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Gen Med: Dermatology > Infections > Flashcards

Infections Flashcards

1
Q

What is the most common bacterial infection?

A

Impetigo

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2
Q

What are the causative agents of impetigo?

A
  1. Bullous – MC caused by Staphylococcus Aureus

2. Non-Bullous – MC caused by Steptococcus

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3
Q

When does impetigo occur?

A
  1. Seen following minor skin injury (bug bite, eczema)
  2. Children - have higher rates of infection
  3. Risk factors - warm moist climates, poor hygiene
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4
Q

How is impetigo dx?

A

Dx – clinically or by bacterial culture

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5
Q

What complications may be asst. with impetigo?

A
  1. Px – If left untreated may last for wks – mo’s
  2. Poststrep. glomerulonephritis may follow in kids 2-4yo
  3. Rheumatic fever - not been reported as a complication
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6
Q

What are the sxs of impetigo?

A
  1. Varied sizes
  2. Localized or Widespread
  3. At site of skin injury
  4. +/- Bullae, papules, vesicles coalescing
  5. Honey-Colored Crusting
  6. Satellite lesions
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7
Q

What is the tx for limited and localized impetigo?

A
  1. Topical therapy best

2. 2% Mupirocin oint/crm (Bactroban) TID for 10days

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8
Q

What is the tx for widespread and severe impetigo?

A

Oral antibiotics (penicillinase-resistant antibx’s)
Dicloxicillin 250mg QID for 5-10days
Cephalexin (Keflex) 250mg QID for 5-10days

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9
Q

What is the tx for recurrent impetigo?

A
  1. 2% Mupirocin oint BID for 5days, repeated monthly for several mo’s
  2. Erradicates nasal carriers of Staph A.
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10
Q

Define cellulitis

A

Infection of the dermis and subcutis
Typically develops near sites of skin injury
Surg wounds, bites, burns, abrasions, lacerations, dermatosis

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11
Q

What are the causative agents of cellulitis?

A

Streptococcus and Staph A.

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12
Q

Wha are the risk factors for cellulitis?

A

DM, Liver dis., Imm compr, Poor Lymph/Circ

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13
Q

How is cellulitis diagnosed?

A

Made clinically, Bact Cx difficult

Labs - CBC wbc’s and ESR elevated

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14
Q

What is the prognosis for cellulitis?

A
  1. Recurrance common in sites of poor circ.

2. Severe forms can progress to Necrotizing Faciitis

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15
Q

What are the sxs of cellulitis?

A
  1. Sx’s of localized pain and tenderness before rash
  2. MC location is lower extr
    A. Can be seen on any part of body
  3. Expanding, Eryth, Warm, Tender to Painful, plaque with indefinite borders
  4. +/- vesicles, hemorrhage, necrosis, or abcess’s seen
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16
Q

What are the treatment options for acute episodes of cellulitis?

A
  1. Systemic Antibx (penicllinase resistant penicillin)
  2. Dicloxicillin 500-1000mg PO QID for 7-14days
  3. Cephalexin (Keflex) 500mg QID for 7-14days
  4. Augmentin 875mg BID for 7-14days
  5. Penacillin allergic?
    Erythromycin 250-500mg QID for 7-14days
    Zithromax (Z-pak) 500mg on day 1, 250mg days 2 to 5
    Clarithromycin (Biaxin) 250-500mg BID for 7-14days
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17
Q

Define erysipelas

A

Acute, inflammatory form of cellulitis

History of prodromal Sx’s up to 48hrs prior

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18
Q

How is erysipelas different from cellulitis?

A
  1. Differs from cellulitis in that…
    lymphatic involvement (“streaking”) is prominent
  2. More superficial and with clearer margins
  3. MC caused by Streptococci (grp A)
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19
Q

What are the risk factors for erysipelas?

A

Lymphatic and Venous Circ. impairment

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20
Q

How is erysipelas diagnosed?

A

Made clinically, Bact Cx difficult

Labs - CBC wbc’s and ESR elevated

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21
Q

What is the prognosis for erysipelas?

