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Clinical pathology > Clinical infections: Orthopaedic, Skin and Soft Tissue > Flashcards

Clinical infections: Orthopaedic, Skin and Soft Tissue Flashcards

1
Q

Functions of the skin

A
  • Physical barrier
  • homeostasis
  • Immunological function
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2
Q

Normal flora of the skin =

A
  • Coagulase-negative Staphylococci

- Staph aureus

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3
Q

Viral warts definition

A

Small asymptomatic growths of skin; on hands, genitals, feet, around nails, throat

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4
Q

Viral warts features

A
  • Aetiology = HPV
  • Pathogenesis = proliferation and thickening of stratum corneum, granulosum and spinosum
  • Clinical presentation = asymptomatic, mechanical, cervical cancer
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5
Q

Viral warts treatment

A
  • Topical – salicylic acid, silver nitrate, cryosurgery

- Gardasil immunisation for HPV

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6
Q

Pilonidal Cysts or Abscesses

A
  • In natal cleft; caused by ingrowing hair
  • Contains hair and debris
  • Discharge to form sinus
  • Clinical presentation = pain, swelling, pus
  • Treatment – hot compress, analgesia, antibiotics, surgical excision
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7
Q

Impetigo

A
  • Superficial skin infection with crusting around nostrils or corners of mouth
  • Aetiology = S. aureus
  • Transmissible
  • Treatment = topical or oral antibiotics
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8
Q

Cellulitis definition

A

Infection affecting inner layers of skin – dermis, subcutaneous fat into lymphatics

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9
Q

Cellulitis aetiology

A

S. aureus, group A strep, group B strep

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10
Q

Cellulitis features

A
  • Bacteria enter through breaks in skin

- Rubor (red), calor (heat), dolor (pain), tumor (swelling) - inflammation

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11
Q

Cellulitis treatment

A
  • Elevation, rest, antibiotics, source control (e.g. drain pus)
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12
Q

Necrotising Fasciitis definition

A
  • Flesh eating bug, rapidly progressive, life threatening

- Tracking along fascia, cutting off blood supply leads to necrosis

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13
Q

Main types of necrotising fasciitis

A
  • Type 1: synergistic/poly-microbial, Presence of host impairment, RFs – diabetes, obesity
  • Type 2: group A strep mediated, Younger people, associated with cut or injury
  • Type 3: vibrio vulnificus – sea water, coral
  • Type 4: fungal – rare
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14
Q

Necrotising Fasciitis pathogenesis

A
  • Type 1 – ischaemic tissue, colonisation then infection resulting in further ischaemia and necrosis.
  • Type 2 – infection, toxin release, disruption in blood supply = necrosis
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15
Q

Necrotising Fasciitis clinical presentation + treatment

A
  • Clinical presentation = swelling, erythema, pain, crepitus, sepsis/toxaemia
  • Treatment = debridement and antibiotics
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16
Q

Gangrene pathogenesis

A
  • poor blood flow
  • tissue necrosis
  • colonisation
  • infection
  • further necrosis
17
Q

Gangrene risk factors

A
  • Dry = mummified, auto-amputate
  • Wet = boggy, swollen “dactylitis”
  • Gas = crepitus due to gas in tissue
18
Q

Gangrene aetiology + treatment

A
  • Aetiology:
    o Skin – Staph, streps
    o Enteric – gram negative bacilli, anaerobes (incl. Clostridium)
  • Treatment – surgical source control, revascularisation +/- antibiotics (if infectious)
19
Q

Fournier gangrene

A
  • Necrotising fasciitis of the external genetalia
  • +/- perineum
  • M>F
20
Q

Diabetic foot definition

A
  • Spectrum of disease from superficial to deep bone infection
  • Caused by organisms that are superficial or deep
21
Q

Orbital cellulitis

A
  • Infection of soft tissue around and behind eye via Infection from skin or sinuses
  • Presentation = erythema, swelling with induration, pain on eye movement, bulging
  • Aetiology = S aureus, group A strep, S pneumoniae, H influenzae
  • Treatment = IV antibiotics
22
Q

Diabetic foot pathogenesis

A
  • Damage to blood vessels – ischaemia, impaired immunity, poor wound healing
  • Damage to nerves – neuropathy, trauma
  • High blood sugars – prone to bacterial infection
23
Q

Osteomyelitis pathogenesis

A
  • Infection of bone
    Mechanism:
  • Contiguous - diabetic foot infection
  • Haematogenous - bacteraemia
  • Penetrating
     Acute - associated with inflammatory reaction, fulminant, sepsis
     Chronic - present for >1 month, smouldering, acute flares
  • Infection results in bone death and new bone formation
24
Q

Osteomyelitis aetiology

A
  • Haematogenous (mostly children) – S aureus
  • Contiguous – skin (staph, strep) or enteric (gram negative bacilli)
  • Penetrating – surgical, open fracture
  • Sickle cell – Salmonella
25
Q

Osteomyelitis presentation + treatment

A

Presentation = acute pain, swelling, erythema, sinus, pathological fracture
- Treatment = 4-6 weeks antibiotics, surgical debridement and stabilisation

26
Q

Septic/Pyogenic Arthritis

A
  • Infection of joint - usually bacterial (staph + strep)
  • Haematogenous, local and penetrating spread
  • Pain, swelling, unable to weight bear
  • Treatment = 4-6 weeks of antibiotics and surgical source control
27
Q

Prosthetic joint infection pathogenesis

A
  • Infection of prosthetic joint or tissue and bone surrounding it
  • Bugs get onto surface of foreign body
  • Immune system cannot reach
  • Early – implanted at time or surgery or shortly after via wound
  • Late – haematogenous or late presenting early infection
28
Q

Prosthetic joint infection aetiology

A
  • Early – S aureus, S epidermis

- Late – above AND E coli, B haemolytic streps, Strep viridans

29
Q

Prosthetic joint infection presentation + treatment

A
  • Presentation = instability, sinus formation + pus

- Treatment = Antibiotics with debridement, remove old joint and replace

30
Q

Syphilis aetiology

A
  • STI or congenital

- Aetiology = Treponema pallidum

31
Q

Syphilis Primary

A
  • Chancre – painless, firm, non-itchy ulcer at the point of contact
  • Usually single; Lasts 3-6 weeks
  • Lymphadenopathy
32
Q

Syphilis Secondary

A
  • 4-6 weeks after chancre
  • Rash – symmetrical, red/pink, non-itchy
  • Everywhere including soles/ palms/ mucous membranes
  • Rash contains treponema
33
Q

Syphilis Tertiary

A
  • 3-15 years after initial infection
  • 3 forms – gummatous, neurological, cardiovascular
  • Gummatous (late benign) – chronic gummas: large inflammatory swellings of bone and liver

Clinical pathology (69 decks)

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