afrimedqa/afrimedqa_v2 huggingface dataset:
Specialty: Obstetrics_and_Gynecology
In the Kenyan protocol for the prevention and treatment of malaria in pregnancy, which of the following statements is TRUE? 

Answer options: option1: Sulfadoxine Pyrimethamine (SP) should not be given concomitantly with antiretrovirals
option2: The recommended treatment for uncomplicated malaria in the first trimester is a three-day course of artemether lumefantrine (AL)
option3: Dihydroartemisinin Piperaquine may be used as IPTp for those who are allergic to sulfur
option4: Sulfadoxine - Pyrimethamine (SP) for IPTp should be given concomitantly with IFAS for prevention of malaria and anaemia in pregnancy.
option5: The dose of IV quinine for the treatment of severe malaria in pregnancy, should be adjusted in patients with renal insufficiency
Correct answer: option4
Specialty: Obstetrics_and_Gynecology
When a patient presents with cord prolapse, which of the following statements is 
INCORRECT? 

Answer options: option1: Funic presentation refers to the cord being below the presenting part, with intact membranes and not palpable on digital vaginal exam.
option2: If the cord is pulsatile, a rapid cesarean section is the best management for overt prolapse.
option3: Occult prolapse may be overcome by appropriate positioning of the patient
option4: A full bladder may avert bad outcomes,
option5: Avoiding early ARM in patients with high presenting part is advised to prevent cord prolapse.
Correct answer: option1
Specialty: Obstetrics_and_Gynecology
A 46 years old nulliparous female presents to a fertility clinic with desire to conceive. Her menses have in the recent past been widely spaced and she occasionally experiences hot flushes. A pelvic ultrasound done is reported as normal. Which of the following tests is a useful investigation for ovarian reserve? 

Answer options: option1: FSH:LH ratio
option2: Anti-Mullerian Hormone
option3: Estradiol level
option4: LH levels
option5: None of the above
Correct answer: option2
Specialty: Obstetrics_and_Gynecology
Violet, a 36-year-old para 0+2 presents with symptoms innkeeping with Hyperemesis gravidarum. Investigations reveal a uterine snow-storm appearance and hyperthyroidism. Which of the following will explain her presentation? 

Answer options: option1: Complete Molar pregnancy
option2: Partial molar pregnancy
option3: Grave's disease
option4: Hashimoto's disease
option5: None of the above
Correct answer: option1
Specialty: Obstetrics_and_Gynecology
Female sexual arousal disorders are defined primarily in terms of a deficiency in a physical or psychological response, and as a result may be caused by a range of physical or psychological factors, including: 

Answer options: option1: Hormone imbalance
option2: Diabetes
option3: Medications being taken for other disorders
option4: All the above
option5: None of the above
Correct answer: option4
Specialty: Obstetrics_and_Gynecology
You are called to review Maria, a 17-year-old who has just delivered a 3.9 kg baby and subsequently developed PPH. You perform a quick assessment and find her to have a tear extending from the vagina, to involve the perineal muscles and the anal sphincters (internal and external) without involvement of the anorectal mucosa. Which of the following statements is true about her? 

Answer options: option1: She disobeyed the midwives hence she suffered the tear
option2: Secondary repair should be done after 24 hours
option3: She suffered a 3rd degree tear
option4: She can be repaired perfectly by an intern on duty
option5: All of the above
Correct answer: option3
Specialty: Obstetrics_and_Gynecology
Which of the following statements is correct concerning operative abdominal delivery? 

Answer options: option1: A hemogram, renal function test and grouping/crossmatch are mandatory tests before a caesarian section is done
option2: Maternal morbidity and mortality from a caesarian section is not higher than vaginal
option3: There is documented evidence that a classical uterine incision is better than a lower uterine segment transverse incision
option4: There is no role in prophylactic antibiotics in elective caesarian sections
option5: The sub-umbilical midline incision is the most popular abdominal entry technique in JOORTH
Correct answer: option1
Specialty: Obstetrics_and_Gynecology
A 32-year-old female, known hypertensive patient on losartan/hydrochlorothiazide, presents for pre-conception care, ALL of the following are advised EXCEPT? 

