Lec23 ID of the Skin

Question 1

What is folliculitis?

Answer 1

• inflammation of hair collicle

- get itching

Question 2

What are the causes of folliculitis?

Answer 2

• gram positives: staph, strep
• gram negatives: pseudomonas “hot tub” folliculitis
• fungal: pityrosporum
• mechanical occlusion [collect debris viewed as foreign, get inflammation

Question 3

What is the treatment of bacterial or mechanical folliculitis?

Answer 3

• topical mupicorin
• oral antibiotics [cephalexin, doxycyclin]
• shower after exercise
• keep skin dry
• wear loose clothing

Question 4

What is treatment of fungal folliculitis?

Answer 4

• topical antifungals [ketoconazole]

Question 5

What is an abscess?

Answer 5

• walled off space with pus, usually infected and painful

Question 6

What is a furuncle?

Answer 6

furuncle = boil

- walled off fluctuant mass encolsoing pus that evolved from superficial folliculitis

Question 7

What is a carbuncle?

Answer 7

group of coalesced furuncles

Question 8

What causes skin absesses?

Answer 8

usually staph aureus

- also can be anaerobe, gram neg, or fungus

Question 9

What is treatment for furuncle/carbuncle?

Answer 9

• incise and drain and culture pus
• warm soak
• antibiotics
• intralesional steroid injection

Question 10

What are normal antibiotics for treating furuncle/carbuncle?

Answer 10

cephalexin orally AND mupirocin topically

Question 11

What is skin sign of MRSA?

Answer 11

• furunculosis

- can evolve in large ebsesses, cellulitis, or necrotic plaque

Question 12

What is treatment for MRSA skin infection?

Answer 12

binor: bactrim, doxycycline, clindamycin
severe: vancomycin

Question 13

What is impetigo?

Answer 13

• superficial skin infection
• can be bullous or non-bullous
• starts around bug bite, pimple, eczema etc
• honey colored crust, weeping, oozing

Question 14

What are causes of impetigo?

Answer 14

• staphylococcus aureus

- streptococci [often colonize nose]

Question 15

What is treatment for impetigo?

Answer 15

• mupirocin

- may also need oral antibiotic for severe disease

Question 16

What is important sequelae of impetigo?

Answer 16

post strep glomerulonephritis[ BUT NOT ARF]

Question 17

What is cellulitis?

Answer 17

• infection of dermis and subcutis [fat], due to break in skin, usually bacterial

Question 18

What causes cellulitis commonly?

Answer 18

most commonly: staph aureus, group A strep

- can be any organism

Question 19

What are the 4 signs of cellulitis?

Answer 19

• rubor [erythema]
• dolor [pain]
• calor [heat]
• tumor [swelling/edema]

Question 20

How do you diagnose cellulitis?

Answer 20

primarily just clinically

Question 21

What is treatment for cellulitis?

Answer 21

antibiotics

if in lower extremity –> elevate leg to minimize edema and increase drug distribution to target

Question 22

What is erysipelas?

Answer 22

superficial bright red cellulitis with lymphatic involvement

- more sharply demarcated than regular celluliits

Question 23

What is common cause of erysipelas?

Answer 23

group A streptococci

Question 24

How is erysipelas diagnosed?

Answer 24

usually based on clinic

Question 25

what is treatment for erysipelas?

Answer 25

oral antibiotics [penicillin]

Question 26

What is cause of scarlet fever?

Answer 26

streptococcus pyogenes [group A strep] | - usually due to pyrogenic exotoxin after pharyngeal infection

Question 27

What are signs of strep pyogenes?

Answer 27

after 2-4 days get: - acute pharyngitis - diffuse eryhtmeatous rash that spares face, palms, sole - pastia's line: petechial lines in skin folds - strawberry tongue - skin rash fades with desquamatoion - fever, malaise, headahce,

Question 28

How is scarlet fever diagnosed?

Answer 28

positive throat culutre for s. pyogenes + clinical symptoms

Question 29

what is treatment for scarlet fever?

Answer 29

normally:: penicillin or amoxicillin | can also use: cephalosporins, macrolide

Question 30

What are signs of necrotizing fasciitis?

