infections, gynecology, dermatology Flashcards
Acute abdominal/pelvic in women
- Mittelschmerz
- ectopic pregn
- Ovarian torion
- Ruptured ovarian cyst
- PID
ruptured ovarian cysts can be presented as …. due to ….
acute abdomen due to hemoperitoneum
Acute bacterial parotitis - presentation
painful swelling of the parotid gland that is aggravated by chewing
high fever and a tender swollen and erythematous parotid gland are common
post-operative acute bacterial parotitis - how to prevent
adequate fluid hydration + oral hygiene
acute bacterial parotitis - MC organism
S. aureus
role of incentive spirometry in surgery
reduce post operative pulm complications
necrotizing fasciitis - microbiology
- strep pyog
- Staph
- Clostiridium perfringens
- polymicrobial
necrotizing fasciitis - pathogenesis
bacterai spread rapidly through subcutaneous tissue + deep fascia, undermining the sin
MC imvolves extremities + perineal region
necrotizing fasciitis - clinical manifestation
- often antecedent history of minor trauma
- erythema of the overlying skin
- swelling + edema
- pain out of proportion to emanination findings
- systemic symptoms (FEVER + HYPOTENSION)
necrotizing fasciitis - treatment
requires surgical debridement + broad spectrum antibiotics
pyomyositis?
muscle abscess
similar presentation to necrotizing fasciitis, with fever, erythema, swelling + pain
limited to 1 muscle group and does not spread rapidly
Prosthetic joint infection - time
early (less than 3 months)
delayed (3-12 months)
late more than 12 months
Prosthetic joint infection - presentation regarding onset
early onset: acute pain, wound infection or breaskdown, fever
delayed: chronic joint pain, implant loosening, sinus tract formation
late: acute symptoms in prev asymptomaitc joints, recent infection at distant site
prostetic joint infection - MC organisms
early: s. aures, gram (-) robs, anaerobes
delayed: coagulase (-) staph, enterococcim, propionibacerium species
late: staph aureus, gram (-) robs, beta hemolutic strep
Most frequent caues of of nosocomial bloodstream infection in patients with IV devices
coagulase (-) staph
factos that favor infection of contamination
- systemic signs (hypotensioon, fever, leukocytosis)
- erythema and tenderness at the catheter entry site (absence of local signs does not rule out infection)
- culture growth within 48 h and in both aerobic and anaerobic bottles
- 2 or more blood culture samples wit the same organism and drug susceptibility
signs and symptoms suggestive of necrotizing surgical site infection
- pain, edema, erythema spreading beyond the surgical site
- systemic signs (fever, tachycardia, hypotension)
- parestesia or anesthesia at the edges
- subcut gas or crepitus
- purulent cloudy gray discharge (dishwater drainage)
postoperative fever - MNEMONIC
Wind (day 1-2) (lungs): Atelectasis, postoperative pneumonia
Water (day 3-5): UTI
Walk (day 5-7): DVT / PE + IV ACCESS LINES
Wound (day 7): surgical site infection
Weird (8-15): drug fever or deep abscess
Wonder (drugs/products): drug fever, blood products, IV lines
Postoperative fever: immediately
prior infection, blood products, malignant hyperthermia
which skin SCC are more aggressive
SCC arises from chronic wounds
skin cancer arises from scar or burn
SCC (Marjolin ulcer)
sepsis after burn - organisms
immediately after sever burn: gram (+) from hair follicles and sweat glands
after 5 or more daysL gram (-) of fungi
wound infections are common after burns - highest risk
if large surface area (more than 20%)
burn wound sepsis - manifestation
Q: more than 39 or les than 36. 5 2. tachycardia 3. tachypnea 4. Refractory hypotension ALSO: oliguria, unexplained hyperglycemia, thrombocytopenia, mental status
burn wound sepsis - diagnosis
quantitative wound culture and biopsy for histopathology.
burn wound sepsis - treatment
empiric, broad spectrum IV antibiotcs (tazosin, carbapeneme) with the addition of potential coverage for MRSA or multi-resistant Pseudomonas (aminoglycoside)
local wound care and debridement are usually necessary
compartment syndrome after burn?
the eschar results drom circumferential, full thickness (3rd degree) burn often leads to constriction of venous and lymphatic drainage, fluid accumulation –> acute compartment syndrome
first sign og burn wound infection
change in burn wound appearance or loss of skin graft
drug fever
diagnosis of exclusion
1-2 wls after medication administration
- rash and peripheral eosinophilia
