Cellulitis and skin tx

Question 1

What is cellulitis?

Answer 1

Acute, spreading pyogenic inflammation of the dermis and subq tissue

Question 2

What is cellulitis a complication of?

Answer 2

Wound or ulcer

Question 3

Describe cellulitis feeling.

Answer 3

Warm, tender, swollen, and erythematous

Question 4

Is cellulitis sharply demarcated from unaffected skin?

Answer 4

No

Question 5

Who is affected by impetigo? And when?

Answer 5

Children

Hot, humid weather

Question 6

What are some common signs of impetigo? What are they secondary to?

Answer 6

Puritis, scratching

Staph infection

Question 7

How do you treat impetigo?

Answer 7

Benzathine PCN

Question 8

How do you administer benzathine?

Answer 8

Single IM injection

Question 9

What is staphylococcal scalded skin syndrome (SSSS)?

Answer 9

Severe manifestation of S. aureus infection

Question 10

What is SSSS caused by?

Answer 10

Exfoliative exotoxin

Question 11

Can SSSS produce epidemics? If so, where?

Answer 11

Yes, in neonatal nurseries

Question 12

What is the rate of mortality for SSSS?

Answer 12

3%

Question 13

How do you treat SSSS? What is the name of this drug?

Answer 13

Penicillinase resistant PCN

Nafcillin

Question 14

What is folliculitis?

Answer 14

Pyoderma in the hair shafts

Question 15

What is the etiology of folliculitis?

Answer 15

S. aureus
Pseudomonas
Candida

Question 16

What is the tx for folliculitis?

Answer 16

Local/topical abx or antifungals

Question 17

What is a furuncle?

Answer 17

Deep inflammatory nodule

Question 18

What is a carbuncle?

Answer 18

Larger nodule that extends into subQ fat (abscess)

Question 19

What causes furuncles and carbuncles?

Answer 19

S. aureus

Question 20

What are predisposing factors for furuncles and carbuncles?

Answer 20

Obesity, blood dyscrasias, steroid tx, DM

Question 21

Tx for furuncles and carbuncles

Answer 21

Antistaphlococcal abx
Clindamycin 150-300 mg po q6 hours (if PCN allergic)
Vancomycin, linezolid, or daptomycin (MRSA)

Question 22

What were chancriform lesions previously associated with?

Answer 22

Wool and animal hides

Question 23

What are chancriform lesions caused by?

Answer 23

Spores of Bacillus anthracis

Question 24

Are chancriform lesions painless or painful?

Answer 24

Painless

Question 25

What happens to the chancriform lesions as they grow??

Answer 25

They become hemorrhagic and necrotic

Question 26

What is the tx for chancriform lesions?

Answer 26

Ciprofloxacin 500 mg po q12 h 7-10 days | 60 for bioterror

Question 27

What is erysipelas?

Answer 27

Its a distinctive type of superficial cellulits

Question 28

What is erysipelas characterized by?

Answer 28

Prominent lymphatic involvement

Question 29

Describe the characters of erysipelas.

Answer 29

Raised border, sharply demarcated

Question 30

How do you treat early cases of erysipelas?

Answer 30

Penicillin Pen V 250-500 mg po q 6 Erythromycin 250-500 mg po q 6

Question 31

How do you treat extensive or hospitalized cases of erysipelas?

Answer 31

Pen G 2 mill units IV q 6 Nafcillin 2g IV q 4 Cefazolin 1-2 g IV q8

Question 32

What are some initiating sources of cellulitis?

Answer 32

``` Skin trauma Bites Wounds Hot tubs/pools Edema ```

Question 33

What % of cellulitis aspirates are gram + organisms, and what are some examples?

Answer 33

``` 80% S. aureus Group A or B streptococci Viridians streptococci E. faecalis (rare) ```

Question 34

Are cultures/bx useful for cellulitis?

Answer 34

Not really -> only really reveal typical skin flora | They are reserved for special cases

Question 35

For diabetic pts what do you add to tx?

Answer 35

Anaerobic coverage

Question 36

What areas does necrotizing fasciitis affect?

Answer 36

Extremities, abdominal wall, perianal, and groing

Question 37

What is Fournier's gangrene? | What is the mortality rate?

Answer 37

NF of the genitalia | 10-20%

Question 38

What to gangrenous areas look like and feel like?

Answer 38

Swollen, hot, and VERY painful | *disproportionate pain is important clue*

Question 39

Does NF progress slowly or rapidly? And over what period of time?

Answer 39

Rapidly over several days

Question 40

What leads to the necrosis?

Answer 40

Thrombosed subQ vessels

Question 41

What is something that can proceed NF?

Answer 41

Anesthesia

Question 42

What is the mortality rate of NF?

Answer 42

20-50%

Question 43

What abx do you give for NF?

Answer 43

Ampicillin, gentamicin, clindamycin, and metronidazole