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Rosens > 126 Skin and soft tissue infection > Flashcards

126 Skin and soft tissue infection Flashcards

1
Q

What important cells live in the epidermis?

A

keratinocyte
langerhands cell
melanocytes
sweat glands

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2
Q

Disruption of the dermis results in what skin changes?

A

vesicles
bullae

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3
Q

What important cells are in the subcutaneous tissue

A

lymphatic drainage

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4
Q

Linear erythema tracking along vascular pathway ddx 2

A

phlebitis
lymphangitis

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5
Q

Pruritic snakelike lesions not particular tender ddx?

A

parasite - scabies, hookeworm, stronglyoides

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6
Q

What are janeway lesions?

A

painless red purple or brown spots on hands or feet from septic embolic from IE

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7
Q

Painless discoloration of the palsm and soles ddx 2 important?

A

secondary syphilis
RMSfever

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8
Q

DDX petechiae and purpura

A

sepsis
mengingococcemia
kawasaki
gpa

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9
Q

What is cellulitis?

A

inflamm cond of skin and subcut tissue caused by bacteria

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10
Q

Cardinal feature of cellulits?

A

inflamm with incr local blood flow

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11
Q

Cellulitis with signs of lymphangitis - commonly seen in what bug?

A

pasteurella multocida

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12
Q

Erysipelas is often caused by ?

A

GAS

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13
Q

MC bugs in acute diabetic foot infections?

A

S aureus
Streptococci

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14
Q

Human bite mc infection?

A

polymicrobial - eikenella, fusobacterium, GAS, S aureus

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15
Q

Cat bite common bug concern?

A

pasteurella

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16
Q

When do even dog bites need prophylactic abx?

A

face
hands
genitals
areas of poor perfusion
immunocomp pt

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17
Q

First line treatment and bug: uncomplicated abscess

A

MRSA
I+D, abx

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18
Q

First line treatment and bug: nonpurulent bacterial skin infection

A

strep, staph aureus
keflex or clinda, adjuncts

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19
Q

First line treatment and bug: purulent cellulitis and wound infections

A

mrsa, strep
septra, doxy

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20
Q

First line treatment and bug: DFU

A

mixed gram neg pos and anaerobes
amox clav and septra

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21
Q

First line treatment and bug: cat bite or infected dog bite?

A

amox clav
pasteurella

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22
Q

First line treatment and bug: human bite

A

oral anaerobes etc
amox clav

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23
Q

First line treatment and bug: erythema migranes

A

borrelia burgdoferi
doxy

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24
Q

First line treatment and bug: puncture would through sole of shoe

A

pseudmonas
levo

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25
Q

First line treatment and bug: buccal cellulitis

A

hinlfu
ceftr or amp sulbactam

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26
Q

First line treatment and bug: balantis

A

candida albicans or GAS
fluconazole and pen/amox + test for db

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27
Q

First line treatment and bug: Liposuction

A

peptostreptococcus, gas

amp-clav acid and septra

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28
Q

First line treatment and bug: saltwater exposure

A

vibrio vulnificus
doxy

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29
Q

First line treatment and bug: freshwater

A

aeromonas sp
ciprofloxacin

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30
Q

First line treatment and bug: butcher, clam handler or vet

A

erysipelothrix rhusiopathiae
amoxicillin

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31
Q

First line treatment and bug: black necrotic eschar with rasied border and severe edema?

A

bacillus anthracis (anthrax)
cipro

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32
Q

Who is particularly at risk from vibrio of salt water?

A

liver disease pt

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33
Q

Pseudocellulitis ddx

A

venous stasis derm
burns
viral infection
fixed drug eruption
lymphedema
VTE
gout
contact dermatitis

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34
Q

ALT-70 to differentiate cellulits from pseudo - what does this entail?

A

Asymm
Leukocytosis
tachycardia
age >/=70

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35
Q

If necrotizing infection is thought ,what imaging can be helpful?

A

ct

but should really call prs/service in charge

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36
Q

How long to tx bites for?

A

3-5d

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37
Q

Bite infection - pen allergic (severe) alternative?

