Skin and Soft tissue

Question 1

inflammatory cells in the wall of hair follicle (no red patches of skin)

Answer 1

folliculitis

Question 2

folliculitis risk factors

Answer 2

MC cause - shaving frequent/poor technique

also obesity, occlusive, hot temps, diabetes, abx, immunosuppression

Question 3

folliculitis common pathogens

Answer 3

staph

pseudomonas (hot tub)

yeast (occasionally)

Question 4

folliculitis treatment

Answer 4

gentle cleansing and hot compress

don’t pop

can use topical or oral abx (anti fungal if yeast) - Keflex, clindamycin, bactrim

Question 5

non necrotizing inflammation of skin and subcutaneous tissue that doesn’t involve fasica/muscle

Answer 5

cellulitis

Question 6

risks for development of cellulitis

Answer 6

untreated and infected breakdown of epithelium (laceration, bite, puncture)

may not have obvious portal of entry

Question 7

cellulitis infecting pathogens

Answer 7

strep pyogenes or staph aureus

Question 8

cellulitis s/s

Answer 8

localized swelling, tenderness, and erythema

slow developing

Question 9

cellulitis tx

Answer 9

if there is no purulence or drainage = strep = dicloxacillin, amoxicillin, cephalexin

purulent = staph = bactrim or doxy

Question 10

acute infection of upper dermis and superficial lymphatics

sharply demarcated border, systemic symptoms

Answer 10

erysipelas

Question 11

erysipelas infecting pathogens

Answer 11

strep species

Question 12

erysipelas ss

Answer 12

raised, well demarcated red region with raised border

acute onset, systemic symptoms

No purulence

Question 13

risk factors for skin infection

Answer 13

elderly

DM

venous stasis and PAD

chronic liver and kidney disease

chronic steroids/immunodeficiency

IVDA

cancer

Question 14

imp. aspects of skin infection

Answer 14

trauma

exposure

chronic disease and level of control

recent ABX use

prior pathogen

immunization status

Question 15

skin infection exam

Answer 15

erythema, pain, swelling, warmth

asses for LAD and toxicity

Question 16

outpatient cellulitis management

Answer 16

Abx

non-prulent (dicloxacillin, amoxicillin, cephalexin)

purulent cellulitis (bactrim, doxycycline)

5-10 days, f/w 48-72hrs

Question 17

inpatient cellulitis antibiotic therapy

uncomplicated

Answer 17

cefazolin (Cephlex IV)

can use oxacillin or naficillin

MSSA coverage

Question 18

inpatient cellulitis antibiotic therapy

cellulitis with purulence

Answer 18

drainage, vancomycin

also ceftaroline, daptomycin

Question 19

inpatient cellulitis antibiotic therapy

aquatic environment

Answer 19

3rd/4th gen cephalosporin (ceftazidime, daptomycin)

or quinalone (Ciprofloxacin, levofloxacin)

Question 20

types of ulcers

Answer 20

1. pressure ulcers
2. stasis ulcers
3. diabetic ulcers

Question 21

pressure ulcers

Answer 21

occurs at weight bearing sites

where skin is hypoxic and necrotic bc mechanical pressure > perfusion pressure

Question 22

stasis ulcers

Answer 22

poor circulation causes hypoxia and edema that predisposes to skin breakdown

Question 23

diabetic ulcers

Answer 23

occurs on foot and lower leg

caused by neurological factors (neuropathy, glucose toxic), vascular factors (Venous stasis/PAD), metabolic factors

Question 24

Stage 1 ulcer

Answer 24

pressure wound

push and reveals no blanching

Question 25

stage 2 ulcer

Answer 25

dermis loss but no fat exposure

raised edges with surrounding redness

Question 26

stage 3 ulcer

Answer 26

visible globular fat molds

Question 27

stage 4

Answer 27

can see all layers of dermis, skin

visible tendons

Question 28

DM ulcers treatment

Answer 28

wound care

hyperbaric oxygen therapy

surgical Treatment (debridement, revascularization)

if infected inpt- Unyson, zosyn

outpt- cephalexin, diclozacillin, bactrim + augmentin

Question 29

deep infection of subcutaneous tissue that rapidly spreads along fascial planes

Answer 29

necrotizing fasciitis

Question 30

necrotizing fasciitis

pathogen

Answer 30

caused by B-hemolytic strep or staph

often poly microbial

Question 31

necrotizing fasciitis

risk factors

Answer 31

recent surgery or trauma

DM and cirrhosis

Question 32

necrotizing fasciitis

presentation

Answer 32

initial injury is trivial but patient will be in significant pain w/o cellulitis

dis proportionate pain for injury, clinical condition will deteriorate

anesthesia of the skin

Question 33

necrotizing fasciitis

diagnostic test

Answer 33

finger test

anesthesia of skin, make 2cm incision, probe with finger

passes directly thru SubQ tissue w/o muscle

Question 34

necrotizing fasciitis

care

Answer 34

immediate or debridement of all necrotic tissue

Question 35

animal bites

most often occur

Answer 35

late on summer afternoons

most animals are known to victim

Question 36

animal bites

dog, tx

Answer 36

typically force injury so crush component

may not be immediately apparent

staph, strep, eikenella, pasteurella

polymicrobial bite

Question 37

animal bites

cat tx

Answer 37

scratches or punctures

likely to become infected

pastuerella, actinomycetes, propionibacterium, bactericides

Question 38

animal bite treatment wound

Answer 38

copious irrigation, debridement of dead tissue, exploration of the wound

primary closure if they are cleaned

if not completely cleaned secondary intuition

Question 39

animal bite

DOC

Answer 39

augmentin

prophylactic 3-5 days, 10+ days

Question 40

clenched fist injury

Answer 40

high risk of infection

tendon moves into hand an infection gets deep into the skin

Question 41

human bite treatments

Answer 41

excellent cleansing with irrigation and debridement

ABX prophylaxis for all human bite wounds w/Augmentin, Moxifloxicin, or Unasyn

Question 42

human bit wounds should not be closed:

Answer 42

obvious infection >12 hrs old

puncture wounds or wounds to hand