Answer options: option1: Folic Acid supplementation
option2: Quit alcohol and cigarette smoking
option3: Change blood pressure medication to Methyldopa
option4: Encourage her to take liver at least three times a week to improve iron stores
option5: Advise her to start ANC when she learns that she is pregnant.
Correct answer: option4
Specialty: Obstetrics_and_Gynecology
In the consideration, evaluation and management of persistent breech presentation:

Answer options: option1: When the estimated fetal weight is less than 1500 gms. vaginal delivery is usually without risk
option2: External Cephalic Version may be offered at 28 weeks with the aim of a consequent vertex delivery
option3: A well-flexed fetal neck is necessary for a vaginal breech delivery
option4: The fetal bisacromial diameter is smaller than the intertrochanteric diameter
option5: The Lovset maneuver is used to overcome head entrapment.
Correct answer: option3
Specialty: General_Surgery
Boundaries of the inguinal canal 
Rationale: •	2 muscles, 2 aponeuroses, 2 ligaments, 2Ts 
•	M-roof-internal oblique and transverse abdominis muscle 
•	A-Anterior- aponeurosis of internal and external oblique muscle 
•	L-Floor-inguinal ligament and Lacunar ligament 
•	T-posterior-transversalis fascia, conjoined tendon
Specialty: General_Surgery
What are the types of inguinal hernia and risk factors 
Rationale: 
•	Direct  
•	Indirect  
 
Risk factors of inguinal hernia 
•	Straining. 
•	Lifting of heavy weight. 
•	Chronic cough (tuberculosis, chronic bronchitis, 
•	bronchial asthma, emphysema). 
•	Chronic constipation (habitual, rectal stricture). 
•	Urinary causes 
–	Old age: BPH, carcinoma prostate. 
–	Young age: stricture urethra. 
–	Very young age: phimosis, meatal stenosis. 
•	Obesity. 
•	Pregnancy and pelvic anatomy (especially in femoral 
•	hernia in females). 
•	Smoking. 
•	Ascites. 
•	Appendicectomy through McBurney’s incision may injure the ilioinguinal nerve causing right-sided direct inguinal hernia. 
•	Familial-collagen disorder—Prune Belly syndrome.
Specialty: General_Surgery
Complications of the Whipple procedure
Rationale: a)	Hemorrhage (peripancreatic vessels) 
b)	Delayed gastric emptying 
c)	Pancreatic duct leak/ fluid collection/fistula 
d)	Biliary/enteric anastomotic leak  
e)	intraabdominal abscess 
f)	Wound sepsis
Specialty: General_Surgery
Management of pancreatic cancer 
Rationale: •	MDT 
•	Modalities include 
a.	Surgery. Only curative 
b.	Chemotherapy  
c.	radiotherapy 
 