A

Recurrence common in sites of poor circ.

22
Q

What are the sxs of erisipelas?

A
  1. Sx’s of itch, burn, pain
  2. MC location is lower extr
    Also seen on face/ears/buttocks
  3. Tense, Eryth, Warm, Tender, elevated patch with irreg outline but well demarcated border
  4. +/- Red streaks of lympangitis
23
Q

How is acute erysipelas treated?

A
  1. Systemic Antibx (penicllinase resistant penicillin)
  2. Dicloxicillin 500-1000mg PO QID for 7-14days
  3. Cephalexin (Keflex) 500mg QID for 7-14days
  4. Augmentin 875mg BID for 7-14days
  5. Penacillin allergic?
    A. Erythromycin 250-500mg QID for 7-14days
    B. Zithromax (Z-pak) 500mg on day 1, 250mg days 2 to 5
    C. Clarithromycin (Biaxin) 250-500mg BID for 7-14days
24
Q

How are severe erysipelas cases treated?

A

Severe infections may require Hosp and IV antibx
Recurrent episodes
Prolonged antibx prophylaxis

25
Q

What are furuncles and carbuncles?

A
  1. Walled off, deep, painful, firm or fluctuant mass
  2. Enclosing a collection of pus = Boils, Abcess’s
  3. Often evolves from a superficial folliculitis
  4. Carbuncles = interconnected and infected, abcessed, follicles
  5. MC caused by Staph A.
  6. Uncommon in children
26
Q

What are the risk factors for furuncles and carbuncles?

A

– Occluded and Sweaty areas, Obesity, Poor Hygiene, DM

27
Q

What is the prognosis fr furuncles and carbuncles?

A

Either comes to a head and ruptures or is reabsorbed

Recurrent Furunculosis can be difficult to eradicate

28
Q

What are the sxs for furuncles?

A

Eryth, Edema, Warm, Painful
Initially - firm Nodule
Later - fluctuant Abcess

29
Q

What are the sxs of carbuncles?

A

Same inflammation seen
Becomes confluent w/in several days
Carbuncles MC seen on post neck
+/- Malaise, chills, fever

30
Q

How are furuncles treated?

A
  1. Warm, moist compresses 15-30min several x a day for firm/small
  2. I&D +/- iodoform packing for fluctuant/larger lesions
  3. May use systemic antibx if think secondary cellulitis involved
    A. Dicloxicillin 500-1000mg PO QID for 7-14days
    B. Cephalexin (Keflex) 500mg QID for 7-14days
    C. Penacillin allergic?
    D. Erythromycin 250-500mg QID for 7-14days
31
Q

How are carbuncles txed?

A

Require Systemic Antibx (as above) and Surgical Management

32
Q

How is recurrent furunclosis treated?

A
  1. Topical eradication of nasal Staph A. (2% Mupirocin oint)
  2. Environmental changes and antibacterial washes (hibaclens, betadine)
  3. Address underlying risk factors (obesity, DM, tight clothes, hygiene)
  4. Systemic Antibx if topical tx fails
    A. Dicloxicillin with Rifampin 600mg QD for 7-10days
33
Q

What is erythrasma

A

Chr bacterial infection affecting intertriginous areas
Corynebacterium minutissimum (gram + rod)
From Greek for “red spot”
Mimics dermatophyte infections
MC seen in adults

34
Q

What are the rf for erythrasma?

A

Humid climates, Occlusive clothing, Obesity, DM

35
Q

How is erythrasma dx?

A

Bact Cx, Neg KOH, Woods Lamp (coral red)

36
Q

What are the ddx for erythrasma?

A

Fungal, Candidal, Seb Derm, Inverse Psor

37
Q

What are the sxs of erythrasma?

A

Located to intertriginous areas
Asymptomatic, occasional sx’s
Duration of Mo’s to Yr’s
Sharply defined red-brown (brawny) patch without scale if site occluded, often symmetrical or in several web spaces

38
Q

How is erythrasma treated?

