor cells
C. High levels of vitamin D
D. Production of parathormone like substance
# A patient presents with swelling in the neck following a thyroidectomy. What is most likely resulting complication?
A. Respiratory obstruction
B. Recurrent laryngeal nerve palsy
C. Hypovolemia
D. Hypocalcemia
# In retrosternal goiter, the most common presenting feature is:
A. Dysphagia
B. Stridor
C. Dyspnoea
D. Superior venacaval syndrome
# Screening method for medullary carcinoma thyroid is:
A. Serum calcitonin
B. Serum calcium
C. Serum alkaline phosphatase
D. Serum acid phosphatase
# Carcinoma thyroid with blood borne metastasis is:
A. Follicular
B. Papillary
C. Mixed
D. Anaplastic
# Lateral aberrant thyroid refers to:
A. Congenital thyroid abnormality
B. Metastatic foci from primary in thyroid
C. Struma ovarii
D. Lingual thyroid
# A patient has pituitary tumor and pheochromocytoma and a thyroid nodule. Which carcinoma is most likely to occur ?
A. Follicular
B. Medullary
C. Papillary
D. Anaplastic
# NOT a feature of de Quervain's disease:
A. Autoimmune in etiology
B. Increased ESR
C. Tends to regress spontaneously
D. Painful and associated with enlargement of thyroid
# Treatment of thyroid storm includes all, EXCEPT :
A. Propranolol
B. Radioactive iodine
C. Hydrocortisone
D. Lugol's iodine
# In case of hypothyroidism, which investigation is most informative and most commonly used ?
A. Serum TSH level
B. Serum T3, T4 level
C. Serum Calcitonin assay
D. Serum TRH assay
# Patient after thyroid surgery presents with perioral paraesthesia, serum calcium level is 7 mg/dL. What will be the best management ?
A. Oral Vit D3
B. Oral vit D3 and Ca
C. IV calcium gluconate
D. Oral calcium
# Therapy of choice for diffuse toxic goiter in a patient over 45 years is :
A. Surgery
B. Antithyroid drugs
C. Radio iodine
D. Antithyroid drugs first followed by surgery
# What percentage of cold thyroid nodules are malignant ?
A. 70 - 80 %
B. 50 - 60 %
C. 40 - 50 %
D. 10 - 20 %
# Absolute indication for surgery in hyperparathyroidism is :
A. Serum calcium < 2.85 mmol/lit
B. Increased bone density
C. Urinary Tract calculi
D. Patient more than 50 years of age
# The commonest thyroid malignancy is:
A. Anaplastic
B. Follicular
C. Papillary
D. Medullary
# Treatment of choice for mixed parotid tumor is :
A. Enucleation
B. Superficial parotidectomy
C. Radical parotidectomy
D. Radiation
# Which of the following is the most common complication of radioiodine treatment of Grave's disease ?
A. Thyroid storm
B. Subacute thyroiditis
C. Thyroid cancer
D. Hypothyroidism
# Which one of the following nerves is not encountered during submandibular gland resection ?
A. Lingual nerve
B. Hypoglossal nerve
C. Accessory nerve
D. Marginal mandibular nerve
# First investigation for solitary thyroid nodules is:
A. Thyroid scan
B. CT scan
C. MRI
D. FNAC
# A patient is wide eyed, very nervous with increased systolic pressure, increased pulse rate, fine skin and hair and loss of body weight. He is probably suffering from ?
