Cellulitis, AOM, Sinusitis

Question 1

Cellulitis

Answer 1

acute, spreading pyogenic inflamm of the dermis and subQ tissue
complicates a wound or ulcer
usually warm, tender, swollen and erythematous
lacks sharp demarcation from unaffected skin
caused by skin trauma, bites, wounds, hot tubs/pools, edema

Question 2

impetigo

Answer 2

occurs mostly ion kids during hot, humid weather

pruritus is common, scratching –> secondary staph infn

Question 3

staph aureus scalded skin syndrome

Answer 3

caused by an exfoliative exotoxin
many produce epidemics in neonatal nurseries
mortality ~3%

Question 4

folliculitis

Answer 4

a pyoderma in the hair shaft

et: S aureus, Pseudomonas, Candida
tx: topical abx, antifungals

Question 5

furuncle

Answer 5

deep inflam nodule

Question 6

carbuncle

Answer 6

larger, extends into subQ fat (abscess)

Question 7

carbuncle and furuncles

Answer 7

invariably caused by staph aureus
predisposing factors: obesity, bloody dyscrasias, steroid tx, DM
can give Vance, linezolid or daptomycin if possible MRSA

Question 8

Chancriform Lesions (cutaneous anthrax)

Answer 8

previously ass'ed with wool and animal hides
caused by spores of bacillus anthraces 
painless 
causes hem and necrosis
avoid incision and debridement!!!!

Question 9

erysipelas

Answer 9

distinctive type of superficial cellulitis
characterized by prominent lymphatic involvement
raised border, sharply demarcated

Question 10

gram + org in cellulitis

Answer 10

80% of causes

s aureus, group A or B strep, viridian’s strep, E faecalis (rare)

Question 11

cultures/bx in cellulitis

Answer 11

usually not helpful (esp swabs), reveal typical skin flora, reserved for special cases (blisters)
exceptions: DM (add anaerobic coverage)

Question 12

necrotizing fasciitis

Answer 12

affects extremities, abd wall, perianal and groin
affected area is swollen, hot and very painful
progresses rapidly over several days
thromboses subQ vessels –> necrosis
anesthesia may precede skin necrosis (clue)
disproportionate pain is important clue
prompt dx is critical
mortality rate 20-50%

Question 13

Fournier’s Gangrene

Answer 13

necrotizing fasciitis of genitalia

mortality rate 10-20%

Question 14

sinusitis

Answer 14

usually secondary to colds (viral rhinosinusitis)
1-2% of VRS progress to bacterial sinusitis
secondary obst favors bacterial growth (resulting in acute bacterial sinusitis)
strep pneumo and H flu are 50% of bacterial cases

Question 15

Acue bacterial sinusitis dx

Answer 15

viral symptoms improve in 7-10 days
so clinical dx of bacterial is either: symptoms persist > 10 days, worsening symptoms after 5-7 days, or + transillumination

Question 16

acute OM

Answer 16

MC reason for abx in kids
strep pneumonia (38%, vaccine), H flu (27% vaccine) and M catarrhalis (10%, most produce B-lactamase)

Question 17

dx of AOM

Answer 17

requires S/S’s + inflam (red TM) and fluid in the middle ear (bulging TM)
retracted eardrum is painful, but not AOM (caused by - middle ear P)
red membrane w/o middle ear fluid isn’t AOM

Question 18

tympanocentesis indicated in:

Answer 18

pt’s critically ill at symptom onset, toxic pt’s not responding in 48-72 hrs, pt’s with altered host defenses