Cellulitis and Erysipelas Flashcards
Cellulitis refers to an infection of the skin. Can this occur anywhere in the body?
- yes
- typically presents in the limbs though
Cellulitis occurs when bacteria are able to penetrate the skin. In cellulitis, which layers of the skin are affected?
1 - epidermis (all cellular layers)
2 - dermis (hair follicles, nerve endings, glands, blood vessels and lymphatics)
3 - hypodermis (subcutaneous fat, connective tissue anchoring to basement membrane)
4 - all of the above
4 - all of the above
Erysipelas is a form of bacterial skin infection. Which layers of the skin are affected?
1 - epidermis (all cellular layers)
2 - dermis (hair follicles, nerve endings, glands, blood vessels and lymphatics)
3 - hypodermis (subcutaneous fat, connective tissue anchoring to basement membrane)
4 - all of the above
1 - epidermis (all cellular layers)
2 - dermis (hair follicles, nerve endings, glands, blood vessels and lymphatics)
- typically does not affect deep tissue as much as cellulitis
Cellulitis is a very common presentation in acute medicine. What is the incidence of cellulitis?
1 - 15 / 100,000
2 - 150 / 100,000
3 - 1500 / 100,000
4 - 15,000 / 100,000
4 - 15,000 / 100,000
Cellulitis is a skin infection, typically caused by bacteria that affects all layers of the skin up to the deeper subcutaneous tissues. What age has a peak incidence of cellulitis?
1 - 20-30
2 - 30-50
3 - 40-60
4 - 50-60
4 - 50-60
Cellulitis is a skin infection, typically caused by bacteria that affects all layers of the skin up to the deeper subcutaneous tissues. Are men or women more likely to develop cellulitis?
- affects both equally
Cellulitis is a skin infection, typically caused by bacteria that affects all layers of the skin up to the deeper subcutaneous tissues. Infection is typically caused by a break in the skin. All of the following are common risk factors, EXCEPT which one?
1 - previous surgery
2 - immunosuppressed
3 - atopic dermatitis (eczema), Athlete’s foot,
4 - lymphoedema
5 - history of cellulitis
6 - obesity
1 - previous surgery
- may cause a wound infection, typically caused by S. aureus, but not cellulitis
- immunosuppression includes diabetes mellitus, HIV, immunosuppressive drugs
Although the exact pathophysiology of cellulitis is poorly understood, exotoxins (proteins secreted by bacteria) have been linked. All of the following can cause cellulitis, but which 2 are most common?
1 - Streptococcus pyogenes
2 - Staphylococcus aureus
3 - Vibrio vulnificus
4 - Methicillin-resistant Staphylococcus aureus (MRSA)
1 - Streptococcus pyogenes
2 - Staphylococcus aureus
Pseudomonas may also occur
When examining a patient with suspected cellulitis, are the borders of the infection typically well demarcated?
- no
- as the deeper dermis is affected, it can be difficult to identify the borders of infection
Which of the following is NOT a common clinical sign of cellulitis?
1 - fever and malaise (feeling crappy)
2 - cool to touch
3 - redness with swelling
4 - tenderness to touch
5 - sign of broken skin where infection began
2 - cool to touch
- typically presents with warmth to the touch
Does cellulitis typically present bilaterally?
- no
- presents unilaterally
- if bilateral, this suggestion other diagnosis
Does cellulitis typically present gradually or acutely?
- presents acutely
- if it presents gradually, this suggests a different diagnosis
When trying to identify if a patient has cellulitis, we can use history, examinations and investigations. Which of the following is NOT a typically differential for cellulitis?
1 - thrombophlebitis (inflammation causing blood clots to form in veins, mostly in the legs)
2 - DVT and PVD
3 - lymphoedema
4 - contact dermatitis (allergy)
5 - ingrown hair
6 - gout
7 - insect sting, cat scratch disease
5 - ingrown hair
Diagnosis of cellulitis is typically a clinical diagnosis. However, all of the following can be useful, EXCEPT which one?
1 - LFTs
2 - U&Es (systemic inflammation may cause AKI)
3 - FBC (WBC may be raised)
4 - CRP and ESR
5 - swab to identify pathogen
1 - LFTs
- wouldn’t hurt, but typically does not aid with the diagnosis
- a swab and blood culture may be useful in some patients
In a patient with confirmed cellulitis, we would typically wash, clean, moisturise and dress infected area regularly. In addition to this patients would be prescribed oral (IV in severe cases) antibiotics. Which of the following class would be the 1st line treatment in cellulitis in a patient with NKDA?