A. Hypothyroidism
B. Hyperthyroidism
C. Hyperpituitarism
D. Hyperparathyroidism
# Which is more dangerous after a thyroidectomy resulting in acute respiratory distress ?
A. Damage to external laryngeal nerve
B. Unilateral complete damage to recurrent laryngeal nerve
C. Unilateral partial damage to recurrent laryngeal nerve
D. Bilateral partial section of recurrent laryngeal nerve
# Causes for primary hyperparathyroidism:
A. Parathyroid carcinoma
B. Renal failure
C. Rickets
D. Malabsorption
# All of the following are features of hyperthyroidism EXCEPT :
A. Thin person
B. Decreased waist:hip ratio
C. Excessive sleep
D. Increased muscular activity
# The following are true of primary thyrotoxicosis EXCEPT:
A. Tremors
B. Warm extremities
C. Diarrhea
D. Intolerance to cold
# Which one of the following feature is not associated with primary hyperparathyroidism ?
A. Giant cell tumor
B. Sharply defined radiolucencies of maxilla and mandible
C. Partial loss of lamina dura
D. Hypercementosis
# Treatment of choice in cold nodule of thyroid :
A. Subtotal thyroidectomy
B. I-131
C. Hemithyroidectomy
D. Excision of Nodule
# Thyroid carrcinoma with pulsating vascular skeletal metastasis is:
A. Follicular
B. Anaplastic
C. Medullary
D. Papillary
# Pleomorphic adenomas arising from the minor salivary glands can be treated with :
A. Local excision with 2 mm margin
B. Local excision with 5 mm margin
C. Radiotherapy
D. Chemotherapy
# Which of the following statements is true regarding thyroglobulin?
A. It is a specific marker for anaplastic carcinoma
B. Elevation after complete therapy suggests recurrence in well-differentiated thyroid malignancies
C. Preoperative elevation always suggests thyroidal disease
D. Intra operative estimation from thyroid veins is very useful for prognosis
# "Thyroid storm" is treated by following EXCEPT:
A. Aspirin for Hyperpyrexia
B. Propranolol
C. Dehydration is corrected
D. Sodium iodide
# Cricothyroidotomy is contraindicated in:
A. Age below 5 years
B. Age between 15-20 years
C. Age between 20-30 years
D. Age between 30-40 years <<< VIEW PART 1PRACTICE MORE MCQs >>>
Click HERE to view all our MCQ Topics. # Which is the most common cause of hypothyroidism ?
A. Multinodular goitre
B. Lymphoma of thyroid
C. Autoimmune thyroiditis
D. Reidel's thyroiditis
# The treatment of anaplastic carcinoma of thyroid is :
A. Total thyroidectomy
B. Palliative radiotherapy
C. Radioactive idoine
D. Tracheostomy
# The histopathologic feature of medullary carcinoma of thyroid is :
A. Anaplasia
B. Mitotic figures
C. Psammoma bodies
D. Amyloid stroma
# The most common level of thyroglossal cyst is :
A. Lingual
B. Infra-lingual
C. Supra-hyoid
D. Infra-hyoid
# All the following are seen in thyrotoxicosis except:
A. Tremor
B. Increased temperature
C. Slow pulse rate
D. Exophthalmos
# The cyst that moves by protruding the tongue is:
A. Thyroglossal cyst
B. Median rhomboid cyst
C. Ranula
D. Tracheal cyst
# A 45 year old woman has a nodule in the neck which moves during swallowing. The nodule most probably is attached to :
A. Thyroid
B. Larynx
C. Oesophagus
D. Pharynx
# Thyroglossal fistula is :
A. Lined by squamous epithelium
B. Causes a bulge in the neck
C. Inflammatory lesion
D. Precancerous lesion
# Symptoms of hyperthyroidism include:
A. Intolerance to cold
B. Decreased appetite
C. Weight gain
D. Palpitations
# Symptoms of hypothyroidism include :
A. Intolerance to heat
B. Diarrhoea
C. Loss of weight
D. Menstrual disturbance
# FNAC (Fine needle aspiration cytology) can diagnose all the following except:
A. Papillary carcinoma of thyroid
B. Follicular carcinoma of thyroid
C. Anaplastic carcinoma of thyroid
D. Medullary carcinoma of thyroid
# Thyroglosal cyst is most often located:
A. Near hyoid bone
B. At the base of the tongue
C. Submandibular
D. Opposite cricoid cartilage
# Retrosternal goiter :
A. Causes stridor
B. Obtains its blood supply from thoracic vessels
C. Characteristically malignant
D. Must be removed by thoracotomy
# Hashimoto's disease is :
A. Agranulomatous thyroiditis
B. An autoimmune thyroiditis
C. Fibrous thytoiditis
D. A viral infection of the thyroid gland
E. None of the above
# A patient with increased metabolic rate, hyperthyroidism, goiter and have deposits of calcium in capsule of thyroid, It can be due to:
A. Follicular carcinoma of thyroid
B. Medullary carcinoma of thyroid
C. De Quervain's thyroiditis
D. Riedel's thyroiditis
# Tachycardia, nervousness, intolerance to heat and exophthalmos is seen in:
A. Hyperthyroidism
B. Hypothyroidism
C. Hyperparathyroidism
D. Hypoparathyroidism
# Sistrunk's operation is done for:
A. Thyroglossal cyst
B. Thyroglossal fistula
C. Both of the above
D. None of the above
# Follicular carcinoma of thyroid is best treated by :
A. Hemithyroidectomy
B. Near total thyroidectomy
C. Sub total thyroidectomy
D. Radiotherapy alone
# Which of the following is true for thyrotoxicosis ?
A. In Grave's disease, antibodies are formed to TSH receptors which results in excessive thyroxine secretion
B. Hashimoto's thyroiditis occurs in young males
C. In primary hypothyroidism, decreased TSH levels are seen.
D. In Grave's Disease, no antibodies are formed to TSH receptors which result in decreased thyroxine secretion
# The origin of thyroglossal duct is:
A. Foramen caceum
B. Tuburculum impar
C. Rathke's pouch
D. Rosenmiller's fossa
# A cold nodule in thyroid on thyroid scintiscan mean:
A. Nodule which is cold
B. Hyperactive nodule
C. Nodule which is nonfunctioning and malignant
D. Nodule which has no signs of inflammation
# The only reason for operating in case of thyroiditis is:
A. To prevent cancerous degeneration
B. For relief of pain in neck and ear
C. To overcome pressure on trachea or oesophagus
D. To cure the toxic reaction
# The carcinoma of thyroid associated with hypocalcemia is :
A. Papillary cancer
B. Medullary cancer
C. Follicular cancer
D. Anaplastic cancer
# Toxic adenoma on scanning appear as:
A. Hot nodule
B. cold nodule
C. Warm nodule
D. Neutral
# Thyroid carcinoma :
A. is often associated with hypothyroidism
B. often producess hyperthyroidism
C. is usually euthyroid
D. occurs in toxic nodules
# All of the following regarding papillary carcinoma thyroid are true except:
A. Multicentric origin
B. Secondary to lymph nodes
C. Slowly growing
D. Bony metastasis in early age
# Commonest thyroid malignancy is :
A. Medullary carcinoma
B. Follicular adenoma
C. Anaplastic carcinoma
D. Papillary carcinoma
# Lymph node metastasis is commonest in:
A. Follicular
B. Papillary
C. Anaplastic
D. Medullary
# Orphan Annie eyed nuclei is the characteristic histologic appearance seen in:
A. Papillary carcinoma thyroid
B. Follicular carcinoma thyroid
C. Medullary carcnoma thyroid
D. Hashimoto's thyroiditis
# Therapy of choice for diffuse toxic goiter in a patient over 45 years is :
A. Surgery
B. Antithyroid drugs
C. Radio iodine
D. Antithyroid drugs first followed by surgery
# Thyroglossal fistula develops due to:
A. Developmental anomaly
B. Injury
C. Incomplete removal of thyroglossal cyst
D. Inflammatory disorder
# Most common cause of Hypercalcemic crisis is:
A. Parathyroid adenoma
B. Parathyroid hyperplasia
C. Carcinoma breast
D. Paget's disease
# A patient has hypocalcemia which was the result of a surgical complication. Which operation could it possibly have been?
A. Nephrectomy
B. Thyroidectomy
C. Gastrectomy
D. Vocal cord tumor biopsy
# Hyperparathyroidism is characterized by the following except:
A. Generalised osteoporosis
B. Renal calculi
C. Hypercalcemia
D. Osteosclerosis
# After thyroidectomy, patient developed stridor within 2 hours. All are likely cause of stridor except:
A. Hypocalcemia
B. Recurrent laryngeal nerve palsy
C. Laryngomalacia
D. Wound hematoma
# A ranula is a :
A. type of epulis
B. Sublingual thyroid
C. Thyroglossal cyst
D. Cystic swelling in the floor of the mouth
# Mickulicz's disease is :
A. an inflammatory disease
B. neoplastic disease
C. an autoimmune disease
D. Viral infection
# A condition of the mouth which increases the caries activity in the oral cavity is :
A. Xerostomia
B. Hairy tongue
C. Fissured tongue
D. Watery saliva
# Reduction in flow of the saliva is not generally seen in:
A. elderly diabetics
B. patients undergoing radiation therapy
C. patients suffering from parkinsonism
D. patients on phenothiazine drugs
# Adenoid cystic carcinoma is also known as:
A. Cylindroma
B. Pindborg tumor
C. Warthins tumor
D. Pleomorphic adenoma
# Anatomical structure injured in excision of ranula is :
A. Lingual vein
B. Lingual artery
C. Submandibular duct
D. Parotid duct
# Stones are maximum in:
A. Parotid gland
B. Submandibular gland
C. Pancreas
D. Sublingual gland
# All are seen in Sjogren's syndrome except :
A. Positive antinuclear factor
B. Decreased immunoglobulins
C. Raised ESR
D. Positive Rheumatoid factor
# Parotid tumor which spreads perineurally is:
A. Mucoepidermoid carcinoma
B. Epidermoid carcinoma
C. Carcinoma in pleomorphic adenoma
D. Adenoid cystic carcinoma
# Treatment of submandibular salivary gland duct calculi is :
A. Excision of submandibular gland
B. Opening of the duct at the frenulum
C. Opening of the duct and removal of calculus
D. Excision of gland and duct
# Sjogren's syndrome is associated with:
A. Rheumatoid arthritis
B. SLE
C. Scleroderma
D. All of the above
# The commonest parotid tumor is :
A. Pleomorphic adenoma
B. Warthins tumor
C. Adenoid carcinoma
D. None of the above
# Adenolymphoma refers to :
A. Warthin's tumor
B. Pleomorphic adenoma
C. Adenocarcinoma
D. Adenocystic carcinoma
# In submandibular gland surgery, the nerve least likely to be injured is:
A. Inferior alveolar nerve
B. Lingual nerve
C. Hypoglossal nerve
D. Mandibular branch of facial nerve
# In case of parotid swelling, the diagnostic procedure of choice is:
A. FNAC
B. Superficial Parotidectomy
C. Enucleation
D. Excision biopsy