• 	Depending on the degree of contact between the tumor and surrounding vessels (namely the portal vein, superior mesenteric artery or vein, coeliac trunk, and common hepatic artery), Pancreatic tumors are classified as  a. 	resectable,  
b.	borderline resectable 
c.	locally advanced and  
d.	metastatic disease. 
Resectable disease. Whipple’s procedure 
•	Remove head, distal stomach(antrum), proximal jejunum, duodenum, gallbladder and common bile duct.  
•	This is followed by post operative chemotherapy 
Borderline resectable 
•	neo-adjuvant chemotherapy, followed by chemoradiation, prior to surgery non resectable disease 
a.	locally advanced disease- direct contact / invasion of local vessels should undergo chemotherapy. 
b.	Metastatic disease-palliative chemotherapy mainstay.  
•	Those with poor performance status, consider symptomatology control. Relieve symptoms associated with jaundice e.g., pruritus by placement of a biliary stent 
•	If there is exocrine insufficiency, consider enzyme replacement i.e., lipase to control steatorrhea and malabsorption
Specialty: Oncology
Investigations of pancreatic cancer
Rationale: •	Laboratory 
a)	CBC 
b)	LFTs (raised bilirubin, alkaline phosphatase, and gamma-GT). 
c)	Serum albumin 
d)	Coagulation screen 
e)	CA 19-9. Not for diagnosis but elevated in Pancreatic head ca. monitoring response for treatment 
f)	AFP. Rule out HCC 
•	Imaging  
a)	Abdominal ultrasound 
b)	CT imaging. Gold standard for preliminary diagnosis, as well as providing prognostic informative, as it can stage disease progression. A CT chest-abdomen-pelvis scan will be further required once pancreatic cancer has been diagnosed for staging.  
c)	PET-CT scan or MRCP may be useful in unclear diagnostic stages 
d)	Endoscopic Ultrasound (EUS) largely used in the staging of adenocarcinoma, alongside potential tissue biopsy for histological confirmation.
Specialty: Oncology
Clinical presentation of pancreatic cancer 
Rationale: 
a)	Obstructive jaundice – due to compression of the common bile duct (present in 90% of cases at the time of diagnosis), typically painless. PRURITUS 
b)	Weight loss – due to the metabolic effects of the cancer, or secondary to exocrine dysfunction 
c)	Abdominal pain (non-specific) – due to invasion of the coeliac plexus or secondary to pancreatitis 
d)	GOO 
e)	Less common presentations include acute pancreatitis or thrombophlebitis migrans (a recurrent migratory superficial thrombophlebitis, caused by a paraneoplastic hypercoagulable state 
f)	Late-onset diabetes mellitus can be the presenting feature for pancreatic cancer;
Specialty: General_Surgery
Risk factors for head of Pancreas Cancer 
Rationale: a)	Smoking 
b)	chronic pancreatitis 
c)	dietary. High red meat intake 
d)	family history 
e)	age  
f)	DM. patients aged 50 yrs. have 8x greater risk of developing pancreatic carcinoma in the following three years, compared to the general population. 
g)	Alcohol consumption • 	Obesity 
h)	Occupational chemicals beta naphthylamine, benzidine.
Specialty: General_Surgery
Screening and prevention of colorectal ca 
Rationale: 
a)	FOBT every year. Fecal immunohistochemistry test more superior • 	Colonoscopy every 10 years 
b)	Sigmoidoscopy every 5 yrs. 
c)	In high-risk patients i.e., family history   Sigmoidoscopy every 3yrs • Colonoscopy every 5-10 yrs. 
•	Prevention 
a)	Public Education  
b)	Regular screening 
c)	Prophylactic colectomy
Specialty: General_Surgery
Management of colorectal ca 
Rationale: 
•	MDT 
•	Modalities include 
a.	Surgery. Mainstay of cure 
b.	Chemotherapy 
c.	Radiotherapy • Surgical procedures 
a.	Colectomy. Choice based on site of the tumor and the blood supply of the region 
b.	Anterior resection for high rectal tumors>5cm above the anus. Anal sphincters intact 
c.	Abdominoperineal resection for rectal ca < 5cm from the anus. Require permanent colostomy as all the anal sphincters, distal colon and rectum are excised 
•	Chemotherapy 
Adjuvant modality of treatment post-surgery 
Part of palliation in advanced colorectal ca 
•	Radiotherapy  

In rectal ca. rarely in colon ca due to risk of small bowel injury. most often as neo-adjuvant treatment, and can be given alongside chemotherapy (Chemo radiation) to shrink the tumor before surgery.  
Colon ca 
a.	T1/T2/T3/T4- surgery first, followed by chemo if T3/T4 
b.	N1/N2 post op chemo 
c.	M1-chemo radiation & palliative surgery 
Rectal ca 
a.	T1/T2-surgical resection 
b.	T3/T4 or N1/N2-chemoradiation alone, or chemoradiation & surgical resection 
c.	MI-chemoradiation and palliative surgery
Specialty: General_Surgery
Investigations for colorectal ca
Rationale: •	Laboratory 
a)	CBC- microcytic hypochromic anemia 
b)	LFTs 
c)	CEA-not to be used for diagnosis but to monitor treatment 
d)	Coagulation screen 
e)	FOBT-for screening 
f)	Fecal immunohistochemistry test-for screening 
•	Imaging 
a)	Colonoscopy-gold standard. Take biopsies for histology 
b)	Ct scan abdomen pelvis. To check for liver mets 
c)	MRI rectum for rectal cancers 
d)	Endo anal Ultrasound- (for early rectal cancers, T1 or T2 only) to assess suitability for trans-anal resection
Specialty: General_Surgery
Clinical presentation colorectal ca
Rationale:  
Weight loss 
Malignant bowel obstruction features?  

When right-sided colon cancers –  
a)	abdominal pain 
b)	iron-deficiency anemia 
c)	palpable mass in the right iliac fossa, often present late 

Left-sided colon cancers –  rectal bleeding 
a)	change in bowel habit 
b)	tenesmus 
c)	palpable mass in left iliac fossa or on PR exam
Specialty: General_Surgery
What are the commonest sites of colorectal ca
Rationale:  
a)	Rectum-38% 
b)	Sigmoid-20% 
c)	Other sites 
d)	Descending colon 
e)	Transverse colon 
f)	Recto sigmoid junction 
g)	Splenic and hepatic flexure 
h)	caecum 
i)	Ascending colon 
j)	Anus
Specialty: General_Surgery
Principles of management of Lower GI Bleeding
Rationale: •	Approach
a)	Depends on the severity of bleed, patients’ stability, patients vital sign 
b)	For Unstable patients ABCs. Ensure adequate fluid resuscitation. 2 wide bore iv catheters, urinary catheter 
c)	Specific interventions depending on the cause 
•	Bleeding vessels can be 
a)	cauterized,  
b)	clipped,  
c)	rubber band ligated, or  
d)	injected with epinephrine -usually 1:10,000 or 1:20,000 dilution, 
e)	argon laser for Angiodysplasia                

