Necrotising Fasciitis Flashcards

1
Q

Necrotising fasciitis is rare but very serious, can be life threatening, infection of the skin and underlying tissues, specifically the fascia. How common is this condition in the UK?

1 - 5/year
2 - 50/year
3 - 500/year
4 - 5000/year

A

4 - 5000/year

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2
Q

Is necrotising fasciitis dangerous?

A
  • yes
  • surgical emergency
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3
Q

What is the mortality rate of necrotising fasciitis?

1 - 1-2%
2 - 4-10%
3 - 20-25%
4 - >50%

A

3 - 20-25%

  • sepsis is also common
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4
Q

Which group of patients are most at risk?

1 - young children
2 - HIV patients
3 - diabetics
4 - cancer patients
5 - all of the above

A

5 - all of the above

  • essentially any patient who is immunocompromised
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5
Q

Necrotising fasciitis can affect anywhere on the body. All of the following are common places it can occur, but which is the most common location?

1 - feet
2 - lower legs
3 - hands
4 - genital areas

A

2 - lower legs

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6
Q

What is the name of Necrotising fasciitis if it occurs in the tongue?

1 - tonguitis
2 - fournier’s gangrene
3 - ludwig’s angina
4 - impetigo

A

3 - ludwig’s angina

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7
Q

What is the name of Necrotising fasciitis if it occurs in the genitals?

1 - tonguitis
2 - fournier’s gangrene
3 - ludwig’s angina
4 - impetigo

A

2 - fournier’s gangrene

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8
Q

Necrotising fasciitis is a very aggressive condition and spreads quickly. How is it able to spread so quickly?

1 - through blood
2 - uses lymphatics
3 - along soft tissue plains
4 - in hair follicles

A

3 - along soft tissue plains

  • generally infects the deep fascia and then the subcutaneous layers
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9
Q

Necrotising fasciitis is typically caused by a bacterial infection. What is the most common bacteria that cause necrotising fasciitis?

1 - E. coli
2 - Group A streptococcus
3 - Staphylococcus aureus
4 - Klebsiella

A

2 - Group A streptococcus

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10
Q

In necrotising fasciitis the can be tissue death. What is the main action by which the bacteria are able to cause tissue death?

1 - eat tissue
2 - damage mitochondria
3 - release toxic substances into tissues
4 - body reduces blood flow to infected area

A

3 - release toxic substances into tissues

  • toxins induce coagulation and clot formation
  • clots blood blood vessels leading to tissue death
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11
Q

In the first 24 hours of a patient having necrotising fasciitis, which of the following presentation may a patient present with?

1 - intense and severe pain out of proportion to external infection of skin
2 - break in the skin
3 - fever and flu like symptoms
4 - increased lactate and WCC
5 - all of the above

A

4 - all of the above

  • can also occur in the absence of a break in the tissue
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12
Q

In the 3-4 days of a patient having necrotising fasciitis, which of the following presentation may a patient present with?

1 - swelling of the painful area
2 - rash in affected area
3 - diarrhoea and vomiting
4 - large dark blotches, that will turn into blisters and fill up with fluid (subcutaneous bullae)
5 - all of the above

A

5 - all of the above

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13
Q

Which of the following are critical symptoms of necrotising fasciitis, which typically occurs in days 4-5 from infection?

1 - severe fall in blood pressure
2 - toxic shock from the poisons released by the bacteria
3 - unconsciousness as the body weakens
4 - all of the above

A

4 - all of the above

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14
Q

Is imaging generally used to diagnose necrotising fasciitis?

A
  • no as it delays surgery
  • BUT may demonstrate subcutaneous gas or foreign body
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15
Q

Which scoring system is used in necrotising fasciitis?

1 - Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC)
2 - modified Glasgow score
3 - CURB score
4 - Necrotising infection calculator

A

1 - Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC)

  • raised WBC, CRP, creatinine
  • low Na+ and Hb

BUT CLINICAL SUSPICION IS MORE IMPORTANT

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16
Q

Necrotising fasciitis is a surgical emergency. What approach is generally taken?

1 - amputation
2 - remove infected skin and apply skin graft
3 - radical debridement to help healthy tissue bleed

A

3 - radical debridement to help healthy tissue bleed

  • repeat debridement after 24-48h until infection is resolved
  • fasciotomy if muscle is involved
17
Q

In addition to surgery for necrotising fasciitis, which of the following must also be performed?

1 - analgesia
2 - fluid resuscitation
3 - appropriate antibiotics (WHH = piperacillin-tazobactam + Clindamycin + Gentamicin)
4 -all of the above

A

4 -all of the above

  • sample of tissue may be taken for culture to target antibiotics