352 Obstetrics and Gynecology Board Review •••
❍ What bacteria are responsible for necrotizing fasciitis?
It may be caused by any of the following: Streptococcus pyogenes, Staphylococcus aureus (including MRSA),
Clostridium perfringens, Bacteroides fragilis, or Aeromonas hydrophila.
❍ What are the characteristics of a drug-induced postoperative fever?
The patient appears well, without tachycardia, occasionally with eosinophilia.
❍ What is the biggest risk factor for the development of a postoperative UTI?
The presence of an indwelling urinary catheter.
❍ What fraction of postoperative febrile morbidity is due to an infectious etiology?
20%.
❍ What is the most common cause of postoperative fever in the first 48 hours?
Atelectasis.
❍ What is the most common complaint associated with retained sponge or laparotomy pad?
A tender infected pelvic mass.
❍ What is the etiology of pseudomembranous colitis?
Broad-spectrum antibiotics such as clindamycin selects Clostridium difficile to predominate in the bowel. C. difficile
releases an exotoxin.
❍ How is pseudomembranous colitis treated?
Oral vancomycin or metronidazole.
❍ How can the spread of C. difficile be prevented?
Hospital workers must wash hands with soap and water as alcohol-based hand rubs do not eradicate the spores of
C. difficile.
❍ How long following laparotomy can a pneumoperitoneum normally be found?
Up to 7 to 10 days following surgery.
❍ What is the incidence of postoperative ileus?
Ileus has been reported to occur in 5% to 25% of patients undergoing gynecologic surgery and is most common
after laparotomy.
❍ What are the causes of postoperative ileus?
It is likely the result of a combination of neurogenic, inflammatory, and pharmacologic mechanisms.
(1) The acute phase is thought to be primarily neurogenic that results from the stimulation of afferent reflexes
from direct peritoneal irritation.
(2) The prolonged phase is likely a stress response to tissue trauma that results in an inflammatory response.