•	surgery indicated for  
a)	A hemodynamically unstable patient with negative CTA and negative OGD/colonoscopy 
b)	The bleeding is unable to be controlled endoscopically 
c)	Necrotic intestine secondary to mesenteric ischemia 
d)	Neoplasia -colorectal ca 
e)	Refractory inflammatory bowel disease,  
f)	Meckel’s diverticulum 
g)	Internal grade 3 and 4 Hemorrhoids 
•	Coagulopathy or thrombocytopenia should be corrected with: 
a)	Vitamin K supplementation  • Fresh frozen plasma,   
b)	Platelet transfusion.  
c)	Discontinue temporarily any antiplatelet or anticoagulant drugs that the patient is taking
Specialty: General_Surgery
Lower GI Bleeding Investigations 
Rationale: 
•	Laboratory 
a)	Full blood count (wbcs- T &D) 
b)	liver function tests,  
c)	renal function,   
d)	Coagulation Screen 
e)	Typing/grouping and crossmatching for blood products 
•	Others  
a)	Anoscopy. Both therapeutic and diagnostic 
b)	Sigmoidoscopy 
c)	Colonoscopy 
d)	CT angiography. Useful for hemodynamically unstable patients 
e)	Nuclear Scintigraphy with Technetium for very slow hemorrhage 
f)	Capsule endoscopy. For stable patients. Useful to detect small bowel abnormalities. 
g)	Balloon enteroscopy. Similar to capsule endoscopy 
h)	Nasogastric lavage to rule out upper GI source of bleeding 
OGD to rule out upper GI source of bleeding
Specialty: General_Surgery
Define lower GI Bleeding and etiology 
Rationale: Bleeding distal to ligament of Treitz Etiology: 
•	Small intestine 
a)	Neoplasm 
b)	Angiodysplasia 
c)	Inflammatory bowel disease 
d)	Mesenteric ischemia 
e)	Recent small intestine surgery 
f)	Meckel’s diverticulum 
g)	Dieulafoy’s lesion 
h)	Aortoenteric fistula 
i)	Intussusception 
•	Colon/rectum 
a)	Diverticulosis-painless bleeding 
b)	Neoplasm 
c)	Angiodysplasia 
d)	Inflammatory bowel disease 
e)	Recent colorectal surgery/colonoscopy/ 
f)	biopsy 
g)	Radiation Proctitis 
h)	Ischemic colitis 
i)	Infectious colitis (Enterohaemorrhagic Escherichia coli-EHEC, Salmonella, 
•	Campylobacter, Shigella, CMV, amoebic infection) 
a)	Rectal varices 
b)	Fecal impaction 
c)	Aortoenteric fistula 
•	Anus 
a)	Hemorrhoids 
b)	Anal fissure 
c)	Inflammatory bowel disease 
d)	Local trauma 
e)	Perianal variceal disease
Specialty: General_Surgery
Management of variceal bleeding 
Rationale: 
a)	ABCs and Resuscitation 
b)	Start octreotide/vasopressin 
c)	Confirm varices on OGD. Endoscopic band ligation and sclerotherapy 
d)	If bleeding stops, patient continues with 7 days of Antibiotics 
If bleeding does not stop, consider balloon tamponade, or surgical shunts
Specialty: General_Surgery
Principles of Management of upper GI bleeding 
Rationale: a)	Multidisciplinary approach to management 
b)	Resuscitate, ABCs. 2 wide bore IV lines for fluid therapy/blood. Collect blood for GXM, FBC, coagulation screen, LFTs 
c)	secure airway. If respiratory compromised, early intubation 
d)	urinary catheter for input, output monitoring. Aim is to prevent multiorgan system failure 
e)	fluid therapy. Replace each milliliter of blood loss with 3 mL of crystalloid fluid. Lactated ringers’ sol 2 litres, else normal saline 
 