A

clinadymin

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38
Q

What is an abscess?

A

bacteria multiplication below the epidermis

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39
Q

Carbuncle defn

A

multiple furuncles with loculation and connecting sinus, often mult sites of drainage

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40
Q

Furuncle defn

A

Boil - abscess of the hair follicle

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41
Q

Carbuncle place mc and disease RF?

A

neck
diabetes

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42
Q

Bartholin gland cyst - what to test for?

A

STBBI

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43
Q

Pilonidal abscess - where is this?

A

superior aspect of gluteal cleft between buttocks
–> surgical excision referral by surg

44
Q

Concerning signs for necrotizing fasc?

A
  1. systemic toxicity - pain out of proportion, abnormal vitals, AMS
  2. crepitance
  3. skip lesions/radid progression
  4. hemorrhage, sloughing, blisterin
45
Q

Ultrasound findings of an abscess

A

hypoechoic areas with posterior acoustic enhancement

46
Q

Oral options for MRSA

A

clinda
septra
doxy
linezolid

47
Q

What is an epidermoid cyst?

A

benign cystic tymor for accumulation of kertainecous material
-can be painful, rupt spontaneously
-can tx abx and nsaid

48
Q

How to I+D an abscess?

A

analgesia
incise
blunt dissect
irrigate
pack

49
Q

How to tx a Bartholin Abscess?

A

small incision around 3mm on site, cavity drained
word catheter insertion and inflated with 4ml of saline
leave in place 4-6 weeks so sinus tract can form
sitz bath

50
Q

When to consider other tx for a barhtolin gland cyst?

A

marsupialization if recurrent (but no usually acute)

51
Q

Abx post abscess?

A

simple, no risk mrsa - risk/benefit discussion with pt

abx if limited f/u, assocv cellulitis, mult infection sites, systemic illness, assoc comribdities and immunosuppression, extreme of age, abscess in area difficult to drain (hands, genitalia, feet), septic phlebitis, poor response to I+D alone

52
Q

Impetigo two forms?

A

bullous and non

53
Q

What does impetigo look like?

A

thin walled vesicles progressing to pustules, honey crusted lesions on face or extremity

often have lymphadenopathy

54
Q

Bullous impetigo bug

A

S aureus, MRSA
toxin procudes bullae from dermal epidermal junction release (0.5-3cm)

55
Q

Deep impetigo - what does this look like?

A

ulcers, punched out appearance, rasied red margins covered. with thick crust
typically LE

56
Q

Nonbullous impetigo tx

A

topical mupirocin
multiple lesions/extensive tx with MRSA

57
Q

Bullous impetigo tx

A

abx against MRSA and strep

keflex + septra

58
Q

Folliculitis defn

A

superficial inflamm of hair follicle limited to epidermis

59
Q

What does folliculitis look like?

A

small 2-5mm raised erythematous, painful, tender lesions typically itchy

ex beard, hot tub

60
Q

Folliculitis tx

A

if regular - topical mupirocin, avoid trigger

if candida concern (immunocomp) - tx antifungals, r/o immunocomp

hot tub (pseudomonas)- cproflox and antihist

61
Q

Hidraenitis suppurativa - what is this?

A

acne inversa - painful usually in axilla or inner area

aceniform disorder with follicular occlusion rather than infection of sweat glands

62
Q

Hidradenitits suppurativa tx

A

incision of painful nondraining lesions for sx release
systemic abx for symptomatic lesions and should cover mrsa
LT immunomod, hormones and en bloc resection (derm vs PRS)

pain control key

63
Q

RF nec fasc

A

db
vascular insuff
immunosuppression
penetrat taruma
recent surg
varicella inection
IVDU
burns
childbirth

64
Q

What bugs cause nec fasc?

A

MC poly:
GAS
s aureus
enterococci
enterobacteriaceae
anaerobes: bacteriodes, clostridium

65
Q

2 types of nec fasc

A

1: polymicrobial: aerobe and anaerobes
2. single organism: GAS, MRSA

66
Q

“Gas gangrene” - medical term

A

clostridial myonecrosis

67
Q

MC cause of traumatic myosistis/myonecrosis?

