Skin 2

Question 1

cellulitis

Answer 1

infection of the subcutaneous tissue and deep dermis, usually group A strep or S. aureus

Question 2

erysipelis

Answer 2

cellulitis limited to the dermis usually group A strep

Question 3

cellulitis may occur when

Answer 3

after disruption of skin

Question 4

cellulitis - clinical pres
3

Answer 4

1. fever
2. pain
3. drainage

Question 5

cellulitis - hx, ask about

Answer 5

household or close contracts w/ similar infections (MRSA)

Question 6

cellulitis - pts may come in concerned about what

Answer 6

a spider bite

Question 7

cellulitis - PE findings
5

Answer 7

1. erythema
2. vague margins
3. edema or induration
4. warmth
5. +/- drainage

Question 8

erysipelas - PE findings
4

Answer 8

1. erythema
2. well defined margins
3. raised
4. beefy red in color

Question 9

cellulitis - constitutional PE findings
3

Answer 9

1. +/- fever
2. toxic appearance
3. diaphoresis

Question 10

cellulitis - skin PE describe what
9

Answer 10

1. size
2. coloration
3. edema/pitting edema
4. margins
5. induration
6. fluctuance
7. crepitus
8. pain w/ palpation
9. drainage

Question 11

cellulitis - MS PE, if cellulitis overlies a joint, describe what
2

Answer 11

1. effusion
2. passive/active ROM (severe pain or lack of passive ROM is consistent w/ septic joint)

Question 12

cellulitis - lymph systen, PE note what

Answer 12

associated lymphadenopathy or evidence of lymphangitis

Question 13

cellulitis - consider wound cultures when

Answer 13

starting abx when purulence or drainage present

Question 14

cellulitis - img/testing consider what
3

Answer 14

1. wound culture
2. US of extremity if hx/ and concern for for DVT
3. plain radiographs

Question 15

cellulitis - consider US of extremity when

Answer 15

hx and exam concern for DVT or underlying abscess

Question 16

cellulitis - consider plain radiographs if concern for
3

Answer 16

osteomyelitis/foreign body/subcutaneous emphysema

Question 17

cellulitis DD - local reactions to bites or stings
4

Answer 17

1. usually rapid onset and not cellulitis (abx not indicated)
2. warmth, erythema, edema present
3. edema usually increased for up to 72 hours after exposure, then recedes
4. itching is predominant symptom

Question 18

cellulitis DD - chornic venous stasis
3

Answer 18

1. usually bilateral
2. chornic
3. afebrile

Question 19

cellulitis DD - DVT
5

Answer 19

1. warmth
2. pain
3. erythema
4. unilateral edema
5. get US to confirm

Question 20

purulent cellulitis - suspect what

Answer 20

MRSA

Question 21

purulent cellulitis - tx overview
3

Answer 21

1. I&D w/ adequate anesthesia is tx of choice
2. incision packing is controversial
3. wound cultures prior to abx start

Question 22

purulent cellulitis - abx choices
3

Answer 22

1. bactrim DS 1-2 tabs (DS dose is 800-150) (P 5 mg/kg TMP) PO BID x 5 days
2. clindamycin 450 mg (P 10 mg/kg) PO q8h
3. doxycycline 100 mg PO BID

Question 23

non purulent cellulitis - rx

Answer 23

5 days
1. cephalexin 500 mg (P 6.25 mg/kg) PO q6H
2. if severe PNC allergy - clindamycin 450 mg (P 10 mg/kg) PO q8H

Question 24

all cellulitis tx duration

Answer 24

5 days per CDC - some may need longer course if not improving after 5 days

Question 25

puncture wound - through the shoe, the most common organism is

Answer 25

Pseudomonas

Question 26

puncture wound through shoe - abx coverage

Answer 26

Pseudomonas converage - give fluoroquinolone such as cipro

Question 27

puncture wounds - consider what imaging and f/u

Answer 27

radiograph for OM/foreign body/subcuntaenous emphysema podiatry f/u for puncture through shoe

Question 28

diabetic foot

Answer 28

infected wound usually on plantar aspect of the foot

Question 29

diabetic foot categories 3

Answer 29

1. mild infection 2. mod infection 3. severe infection

Question 30

diabetic foot - mild infection

Answer 30

0.5-2 cm involving only the skin and subcutaneous tissue; can be tx OP

Question 31

diabetic foot mild infection tx rx 3

Answer 31

1. cephalexin 500 mg PO q6h 2. MRSA suspected then ADD: doxy 100 mg PO BID OR Bactrim DS 800/150 mg PO BID 3. PCN allergy: replace cephalexin w/ clindamycin 450 mg PO q8H

Question 32

diabetic foot mod infection

Answer 32

2 cm or greater, may involve deeper tissue or bone, and no systemic symptoms are present

Question 33

diabetic foot mod infection - w/u 3

Answer 33

1. consider ER referral for w/u and IV abx 2. x ray to r/o OM 3. OP mgmt w/ oral abx may be appropriate given pt preference and close f/u with PCP or podiatry in 24-48 hours

Question 34

diabetic foot severe infection

Answer 34

systemic s/sx, leukocytosis

Question 35

diabetic foot severe infection w/u

Answer 35

ER, may need surgical intervention