1 - Glycopeptides
2 - Penicillins
3 - Cephalosporins
4 - Macrolids
2 - Penicillins
- Flucloxacillin 1st line
- Cephalosporins are 1st line if patient has an allergy to penicillins
When treating a patient, is it important to draw around the borders of cellulitis, if this is possible?
- yes
- helps identify the response to treatment
The severity of cellulitis can be graded using the Eron classification, which is graded from I to IV with increasing severity. At what severity should patients be admitted to hospital?
1 - IV
2 - III
3 - II
4 - I
3 - II
- typically reviewed , but >II
Despite treating cellulitis, complications may occur. One of these is bacteraemia. Which one of the following matches the description of bacteraemia?
1 - bacteria from cellulitis has entered the blood stream
2 - abnormal system wide response to an infection that is a medical emergency
3 - infection of the endocardium surrounding the heart
4 - bone marrow become infected
1 - bacteria from cellulitis has entered the blood stream
Despite treating cellulitis, complications may occur. One of these is osteomyelitis. Which one of the following matches the description of osteomyelitis?
1 - bacteria from cellulitis has entered the blood stream
2 - abnormal system wide response to an infection that is a medical emergency
3 - infection of the endocardium surrounding the heart
4 - bone marrow becomes inflamed due to infection
4 - bone marrow becomes inflamed due to infection
Despite treating cellulitis, complications may occur. One of these is sepsis. Which one of the following matches the description of sepsis?
1 - bacteria from cellulitis has entered the blood stream
2 - abnormal system wide response to an infection that is a medical emergency
3 - infection of the endocardium surrounding the heart
4 - bone marrow becomes inflamed due to infection
2 - abnormal system wide response to an infection that is a medical emergency
Despite treating cellulitis, complications may occur. One of these is infective endocarditis. Which one of the following matches the description of infective endocarditis?
1 - bacteria from cellulitis has entered the blood stream
2 - abnormal system wide response to an infection that is a medical emergency
3 - infection of the endocardium surrounding the heart
4 - bone marrow becomes inflamed due to infection
3 - infection of the endocardium surrounding the heart
Despite treating cellulitis, complications may occur. One of these is necrotising fasciitis. Which one of the following matches the description of necrotising fasciitis?
1 - bacteria from cellulitis has entered the blood stream
2 - abnormal system wide response to an infection that is a medical emergency
3 - infection of the endocardium surrounding the heart
4 - infection causes necrosis of deep dermis, including subcutaneous fat and muscle
4 - infection causes necrosis of deep dermis, including subcutaneous fat and muscle
Necrotising fasciitis is a complication that can be caused by cellulitis where the deep subcutaneous skin layers including muscle and fat are necrosed. Is this dangerous?
- yes
- can develop rapidly, cause limb loss, sepsis and death
- typically affects the limbs
Diabetic patients are at risk of recurrent cellulitis. Which of the following can be used to reduce the risk of recurrence?
1 - foot and leg checks
2 - correct footwear
3 - awareness of cellulitis
4 - all of the above
4 - all of the above
When examining a patient with suspected Erysipelas, are the borders of the infection typically well demarcated?
- yes
- this is how to distinguish between cellulitis and Erysipelas
When comparing cellulitis and erysipelas, which of them have can present with an unwell patient with fever, hot, painful erythematous and oedematous area primarily affecting face and extremities?
- cellulitis
- erysipelas,
- both
- both
Although the exact pathophysiology of erysipelas is poorly understood, exotoxins (proteins secreted by bacteria) have been linked. All of the following can cause erysipelas, but which 1 is most common?
1 - Group A Streptococcus pyogenes
2 - Staphylococcus aureus
3 - Vibrio vulnificus
4 - Methicillin-resistant Staphylococcus aureus (MRSA)
1 - Group A Streptococcus pyogenes
Typically which areas of the body do cellulitis and erysipelas affect?
1 - face and extremities
2 - torso and face
3 - back and legs
4 - face and scalp
1 - face and extremities
A non-infectious cause for pyrexia should always be considered. Which blood test is most useful in distinguishing bacterial from non-bacterial causes of fever?
1 - CRP
2 - Differential WBC
3 - ESR
4 - Ferritin
5 - Procalcitonin
5 - Procalcitoni
- A serum biomarker that helps distinguish bacterial infections from other causes of infection or inflammation.
High in bacterial infection
Low in inflammation
Could be systemic juvenile idiopathic arthritis
