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Clinical Pathology > CP10-4 Clinical Infections Orthopaedic, Skin And Soft Tissue > Flashcards

CP10-4 Clinical Infections Orthopaedic, Skin And Soft Tissue Flashcards

1
Q

What is the function of skin?

A

Physical barrier
Homeostasis including thermoregulation
Immunological function

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2
Q

What type of bacteria colonises the skin?

A

Coagulase+negative staphylococci

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3
Q

What are viral warts?

A

Small asymptomatic growths of skin on hands, genitals, feet, around nails and/or throat due to HPV virus causing proliferation and thickening of stratum cornerman, granulosum and spinosum

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4
Q

How do clinical warts present?

A
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5
Q

How are viral warts treated?

A

Topically with salicylic acid, silver nitrate and with cryosurgery

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6
Q

How can viral warts be prevented?

A

gardasil
barrier protection (to protect against genital warts)

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7
Q

What are pilonidal cysts or abscesses?

A

Cysts or abscesses in natal cleft potentially caused by in growing hair. They contain hair and debris and can discharge to form a sinus.

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8
Q

How do pilonidal cysts present?

A
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9
Q

How are pilonidal cysts treated?

A
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10
Q

What is impetigo?

A

A superficial skin infection caused by staph aureus which causes crusting around nares or corners of the mouth.

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11
Q

How is impetigo treated?

A
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12
Q

What is erysipelas?

A

An infection affecting the upper dermis, which can involve the lymphatic system, causing a rash over the face which is raised and demarcated. It is caused by strep pyogenes (strep Aj.

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13
Q

How is erysipelas treated?

A
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14
Q

What is cellulitis?

A

Infection affecting the inner layers of the skin including the dermis and subcutaneous fat, into lymphatics, due to staph aureus or strep pyogenese.

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15
Q

How do patients with cellulitis present?

A
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16
Q

How are patients diagnosed with cellulitis?

A
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17
Q

How are patients with cellulitis treated?

A

With elevation, rest, antibiotics and source control e.g. drainage of pus.

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18
Q

What is orbital cellulitis?

A

An infection of soft tissues around and behind the eye which develops from infection in the skin, or sinuses or blood, or can be caused by trauma.

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19
Q

How do patients with orbital cellulitis present?

A
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20
Q

What are causative organisms of orbital cellulitis?

A

Staph aureus
Strep pyogenes
Strep pneumoniae
Haemophilus influenza

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21
Q

How is orbital cellulitis treated?

A

With IV antibiotics

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22
Q

What is necrotising fasciitis?

A

A rapidly progressive, life threatening infection which tracks along the fascia and causes necrosis which cuts of blood supply.

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23
Q

What are the four types of necrotising fasciitis?

A

Type 1: synergistic/poly-microbial infection in older people caused by gram negative staph, strep and anaerobes, affecting impaired hosts e.g. by diabetes mellitus, immunosupression etc…

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24
Q

What is an example of type 1 necrotising fasciitis?

A

Fournier gangrene

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25
Q

What is the pathogenesis of type 1 necrotising fasciitis?

A
26
Q

What is the pathogenesis of type 2 necrotising fasciitis?

A
27
Q

How do patients with necrotising fasciitis present?

A

swelling
erythema
pain
crepitus
sepsis/toxaemia
necrosis of tissue with “dish water” exudate

28
Q

How is necrotising fasciitis treated?

A

Is a surgical emergency requiring debridement and antibiotics

29
Q

What is gangrene?

A

Necrosis caused by inadequate blood supply separated into dry, wet or gas gangrene.

30
Q

What are risk factors for gangrene?

A

Atherosclerosis, smoking, diabetes mellitus and auto-immune disease

31
Q

What is the pathogenesis of gangrene?

A

Poor blood flow = tissue necrosis = colonisation = infection = synergistic infection = further necrosis

32
Q

How do patients present with dry vs wet vs gas gangrene?

