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Bacterial and Viral Skin infections Flashcards

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1
Q
  1. What is impetigo?
  2. Caused by? 2
  3. High incidence in who?
  4. Prognosis?
  5. What could be a complication of this?
A
  1. Common, contagious, superficial skin infection.
  2. Caused by
    - streptococci,
    - staphylococci, or combination.
  3. High incidence in children.
  4. Self limiting, but if not treated may last for weeks or months.
  5. Post streptococcal glomerulonephritis may follow impetigo.
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2
Q
  1. PE of Impetigo: Name the lesion types? 2
  2. What do they contain?
  3. How big are the vesicles and what do they look like?
A
  1. Nonbullous and or bullous
  2. Vesicles and bullae containing clear yellow or slightly turbid fluid without surrounding erythema
    • Superficial small vesicle or pustules, 1-3cm lesions
    • Golden-yellow (honey) crusted
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3
Q
  1. Impetigo treatment?

2. Severe cases? 3

A
  1. Bactroban (Mupirocin) ointment
  2. In severe cases - Oral antibiotics (cover for Staph aureus - therefore MRSA –
    - Bactrim,
    - Clindamycin or
    - Doxy
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4
Q

Meningococcemia

  1. Caused by what bacteria?
  2. Highest incidence in age?
  3. Highest incidence in season?
  4. How do these kids die very rapidly?
A
  1. Neisseria meningitidis
  2. Highest incidence between 6 mos. and 3 years of age.
  3. Highest incidence, midwinter, early spring
  4. Most rapidly lethal form of septic shock
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5
Q

Meningococcemia
1. PE findings? 5

  1. Characteristics of the rash? 3
  2. Where is the rash often found? 4
  3. Later lesions will look like what? 4
A
  1. PE
    - High fever,
    - tachycardia,
    - mild hypotension,
    - signs of meningeal irritation
    - patient appears acutely ill.
  2. -Early Exanthem
    (Occurs soon after onset)
    -Pink 2mm-10mm
    -macules/papules,
  3. sparsely distributed on
    - trunk/lower extremities,
    - face,
    - palate,
    - conjunctivae.
  4. Later lesions
    - Petechiae in center of macules
    - Lesion become hemorrhagic within hours, purpura
    - Purpura fulminans,
    - hemorrahgic bullae
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6
Q

Dx of Menigococcemia? 3

Tx? 3

A
  1. Blood cultures
  2. Pus from nodular lesion shows gram neg. diplococci
  3. D-dimers

Treatment

  1. Cefotaxine (Claforin)
  2. Ceftriaxone (Rocephin)
  3. Hemodynamic stabilization
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7
Q

What is waterhouse fredirickson syndrome?

A

Waterhouse–Friderichsen syndrome (WFS), hemorrhagic adrenalitis or fulminant meningococcemia is defined as adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection

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8
Q

Characteristics of bacterial endocarditis:

  1. Caused by what bugs? 2
  2. Describe what is it?
  3. Incidence is increasing in what populations? 3
  4. Positive findings on hx? 4
  5. PE findings? 3
  6. Which part of the heart is commonly damaged?
A

Characteristics

    • Staph Aureus,
    • Strep Viridans
  2. Proliferation of microorganisms on the endocardium of the heart.
  3. Incidence is increasing in the
    - elderly,
    - IVDU, and those with
    - prosthestic valves.
  4. History
    - Fever,
    - chills/sweats,
    - anorexia/wt loss/
    - malaise
  5. PE (endocarditis until proven otherwise)
    - Heart murmur
    - Arterial emboli
    - Splenomegaly
  6. Right side, tricuspid valve
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9
Q

What are the skin lesions that bacterial endocarditis may cause? 4

A
  1. Janeway lesions
  2. Osler’s node
  3. Subungual Splinter hemorrhage
  4. Petechial lesion
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10
Q

How do the following present:
1. Janeway lesions?