A
  1. Prevention
    A. Keep area clean – wash with Panoxyl (BPO) 5% bar in shower
    B. Keep area dry – Loose fitting clothing, Zeasorb AF powder
  2. Topical
    A. BPO gel BID x 7days or until clear
    B. E-mycin 2% BID x 7days or until clear
    C. Clindamycin 2% BID x 7days or until clear
  3. Systemic
    A. E-mycin 250mg QID for 14days
    B. Tetracyclin 250mg QID for 14days
39
Q

What is tinea corporus

A

Ringworm of the body
Round Annular Lesions (central clearing and scaly border)
Deep Inflammatory Lesions
Seem in all age groups

40
Q

What are rf for tinea?

A

MC spread from fungus of feet, Animal workers

41
Q

What are the sxs of tinea corporis?

A

1 Sx = Itching

Variable sized well demarcated erythematous plaques with peripheral enlargement and central clearing
+/- Pustules/Vesicles
Intensely inflammed lesions with elevated and boggy pustular surfaces

42
Q

How is tinea corporis treated?

A
  1. Prevention
    A. Treat underlying Tinea infections
  2. Topical
    A. Lamisil, Mentax, Naftin – Allylamines
    B. Clotramin, Spectazole, Oxistat – Imidazoles
    C. AAA BID for 2-4wks or until clear (+1wk)
  3. Systemic
    A. See chart
    B. Short course of prednisone for highly infl lesions
43
Q

What is tinea pedis?

A

The MC area affected by dermatophytes = FEET
Tinea Pedis = “Athlete’s foot” MC caused by T. rubrum
MC in young-mid aged adults (Men>Women)

44
Q

What are the rf for tinea pedis?

A

= Occlusive/Prolonged shoe wear, Hyperhidrosis

45
Q

What are the morphological types of tinea pedis?

A
  1. Interdigital Tinea Pedis (MC 4th and 5th Web spaces)
  2. Chronic Scaly Infection of Plantar Surface
  3. Acute Vesicular Tinea Pedis
  4. Ulcerative
46
Q

What are the sxs of tinea pedis?

A
  1. # 1 Sx = Itching
  2. Dry scaly or Wet and macerated web spaces
  3. Plantar hyperkeratosis with fine silvery white scale (+/- hands inf too)
  4. Inflammatory infection with vesicles/bullae, (+/- thick scale trapped)
  5. Ulcers and Erosions in web spaces, commonly bacterial secondary infection
47
Q

What is the tx for tinea pedis?

A 
1. Prevention
A. Allow feet to air out as much as possible
B. Wear wider shoes
C. Dr Scholl’s Lamb wool to web spaces
D. Zeasorb AF powder
2. Topical
A. Lamisil, Mentax, Naftin – Allylamines
B. Clotramin, Spectazole, Oxistat – Imidazoles
C. AAA BID for 2-4wks or until clear
3. Systemic 
See chart
48
Q

What is tinea cruris?

A

Subacute or Chr dermatophyte infection of crural folds
Tinea Cruris = “Jock Itch”
MC caused by T. rubrum or metngrophytes
MC in adults (Men>Women)

49
Q

What are the sxs of tinea cruris?

A

Often prior Hx of Tinea Pedis/Ungium, Pruritis

50
Q

Where is tinea cruris found?

A
  1. Seen on groin, thighs, buttocks (scrotum and penis spared)
  2. Large well demarcated dull red/tan/brown patchs or plaques
  3. +/- Papules/Pustules at margins and central clearing
51
Q

How is tinea cruris treated?

A
  1. Prevention
    A. Keep area clean – wash with Panoxyl (BPO) 5% bar in shower
    B. Keep area dry – Loose fitting clothing, Zeasorb AF powder
    C. Treat any underlying Tinea Pedis/Ungium
  2. Topical
    A. Lamisil, Mentax, Naftin – Allylamines
    B. Clotramin, Spectazole, C. Miconazole – Imidazoles
    AAA BID for 2-4wks or until clear
    Systemic
    See chart

Gen Med: Dermatology (10 decks)

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