A

clos perfringins
exotoxins causing shock –> IV hemolysis + DIC

68
Q

Anaerobic streptococcal myositis: bug? general course?

A

peptostreptococus, or GAS or S aureus
insidious but still resembles clostridial myonecrosis

69
Q

Pyomyositis defn

A

deep abscess within striated m resulting from hematogenous spread of bacteria in setting of m injury
-S Aureus

70
Q

Phlegmasia cerulea dolens - what is this?

A

iliofemoralvein thrombosis - may look like nec fasc

71
Q

Nec fasc tx

A

clinda
pip tazo
vanco

surg asap

72
Q

3 main types of toxic shock syndromes

A

-staph
-strep
-staphyloccla scalded skin syndrome

73
Q

Stretococcal toxic shock syndrome: can occur in ?

A

prior healthy people

74
Q

Invasive GAS: how do toxins work?

A

exotoxin A and B act as superAg and cause overactivation of T cells with massive release CK
- flu likefirst, then septic shock

75
Q

GAS toxic shock syndrome: complications

A

DIC
renal failure
ARDS

76
Q

Streptococcal TSS: organism and toxin

A

GAS, pyogenic exotoxion

77
Q

Streptococcal TSS: source

A

nec infection

78
Q

Streptococcal TSS: rash

A

erythematous rash only in 10%
oftne have signs of nec infection and exfoliation weeks later

79
Q

Streptococcal TSS: mortality %

A

30-80

80
Q

Streptococcal TSS: tx

A

resus
op debridement

81
Q

Staph TSS: toxin and organism

A

tss type 1: enterotoxin A, B, C
staph aureus

82
Q

Staph TSS: pt type

A

prior healthy

83
Q

Staph TSS: source

A

nasal wound or packing
tampon
infection may also not be clear

84
Q

Staph TSS: rash

A

initially diffuse erythroderma exfoliation after 1-2wk, mucosal hyperemia

85
Q

Staph TSS: systemic illness findings compared to strep

A

similar: hypotension, shock: multiorgan failure more likely in GAS > staph

86
Q

Staph TSS: tx

A

resus

87
Q

Staph ScaledSS: bug and toxin?

A

staph aureus
epidermolytic toxin A or B

88
Q

Staph ScaledSS: pt?

A

infant

89
Q

Staph ScaledSS: source

A

skin flora

90
Q

Staph ScaledSS: rash

A

tender erythematous rash
localized blister
extensive exfoliation if have no abx to toxin
mucosa spread

91
Q

Staph ScaledSS: sx

A

fever, irritability ( as particularly infant)

92
Q

Staph ScaledSS: mortality

A

<5%

93
Q

Staph ScaledSS: tx

A

wound care
hydration

94
Q

Staph TSS: mortality %

A

<5

95
Q

What toxin is most associated with Staph TSS in menstrual causes?

A

TSST-1

96
Q

SSSS: where does toxin target?

A

act as proteases - target protein desmoglein 1 on stratum granulosum layer or epidemrus

97
Q

Staph ScaledSS: nikolsky?

A

+

98
Q

Trend of rash in RMS fever?

A

wrists and spreads everywhere including palsm and soles
macular –> petechial and then dusky

99
Q

Anthrax rash presentation

A

incubation 1 week –> vesicle
ruptures leaing shallow based ulcer with raised border
painless necrosis and escar, surrounding edema

100
Q

Tularemia: from?

A

exposure to rodents, rabbits hairs

101
Q

Tularemia: skin presentation and other sx?

A

flu like
ulceroglandular form
lesion itself is raised vs border only in anthrax

102
Q

Cutaneous leishmaniasis lesions:

A

face - painless, ulcerative, dysfiguring
papules - wory about myiasis botfly!

103
Q

What type of skin rash in kids can lead to PSGN?

A

impetigo

104
Q

How to treat eosinoophilic folliculitis?

A

isotretinoin

105
Q

SSSS - key: spares what?

A

mucous membranes

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