  1. Osler’s node?
  2. Petechial lesion? 2
A
  1. -Nontender, hemorrhagic maculopapular lesions on palms and soles.
  2. -Painful, red nodules on fingertips
  3. -Small, non-blanching, reddish-brown macules on extremities, upper chest, mucus membranes. Occur in crops.
    - Asymptomatic red streaks in nail bed.
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11
Q

Dx for bacterial endocarditis? 6

Rx? 5

A
  1. ID at risk patients and prophylax
  2. Blood cultures
  3. CBC,
  4. Chem panel,
  5. Coags,
  6. Echo

Treatment:

  1. PCN-G
  2. Nafcillin
  3. Gentamycin
  4. Vanco in MRSA
  5. Zyvox in MRSA
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12
Q

Rocky Mountain Spotted Fever

  1. Caused by what bacteria?
  2. Common in what months?
  3. Who can this be especially fatal in?
  4. Positive findings on Hx? 3
  5. PE? 4
A

Characteristics

  1. Rickettsia rickettsii spirochete
  2. Common May thru September
  3. Can be fetal if not treated, especially in the elderly
  4. History
    - History of tick bite given in 60% of cases
    - Ask about outdoor activity
    - Prodrome of anorexia, irritability, malaise
5. PE
1-2 weeks after tick bite:  
-Fever (>102), chills, 
-weakness
-Headache, 
-photophobia
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13
Q

Rocky Mountain Spotted Fever

  1. What do the skin lesions initially look like?
  2. Where does the rash commonly begin? 4
  3. What do they evolve to over hours to a couple of days? 2
A
  1. Initially 2 to 6mm, pink blanching macules begin on extremities & spread centrally.
  2. Characteristically, rash begins on
    - wrists,
    - forearms,
    - ankles and later on
    - palms
  3. Evolve to
    - papules &
    - petechiae over hours to couple of days.
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14
Q

Treatment for RMSF? 2

A

Treatment:

  1. Doxycycline (accept for PG)
  2. Chloramphenical (for PG)
  • Start antibiotics if diagnosis is even suspected!
  • Doxycyline even in children now, per the CDC!!!
  • Less effect on teeth than Tetracycline.
  • Mortality rate ~60% in elderly
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15
Q

What is lyme disease?

A

Lyme disease (LD) is a multi-stage, multi-system bacterial infection caused by the spirochete Borrelia burgdorferi from a tick bite.

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16
Q

Rash of Lyme Disease:

  1. Appears when after infection?
  2. Can last how long?
  3. Size?
  4. Can mimic what? 5
  5. Associated symptoms? 3
  6. Reoccurrence?
A
  1. appear several days after infection, or not at all.
  2. can last a few hours or up to several weeks.
  3. can be very small or very large (up to 12 inches across).
  4. can mimic such skin problems as
    - hives,
    - eczema,
    - sunburn,
    - poison ivy,
    - flea bites.
  5. can
    - itch or
    - feel hot, or
    - may not be felt at all.
  6. can disappear and return several weeks later.
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17
Q

Lyme Disease: Several days or weeks after a bite from an infected tick, a patient usually experiences flu-like symptoms such as the following?
9

A
  1. headache
  2. stiff neck
  3. aches and pains in muscles and joints
  4. low-grade fever and chills
  5. fatigue
  6. poor appetite
  7. sore throat
  8. swollen glands
  9. After several months, arthritis-like symptoms may develop, including painful and swollen joints.

Bullseye rash

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18
Q

How is Lyme disease diagnosed?

A

The primary symptom is a rash, but it may not be present in up to 10 to 15 percent of cases.

Diagnosis for Lyme disease is a clinical one and must be made by a provider experienced in recognizing LD.

Diagnosis is usually based on symptoms and a history of a tick bite. Testing is generally done to eliminate other conditions and may be supported through blood and laboratory tests, although these tests are not absolutely reliable for diagnosing LD.

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19
Q

Lyme disease treatment?
2

How long of course is recommended?

