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Infectious Disease > Osteo/HeadNeck/Skin > Flashcards

Osteo/HeadNeck/Skin Flashcards

1
Q

Osteomyelitis: testing

A 
best initial: Plain XR (periosteal elevation)
second line: MRI
most accurate: Bone biopsy & culture
monitory therapy: ESR
CCS: (+) blood cultures (+) ESR
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2
Q

Osteomyelitis: presentation

A

Warmth, Redness, Swelling, +/- draining purulent sinus tract

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3
Q

Osteomyelitis: cause

A

MCC: S. Aureus; S.S: Salmonella
Adults: Contiguous spread (nearby infection) from vascular insufficiency/diabetes
Kids: Hematogenous spread

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4
Q

Osteomyelitis: risk factors

A

Diabetes, Peripheral Vascular Disease with an ulcer, soft tissue infection

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5
Q

Osteomyelitis treatment: MSSA, MRSA

A

M.S.S.A: Oxacillin or Nafcillin IV x 4-6 weeks

M.R.S.A: Vancomycin, Linezolid, or Daptomycin IV 4-6 wks

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6
Q

Osteomyelitis treatment: Gram-negative bacilli

(salmonella or pseudomonas)

A

1) Confirm gram (-) with bone biopsy
2) Organism MUST be sensitive to antibiotics
3) Oral antibiotics

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7
Q

Otitis Externa (swimmer’s ear)

A
  • Swimming washes out acidic environment/foreign objects
    Diagnosis: itching, drainage, painful, swelling
    Tx: topical ofloxacin or polymyxin/neomycin + acetic acid + water solution
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8
Q

Malignant Otitis Externa (osteomyelitis of the skull from Pseudomonas in diabetic patient): presentation

A
  • Pain + purulent discharge
    pathognomonic: granulation tissue @ floor of bone-cartilage junction
    +/- h/o aural irrigation for cerumen removal
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9
Q

Malignant Otitis Externa: Dx/Tx

A

Best initial test: Skull XR or MRI
Most accurate: Biopsy
Tx: Surgical debridement and antibiotics against Pseudomonas (IV Ciprofloxacin)

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10
Q

Otitis Media: Key features

A

Redness, bulging, decreased/muffled hearing, Loss of light reflex, Immobility of tympanic membrane

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11
Q

Otitis Media: Causes

A

S. Pneumonia, Morexella Cattarhalis,

Nontypable Haemophilus Influenzae (+ purulent conjunctivitis)

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12
Q

Otitis Media: Treatment

A

Best initial: Amoxicillin x 7-10 days;
older (shorter) younger (longer)
Treatment failure: Amoxicillin + Clavulanate

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13
Q

Otitis Media: Complication - Acute Mastoiditis

A

Occurs exclusively as complication of AOM - mucosal response of mastoid air cells
-pain/swelling behind ear; erythematous tympanic memb.
TX: resolves quickly upon ABX treatment

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14
Q

Sinusitis: causes

A

MCC: viral
Bacterial: S. Pneumonia, H. Influenzae, Moraxella catarrhalis (same as otitis media)

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15
Q

Sinusitis: presentation

A

Nasal Discharge, Recent URI, HA, Facial pain/tenderness, tooth pain, bad taste in mouth, decreased transillumination of sinuses

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16
Q

Sinusitis: diagnosis

A

Best initial test: XR
Most accurate: Sinus aspirate for culture
CCS (office): treat, follow up in two weeks

17
Q

Sinusitis: treatment

A

Amoxicillin + Inhaled steroids (Fluticasone) IF:
(1) Fever/Pain (2) Persistent sx despite 7 days of decongestants (3) Purulent nasal discharge
CCS: Pseudophedrine + Acetaminophen + Amoxicillin
(Pen allergic: TMP-SMX, Doxycycline, Macrolides)

18
Q

Pharyngitis: (group A Strep; S. Pyogenes)

A

(1) Pain, sore throat (2) Exudate in Pharynx

(3) Adenopathy (4) No cough/hoarseness

19
Q

Pharyngitis: Dx

A

initial: Rapid Strep test (sensitive enough for adults)
accurate: Culture

20
Q

Pharyngitis: Tx

A

Penicillin or Amoxicillin

Penicillin allergy: Azithromycin or Clarithromycin

21
Q

Influenza: presentation

A

Arthralgia, Myalgia, Cough, HA, Fever, Sore throat, Fatigue

22
Q

Influenza: Dx

A

Viral antigen detection: nasopharyngeal swab/next step

23
Q

Influenza: Tx

A

< 48 hrs: Oseltamivir or Zanamivir

> 48 hrs: Symptomatic; Acetaminophen, Rest, Hydration

24
Q

Influenza Vaccine: Every year

A
  • not 100%; (may contact flu especially in first 2 weeks)

- Strongest indications: COPD, CHF, Dialysis, Steroid users, Healthcare workers, >50yo

25
Q

Impetigo (most superficial skin infection; epidermis)

A

Cause: Streptococcus Pyogenes/group A or Staph Aureus
Dx: Weeping, crusting, oozing, honey-colored lesions

26
Q

Impetigo: Tx

A

Mild: Topical mupirocin or retapamulin
Severe: Oral dicloxacillin or cephalexin
CA-MRSA: TMP/SMX, Clindaymycin, Doxycycline (B,C,D)

27
Q

Erysipelas (dermis)

A

Cause: Streptococcus Pyogenes (group A)
Dx: Bright red, hot, swollen, sharply-demarcated on face
(CCS: order blood cultures; MC: straight to treatment)

28
Q

Erysipelas: Tx

A

Best initial: Oral dicloxacillin or cephalexin

If confirmed group A beta hemolytic strept: Penicillin VK

29
Q

Cellulitis - (soft tissue infection - dermis into subcutaneous tissue)

A

cause: Staph Aureus = Streptococcus pyogenes (group A)
-red, warm, swollen, tender skin
Risk factors: IV drug use, DM, IC, Obesity

30
Q

Cellulitis: Dx

A

Leg: Order lower extremity doppler to exclude clot (both cause fever)

31
Q

Cellulitis: Tx

A

Minor: Dicloxacillin (PO) or Cephalexin (PO)
Severe: Oxacillin (IV) Nafcillin (IV) Cefazolin (IV)

32
Q

Folliculitis > Furuncles > Carbuncles > Boils

A

S. aureus related skin infections beginning @ hair follicle

Dx: based on appearance; only difference is size

33
Q

Folliculitis > Furuncles > Carbuncles > Boils:

Tx same as cellulitis

A

Minor: Dicloxacillin (PO) or Cephalexin (PO)
Severe: Oxacillin (IV) Nafcillin (IV) Cefazolin (IV)
Larger infections (boils): drainage

34
Q

Fungal infections of Skin & Nails:
Tinea corporus, manus, pedis, cruris, capitis, unguium
-Pruritis, erthromatous scaly plaques with central clearing

A

Best initial test: KOH prep (scrape; slide with KOH/acid/heat; epithelial cells dissolve and leave behind fungal forms); Accurate: Fungal culture

35
Q

Fungal infections: Tx

A

No hair/Nail involvement: Topical
(Clotrimazole, miconazole, ketoconazol, ciclopirox)
Hair/Nail involvement: Oral
(Terbinafine (LFTs); Griseofulvin (tinea capitis); Itraconazole

Infectious Disease (4 decks)

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