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Dermatology > Bacterial & Viral Infections > Flashcards

Bacterial & Viral Infections Flashcards

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Dermatology Board Prep flashcards
1
Q

Characteristics of Impetigo

A 
Common, contagious, superficial skin infection
Culprits: strep, staph, or both
Self limiting
High incidence in children
Post strep glomerulonephritis
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2
Q

PE Findings in Impetigo

A

Nonbullous and/or bulls
Vesicles & bullae contain clear yellow or slightly turbid fluid without surrounding erythema
“Honey” crusted

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3
Q

Treatment of Impetigo

A

Bactroban (Mupirocin) ointment

Severe: oral antibiotics (Bactrim, clindamycin, or doxycycline)

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4
Q

Characteristics of Meningococcemia

A

N. meningitidis
Highest incidence: midwinter-early spring ages 6 months-3 years
Most rapidly lethal form of septic shock

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5
Q

PE Findings in Meningococcemia

A 
High fever
Tachycardia
Mild hypotension
Meningeal irritation
Appears acutely ill
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6
Q

Early Exanthem of Meningococcemia

A

Soon after onset

Pink macules/papules, sparsely distributed on trunk/lower extremities, face, palate, conjunctivae

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7
Q

Later Lesions of Meningococcemia

A

Petechiae in center of macules
Lesions become hemorrhagic within hours
Purpura fulminans
Hemorrhagic bullae

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8
Q

Work Up of Meningococcemia

A

Blood cultures
Pus from nodular lesion
D-dimers

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9
Q

Treatment of Meningococcemia

A

Cefotaxine (Claforin)
Ceftriaxone (Rocephin)
Hemodynamic stabilization

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10
Q

Characteristics of Bacterial Endocarditis

A

Staph aureus or strep viridans
Proliferation of microorganisms on the endocardium of the heart
Incidence increasing in elderly, IVDU, & prosthetic valves

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11
Q

Important H&P Findings for Bacterial Endocarditis

A 
Fever
Chills/sweats
Anorexia/weight loss/malaise
Heart murmur
Arterial emboli
Splenomegaly
Hematuria
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12
Q

Skin Lesions in Bacterial Endocarditis

A

January lesions
Osler’s nodes
Subungual Splinter hemorrhage
Petchial lesions

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13
Q

Describe Janeyway Lesions

A

Non-tender, hemorrhagic maculopapular lesions on palms & soles

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14
Q

Describe Osler’s Nodes

A

Painful, red nodules on fingertips

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15
Q

Describe Petechial Lesions

A

Small, non-blanching, reddish-brown merciless on extremities, upper chest, mucus membranes
Occurs in crops
Asymptomatic red streaks in nail bed

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16
Q

Work Up for Bacterial Endocarditis

A 
Blood cultures
CBC
CMP
Coags
Echo
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17
Q

Treatment of Bacterial Endocarditis

A 
PCN-G
Nafcillin
Gentamycin
Vanco in MRSA
Zyvox in MRSA
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18
Q

Characteristics of Rocky Mountain Spotted Fever

A

Common May-September

Can be fatal

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19
Q

Important History to Obtain for Rocky Mountain Spotted Fever

A

Hx of tick bite
Outdoor activity
Prodrome: anorexia, irritability, malaise

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20
Q

PE Findings of Rocky Mountain Spotted Fever

A 
1-2 weeks after bite
Fever (>102)
Chills
Weakness
Headache
Photophobia
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21
Q

Skin Lesions in Rocky Mountain Spotted Fever

A

Initially: 2-6 mm, pink blanching macules on extremities; spread centrally
Evolve to papules & petechiae over hours to days

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22
Q

Rash Movement in Rocky Mountain Spotted Fever

A

Wrists
Forearms
Ankles
Palms

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23
Q

Treatment for Rocky Mountain Spotted Fever

A

Doxycycline

Pregnancy: Chloramphenical

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24
Q

Bug that Causes Lyme Disease

A

Spirochete Borrelia burgdorferi

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25
Q

Rash Description of Lyme Disease

A 
Appears several days after infection
Last few hours to several weeks
Very small or very large
Mimic hives, eczema, sunburn, poison ivy, flea bites
Can itch/feel hot or not felt at al
Can disappear and return later
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26
Q