Answer 30

- rapidly progressive necrosis of subcutaneous fat/fascia/muslce - begins with area of tenderness, erythema, warmth, swellin - quicky progression - skin changes from red & purple to gray-blue water, bad smelling fluid - life threatening need emergency surgery

Question 31

What are causes of necrotizing fasciitis?

Answer 31

- streptococci | - polymicrobial

Question 32

How do you diagnose necrotizing fasciitis?

Answer 32

- MRI to look for gas and soft tisuse involvement

Question 33

What is treatment for necrotizing fasciitis?

Answer 33

- early and aggressive debridement | - IV broad spectrum antibiotics

Question 34

What is cause of menigococcemia?

Answer 34

neisseria meningitidis = gram negative diplococci | = derm emergency must notify state dept of health

Question 35

What are signs of meningococcemia?

Answer 35

- meningitis - septic shock - slate-gray purpura/ecchymosis signaling DIC

Question 36

What is therapy for meningococcemia?

Answer 36

- droplet isolation | - penicillin G

Question 37

What do you use for prophylaxis of contacts to meningococcemia?

Answer 37

rifampin, cirpofloxacin

Question 38

What is cause of lyme disease?

Answer 38

borrelia burgdorferi from bites of ixodes [deer tick]

Question 39

What are 3 stages of lyme disease?

Answer 39

1. erythema chronicum migrans = circle shaped rash 2. carditis [AV block] and bell's palsy 3. arthritis

Question 40

What is treatment for lyme disease?

Answer 40

doxycycline or amoxicillin

Question 41

What is prophylaxtic treatment for lyme diease?

Answer 41

- insect repellent | - doxycline at time of tick bite

Question 42

What are skin signs of primary, secondary, and latent syphilis?

Answer 42

primary: chancre --> painless secondary: palsm/soles like erythema multiforme, papulosquamous like pityriasis roasea, mucous patch in mucosal surface, condyloma latum

Question 43

What are skin signs in latent syphilis?

Answer 43

no rash

Question 44

what are skin signs in tertiary syphillus?

Answer 44

- gumma [rubbery ulcerated nodule]

Question 45

clinical: insect bite then redness and swelling around bite, spread up leg = red and swollen what should you think?

Answer 45

cellulitis --> likely due to staph aureus, group A strep

Question 46

clinical: 18 yo, fever, sore throat, malaise, generalized erythematous rash, strawberry tongue, sister recently treated with penicillin for sore throat what should you think?

Answer 46

scarlet fever --> strep A [pyogenes]

Question 47

diabetic with necrotic area on anterior thigh, foul smelling? what should you think?

Answer 47

necrotizing fasciitis due to strep or polymicrobial

Question 48

18 yo with low grade fever, runny nose, headache, stiff neck, petechial rash what should you think?

Answer 48

meningococcemia due to neisseria meningitidis

Question 49

30 yo with sore throat, neck stiff, erythematous circular rash on back, EKG incomplete right bundle branch block, just got back from hamptons what should you think?

Answer 49

lyme disease due to borrelia burgorferia via bite of ixodes deer tick

Question 50

clinical: 1 wk history of painless penile lesion, condom use intermittent, no fever, chills, dysuria, nontender adenopathy what should you think?

Answer 50

syphilis due to terponema pallidum

Question 51

What are signs of early and late congenital syphilis?

Answer 51

early: first two yrs have rhinitis late: untreated get cutaneous, dnetal, skelatal, deafness

Question 52

How do you diagnose syphilis?

Answer 52

- dark field microscopy - RPR [for acute infection] - FTA-Abs [pos for live]

Question 53

What is treatment for syphilis?

Answer 53

- penicillin - HIV test - alert sexual contacts and state dept

Question 54

What is salmonellosis?

Answer 54

- infection by G-aerobic bacilli in genus salmonella

Question 55

What is typhoid fever? how is it spread?

Answer 55

enteric fever due to S. typhi | - via direct contact with persons with typhoid fever

Question 56

what is paratyphoid fever? how is it spread?

Answer 56

enteric fever by non-typhoidal strains [s. paratyphi] | - from inadequately cooked poultry or eggs

Question 57

What are signs of salmonellossi?

Answer 57

rose spots = red blanching macules and papules on chest and abdomen in groups fever GI symptoms

Question 58

How do you treat salmonellosis?

Answer 58

- ceftriaxone | - quinolones