A

Oral antibiotics are the standard treatment for early-stage Lyme disease.

  1. Doxycycline for adults and children older than 8
  2. Amoxicillin for adults, children, pregnant or breast feeding

A 14- to 21-day course of antibiotics is usually recommended, but some studies suggest that courses lasting 10 to 14 days are equally effective. In some cases, longer treatment has been linked to serious complications.

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20
Q

Cellulitis:

  1. What is it?
  2. Occurs in what ages?
  3. Bugs? 2
  4. Hx of what?
  5. More common is what diseases but can happen in anyone? 2
A
  1. Acute, spreading infections of dermal and subcutaneous tissues thru a skin portal.
  2. Occurs in all ages
    • Staph aureus and
    • Group A Strep common
  4. History of trauma or may be unaware of wound of entry
    - Don’t forget dog, cat and human bites
  5. Common with
    - diabetes,
    - PVD, but can happen in anyone.
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21
Q

Cellulitis PE findings
1. What will the effected area look like? 4

  1. What is specific about the margins?
  2. Cellulitis is characterized by what color?
    - What would suggest infection with Strep pneumo?
A
    • Warmth,
    • erythema,
    • edema, and
    • tenderness of the affected area
  2. The margin of cellulitis will not be palpable.
  3. Cellulitis characterized by
    - violaceous color and
    - bullae suggests infection with Streptococcus pneumoniae (pneumococcus)
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22
Q

Cellulitis:
1. No workup is required in uncomplicated cases that meet the following criteria? 4

If complicated with signs of systemic involvement what do you need to order? 3

A
  1. Small area of involvement
  2. Minimal pain
  3. No systemic signs of illness (eg, fever, chills, dehydration, altered mental status, tachypnea, tachycardia, hypotension)
  4. No risk factors for serious illness
  5. Complete blood count
  6. Blood Cultures
  7. Chem panel
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23
Q

Cellulitis
1. General Treatment?

  1. Mild? 5
  2. Complicated? 5
A
  1. Treatment
    Empiric coverage for staph and strep
  2. Mild
    - Bactrim,
    - Clinda,
    - Doxy – Cover MRSA
    - Cephalexin (Keflex)
    - Dicloxacillin (Dynapen)

Complicated

  • Hospitalization for IV antibiotics (Cover MRSA PLUS)
  • Ancef (Cephalexin)
  • Ceftriaxone (Rocephin)
  • Ampicillin-Sulbactam
  • Zyvox
24
Q
  1. Erysipelas is caused by what?
  2. How does it begin and what does it progress to?
  3. Skin classicly exhibits what kind of margins?
  4. How is it different from cellulitis? 2
  5. What will the area look like?
  6. How is lymphatic involvemnet often manifested? 2
  7. More severe infection may exhibit what? 2
A
  1. Erysipelas (group A β hemolytic strep)
  2. begins as a small erythematous patch that progresses to a fiery-red, indurated, tense, and shiny plaque. Known as “St Anthony’s fire”.
  3. lesion classically exhibits raised sharply demarcated advancing margins,
  4. this differenciates it from cellulitis. Cellulitis has no lymphatic component and exhibits indiscreet margins.
  5. inflammation, such as warmth, edema, and extreme tenderness,
  6. Lymphatic involvement often is manifested by
    - overlying skin streaking and
    - regional lymphadenopathy.
  7. More severe infections may exhibit
    - numerous vesicles and
    - bullae.
25
Q

Erysipelas prodrome? 3

A
  1. malaise,
  2. chills, fever
  3. Several spots of redness and tenderness, increase in size to form a tense, red, hot, uniformly elevated, shining patch
26
Q

