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The N95 respirator mask is essential when handling patients with tuberculosis because it filters out airborne particles, including the Mycobacterium tuberculosis bacteria, which are transmitted via airborne droplet nuclei. Unlike surgical or cloth masks, the N95 provides a tight seal around the face, ensuring effective protection against inhalation of infectious aerosols. This is critical in preventing nosocomial transmission among healthcare workers and other patients. Surgical masks do not offer sufficient filtration for airborne pathogens like tuberculosis. Therefore, an N95 respirator is the recommended PPE for airborne precautions in TB cases.

Reference: Harrison's Principles of Internal Medicine, Fauci et al., 20th Edition.
The primary route of transmission for MRSA in hospitals is direct contact with infected surfaces or people. MRSA colonizes the skin and mucous membranes, making it easily transferable through touch. Healthcare workers' hands and contaminated medical equipment are common sources, leading to cross-contamination between patients. Unlike airborne pathogens, MRSA does not spread efficiently through droplets or air. Therefore, strict hand hygiene and environmental cleaning are critical to prevent its transmission in healthcare settings.

Reference: Principles of Infectious Diseases, Mandell, Douglas, and Bennett, 9th Edition.
Recapping needles after use is discouraged because it significantly increases the risk of needlestick injuries, which can transmit bloodborne pathogens such as HIV and hepatitis B or C. Instead, used needles should be immediately disposed of in an approved sharps container without recapping. This practice is a critical component of standard precautions to protect healthcare workers from exposure to infectious materials. Proper hand hygiene, use of gloves, and wearing masks during procedures with splash risk are recommended, but recapping needles is not standard precaution for infection prevention.

Reference: Infection Control and Hospital Epidemiology, J. S. Bennett et al., 6th Edition.
A surgical scrub should typically last 2-6 minutes to effectively reduce the microbial load on the hands and forearms. This duration allows the antiseptic agent to adequately penetrate skin crevices and remove transient and resident flora, thereby minimizing the risk of surgical site infections. Shorter scrubs, such as 30 seconds or 1 minute, are insufficient to achieve this microbial reduction, while excessively long scrubs may cause skin irritation without added benefit. Maintaining this recommended time frame ensures optimal hand antisepsis before sterile procedures.

Reference: Sabiston Textbook of Surgery, Townsend et al., 21st Edition.
Ethylene oxide (ETO) gas is the preferred sterilization method for heat-sensitive medical instruments such as endoscopes because it operates at low temperatures (30-60°C), preventing damage to delicate materials and electronics. Unlike autoclaving or dry heat, which require high temperatures, ETO effectively penetrates complex device lumens and packaging to ensure comprehensive sterilization. It is highly effective against all microorganisms, including spores, without compromising the integrity or function of sensitive instruments. Hence, ETO maintains the sterility and longevity of heat-labile medical equipment.

Reference: Principles and Practice of Infectious Diseases, Mandell, Douglas, and Bennett, 9th Edition.
The minimum recommended alcohol concentration for effective hand sanitizers is 60%. Alcohol solutions below this concentration are less effective in denaturing proteins and disrupting lipid membranes of microorganisms, including viruses and bacteria. Solutions with at least 60% alcohol rapidly kill most pathogens by penetrating their cell walls, leading to cell lysis and death. Concentrations above 60% ensure optimal antimicrobial activity without excessive evaporation that reduces contact time. Thus, a minimum of 60% alcohol is essential for effective antiseptic action and infection control.

Reference: Centers for Disease Control and Prevention (CDC) Guidelines for Hand Hygiene, 2021 Edition.
Hydrogen peroxide (6-7.5%) is effective against bacterial spores due to its strong oxidizing properties, which disrupt essential cellular components including DNA and enzymes. This leads to irreversible damage, making it sporicidal. In contrast, disinfectants like chlorhexidine and alcohol lack the ability to penetrate and destroy spores effectively. The concentration of hydrogen peroxide is critical; at 6-7.5%, it ensures sufficient release of reactive oxygen species to kill resilient spores. This makes it particularly valuable for sterilizing surgical instruments and surfaces where spore-forming bacteria may be present.

