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Ebopras > Infections of the Hand > Flashcards

Infections of the Hand Flashcards

1
Q

What organism is commonly found in all the hand infections?

A

Staphylococcusaureus. Seen in 50% to 80% of infections.

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2
Q

What is the basic treatment principle when dealing with infections of the hand?

A

DICE. Drainage and Debridement. Immobilization. Chemotherapy (antibiotics). Elevation.

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3
Q

What is the most common site of hand infections?

A

Subcutaneous level. Followed by tendon, joint, bone, and the subfascia.

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4
Q

What are the common pathogens found in diabetic patients with hand infections?

A

Gram-negative and polymicrobial infections. Subepidermal abscesses are unique to this patient population.

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5
Q

How do hand infections in immunocompromised patients behave?

A

Hand infections in this population tend to run a virulent course; for example, herpetic whitlow will not resolve
spontaneously and require antiviral agents.

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6
Q

What characterizes cellulitis in the hand?

A

Characterized by erythema, swelling, and tenderness

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7
Q

What is the most commonly involved organism in cellulitis of the hand?

A

Group A 􏰁-hemolytic Streptococcus.

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8
Q

What other organism is also involved, specifically in less severe cases of cellulitis?

A

S aureus.

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9
Q

What are the oral antibiotics of choice in cellulitis of the hand?

A

Nafcillin, dicloxacillin, and cephalexin; erythromycin if allergic to penicillin

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10
Q

How do subcutaneous abscesses typically occur in the hand?

A

After a puncture wound or as a response to a retained foreign body.

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11
Q

What are the most commonly isolated pathogens in human-bite infections?

A

􏰂-Hemolytic Streptococcus and S aureus.

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12
Q

Where is the most common topography for occurrence of hand infections?

A

Flexor tendon zone injury II.

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13
Q

What organism is commonly isolated in one-third of human bite wounds?

A

Eikenella corrodens. Cultured in 7% to 29% of human bites. Must be cultured in 10% carbon dioxide. Destroys
articular cartilage quickly.

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14
Q

What organism commonly infects animal bite and scratch wounds?

A

Pasteurella multocida.

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15
Q

Why do you need an X-ray if the patient had a simple animal bite?

A

To rule out a retained foreign body like a broken tooth.

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16
Q

What are the common cultures requested in hand infections?

A

Aerobic cultures, anaerobic cultures, cultures Lo ̈wenstein–Jensen medium for atypical Mycobacterium
(Mycobacterium marinum at 32◦C, Mycobacterium tuberculosis at 37◦C).

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17
Q

What are the common stains needed in hand infections?

A

Gram stain, Ziehl–Nielson stain (atypical Mycobacteria), Tzanck smear (herpes simplex virus).

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18
Q

When evaluating a hand infection and a fungus is suspected, what preparation should be done for
examination?

A

Potassium hydroxide preparation.

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19
Q

What is the most common infection in the hand in human immunodeficiency virus (HIV)-positive patients?

A

Herpes simplex infection.

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20
Q

When using an aminoglycoside (eg, gentamicin) for gram-negative coverage, what adverse effects are commonly overlooked?

A

Nephrotoxicity and ototoxicity.

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21
Q

What is the drug of choice for methicillin-resistant S aureus (MRSA) infections of the hand?

A

Vancomycin.

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22
Q

Is the reported incidence of MRSA community acquired hand infections rising?

A

Yes. Recommended empirical oral antibiotic is sulfamethoxazole/trimethoprim (Bactrim) or Clindamycin. The mecA gene, which codes for penicillin-binding protein 2A, provides its resistance to methicillin.

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23
Q

The most common hand infection?

A

Paronychia. It is an infection beneath the eponychial fold or along the paronychial fold and nail plate. Not to be
confused with perionychium, which is the skin around the nail margin

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24
Q

Which is the area around the fingertip most resistant to infection?

A

The hyponychium is the most resistant area to infection.

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25
Q

What is a runaround abscess?

A

A paronychial infection that forms an abscess that tracks around beneath the entire nail fold superficial to the nail
plate.

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26
Q

In what type of patient population is chronic paronychial infection often seen?

A

Patients exposed to constant moisture. Also, children who frequently dig in dirt.