Treatment of Erysiples? 7

A
  1. Penicillin G
  2. Penicillin VK
  3. Dicloxacillin (Dynapen)
  4. Keflex (Cephalexin)
  5. Clindamycin
  6. Erythromycin
  7. May need analgesics for pain.
27
Q
  1. What bugs should we think about with Human bites?
  2. Most common in what population?
  3. Dx?
  4. When would we get an Xray? 2
A
  1. Human bites (think about anaerobes)
  2. Common in young males
  3. Routine laboratory studies: These are generally not indicated because the injured population is usually young and healthy. Diagnosis of infection is clinical.
  4. Xray –
    - osteomyelitis,
    - metalcarpal head fracture
28
Q

Human Bites
1. What kind of injuries? 3

  1. Treatment? 4
  2. When should patient followup?
A
    • Closed fist injuries
    • Chomping type injury
    • Puncture wound on head from clashes with teeth
    • Amoxicillin-Clavulante (Augmentin)
    • Moxifloxin (Avelox) (not under 18)
    • Clindamycin
    • DON’T FORGET A TETANUS SHOT (should give in opposite extremity)
  3. Patient must follow-up in 1-2 days
29
Q

Dog and Cat bites:
1. Consider what kind of prophylais for all wounds? 2

  1. What is the bacteria for cat bites?
  2. What kind of bites are worse and have a higher risk of infection?
A
  1. Consider tetanus and rabies prophylaxis for all wounds.
  2. Pasteurella multocida.
  3. More penetrating wounds with cat bites because of sharp teeth
    Risk of infection higher with cat bites
30
Q
  1. Inspect, debride, irrigate… should we close??
  2. Facial wounds?
  3. Lowere extremity wounds?
  4. Patient followup?
A
  1. Primary closure for wounds that can be cleaned effectively, but more often left open to heal.
  2. Facial wounds can be closed
  3. Lower extremity wounds need delayed closure
  4. Patient follow-up in 1-2 days
31
Q

Dog and Cat bites Rx? 5

A
  1. Amoxicillin-Clavulate (Augmentin)
  2. Erythromycin
  3. Bactrim DS, Septra DS
  4. Clindamycin
  5. Cipro
32
Q

Necrotizing Fasciitis

  1. AKA?
  2. What is it?
  3. Moves along the _____ ______ plane?
  4. Bugs? 2
  5. Mean age of infection?
A
  1. referred to as hemolytic streptococcal gangrene
  2. progressive, rapidly spreading, inflammatory infection located in the deep fascia, with secondary necrosis of the subcutaneous tissues.
  3. moves along the deep fascial plane.
  4. have anaerobic bacteria present, usually in combination with aerobic gram-negative organisms.
    - group A hemolytic streptococci, and Staph, alone or together are frequently the initiating infecting bacteria.
  5. Mean age of is 38-44 years.
33
Q

Necrotizing Fasciitis

Causes? 5

Clinical manifestations? 2

A
  1. trauma or a recent surgery to the involved area is often present.
  2. insect bites,
  3. surgical procedures (infectious),
  4. IM injections and IV infusions
  5. Idiopathic cases are not uncommon.
  6. a sudden onset of pain and swelling at the site of trauma or recent surgery
  7. Over the next several hours to days, the local pain progresses to anesthesia
34
Q

PE from necrotizing fasciitis:
1. Begins with an area of what?

  1. It quickly spreads over a course of how long?
  2. the margins of infection move out into normal skin without being what?
  3. How does the color change near the site of insult as it progresses?
  4. If the skin is open, gloved fingers can pass easily between the 2 layers and may reveal what?
A
  1. begins with an area of erythema
  2. that quickly spreads over a course of hours to days.
    - redness quickly spreads
  3. without being raised or sharply demarcated.
  4. With progression - dusky or purplish skin discoloration near the site of insult.
  5. yellowish-green necrotic fascia.
35
Q

Most important signs are what?

7

A
  1. tissue necrosis,
  2. putrid discharge,
  3. bullae,
  4. severe pain,
  5. gas production,
  6. rapid burrowing through fascial planes, and
  7. lack of classical tissue inflammatory signs.
36
Q

Workup on Necrotizing Fasciitis?

