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3. E Med & Surgery > 3- Skin and Soft Tissue Disorders > Flashcards

3- Skin and Soft Tissue Disorders Flashcards

1
Q

What indicates a tetanus-prone wound?

A

> 6 hrs old

Deep (> 1cm)

Grossly contaminated

Avulsion/ puncture/ crush

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2
Q

What is the most common pathogen a/w animal bites?

(oral flora of biting animal and human skin)

A

Pasteurella

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3
Q

Dog bites are most common in children of what age/ where?

A

< 10 yo, head + neck

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4
Q

Cat bites often result in deep wounds due to long slender teeth. Punctires below the periosteum may lead to what?

A

Osteomyelitis or septic arthritis

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5
Q

What pathogens are most commonly a/w human bites? (3)

A

Eikenella Corrodens

Group A strep

Staph

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6
Q

What must you check for when a pt presents with a human bite?

A

Meaure- maxillary inter-canine distance is > 2.5cm = adult bite

(child abuse)

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7
Q

What is included in the mangement of bite wounds?

A

X-ray

Clean surface- povidone iodine

Clean depths- copious irrigation

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8
Q

When is a surgical consult indicated for a bite wound?

A

Deep/ penetrating to bones, tendons, joints

Complex facial lacerations

Neurovascular compromise

Complex infections

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9
Q

When are prophylactic abx indicated for a bite wound?

A

Deep/ require closure

IMC

Mod-severe + a/w crush injury

Venous/ lymphatic compromise

Hands, genitalis, face, close contact w/ bone/ joint

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10
Q

What is the most common plantar puncture?

A

Stepping on a nail

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11
Q

What imaging is indicated for a plantar puncture?

A

X-ray

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12
Q

What should be done after occurence of a needle stick injury?

A

Cleanse w/ soap, water, alcohol

Determine HIV status (B + C)

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13
Q

What are the indications for closure aside from decrease healing time, reduce likelihood of infection, decrease scar function, and improve cosmesis?

A

Extension into sub Q

Repair loss of structure or function

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14
Q

What are the contraindications for closure of a wound?

A

Contaminated/ presence of FB

> 12 hrs old

Wounds involving: tendons, nerves, arteries

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15
Q

What are complications of closure, aside from infection, scars, loss of function, and loss of cosmesis?

A

Wound dehiscence (wound reopens and has to close by secondary intention)

Tetanus

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16
Q

What type of wound has involvement of GU, GI, and respiratory tracts?

A

Clean-contaminated

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17
Q

What type of wound has gross spillage into the surgical wound (bile, stool)?

A

Contaminated

(typically traumatic)

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18
Q

What type of wound closure is used for clean/ clean-contaminated wounds, involves closure of all layers, and results in minimal scarring?

A

Primary intention

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19
Q

What type of wound closure involves closure of deep layers but allows for granulation of superficial laters, and can leave a wide scar?

A

Secondary intention

(requires frequent wound care)

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20
Q

What type of wound closure involves closure of deep layers followed by closure of superficial layers 4-5 days later after infection is not a concern?

A

Delayed primary intention

21
Q

What type of sutures are absorbable?

A

Vicryl

PDS

Chromic gut

22
Q

What type of sutures are nonabsorbable?

A

Prolene

Nylon

23
Q

What type of suture method is frequently used to close skin lacerations?

A

Simple interrupted

24
Q

What type of suture method is useful for deep wounds and helps eliminate dead space?

A

Vertical mattress

25
Q

What type of suture method is useful in flaps or wounds under tension?

A

Horizontal mattress

26
Q

What type of suture method provides tighter closure if locked?

A

Continuous

27
Q

What type of suture method is often used for surgical or clean wounds and must be performed with absorbable suture?

A

Subcuticular

28
Q

What are defined as skin tension lines that indicate orientation of collagen fibers?

A

Langer’s lines

Lacerations @ right angles to lines tend to gape

29
Q

How long should a suture site be kept clean and dry?

A

No contact w/ water for 48 hours

30
Q

When should sutures generally be removed based on body location?

