Bacterial skin

Question 1

What are the clinical presentations of impetigo?

Answer 1

honey-crusted, non-bullous or bullous lesions superficial, contagious, usually on face or arms

Question 2

What are the risks for impetigo?

Answer 2

poverty, crowded living conditions, poor hygiene, underlying scabies, GAS

Question 3

What helps diagnose impetigo?

Answer 3

culture of pus or bullae fluid

Question 4

How can you treat non-bullous impetigo?

Answer 4

topical – mupirocin, bacitracin, retapamulin, hydrogen peroxide cream

Question 5

How can you treat bullous impetigo?

Answer 5

cephalexin, dicloxacillin, clindamycin and recommend IN mupirocin for everyone in the household to kill staph aureus

Question 6

If the culture comes back as MRSA for impetigo, how do you treat it?

Answer 6

bactrim, doxycycline

Question 7

If your impetigo case presents with systemic symptoms, how will you adjust your treatment?

Answer 7

oral cephalexin and or dicloxacillin

Question 8

How does cellulitis present?

Answer 8

erythema or edema that is rare on the face

Question 9

What are risks for cellulitis?

Answer 9

inflammation, pre-existing skin infection, previous edema, lymphatic obstruction, HIV

Question 10

How does cellulitis occur?

Answer 10

bacterial entry with breaches in the skin barrier with staph aureus, gram + like strep

Question 11

What diagnosis step is needed for cellulitis?

Answer 11

culture of blood, pus or bullae and mark the margins!

Question 12

How do you treat cellulitis?

Answer 12

elevate affected area and treatment of underlying conditions
systemic toxicity means parenteral abx: nafcillin, cefazolin, clindamycin, cephalexin, doxycycline
followed by oral: cephalexin, dicloxacillin
treat everyone in home with mupirocin, and IV vanc if MRSA

Question 13

What is necrotizing fasciitis?

Answer 13

thrombosis in blood vessels, destruction of soft tissues and fascia, a serious complication of cellulitis

Question 14

What is erysipelas?

Answer 14

clear demarcation of erythema and edema often on face and lower legs. Often in young children in elderly, and can be considered cellulitis but in the dermis with strep pyogenes

Question 15

How can you manage erysipelas?

Answer 15

oral penicillin, dicloxacillin, cephalexin, clindamycin, azithromycin

Question 16

How do you treat severe erysipelas?

Answer 16

IV cefazolin or ceftriaxone; MRSA = vanc

Question 17

How does folliculitis present?

Answer 17

clusters of small, raised pruritic erythematous lesions and pustules in areas of repeated shaving

Question 18

What are common causes of folliculitis?

Answer 18

staph aureus, but from hot tubs = pseudomonas, malassezia, jellyfish!

Question 19

How can you manage folliculitis?

Answer 19

anhydrous ethyl alcohol or topical abx (mupirocin or clindamycin) + BPO

if other organisms, systemic abx

Question 20

What is pseudo folliculitis barbae?

Answer 20

papular and pustular inflammatory reaction, mostly on neck in beard area - massage area, stop shaving

Question 21

What is erythrasma?

Answer 21

infection of intertriginous areas in well-demarcated, brown-red macular patches, often wrinkly with fine scales, potentially pruritic

Question 22

How can you diagnose erythrasma?

Answer 22

wood’s lamp to view under fluorescence, KOH to rule out tinea, culture bacteria

Question 23

How do you treat erythrasma?

Answer 23

topical abx - fusidic acid cream and clindamycin solution
OR
oral abx - erythromycin, penicillins, cephalosporins, clindamycin

Question 24

What is a furuncle?

Answer 24

deep infection or small abscess in hair follicle; boil-like
indurated nodule with fluctuance

Question 25

How do you decide whether to prescribe abx for furuncles?

Answer 25

whether there is associated extensive surrounding cellulitis or signs of systemic infection

Question 26

How do you treat furuncles?

Answer 26

warm compress or I&D
oral abx: clindamycin or cephalexin, MRSA=doxycycline, clindamcyin

Question 27

What is a carbuncle?

Answer 27

several head of inflamed follicles within 1 purulent mass. Ulcerated looking can present with fever, malaise, chills

Question 28

What is the treatment of carbuncle?

Answer 28

require I&D, oral abx: clindamycin or cephalexin, MRSA=doxy

Question 29

What’s the difference between a furuncle and carbuncle?

Answer 29

furuncle = 1 head, 1 follicle
carbuncle = multiple; ulcerated

Question 30

What is a pilonidial cyst?

Answer 30

abnormal pocket in skin with hair and skin debris near tailbone from friction or pressure
soak, I&D, pack!

Question 31

Where can MRSA present and how should you address it?

Answer 31

abscesses, furuncles, carbuncles, impetigo, cellulitis, wound
oral clindamycin, bactrim, doxy, or IV vanc, mupirocin for carriers

Question 32

What is Hansen’s disease?

Answer 32

leprosy!
discolored patches of skin flat, numb, faded, nodules, considering painless, skin lesions

Question 33

How do you manage Hansen’s disease?

Answer 33

rifampin, dapsone, clofazimine

Question 34

How does subcutaneous tuberculosis present?

Answer 34

inflammatory papules with granuloma formation, chronic ulcers, plaques, warty area. This requires PCR, punch biopsy, check blood

Question 35

What causes subcutaneous tuberculosis?

Answer 35

ritual circumcision, tattoo, piercing, venipuncture, intercourse, tooth extraction, spread through lymphactic/heme spread

Question 36

What is meningococcemia?

Answer 36

maculopapular eruption frequently on trunk and lower extremeties that become a petechial rash, mucus membranes may show hemorrhage, can coalesce into purpuric and ecchymotic lesions

Question 37

What should you do if a patient presents with meningococcemia?

Answer 37

admit to hospital for ceftriaxone, cefotaxime or ampicllin, a flox

resistant to vanc and aminoglycosides