Symptoms of Lyme Disease

A 
Headache
Stiff neck
Aches & pains in muscles & joints
Low-grade fever & chills
Fatigue
Poor appetite
Sore throat
Swollen glands
Arthritis-like symptoms may develop
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27
Q

Diagnosing Lyme Disease

A

Look for rash

Based on symptoms & Hx of tick bite

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28
Q

Treatment of Early-Stage Lyme Disease

A

Doxycycline: >8 years
Amoxicillin: adults, children, pregnant or breast feeding women

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29
Q

Characteristics of Cellulitis

A 
Acute, spreading infections of dermal & subcutaneous tissues through a skin portal
Staph aureus & group A strep
Hx of trauma
Dog, cat, human bites
Common in DM & PVD
30
Q

PE Findings in Cellulitis

A 
Warmth
Erythema
Edema
Tenderness of affected area
Margin not palpable
Violaceous color & bullae = strep pneumo
31
Q

Systemic Signs of Cellulitis

A 
Fever
Chills
Dehydration
Altered mental status
Tachypnea
Tachycardia
Hypotension
32
Q

Work Up for Complicated Cellulitis

A

CBC
Blood cultures
Chem panel

33
Q

Treatment of Mild Cellulitis

A

MRSA: bactrim, clindamycin, doxycyclinee
Cephalexin (Keflex)
Dicloxacillin (Dynapen)

34
Q

Treatment of Complicated Cellulitis

A 
Hospitalization for IV antibiotics
Ancef (Cephalexin)
Ceftriaxone (Rocephin)
Ampicillin-Sulbactam
Zyvox
35
Q

Characteristics of Erysipelas

A

Raised, sharply demarcated advancing margins
Inflammation: warmth, edema, & extreme tenderness
Regional lymphadenopathy
Fiery-red, indurated, tense, & shiny plaque

36
Q

Prodrome of Erysipelas

A

Malaise
Chills
Fever

37
Q

Treatment of Erysipelas

A 
Penicillin G
Penicillin VK
Dicloxacillin (Dynapen)
Keflex (Cephalexin)
Clindamycin
Erythromycin
Analgesics for pain
38
Q

Types of Human Bite Injuries

A

Closed fist
Chomping type
Puncture wounds head from clashes with teeth

39
Q

Treatment of Human Bites

A 
Amoxicillin-Clavulate (Augmentin)
Moxifloxin (Avelox)
Clindamycin
Tetanus shot
Follow up in 1-2 days
40
Q

What should be given as prophylaxis for all dog & cat bite wounds?

A

Tetanus

Rabies

41
Q

Treatment of Dog & Cat Bites

A

I&D
Follow up in 1-2 days
Antibiotics: amoxicillin-clavulate (Augmentin), erythromycin, bactrim DS, septum DS, clindamycin, cipro

42
Q

Characteristics of Necrotizing Fasciitis

A

Hemolytic strep gangrene
Progressive, rapidly spreading, inflammatory infection in the deep fascia
Anaerobic bacteria + aerobic gram - organisms
Group A beta hemolytic strep, staph

43
Q

Important History to Diagnosing Necrotizing Fasciitis

A

Trauma/recent surgery
Insect bites, surgical procedures, IM injections, IV infusion
Sudden onset in pain & swelling
Local pain progresses to anesthesia

44
Q

PE Finding in Necrotizing Fasciitis

A

Area of erythema that spreads
Margins move out into normal skin
Dusky or purplish skin discoloration
Produce large area of gangrenous skin

45
Q

Important Signs of Necrotizing Fasciitis

A 
Tissue necrosis
Putrid discharge
Bullae
Severe pain
Gas production
Rapid burrowing through fascial planes
Lack of classical tissue inflammatory signs
46
Q

Work Up of Necrotizing Fasciitis

A 
CBC with differential
CMP
Blood & tissue cultures
Urinalysis
Arterial blood gas
Xray
CT
Biopsy
47
Q

Treatment of Necrotizing Fasciitis

A 
Aggressive antibiotics
Hemodynamic stabilization
Surgical consult for debriding
Infectious disease specialist
Hyperbaric specialist
48
Q

Antibiotics to Treat Necrotizing Fasciitis

A 
Ceftriaxone (Rocephin)
PCN-G
Clindamycin (Clecin)
Flagyl: good for anaerobes
Gentamicin (Garamycin)
Chloramphenicol (Chloromycetin)
Ampicillin (Omnipen)
49
Q