8

A
  1. CBC with differential
  2. Chem panel
  3. Blood and tissue cultures
  4. Urinalysis
  5. Arterial blood gas
  6. Xray
  7. CT
  8. Biopsy is best to use when diagnosing
37
Q

Necrotizing Fasciitis
Rx? 5

Abx? 7

A

Treatment

  1. Aggressive antibiotics
  2. Hemodynamic stablization
  3. Surgical consult for debriding
  4. Infectious disease specialist
  5. Hyperbaric specialist

Antibiotics

  1. Ceftriaxone (Rocephin)
  2. PCN-G
  3. Clindamycin (Cleocin)
  4. Flagyl
  5. Gentamicin (Garamycin)
  6. Chloramphenicol (Chloromycetin)
  7. Ampicillin (Omnipen)
38
Q

Hidradenitis suppurativa

  1. What is it?
  2. Predisposing factors? 3
  3. Common sites? 2
A
  1. Chronic, suppurative disease of apocrine gland-bearing skin.
  2. Predisposing factors:
    - Obesity,
    - genetic disposition to acne,
    - apocrine duct obstruction
  3. Common sites:
    - Axilla
    - Anogenital region
39
Q

Hidradenitis suppurativa
1. Positive Hx findings?

  1. PE findings? 5
A
  1. History
    Intermittent pain and marked point tenderness related to abscess formation
  2. PE
    - Very tender, red inflammatory nodules
    - May drain purulent/seropurulent material
    - Open comedones/double comedones
    - Fibrosis, bridge scars
    - Lesions may become infected
40
Q

Treatment of Hidradenitis suppurativa?

5

A

Combination of:

  1. Intralesional glucocorticoids
    - Triamsinolone
  2. PO steroids
    - Predisone
  3. Surgery
    - I & D abscess LAST RESORT!!
  4. Oral antibiotics
  5. Isotretinoin
41
Q

What kind of oral antibiotics would you give for Hidradenitis suppurativa? 3

A
  1. Erythomycin
  2. Tetracycline
  3. minocycline
42
Q

Viral Dermatology

6

A
  1. HIV/AIDS
    - Kaposi’s
    - Oral Hairy leukoplakia
  2. HSV
  3. HPV – Condyloma Acuminata
  4. Molluscum Contagiosum
  5. Primary Varicella
  6. Varicella-Zoster (Shingles)
43
Q

Herpes Virus Family
1. Primary infection can present how?

  1. How is it spread?
  2. Symptoms occur 3 - 7 days after contact. What are they? 7
A
  1. Can be symptomatic or asymptomatic
  2. Can be spread by direct contact or fluid
  3. Symptoms occur 3 - 7 days after contact
    - Tenderness
    - Pain
    - Mild paresthesias or burning
    - Grouped vesicles on an erythematous base
    - Centers become depressed
    - Crusts form and heal without scaring
    - The virus enters the nerve endings, runs through peripheral nerves to dorsal root ganglia
44
Q
  1. What can cause recurrent or reactivation of infection of herpes virus? 2
  2. Type I: Can be found where? 2
    - Common sign?
  3. Type II: Is found where?
    - May mimic what?
A
  1. Recurrent infection / Reactivation of the virus
    - Local skin trauma, especially ultraviolet
    - Systemic changes (fever, infection, stress)
  2. Oral and Labial Herpes Simplex
    - Whitlow-fingers
  3. Type II (Genital Herpes Simplex)
    - May mimic zoster in sacral distributions
45
Q

Dx of Herpes simplex?

4

A
  1. Inspection
  2. Tzanck smear
  3. Direct Immuno Fluorescence Antibody
  4. Culture (viral)
46
Q

Treatment of Herpes Simplex?

7

A
  1. Cool compresses
  2. Air or heat lamp drying of lesions
  3. Penciclovir (Denavir) – topical agent
  4. Famcicolvir (Famvir) or
  5. Valacyclovir (Valtrex)
  6. Acyclovir - less expensive alternative
  7. Pain control PRN
47
Q

Varicella (Chicken Pox)
1. Highly contagious: For what time period?

