5 - Staph/Strep

Question 1

Cellulitis with pain out of proportion, suspect

Answer 1

Nec-fasc

Question 2

PE for nec-fasc

Answer 2

Failure to respond to ABX w/in 48-72 hrs (if suspected cellulitis)

Woody feel
SubQ emphysema
Systemic toxicity
Skin opens easily

Question 3

What’s a good start for nec-fasc pending labs?

Answer 3

Pen G and Clinda

Or

Doripenem
Vancomycin

Also, debride that shit

Hyperbarics if the ID geeks want

Question 4

Preferred imaging for nec-fasc?

Answer 4

MRI, to see all that tissue destruction

Question 5

Strep throat

Answer 5

Grp A B-hemolytic streptococcus

Kids age 5-12, uncommon <3yrs old

Sore throat
Tonsils enlarged and red
Exudate
Dysphagia / Odynophagia
Fever / Chills / Malaise / HA
Anterior cervical lymphadenopathy 

Txt - Benzathine PCN IM or 10-day course of PO Pen V

Alt - clinda

Question 6

Scarlet fever

Answer 6

Grp A B-hemolytic step - the Erythrogenic toxin

Fever
Chills
HA
Vomiting
Pharyngitis 
White exudate on tongue
Strawberry tongue 

Sandpaper rash, beginning groin/neck/axillae, then everywhere

Txt - Pen V, Ery

Question 7

Scalded skin syndrome

Answer 7

Similar to scarlet fever
Endotoxin mediated

ACUTE exfoliation
Oral/nasal cavities, throat, umbilicus

Fever, TTP, WTP

Diffuse sandpaper rash
(+) Nikolsky sign (gentle stroking of skin separates the epidermis

Dehydration

Txt - supportive and IV Naf until C and S comes back

Question 8

Toxic Shock Syndrome

Answer 8

Tampons
Staph aureus

Flu-like at first
Confusion
Fever
N/V/D
Pain
HA
Scarlet-fever-like rash
Petechiae
DESQUAMATION palms and soles
HOTN 

Consider TSS with: sudden onset fever, rash, HOTN, toxicity evidence

3 or more systemic sxs req’d for DX - GI, muscular, mucus membranes, renal, hepatic, heme, CNS

Txt - aggressive support, Nafcillin

No more tampons for you, girl

Question 9

Group B strep

Answer 9

Strep agalctiae

Neonates pick it up from mom’s vagina

Early onset - respiratory distress, lethargy, HOTN, RDS, meningitis

Late onset - 1 week to 3 mos - bacteremia, facial cellulitis, septic arthritis, osteomyelitis

Txt - Pen G

Question 10

Group B strep in adults

Answer 10

High fatality

DM
Malignancy
Immunocompromised

Peripartum fever = MC manifestation

Txt - Pen G

Question 11

MRSA

Answer 11

Cellulitis, abscess, septic arthritis, pneumonia

AK, CA, GA, TX

< 5cm, outpatient Rx Bactrim / Doxy / Clinda

Larger or more serious - inpatient with Vanc

Question 12

Tetanus

Answer 12

Clostridium tetani

Generalized, local, cephalic, or neonatal

Lockjaw
Irritability
Muscle cramps
Dysphagia
Fx’s, dislocations
Respiratory involvement -> death 

No loss of consciousness with seizures (fuck that sounds horrible)

Txt - diazepam for the seizures, tetanus immunoglobulins, metronidazole