I&D

Question 1

confined collection of pus surrounded by inflamed tissue. Comes to a point.

Answer 1

abscess

Question 2

This abscess resolves w/o rupture

Answer 2

dry abscess

Question 3

This abscess is cultured and shows no bacteria growth

Answer 3

sterile abscess

Question 4

This abscess has signs of inflammation, invaded by pyogenic bacteria

Answer 4

hot abscess

Question 5

Associated with liquefactive necrosis or tuberculous lesions

Answer 5

cold abscess

Question 6

abscess formed form a sweat gland or hair follicle

Answer 6

furuncle

Question 7

furuncle that extends into the subcut tissue

Answer 7

carbuncle

Question 8

abscess involving the nail cuticle

Answer 8

paronychia

Question 9

What differentiates an abscess from cellulitis?

Answer 9

abscess stuff is surrounded by a capsule

Question 10

Most common organism of abscess?

Answer 10

S. aureus, strept (gram neg), anaerobs, enteric organisms

Question 11

What are risk factors for MRSA?

Answer 11

Previous MRSA, abx tx, hospitalized, IV drug use, contact w/ MRSA, immunocompromised, residents - especially ill ppl, hemodialysis pt

Question 12

Tx for abscess <5 mm

Answer 12

warm compress, abx

Question 13

Contraindications for I&D?

Answer 13

Extremely large abscess, facial furuncles, palms of hands and feet, rectum/genitalia, DM, debilitating disease, immuno

Question 14

What are come complications of I&D?

Answer 14

cellulitis, chronic fistula, infection near tendons…

Question 15

How would you navigate potential anatomy cautions?

Answer 15

aspirate I&D with 18 gauge needle attached to 10mL syringe- avoid pulling back blood

Question 16

How do you anesthetize the field that you are I&D?

Answer 16

Field block 1cm away from red border

Question 17

Tip for culture samples.

Answer 17

Get deep in the wound to avoid skin flora

Question 18

How many packing ribbons do you place in a wound?

Answer 18

only 1

Question 19

T/F, a breast abscess is common in a non-lactating women.

Answer 19

False

Question 20

Treat abscess with abx when (these 5).

Answer 20

Cellulitis or Lymphangitis
Diabetics or immunocompromised (change abx therapy once culture results received if necessary)
Breast abscess
An abscess >0.5cm in diameter
MRSA coverage

Question 21

What drugs are MRSA coverage friendly?

Answer 21

Trimethoprim-sulfamethoxazole DS 1-2 tablets po BID for 5-10 days

Clindamycin 300-600mg orally every 6-8hrs

Doxycycline 100mg BID

IV Vancomycin 15-20mg/kg/dose BID

IV Daptomycin 4mg/kg daily

Question 22

Who do you give IV abx?

Answer 22

pt who look really sick, septic, previous/current IV drug users, abscess is in the sinus