  1. Appear where and spread where?
  2. What are the vesciles like? 3
A
  1. Highly contagious
    - Two days before onset of rash
    - Until all lesions have crusted
  2. Appear on face and scalp, spread inferiorly to truck (centripetal)
  3. Vesicles appear as small “drops of water” on a red base.
    - Delicate “dew drops on a rose pedal” like lesion.
    - pruritic
    - Becomes pustules and crusts over
48
Q

Varicella treatment:
Symptomatic treatment? 2

Systemic treatment? 1

A

Usually self limiting

  1. Symptomatic
    - Benadryl for pruritis
    - Tylenol for fever
  2. Systemic
    - Acyclovir (Zovirax)
49
Q

Herpes Zoster (Shingles)

  1. What is it?
  2. Unilateral or Bilateral?
  3. Pain?
  4. What kind of prodrome?
A
  1. Reactivation of varicella virus in cutaneous nerves from earlier varicella
  2. Unilateral
  3. Very painful
  4. Flu like prodrome
50
Q

Common areas that herpes zoster affects? 4

Common Skin Lesions? 5

Complications? 2

A

Common

  1. Thoracic
  2. Trigeminal
  3. Lumbosacral
  4. Cervical

Skin lesions

  1. Papules to vesicles-bullae
  2. Pustules to crusts
  3. Erythematous, edematous base with superimposed clear vesicles, sometimes hemorrhagic
  4. Vesicle is oval or round
  5. Can have regional lymphadenopathy

Complications

  1. Postherpetic neuralgia
  2. Temporary motor paresis
51
Q

Herpes Zoster treatment? 2

For pain? 2

A
  1. Famvir, Valtrex, or Acyclovir 800 mg 5 x d for 7-10 days
  2. Antibiotic cream to prevent secondary infections
  3. If extremely painful
    - Burrow’s solution or cool tap water compresses
    - Ultram PO
52
Q

Genital warts

  1. AKA?
  2. Evidence of a realtionship with what is overwhelming?
  3. Spreads rapidly over what?
  4. What kind of lesions occur?
  5. Warts may extend where?
  6. Genital warts in children indicate what? 2
  7. What family of virus is it?
A
  1. Condyloma acuminata / venereal warts
  2. Evidence of a relationship with genital cancer is overwhelming
  3. Spread rapidly over moist areas
  4. small papules to large verrucous lesions
  5. Warts may extend into vaginal tract, urethra, rectum
  6. Genital warts in children. if less than I y/o ,
    - probably infected during birth
    - Estimated that 50% are from sexual abuse
    - Can be obtained without sexual , auto-inoculation
  7. Papilloma virus
53
Q

Treatment of Genital Warts?

5

A

All genital warts should be treated
1. Podophyllum, 20% in tincture of benzoin varies in effectiveness

  1. Trichloroacetic acid 25 - 50% (particularly helpful for vaginal)
  2. Cryosurgery
  3. Carbon dioxide laser
  4. Electrosurgery
54
Q

Molluscum Contagiosum

  1. What can of virus?
  2. What kind of lesions?
  3. Spread how? 3
  4. Common on what parts of the body in children? 3
  5. Adults? 2
A
  1. Pox virus
  2. Discrete, 2 - 5 mm, umbilicated, domed-shaped papules
  3. Spread by
    - autoinoculation,
    - scratching, or
    - touching a lesion
  4. Common on
    - face,
    - trunk,
    - extremities in children
  5. Common in
    - genital and
    - pubic areas in adults
55
Q

Molluscum Contagiosum
Treatment (not necessary to treat in children, as they are self limited)
5

A
  1. Curettage
  2. Cryosurgery
  3. TCA / Podophyllin
  4. Retin A cream
  5. Cantharidin

Dermatology (12 decks)

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