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27
Q

What organism is commonly implicated in chronic paronychial infection and how is it treated?

A

Candida albicans. Marsupialization and nail removal.

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28
Q

What adjunct treatment for chronic paronychial infections is recommended?

A

Topical corticosteroid—antifungal ointment (3% clioquinol in a triamcinolone-nystatin ointment). (Mycolog)

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29
Q

In what subset of diabetic patients with hand infections is morbidity particularly high?

A

Renal transplant patients.

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30
Q

What is a felon?

A

Close space infections of the digital pulp.

31
Q

What is the most common organism found in felons?

A

S aureus.

32
Q

What are the preferred incisions for draining a felon?

A

Midvolar and high lateral incisions

33
Q

What type of incision used for draining a felon is associated with vascular compromise of the digital pad?

A

Fish-mouth incisions.

34
Q

What are the consequences of untreated felons?

A

Deep space infections, septic arthritis, osteomyelitis, amputation, acute flexor tenosynovitis, and painful/insensate
pulp scars.

35
Q

How long does viral shedding and ability to infect others persist in people with herpetic whitlow?

A

Until lesion epithelialization is complete

36
Q

What is the natural course of herpetic whitlow?

A

A self-limiting disease resolving over a period of 3 to 4 weeks. Presents initially with prodromal throbbing pain, tingling, swelling, and erythema of the affected finger (first 48–72 hours). Followed by erythema, tenderness around clear vesicles which coalesce to form ulcers over 10 to 14 days. Twenty percent recurrence rate reported.

37
Q

What is pyogenic flexor tenosynovitis of the hand?

A

A bacterial infection of the flexor sheath. S aureus most common causative organism.

38
Q

What are the four cardinal signs described by Kanavel characteristic of pyogenic flexor tenosynovitis?

A
  1. Flexed resting position of the involved digit.
  2. Tenderness over the flexor sheath.
  3. Severe pain of passive extension (commonly proximally along the finger tendon sheath).
  4. Fusiform swelling of the finger.
    ∗∗All signs may not be present, especially early in the course of infection.
39
Q

What type of bacterial flexor tenosynovitis usually results from hematogenous spread?

A

Gonococcal infections.

40
Q

Which two digital flexor sheaths communicate with bursae in the palm and thus can propagate proximal
extension of tenosynovial infections?

A

The flexor sheath of the thumb (radial bursa) and the small finger (ulnar bursa). The ulnar and radial bursae extend proximally in 50% to 80% of persons into carpal tunnel.

41
Q

What is a horseshoe abscess?

A

Infection of either small finger or thumb flexor sheath with contiguous spread through communication of the radial
and ulnar bursae.

42
Q

What has happened if a patient with suppurative flexor tenosynovitis of small finger suddenly develops acute carpal tunnel symptoms?

A

Extensive proximal spread of infection into Paronas space (the quadrilateral potential space at the wrist bordered by the pronator quadratus, digital flexors, pollicis longus, and flexor carpi ulnaris).

43
Q

Can contiguous spread from the index-finger sheath cause infection of thenar space?

A

Yes.

44
Q

How do you treat early infections of suppurative flexor tenosynovitis (within 24 hours)? Late?

A

Elevation, splinting, and intravenous antibiotics. Surgical debridement.

45
Q

If limited incision and catheter irrigation are used, why is it important to make sure catheter is within digital sheath?

A

Digital compartment syndrome can occur. The presence of fluid in the interstitial tissue.

46
Q

What deep spaces of the hand can be involved in infection?

A

Dorsal subaponeurotic, thenar, midpalmar, Parona’s quadrilateral, and interdigital subfascial web spaces

47
Q

Name fascial spaces of the hand and its possible pertinent infecting area.

A

middle palmar space -> infection of ring or middle finger flexor tendon sheath
thenar space -> infection of index flexor tendon sheath
dorsal subaponeurotic space->aponeurosis pf extensor tendons (deep)
dorsal subcutaneous space ->entire dorsum of hand

48
Q

What are the most common infectious agents in deep space hand infections?

A

Streptococcus, S aureus, and coliform organisms.

49
Q

What is the name used when the interdigital subfascial web space is infected?

A

Collar button abscess. Treated with incision and drainage/broad-spectrum antibiotics.

50
Q

Why are they called collar button abscesses?