A

Dry = mummified and auto amputate
Wet =boggy, swollen, dactylitis tissue with exudate and surrounding erythema
Gas = as above but with crepitus due to gas in tissue

33
Q

What organisms causes gangrene?

A
34
Q

How is gangrene treated?

A

Surgically for source control and revascularisation + antibiotics

35
Q

What is diabetic foot infection?

A

A spectrum of diseases from superficial through to deep bone infection in patients with diabetes

36
Q

What is the pathogenesis of diabetic foot infection?

A

Damage to blood vessels = ischaemia, impaired immunity and poor wound healing
Damage to nerves = neuropathy and lead to trauma as reduced sensation
High blood sugars =more prone to bacterial infection

37
Q

What organisms cause diabetic foot infection?

A

Staph aureus, streps, corynebacterium + GNB and anaerobes can cause deeper infections

38
Q

How is diabetic foot infection treated?

A

Surgical debridement and revascularisation
Antibiotics
Off loading
Diabetic control

39
Q

What is osteomyelitis?

A

Infection of bone

40
Q

What is the pathogenesis of osteomyelitis?

A

Contiguous e.g. diabetic foot infection
Haematogenous e.g. bacteraemia
Penetrating e.g. due to trauma
Infection results in sequestrum (bone death) and new bone formation (involucrum)

41
Q

How does acute and chronic osteomyelitis differ?

A
42
Q

What organisms cause osteomyelitis?

A

bacteria inc. staph aureus, strep, kingella, salmonella (in people with sickle cell) & haemophilus spp.

43
Q

How do patients with osteomyelitis present?

A

With acute pain, swelling, erythema, sinus and pathological fracture

44
Q

How are patients with osteomyelitis treated?

A

Antibiotics for 4-6 weeks, especially if haematogenous cause, Surgical debridement and stabilisation of bone if dead bone present

45
Q

What pathogen can cause osteomyelitis in people with sickle cell?

A

Salmonella

46
Q

What is septic (or pyogenic) arthritis?

A

An infection of the joint via haematogenous infections, local spread from adjacent soft tissue, bone or bursa or due to penetrating injuries like surgery, trauma or joint injections.

47
Q

What organisms cause septic arthritis?

A
48
Q

How to patients with septic arthritis present?

A

Pain, swelling, erythema, reduced range of movement with inability to weight bear +/- sepsis

49
Q

How are patients diagnosed with septic arthritis?

A

From clinical examination with confirmation via joint aspiration

50
Q

How is septic arthritis treated?

A

Antibiotics guided by cultures for 4-6 weeks
Surgical source control with a joint washout

51
Q

What is prosthetic joint infection?

A

Infection of tissue and bone surrounding a prosthetic joint which occur as bugs get onto an area the immune system cannot reach and establish a biofilm.

52
Q

What are the two types of prosthetic joint infection and how do they differ?

A

Early - bugs implanted at time of surgery or shortly after via the wound
Later - haematogenous cause resulting in late presenting infection

53
Q

What organisms cause prosthetic joint infection?

A
54
Q

How do patients with prosthetic joint infection present?

A
55
Q

How are patients with prosthetic joint infection treated?

A

Antibiotics alone (but rarely work)
Antibiotics.+ debridement (also prone to treatment failure)
Single stage revision - infected joint removed and replaced with a new one in same operation
Two stage revision - infected joint removed, 6 weeks of antibiotics then new joint inserted when infection settled (gold standard)

56
Q

What is syphilis?

A

An STI caused by treponema pallidum which has three stages of disease - primary, secondary and tertiary. Can also be transmitted vertically.

57
Q

What is primary syphilis?

A
58
Q

What is secondary syphilis?

A

Occurs 4-10 weeks after chancre and presents as

59
Q

What is tertiary syphilis?

A
60
Q

How is syphilis treated?

A

With penicillin

Clinical Pathology (65 decks)

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