Reference: Medical Microbiology, Murray et al., 8th Edition.
Handwashing with soap and water is an example of medical asepsis because it reduces the number of microorganisms and prevents their spread, but does not eliminate all pathogens completely. It is a key technique to maintain a clean environment and minimize infection risk during routine care. In contrast, wearing a sterile gown, using a sterile drape, and sterilizing instruments are practices of surgical asepsis, aiming to create and maintain a completely sterile field. Therefore, handwashing exemplifies the principle of clean technique (medical asepsis), which focuses on reducing contamination rather than achieving total sterility.
Reference: Medical-Surgical Nursing, Ignatavicius & Workman, 9th Edition.
The primary purpose of surgical asepsis is to maintain a sterile field during invasive procedures. This practice eliminates all microorganisms to prevent contamination of the surgical site, thereby reducing the risk of postoperative infections. Maintaining sterility is critical because any breach can introduce pathogens directly into sterile tissues. Ensuring a sterile environment protects patient safety and promotes optimal surgical outcomes. Therefore, strict adherence to surgical asepsis principles is essential during all invasive procedures to prevent infection and complications.

Reference: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Hinkle & Cheever, 15th Edition.

ফ্রিতে ২ লাখ প্রশ্নের টপিক, সাব-টপিক ভিত্তিক ও ১০০০+ জব শুলুশন্স বিস্তারিতে ব্যাখ্যাসহ পড়তে ও আপনার পড়ার ট্র্যাকিং রাখতে সাইটে লগইন করুন।

লগইন করুন
Autoclaving at 121°C for 15 minutes is the most reliable method for sterilizing heat-resistant surgical instruments because it uses steam under pressure to achieve complete microbial kill, including bacterial spores. The high temperature and pressure combination ensures rapid and effective sterilization, surpassing methods like boiling or chemical soaking. This method maintains instrument integrity while ensuring sterility, crucial for preventing postoperative infections. Autoclaving is the gold standard for sterilizing surgical tools due to its proven efficacy and reproducibility in clinical settings.

Reference: Medical Microbiology, Murray et al., 9th Edition.
Proper waste segregation in wards and OTs is crucial to prevent infections and injuries caused by biomedical waste such as sharps and infectious materials. Segregation ensures that hazardous waste is separated from general waste, minimizing the risk of accidental needle sticks, cross-contamination, and spread of healthcare-associated infections. This practice protects healthcare workers, patients, and waste handlers from biological hazards and supports effective infection control protocols essential in clinical environments. Correct segregation also facilitates safe and compliant disposal of biomedical waste, reducing potential environmental and health risks.

Reference: Medical Surgical Nursing, Brunner & Suddarth, 14th Edition.

Triage in the OPD prioritizes patients based on the urgency of their conditions, ensuring critically ill patients receive immediate care while non-urgent cases wait longer. This system reduces overcrowding by managing patient flow efficiently, which lowers the risk of cross-infection in a busy clinical environment. By streamlining patient assessment, triage also enhances staff safety by preventing exposure to potentially infectious or unstable cases without proper preparation. Overall, triage optimizes resource allocation and safeguards both patients and healthcare workers from preventable harm.

Reference: Davidson’s Principles and Practice of Medicine, Haslett, Edition 23.
Ensuring proper sterilization of surgical instruments is a critical safety measure in the Operation Theatre (OT) because it prevents surgical site infections (SSIs) caused by microbial contamination. Sterilized instruments eliminate all forms of microbial life, reducing the risk of postoperative complications and promoting patient safety. Maintaining strict sterilization protocols is essential to uphold aseptic technique and ensure successful surgical outcomes. Any lapse in sterilization can lead to severe infections, delayed healing, or even life-threatening conditions.

Reference: Bailey & Love's Short Practice of Surgery, Norman S Williams, Edition 27.
Strict adherence to hand hygiene protocols is the most effective way to prevent hospital-acquired infections (HAIs) because hands are the primary vehicle for the transmission of pathogens between patients, healthcare workers, and the environment. Proper hand hygiene significantly reduces microbial load on the skin, interrupting the chain of infection. This simple yet crucial practice is proven to decrease the incidence of surgical site infections and other HAIs in wards and operating theaters. Other measures are supportive but cannot replace the fundamental role of hand hygiene in infection control.

Reference: Bailey & Love's Short Practice of Surgery, Norman Williams, 27th Edition.
Surgical gloves are essential for maintaining a sterile barrier to prevent infection transmission between patient and surgeon. A tear compromises this barrier, increasing the risk of contamination and surgical site infection. Immediate cessation of the procedure allows for safe removal and replacement of gloves to restore sterility. Additionally, washing hands after glove removal helps eliminate any potential contaminants that may have contacted the skin through the tear. Continuing with torn gloves or ignoring the tear risks spreading pathogens and endangering patient safety. Applying tape does not restore an effective sterile barrier. Patient safety and infection control mandate immediate glove change upon breach.