A

Face, ear = shortest (~4-5 days)

Scalp, trunk, extremities (~7-14)

Hand, foot, fingertips = longest (~8-14)

31
Q

When are antibiotics indicated for wound repair?

(aside from bites, crush wounds, contaminated wounds, IMC)

A

> 12 hrs old (esp on hands)

Avascular areas (ex. ear)

Joint spaces, tendon, bone

Hx of valvular heart disease

32
Q

Does hair need to be shaved off prior to suturing?

A

No (can increase risk of infection and leave particles in wound)

33
Q

What is the most important means to decrease infection risk?

A

Irrigation

34
Q

When are suture wounds re-checked?

A

24-48 hrs

+ additional re-check in 48-72 hrs if highly contaminated

35
Q

Pt presents with localized pain, swlling, tenderness, erythema and warmth but absence of abscess, purulent drainage or ulceration. You suspect an acute infection that does not involve fascia or muscles. What is this called?

A

Cellulitis - nonnecrotizing inflammation of skin + subq tissues

36
Q

What is the most common etiology of cellulitis for immunocompetent vs IMC pts?

A

Immunocompetent- A strep, S. aureus

IMC- Pseudomonas

37
Q

What signs/ sxs of cellulitis indicate deep soft-tissue infection and therefore require emergent sugical eval? (6)

A

Violaceous bullae

Cutaneous hemorrhage

Skin sloughing

Skin anesthesia

Rapid progression

Gas in tissue

38
Q

Outpt care of cellulitis is indicated for mild, local sxs w/o evidence of systemic disease. What is included in care?

(strep most likely pathogen)

A

Limb elevation, empiric abx x 5 days

F/u 48-72 hrs

39
Q

When is inpatient management for cellulitis considered (aside from IMC and comorbidities)?

A

Facial cellulitis of odontogenic origin

Orbital cellulitis

Cellulitis affecting > 1/4 of extremity

40
Q

What is 1st line abx treatment for cellulitis?

A

Beta-lactams x 10-14 days

(Amoxicillin, amoxicillin- clavulante)

41
Q

How is recurrent cellulitis defined and what is the tx?

A

3-4 episodes/ yr (usually due to venous/ lymphatic obstruction)

Penicillin/ Erythromycin BID x 4-52 weeks

42
Q

Hx of MRSA, break in skin, and IMC puts pts at increased risk for what?

A

Abscess

43
Q

When do abscesses require surgical referral for drainage? (5)

(body locations)

A

Perirectal

Neck

Hand

Breast (near aeola/ nipple)

Adjacent to vital nerves/ blood vessels (facial nerve, carotid/ femoral artery)

44
Q

What is included in the home care for abscesses and when should the pt f/u?

A

Change packing q 24 hrs

If recurrent infections- bathe w/ chlorhexidine daily

F/u 24-48 hrs

45
Q

Cellulitis with abscess or recurrent abscesses may indicate a MRSA infection. What is included as part of the 5 day decolonization regimen?

A

BID nasal mupirocin

Daily chlorhexidine washes

Daily decontamination of personal items (towels, sheets)

46
Q

If pt with a burn wound infection develops cellulitis, what drugs should prescribed for tx?

A

IV Cefazolin/ Clindamycin/ Vancomycin

47
Q

What is defined as an infection of the deep soft tissues, and results in progressive destruction of muscle fascia/ overlying sub-q fat?

A

Necrotizing fasciitis

48
Q

What is spared in necrotizing fasciitis and what is the likely pathogen?

A

Spares muscle

GAS or beta-hemolytic strep

49
Q

Pt presents with severe pain starting in the anterior abd wall and migrates to gluteal muscles, scrotum and penis. You note tense edema outside the involved skin, blisters/ bullae, crepitus, and sub-q gas. Systemic sxs include fever, tachycardia, and hypotension. What are you concerned for and what is the tx?

A

Fournier’s Gangrene

Aggressive surgical debridement + broad spectrum abx

3. E Med & Surgery (19 decks)

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