MTB 2 Flashcards by Nadia Mahmud

Presentation of perianal abscess

Anal pain
Tender erythematous bulge at anal verge
Superior to anus over coccyx in midline

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Erysipelas pathophys

Strep infxn (sometimes staph)
Invades dermal lymphatics
Bacteremia, leukocytosis, fever, chills

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Presentation of Erysipelas

Bright, red hot swollen lesion on face

Leukocytosis

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TX for Erysipelas, Cellulitis, Folliculitis, Furuncles, Carbuncles - MILD Dz

Oral
Dicloxacillin, cephalexin, cefadroxyl
PCN Allergic: Erythromycin, Clarithromycin, Clindamycin
MRSA: Doxycycline, Clindamycin, TMP/SMZ

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Presentation of perianal fistula

Chronic and crypt infxn of Crohns
External/cutaneous opening drains purulent material
Win 3 cm of anal margin

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TX for Erysipelas, Cellulitis, Folliculitis, Furuncles, Carbuncles - SEVERE Dz

IV 
Oxacillin, nafcillin, cefazolin
PCN Allergic: Clindamycin, Vanco
MRSA: Vanco, Linezolid, Daptomycin, Tigecycline
Anaerobes - Imipenem

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What are the Antistaph PCNs

OX
CLOX
DICLOX
NAF

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Presentation of Cellulitis

Skin - warm, red, swollen, tender

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Community Acquired MRSA Cellulitis Presentation

Purulence = Pus
Abscess
Contact sports, prisoners, Native Americans

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Mupirocin MOA

Inhibits protein synthesis by reversibly binding to t-RNA synthetase in Staph Auereus and strep

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What is molluscum contagiosum

Pox Virus

Umbilicated, flesh colored, dome shaped papules on trunk, limbs, anogenital areas

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Transmission for molluscum contagiosum

Skin to skin

Sexual contact

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Presentation of tinea corporis

Ring-shaped scaly patches
Central clearing
Distinct bordres
Itching

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MCC Tinea corporis

Trichophyton rubrum

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Presentation of Tinea Versicolor

Multiple macules
Vary in color - white to brown, pink
Chest, neck, abdomen, face

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Tinea Versicolor cause

Malassezia furfur

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Malassezia furfur on KOH prep

Spaghetti and meatball

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TX Malassezia furfur

Topical selenium sulfide
Ketoconazole
Clotrimazole
Oral itraconazole

Presentation of Vibrio vulnificans

Fisherman, Gulf of Mexico
Poorly controlled DM
Cirrhosis
Dark, bullous lesions, wound infxn -> Septicemia

TX for Vibrio vulnificans

3rd G Cephalosporins
Ceftriaxone
Cefotaxime
Cefalexin
Ceftazidime
AND 
Doxycycline 
Cipro

Best initial test for Fungal skin infxn

KOH prep

Most accurate test for fungal skin infxn

Fungal Culture

Best initial TX for fungal skin infxn

Topical antifungal

Best intial Tx for hair and nail

Terbinafine

AE of Ketoconazole

Antiandrogenic - gynecomastia | Hepatotoxic

Best initial test for Candida

KOH

Most accurate test for Candida

Fungal Cultue

Best next step in Candida Infxn

Topical antifungal

AE of terbinafine

Hepatotoxic

Presentation of morbilliform rash

Generalized maculopapular rash that blanches with pressure

Presentation of Erythema Multiforme (EM Minor)

``` Widespread, small, target lesions Palms and soles No mucous membrane involved Sudden onset MC after HSV Infxn ```

Presentation of Steven-Johnson Syndrome (EM Major)

Involves mucous membranes | Sloughs off resp epithelium -> resp failure

TX for Steven-Johnson Syndrome

IVIG

Presentation of Toxic Epidermal Necrosis

Rash with mucous membrane involvement | Nikolsky sign +

MCC of death w TEN

Sepsis

TX for TEN

IVIG

Presentation of Staph scalded skin syndrome

Similar to TEN

Presentation of Toxic Shock Syndrome

``` Skin involvement like SSSS HypoTN Renal Dysfnc (Hi BUN/Cr) Liver Dysfunc CNS involved Fever Rash - desquamative Vomiting ```

Management of SSSS and TSS

``` Supportive care - IVF, Pressors (Dopamine) Antistaph ABX - Oxacillin or Nafcillin - Cefazolin MRSA - Vanco -Linezolid ```

TX for Mild Acne

1. Benzoyl peroxide | 2. Topical Abx = Clindamycin, Erythromycin

Presentation of Acne

Pustules Cysts Comedones

TX for Moderate Acne

Add Topical Vit A derivatives | Oral Abx- minocycline, tetracycline

TX for Severe Acne

Add Oral Vit A derivatives | Isotretinoin

AE of Isotretinoin

Hyperlipidemia | Teratogenic