Reference: Sabiston Textbook of Surgery, Townsend CM Jr., 21st Edition.
The gold standard for sterilizing instruments exposed to hepatitis B virus (HBV) is autoclaving at 121°C for 15 minutes because HBV is a resilient, heat-resistant virus that requires steam under pressure to achieve complete inactivation. Autoclaving ensures penetration of moist heat, effectively destroying all microbial life, including spores and viruses like HBV. Boiling, alcohol soaking, or washing with soap and water do not reliably inactivate HBV on instruments. Thus, autoclaving provides the most consistent and safe sterilization in clinical practice.

Reference: Medical Microbiology, Murray et al., 9th Edition.
For procedures with a splash risk, such as trauma surgery, wearing gloves, goggles, and a fluid-resistant gown is mandatory to protect against exposure to blood and bodily fluids. Gloves prevent hand contamination, goggles shield the eyes from splashes, and a fluid-resistant gown protects clothing and skin from fluid penetration. This comprehensive PPE minimizes the risk of infection transmission to healthcare workers, maintaining a sterile field and ensuring safety. Partial protection, like gloves or masks alone, is insufficient in splash-risk settings.

Reference: Surgical Care at the District Hospital, David H. Walker, 2nd Edition.
The immediate action after a needlestick injury with HIV-positive blood is to wash the area thoroughly with soap and water. This helps to reduce the viral load at the site of injury and lowers the risk of HIV transmission. Using soap and water ensures effective mechanical removal of blood and potential virus particles. Alcohol-based sanitizers do not replace washing and may be insufficient. Prompt cleansing is critical before any further post-exposure prophylaxis measures. Delaying or ignoring this step increases the risk of infection.

Reference: Harrison's Principles of Internal Medicine, Fauci et al., 20th Edition.

ফ্রিতে ২ লাখ প্রশ্নের টপিক, সাব-টপিক ভিত্তিক ও ১০০০+ জব শুলুশন্স বিস্তারিতে ব্যাখ্যাসহ পড়তে ও আপনার পড়ার ট্র্যাকিং রাখতে সাইটে লগইন করুন।

লগইন করুন
Blunt-tip suture needles significantly reduce the risk of penetrating injuries during tissue handling, especially in deep or dense tissues where sharp needles can easily cause accidental punctures. Their design allows effective suturing with minimal risk of needlestick injury to surgeons and scrub staff. Studies have shown that using blunt needles can reduce injuries by up to 70% compared to conventional sharp needles, making them the most effective preventive measure in the operating room. This method directly addresses the primary cause of injuries—accidental skin puncture—without compromising surgical efficacy.

Reference: Sabiston Textbook of Surgery, Townsend et al., 21st Edition.
The patient exhibits signs of wound dehiscence with visible bowel, indicating an evisceration, a surgical emergency. Immediate action is to cover the exposed bowel with sterile saline-moistened gauze to prevent desiccation and contamination, minimizing risk of infection and further injury. Prompt referral for emergency reoperation is critical to properly repair the wound and prevent life-threatening complications such as bowel ischemia or sepsis. Attempting to close the wound bedside or simply observing risks worsening the patient’s condition. Oral antibiotics alone do not address the urgency of surgical repair.

Reference: Sabiston Textbook of Surgery, Townsend et al., 21st Edition.
The ingestion of a button battery lodged in the esophagus is an emergency due to the risk of rapid tissue necrosis from electrical discharge, pressure necrosis, and leakage of caustic contents. The presence of drooling suggests esophageal obstruction or injury. Immediate endoscopic retrieval is critical to prevent severe complications such as perforation, fistula formation, or mediastinitis. Delay in removal increases the risk of fatal outcomes. Thus, urgent transfer to a facility capable of endoscopic battery extraction is the correct management.

Reference: Nelson’s Textbook of Pediatrics, Kliegman R, 21st Edition.
Flail chest causes paradoxical chest wall movement leading to ineffective ventilation and hypoxia. Positive-pressure ventilation stabilizes the chest wall internally, improves oxygenation, and decreases the work of breathing. Immediate referral to a trauma center ensures specialized management of associated injuries. Chest physiotherapy or oral analgesics alone are insufficient for respiratory compromise in flail chest. Chest tube insertion is indicated only if there is a pneumothorax or hemothorax, not as primary treatment for flail chest. Early ventilatory support is critical to prevent respiratory failure and reduce mortality.