TRANSFUSE if:     
 unstable after the initial fluid challenge,  
a)	limited fluid use by cardiopulmonary dx (Packed cells),  
b)	ongoing bleed, 
c)	 high-risk rebleed 
then assess (hx/pe), (define dx), control bleed, prevent recurrence 
depending on the cause stop bleeding/prevent recurrence using
 a) 	pharmacological therapy 
b)	Endoscopic hemostatic therapy  
c)	Angiography (vasoconstrictor or embolization) 
d)	Surgical repair
Specialty: General_Surgery
Forest classification of ulcers on endoscopy 
Rationale: Forest classification of ulcers 
a)	Grade Ia:  Active, pulsatile bleeding.  High Risk 
b)	Grade Ib:  Active, non-pulsatile bleeding. High Risk 
c)	Grade IIa: Nonbleeding visible vessel.  High risk 
d)	Grade IIb: Adherent clot. Intermediate Risk 
e)	Grade IIc: Ulcer with black spot. Low Risk 
f)	Grade III: Clean, nonbleeding ulcer bed.  Low Risk
Specialty: General_Surgery
Investigations for Upper GI Bleeding
Rationale: •	Laboratory 

a)	CBC and differential white cell count 
b)	UECS 
c)	LFTs 
d)	ESR, CRP 
e)	Urinalysis 
f)	Gastrin levels in patients with multiple ulcers 
g)	Coagulation screen. PT, APTT, bleeding time 
h)	H. pylori tests.  
i)	Tumor markers
j)      Fecal Occult Blood test  

•	Imaging 
a)	OGD 
b)	CT scan abdomen 
c)	Chest X ray 
d)	CT angiography 
e)	MRI angiography 
f)	Tagged RBC Scan 
g)	Ultrasonography 

•	Others  
a)	Ng tube lavage.  
b)	ECG before OGD. Risk of cardiac arrest
Specialty: General_Surgery
Define Upper GI Bleeding and causes 
Rationale: Bleeding proximal to the ligament of treitz 

Causes: 
•	Swallowed blood- 
a)	dental,  
b)	ca larynx,  
c)	hemoptysis,  
d)	epistaxis 
•	Esophagus- 
a)	Varices 
b)	Trauma, fish bone 
c)	Mallory Weiss tears 
d)	Aortic aneurysm 
e)	Mediastinal tumors 
f)	Esophagitis 
g)	BoerHaave’s syndrome Stomach 
h)	Gastritis 
i)	Mallory Weiss tears 
j)	Ca stomach 
k)	Dieulafoy lesions 
l)	PUD 
•	Duodenum 
a)	PUD 
b)	Aortoenteric fistula 
c)	invasive ca pancreas/cholangio ca or  
d)	primary tumour, divertivuli 
•	Liver, pancreas, biliary tree  
a)	Haemobilia, 
b)	hemosuccus pancreaticus 
•	Systemic disease:  
a)	Coagulopathies: leukaemia, haemophilia, Ebola, yellow fever, blackwater fever 
b)	Iatrogenic causes 
•	During or after procedures such as  
a)	endoscopic sphincterotomy 
b)	percutaneous endoscopic gastrostomy 
c)	stress ulcers  
d)	curling ulcers following burn injuries 
e)	Cushing ulcers following brain injuries
Specialty: General_Surgery
Management of Sigmoid volvulus
Rationale: •	Supportive 
a)	Fluid resuscitation to correct fluid losses and electrolyte imbalances 
b)	Pain management 
c)	Ng tube decompression if vomiting
 
•	Definitive: Non-surgical 
a)	Endoscopic decompression/reduction using a sigmoidoscope 
b)	Hydrostatic reduction 

Definitive: Surgical 
a)	Check for viability of the colon by color and presence of peristalsis. If viable, 
Sigmoidopexy 
b)	If not viable(gangrene) sigmoidectomy and end colostomy. (Hartman’s procedure) or Paul Mikulicz procedure (double-barreled colostomy).
Specialty: General_Surgery
Define Sigmoid Volvulus and its etiology 
Rationale: A twisting of a loop of sigmoid colon around its mesenteric axis, which results in a combination of obstruction together with occlusion of the main vessels at the base of the involved mesentery. 
 