Characteristics of Hidradenitis Suppurativa

A

Chronic, suppurative disease of apocrine gland-bearing skin
Onset from puberty to climacteric
Predisposing factors: obesity, genetic disposition to acne, apocrine duct obstruction

50
Q

Common Sites for Hidradenitis Suppurativa

A

Axilla

Anogenital region

51
Q

Important History for Hidradenitis Suppurativa

A

Intermittent pain

Marked point tenderness related to abscess formation

52
Q

PE Findings of Hidradenitis Suppurativa

A 
Very tender, red inflammatory nodules
Drain purulent/seropurulent material
Open comedones/double comedones
Fibrosis, bridge scars
Lesions may become infected
53
Q

Treatment of Hidradenitis Suppurativa

A

Intralesional glucocorticoids: triamsinolone
PO steroids: prednisone
Surgery: I&D
Oral Antibiotics: erythromycin, tetracycline, minocycline
Isotretinoin

54
Q

Primary Herpes Infection

A

Symptomatic or asymptomatic

Spread by direct contact or fluid

55
Q

Symptoms of a Primary Herpes Infection

A 
3-7 days after contact
Tenderness
Pain
Mild paresthesias or burning
Grouped vesicles on an erythematous base
Centers become depressed
Crusts form & heal without scarring
Virus enters nerve endings and moves to dorsal root ganglia
56
Q

Type I Herpes Virus

A

Oral & labial herpes simplex

Whitlow-fingers

57
Q

Type II Herpes Virus

A

Genital herpes
Primary/recurrent
May mimic zoster in sacral distributions

58
Q

Diagnosis of Herpes Simplex

A

Inspection
Tzanck smear
Direct Immuno Fluorescence Antibody
Viral culture

59
Q

Treatment of Herpes Simplex

A

Cool compresses
Air or heat lamp drying of lesions
Medications
Pain control PRN

60
Q

Medications to Treat Herpes Simplex

A

Penciclovir (Denavir): topical
Famciclovir (Famvir)
Valacyclovir (Valtrex)
Acyclovir

61
Q

How long is varicella (chicken pox) contagious for?

A

Two days before onset of rash

Until all lesions have crusted

62
Q

Appearance of Varicella

A

“Dew drops on a rose pedal”
Pruritic
Becomes pustules & crusts over

63
Q

Treatment of Varicella (Chicken Pox)

A

Self limiting
Symptomatic: Benadryl, Tylenol
Systemic: acyclovir (Zovirax)

64
Q

Describe Herpes Zoster (Shingles)

A

Reactivation of varicella virus in cutaneous nerves from earlier varicella
Unilateral
Very painful
Flu-like prodrome

65
Q

Common Areas for Herpes Zoster (Shingles)

A

Thoracic
Trigeminal
Lumbosacral
Cervical

66
Q

Skin Lesions with Herpes Zoster (Shingles)

A 
Papules to vesicles-bullae
Pustules to crusts
Erythematous, edematous base
Superimposed clear vesicles
Vesicle oval or round
Regional lymphadenopathy
67
Q

Complications with Herpes Zoster (Shingles)

A

Postherpetic neuralgia

Temporary motor paresis

68
Q

Treatment for Herpes Zoster (Shingles)

A 
Famvir, Valtrex, or Acyclovir
\+/- oral steroids
Antibiotic cream
Burrow's solution or cool compress
Ultram PO
69
Q

Describe Genital Warts

A

Papilloma virus
Spread rapidly over moist areas
Small papules to large veracious lesions
May extend to vaginal tract, urethra, rectum

70
Q

Treatment of Genital Warts

A 
Podophyllum: small areas
Trichloroacetic acid (vaginal)
Crysurgery
Carbon dioxide laser
Electrosurgery
71
Q

Molluscum Contagiosum

A

Discrete, umbilicated, domed-shaped papules
Auto-inoculation, scratching
Children: on face, trunk, extremities
Adults: genital & pubic areas

72
Q

Treatment of Molluscum Contagious

A 
Curettage
Cryosurgery
TCA/Podophyllin
Retin A cream
Cantharidin

Dermatology (13 decks)

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