Infections of Skin & Soft Tissues

Question 1

Infection of obstructed hair follicles - clinically manifested as series of raised, painful, reddish lesions centered on a follicle

Answer 1

Folliculitis

Question 2

Deep-seated infections around hair follicles

Answer 2

Furuncles

Question 3

Deep-seated infections around hair follicles that result from coalescence of furuncles

Answer 3

Carbuncles

Question 4

Form of cellulitis characterized by diffuse lymphangitis of skin, with redness & pain at advancing margins

Answer 4

Erysipelas

Question 5

What should women who have had mastectomies with ispilateral LN dissections wear to decrease swelling & edema?

Answer 5

Arm compression sleeves

Question 6

Soft-tissue swelling, erythema, warmth & tenderness, frequently in association with ulcer

MCC?
Vast majority of cellulitis due to what organism?

Answer 6

Cellulitis

S. pyogenes

(or S. aureus)

Question 7

Rapidly progressing necrotizing soft tissue infections (crepitant & gangrenous) - top 5 causes.

Answer 7

1. Group A strep
2. Vibrio
3. Aeromonas
4. Clostridium
5. Rarely, S. aureus

Question 8

What is anaerobic cellulitis characterized by?

Answer 8

Foul discharge & gas in the wound

Question 9

What species of Clostridium is frequently associated with underlying systemic malignancy? Wound feels like rice krispies. What do you treat with?

Answer 9

Clostridium septicum

Treat with penicillin

Question 10

Therapy of Clostridial gangrene/myonecrosis?

Answer 10

Surgical debridement/amputation, high dose penicillin, hyperbaric O2, clindamycin to decrease toxin production

Question 11

Poor killing activity of penicillin against slow growing (or dormant) organisms when they exist in a high inoculum.

Answer 11

Eagle effect

Question 12

Individuals with necrotizing soft tissue infections due to Vibrio are usually compromised by what? Often results after exposure to what?

Answer 12

cirrhosis, AIDS, or malignancy

Brackish or salty water

Question 13

Soft tissue infections due to Aeromonas hydrophila occurs after exposure to what?

Answer 13

Fresh water exposure or use of leeches in surgical procedures

Question 14

Necrotizing perineal infections that occur most frequently in diabetics and patients with granulocytopenia - microbiology reflects mixed bowel flora

Answer 14

Fournier’s gangrene

Question 15

Post-surgical mixed infection - microbiology reflects site of surgery

Answer 15

Meleney’s gangrene

Question 16

Polymicrobial infection of submandibular and submental spaces - bacteriology reflects complex oral flora

Answer 16

Ludwig’s angina

Question 17

Acronym for management of bite wounds.

Answer 17

H		History
E		Examination of wound
L		Liberal cleansing &
I		Irrigation
C		Closure, culture purulent material
O		Operative debridement & closure
P		Prophylactic/therapeutic antimicrobials
T		Tetanus immunization status
E		Elevation & immobilization 
R		Rabies risk assessment & radiology

Question 18

Diabetic foot infections in diabetecs due to vascular disease

Answer 18

Microangiopathy

Question 19

What does gangrene in diabetic feet result from?

Answer 19

thrombosis of digital arteries, due to inflammation around ulcerated bunions OR

from inflammation around web space and subsequent thrombosis of small arteries

Question 20

How does diabetic neuropathy lead to foot infections?

Answer 20

Parasthesias and numbness - can’t feel trauma if occurring

Wasting of lumbrical and interosseous muscles results in collapse of arch, loss of stability, claw or hammer toe which predispose to ulceration from abnormal pressure (motor neuropathy)

Wasting of intrinsic foot muscles - plantar fat pad pulled away from metatarsal heads

Question 21

Autonomic neuropathy in diabetic feet results in what?

Answer 21

Loss of perspiration –> drying of feet with cracking, increases risk of ulceration

Question 22

Ulcer that occurs over sites of bony protrusions, like over metatarsal heads in diabetics

Answer 22

Mal perforans ulcer

Question 23

Abnormal perfusion to bones causes bony fragmentation and collapse of arch with bony protrusions - “rocker bottom feet”

Answer 23

Charcot’s foot - autonomic neuropathy

Question 24

Dermatophyte infections (Athlete’s foot) often caused by___

Answer 24

Candida albicans

Question 25

Which diagnostic method is best for obtaining cultures?

Answer 25

Needle aspiration

Question 26

Vascular laboratories can be helpful in order to predict the likelihood that foot lesions (either ulcers or post-surgical debridement) will heal based on _______

Answer 26

Vascular pressures

Question 27

Fungal infection of toenails

Answer 27

Onchomycosis

Question 28

Clenched fist injury - most commonly caused by?

Answer 28

Punch someone in the mouth - infection by anaerobic organisms like Peptostreptococcus

Question 29

Difference between pyoderma/impetigo in Strep pyogenes and Staph aureus

Answer 29

Staph aureus - bullous impetigo