Risk factors/etiology include:
a)	Narrow mesentery 
b)	Long tortuous sigmoid 
c)	Megacolon 
d)	Neurological disorders ie pseudobulbar palsy 
e)	Adhesions  
f)	Chronic constipation 
g)	Chaga’s disease 
h)	Old age 
i)	High fiber diet
Specialty: General_Surgery
Radiological features of bowel obstruction 
Rationale: •	Small bowel 
a)	Step ladder pattern 
b)	Centrally located bowel loops 
c)	Valvulae conniventes 
d)	Sentinel loop in ileus 
e)	Depending on the cause: Double bubble sign, duodenal atresia 
•	Large bowel 
a)	Peripherally located loops 
b)	Haustrations 
c)	Depending on the cause, coffee bean sign- sigmoid volvulus
Specialty: General_Surgery
Principles of management for intestinal obstruction
Rationale: 
•	Supportive management 
a)	Fluid therapy 
b)	Urinary catheter for input-output monitoring 
c)	NG tube decompression 
d)	Antibiotics
e)	Analgesia 
f)	Monitor vitals. HR, RR, BP, O2 sat, temperature 
•	Definitive 
a)	Exploratory laparotomy or definitive laparotomy
Specialty: General_Surgery
Investigations for intestinal obstruction 
Rationale: •	Laboratory 
a)	Routine lab work i.e., CBC, UECS, LFTS 
b)	Inflammatory markers. ESR, CRP 
c)	Pancreatic function tests. Serum amylase, lipase 
d)	Random blood sugar 
e)	Gene Xpert 
•	Imaging 
a)	Plain abdominal X ray 
b)	US 
c)	CT Scan abdomen pelvis 
d)	Contrast studies
Specialty: General_Surgery
Clinical presentation of intestinal obstruction 
 
Rationale: a)	Abdominal distension 
b)	Abdominal pain 
c)	Vomiting 
d)	Absolute constipation 
e)	Dehydration 
f)	Features of strangulation and septicemia in complicated bowel obstruction. Increased HR, RR, fever, cold peripheries, decreased BP
Specialty: General_Surgery
Causes of large bowel obstruction 
Rationale: a)	Malignancies 
b)	Fecal impaction 
c)	Crohn’s disease 
d)	Sigmoid volvulus 
e)	Cecal volvulus 
f)	ARMs 
g)	Congenital megacolon 
h)	Ulcerative colitis
Specialty: General_Surgery
Causes of small bowel obstruction 
Rationale: a)	Adhesions 
b)	Inguinal Hernias 
c)	Helminths 
d)	Intussusception 
e)	Midgut volvulus 
f)	Crohn’s disease 
g)	Congenital duodenal atresia 
h)	Meconium 
i)	Bezoars 
j)	TB strictures 
k)	Paralytic ileus 
l)	Gall stone
Specialty: General_Surgery
What is the difference between wound dehiscence and burst abdomen? 
Rationale: Wound dehiscence occurs when a wound fails to heal hence reopening, mostly in abdominal surgery There are 2 types 
a)	Superficial. Only skin reopen. Rectus sheath intact 
b)	Full thickness. The rectus sheath and skin remain open. 


Burst abdomen  is Commonly caused by infection 
Other risk factors include: 
•	steroid use 
•	Male gender 
•	Heavy weight lifting 
•	Smoking 
•	Obesity 
•	Prolonged abdominal surgery
Specialty: General_Surgery
Write short notes on surgical site infections under the following subheadings: Prevention of SSIs 
Rationale: 
•	Preoperatively 
a)	Prophylactic antibiotics 
b)	Avoid shaving hair routinely 
c)	Patient to stop smoking, 
d)	Advice patient on good nutrition 

•	Intra-operatively 
a)	Proper skin washing 
b)	Change gloves or gowns if contaminated 
c)	Wound irrigation at closure and use of antibiotic-impregnated sutures to close 
a.	Post-op 
d)	Close monitoring of wounds
Specialty: General_Surgery
Write short notes on surgical site infections under the following subheadings: Risk factors 
Rationale: 
•	Patient factors 
a)	Increasing age 
b)	Poor glucose control 
c)	Obesity 
d)	Smoking 
e)	Renal Failure 
f)	Immunosuppression 


•	Operative factors 
a)	Preoperative shaving 
b)	Length of operation 
c)	Use of antimicrobial prophylaxis (protective) 
d)	Appropriate skin preparation (protective) 
e)	Appropriate gowning and sterile equipment (protective)
Specialty: General_Surgery
Write short notes on surgical site infections under the following subheadings: Definition and classification 

Rationale: These are infections caused by microbial invasion of wounds created by an invasive surgical procedure 
Classification: 
•	Incisional 
•	Superficial: Skin and subcutaneous layer 
•	Deep: Involving the muscle and fascial planes 
•	Organ space: Infection involves any part of the anatomy in organs and spaces other than the incision, which was opened or manipulated during the operation