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Bacterial & Viral Infections 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
Rash Description of Lyme Disease
``` 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 ```
26
Symptoms of Lyme Disease
``` Headache Stiff neck Aches & pains in muscles & joints Low-grade fever & chills Fatigue Poor appetite Sore throat Swollen glands Arthritis-like symptoms may develop ```
27
Diagnosing Lyme Disease
Look for rash | Based on symptoms & Hx of tick bite
28
Treatment of Early-Stage Lyme Disease
Doxycycline: >8 years Amoxicillin: adults, children, pregnant or breast feeding women
29
Characteristics of Cellulitis
``` 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
PE Findings in Cellulitis
``` Warmth Erythema Edema Tenderness of affected area Margin not palpable Violaceous color & bullae = strep pneumo ```
31
Systemic Signs of Cellulitis
``` Fever Chills Dehydration Altered mental status Tachypnea Tachycardia Hypotension ```
32
Work Up for Complicated Cellulitis
CBC Blood cultures Chem panel
33
Treatment of Mild Cellulitis
MRSA: bactrim, clindamycin, doxycyclinee Cephalexin (Keflex) Dicloxacillin (Dynapen)
34
Treatment of Complicated Cellulitis
``` Hospitalization for IV antibiotics Ancef (Cephalexin) Ceftriaxone (Rocephin) Ampicillin-Sulbactam Zyvox ```
35
Characteristics of Erysipelas
Raised, sharply demarcated advancing margins Inflammation: warmth, edema, & extreme tenderness Regional lymphadenopathy Fiery-red, indurated, tense, & shiny plaque
36
Prodrome of Erysipelas
Malaise Chills Fever
37
Treatment of Erysipelas
``` Penicillin G Penicillin VK Dicloxacillin (Dynapen) Keflex (Cephalexin) Clindamycin Erythromycin Analgesics for pain ```
38
Types of Human Bite Injuries
Closed fist Chomping type Puncture wounds head from clashes with teeth
39
Treatment of Human Bites
``` Amoxicillin-Clavulate (Augmentin) Moxifloxin (Avelox) Clindamycin Tetanus shot Follow up in 1-2 days ```
40
What should be given as prophylaxis for all dog & cat bite wounds?
Tetanus | Rabies
41
Treatment of Dog & Cat Bites
I&D Follow up in 1-2 days Antibiotics: amoxicillin-clavulate (Augmentin), erythromycin, bactrim DS, septum DS, clindamycin, cipro
42
Characteristics of Necrotizing Fasciitis
Hemolytic strep gangrene Progressive, rapidly spreading, inflammatory infection in the deep fascia Anaerobic bacteria + aerobic gram - organisms Group A beta hemolytic strep, staph
43
Important History to Diagnosing Necrotizing Fasciitis
Trauma/recent surgery Insect bites, surgical procedures, IM injections, IV infusion Sudden onset in pain & swelling Local pain progresses to anesthesia
44
PE Finding in Necrotizing Fasciitis
Area of erythema that spreads Margins move out into normal skin Dusky or purplish skin discoloration Produce large area of gangrenous skin
45
Important Signs of Necrotizing Fasciitis
``` Tissue necrosis Putrid discharge Bullae Severe pain Gas production Rapid burrowing through fascial planes Lack of classical tissue inflammatory signs ```
46
Work Up of Necrotizing Fasciitis
``` CBC with differential CMP Blood & tissue cultures Urinalysis Arterial blood gas Xray CT Biopsy ```
47
Treatment of Necrotizing Fasciitis
``` Aggressive antibiotics Hemodynamic stabilization Surgical consult for debriding Infectious disease specialist Hyperbaric specialist ```
48
Antibiotics to Treat Necrotizing Fasciitis
``` Ceftriaxone (Rocephin) PCN-G Clindamycin (Clecin) Flagyl: good for anaerobes Gentamicin (Garamycin) Chloramphenicol (Chloromycetin) Ampicillin (Omnipen) ```
49
Characteristics of Hidradenitis Suppurativa
Chronic, suppurative disease of apocrine gland-bearing skin Onset from puberty to climacteric Predisposing factors: obesity, genetic disposition to acne, apocrine duct obstruction
50
Common Sites for Hidradenitis Suppurativa
Axilla | Anogenital region
51
Important History for Hidradenitis Suppurativa
Intermittent pain | Marked point tenderness related to abscess formation
52
PE Findings of Hidradenitis Suppurativa
``` Very tender, red inflammatory nodules Drain purulent/seropurulent material Open comedones/double comedones Fibrosis, bridge scars Lesions may become infected ```
53
Treatment of Hidradenitis Suppurativa
Intralesional glucocorticoids: triamsinolone PO steroids: prednisone Surgery: I&D Oral Antibiotics: erythromycin, tetracycline, minocycline Isotretinoin
54
Primary Herpes Infection
Symptomatic or asymptomatic | Spread by direct contact or fluid
55
Symptoms of a Primary Herpes Infection
``` 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
Type I Herpes Virus
Oral & labial herpes simplex | Whitlow-fingers
57
Type II Herpes Virus
Genital herpes Primary/recurrent May mimic zoster in sacral distributions
58
Diagnosis of Herpes Simplex
Inspection Tzanck smear Direct Immuno Fluorescence Antibody Viral culture
59
Treatment of Herpes Simplex
Cool compresses Air or heat lamp drying of lesions Medications Pain control PRN
60
Medications to Treat Herpes Simplex
Penciclovir (Denavir): topical Famciclovir (Famvir) Valacyclovir (Valtrex) Acyclovir
61
How long is varicella (chicken pox) contagious for?
Two days before onset of rash | Until all lesions have crusted
62
Appearance of Varicella
"Dew drops on a rose pedal" Pruritic Becomes pustules & crusts over
63
Treatment of Varicella (Chicken Pox)
Self limiting Symptomatic: Benadryl, Tylenol Systemic: acyclovir (Zovirax)
64
Describe Herpes Zoster (Shingles)
Reactivation of varicella virus in cutaneous nerves from earlier varicella Unilateral Very painful Flu-like prodrome
65
Common Areas for Herpes Zoster (Shingles)
Thoracic Trigeminal Lumbosacral Cervical
66
Skin Lesions with Herpes Zoster (Shingles)
``` Papules to vesicles-bullae Pustules to crusts Erythematous, edematous base Superimposed clear vesicles Vesicle oval or round Regional lymphadenopathy ```
67
Complications with Herpes Zoster (Shingles)
Postherpetic neuralgia | Temporary motor paresis
68
Treatment for Herpes Zoster (Shingles)
``` Famvir, Valtrex, or Acyclovir +/- oral steroids Antibiotic cream Burrow's solution or cool compress Ultram PO ```
69
Describe Genital Warts
Papilloma virus Spread rapidly over moist areas Small papules to large veracious lesions May extend to vaginal tract, urethra, rectum
70
Treatment of Genital Warts
``` Podophyllum: small areas Trichloroacetic acid (vaginal) Crysurgery Carbon dioxide laser Electrosurgery ```
71
Molluscum Contagiosum
Discrete, umbilicated, domed-shaped papules Auto-inoculation, scratching Children: on face, trunk, extremities Adults: genital & pubic areas
72
Treatment of Molluscum Contagious
``` Curettage Cryosurgery TCA/Podophyllin Retin A cream Cantharidin ```

Dermatology (13 decks)

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