Reference: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Judith E. Tintinalli, 9th Edition.
The presence of necrosis, crepitus, and foul odor in a diabetic foot ulcer indicates a severe soft tissue infection, likely necrotizing fasciitis or gas gangrene. This condition requires immediate surgical debridement to remove all necrotic tissue and halt the spread of infection. Intravenous broad-spectrum antibiotics are essential to control systemic infection and sepsis. Delay in surgical intervention significantly increases mortality and limb loss risk. Conservative measures alone are insufficient due to rapid progression. Early aggressive treatment is crucial for patient survival and limb salvage.

Reference: Harrison's Principles of Internal Medicine, Kasper et al., 20th Edition.
The priority in a suspected ruptured abdominal aortic aneurysm (AAA) with hypotension is permissive hypotension to maintain a low but adequate blood pressure, minimizing further bleeding. Aggressive fluid resuscitation can increase blood pressure and worsen hemorrhage. Immediate surgical referral is critical as definitive management requires urgent repair of the aneurysm. Delays for imaging or inappropriate medical management increase mortality. This approach stabilizes the patient just enough to survive until emergency surgery.

Reference: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, Judith E. Tintinalli, 9th Edition.
The sudden onset of chest pain, hypoxia, and tachycardia in a post-operative patient strongly suggests pulmonary embolism (PE), a life-threatening emergency. The immediate priority is to ensure adequate oxygenation to prevent hypoxic injury; therefore, providing high-flow oxygen is critical. Simultaneously, urgent escalation of care with emergency transfer to a higher-level facility enables prompt diagnostic workup and treatment. Delaying oxygen or transfer increases morbidity and mortality. Initiating anticoagulation or diagnostic tests without stabilization may risk delay or harm. Hence, oxygen and emergency transfer are the first essential steps.
Reference: Harrison’s Principles of Internal Medicine, Jameson et al., 20th Edition.
The correct immediate action is to cover the wound with a sterile, moist dressing to protect the exposed intestines from contamination and prevent drying out, which can cause tissue damage. Do not attempt to push the intestines back in as this can cause further injury and increase the risk of infection. A moist dressing maintains tissue viability while minimizing bacterial invasion until surgical intervention can be performed. Avoid giving oral fluids in case surgery is urgently required. This approach reduces morbidity and improves patient outcomes in penetrating abdominal trauma.

Reference: Sabiston Textbook of Surgery, Courtney M. Townsend Jr., 21st Edition.
The ultrasound features of a thyroid nodule—hypoechoic texture, irregular margins, and microcalcifications—are highly suspicious for malignancy. Fine-needle aspiration (FNA) biopsy is the most accurate and minimally invasive method to obtain cytological diagnosis, guiding further management. Early identification of malignant cells allows for timely surgical intervention if needed. Other options like thyroid hormone therapy or observation do not provide diagnostic clarity, and radioactive iodine scan is less sensitive for initial evaluation of suspicious nodules. Therefore, FNA is the next essential diagnostic step to confirm or exclude thyroid cancer.

Reference: Harrison's Principles of Internal Medicine, Kasper et al., 20th Edition.
The ABG shows a low pH (7.25), indicating acidemia. The PaCO₂ is low (30 mmHg), which is a respiratory compensation for a primary metabolic disturbance. The bicarbonate (HCO₃⁻) is decreased at 18 mEq/L, confirming a primary metabolic acidosis. In post-op patients, metabolic acidosis commonly results from tissue hypoperfusion, lactic acid accumulation, or renal impairment. The respiratory system compensates by hyperventilating to decrease PaCO₂ and mitigate acidemia. Thus, the findings are consistent with primary metabolic acidosis with respiratory compensation.

Reference: Clinical Anesthesia, Barash, 7th Edition.

ফ্রিতে ২ লাখ প্রশ্নের টপিক, সাব-টপিক ভিত্তিক ও ১০০০+ জব শুলুশন্স বিস্তারিতে ব্যাখ্যাসহ পড়তে ও আপনার পড়ার ট্র্যাকিং রাখতে সাইটে লগইন করুন।

লগইন করুন
Thumbprinting on abdominal X-ray refers to the appearance of rounded mucosal indentations protruding into the lumen, caused by submucosal edema or hemorrhage. This radiologic sign is classically associated with ischemic colitis, where compromised blood flow leads to mucosal and submucosal swelling. Unlike inflammatory bowel diseases or colon cancer, ischemic colitis predominantly shows this pattern due to acute vascular insufficiency affecting the colon wall, making thumbprinting a hallmark imaging feature in ischemic injury diagnosis.

Reference: Bailey & Love's Short Practice of Surgery, R. C. Russell, 27th Edition.
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