A

They typically form two swellings—one volarly and one dorsally with each on one end of a narrower stalk. The shape is like a dumbbell or the collar buttons used on shirts years ago. Tuxedos still come with collar buttons frequently.

51
Q

In contrast to a simple dorsal subcutaneous abscess, a collar button abscess is characterized by:

A

Abducted resting posture of the adjacent digits.

52
Q

In infection of the thenar space, first web space, and dorsoradial aspect of the hand is known as?

A

Dumbbell or pantaloon infection

53
Q

The boundaries of the thenar space are:

A

Volar: Index finger flexor tendon.
Dorsal: Adductor pollicis musculature.
Radial: Insertion of adductor pollicis into the proximal phalanx of thumb and thenar muscle fascia.
Ulnar: Midpalmar space or oblique septum extending from palmar fascia to the volar ridge to the third
metacarpal (midpalmar septum).

54
Q

Why is the thumb held in marked abduction in thenar space infections?

A

This posture reduces pressure (and thus pain) within the thenar space.

55
Q

What are the mimickers of hand infection?

A

Gout, pseudogout, pyogenic granuloma, pyoderma gangrenosum, and neoplasia.

56
Q

What is the most common algae infections seen in fisherman?

A

Prototheca wickerhamii (Tx: Tetracycline).

57
Q

What are the recommended incisions for drainage of thenar-space infections?

A

Combined volar and dorsal incisions

58
Q

Why are incisions that parallel the first-web commissure not recommended in thenar space infection?

A

To avoid web space contracture.

59
Q

What is the only infection resulting in loss of palmar concavity?

A

Midpalmar space infection.

60
Q

What are the boundaries of the midpalmar space?

A

Volar: Flexor tendons and lumbricals
Dorsal: Middle and ring finger metacarpals and second and third palmar interosseous muscles Radial: Midpalmar septum
Ulnar: Hypothenar muscles

61
Q

Exposure to what virus causes milker’s node in the hand (or granuloma)?

A

Poxvirus. Handling a cow’s udder.

62
Q

What is an interdigital pilonidal cyst?

A

When a foreign piece of hair enters the web space and becomes secondarily infected. Seen in barbers and sheep shearers.

63
Q

What is the usual rate of infections after elective hand surgery?

A

1% to 7%; 0.47% deep rate infection after carpal tunnel release.

64
Q

What are the recommended incisions for midpalmar space infections?

A

şekil

65
Q

Name organisms found in hand infections associated with river or seawater?

A

Vibrio vulnificus—coastal and brackish water (Tx: tetracycline, chloramphenicol)
Mycobacterium marinum—fresh water (Tx: rifampin, ethambutol trimethoprim-sulfamethoxazole)
Aeromonas hydrophila—fresh water (Tx: ciprofloxacin, tetracylcine, trimethoprim-sulfamethoxazole)

66
Q

What is sporotrichosis?

A

A chronic granulomatous infection caused by the saprophytic fungus Sporothrix schenckii. Most common
subcutaneous fungal lesion in North America seen mostly in the upper extremities.

67
Q

What is the treatment of choice for sporotrichosis? If allergic to iodine?

A

Oral potassium iodide. Itraconazole.

68
Q

What organisms are commonly found in septic arthritis of the hand? Cause?

A

S aureus and Streptococcus. Haemophilus influenzae (young). Gonococcus (young adult with monarticular nontraumatic septic arthritis). Penetrating trauma.

69
Q

What is the most common cause of osteomyelitis in the hand?

A

Open fractures.

70
Q

What is necrotizing fascitis? How it is usually caused by?

A

Liquefaction necrosis of the fascia with selective spread along fascial planes with involvement of skin and muscle
during later stages of infection with bullae formation, myonecrosis, and skin slough. Group A Streptococcus.

71
Q

Gas gangrene is frequently caused by?

A

Clostridium perfringens.

72
Q

Are there pathognomonic physical findings in mycobacterial infections of the hand?

A

No, but deep infections are frequently associated with abundant tenosynovitis or joint synovitis.

73
Q

What unique infection can occur in the hands of patient receiving Taxol?

A

Subungal abscess of multiple digits (including the toes) with painful onycholysis or nail plate separation.

Ebopras (32 decks)

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