Skin and soft tissue infection

Question 1

What is impetigo

Answer 1

A common childhood skin condition that affects the face, legs and exposed areas.

Show red patch with central fluid

Question 2

what is impetigo cause by

Answer 2

staphylococcus aureus
Streptococcus pyogenes (group a strep)

Question 3

Treatment for impetigo

Answer 3

Flucloxacillin
* Erythromycin is allergic to penicillin

Question 4

Complication for impetigo

Answer 4

Staphylococcal scalded skin syndrome (SSSS)
larger vesicles & serious forms of impetigo
secrete epidermolytic toxins

Question 5

diagnosis for impetigo

Answer 5

visual diagnosis
swab lesion for culture & sensitive testing

Question 6

what is abscesses

Answer 6

a localised collection of pus

Question 7

types fo abscesses

Answer 7

Furuncle
- occurs in the hair follicles
- cause by common bacteria like S.aureus
- swelling with central pus collection

Carbuncle
- involve many follicles or glands
- create multiple discharging heads

Question 8

What is the context that is within the abscess?

Answer 8

mostly fluid + neutrophils + causative organisms

Question 9

identify the cause of organisms in the following types of abscesses
- skin abscess
- buttock abscesses
- deep tissue abscesses

Answer 9

• skin abscess
  S.aureus
• buttock abscesses
  obligate anaerobes + other gut flora
• deep tissue abscesses
  obligate anaerobes, +/- streptococci, +/- S.aureus

Question 10

What are the treatments for abscesses

Answer 10

Incision and drainage
apply antibiotics
(penicillin/flucloxacillin + metronidazole)

Question 11

Diagnosis for abscesses

Answer 11

microscopy for deep tissues
culture bacteria including the anaerobic
sensitivity testing

Question 12

what is the condition fo cellulitis

Answer 12

acute spreading infection under the skin

Question 13

clinical appearance of cellulitis

Answer 13

hot
red
swollen
painful
fever

Question 14

complication of cellulitis

Answer 14

Spread into deeper soft tissue e.g. fat and muscle
which can cause septicaemia

Question 15

organisms causes for cellulitis

Answer 15

S.aureus
Group A streptococcus
haemolytic strep B, C, G
Enterobacteriaceae and anaerobes in buttock cellulitis

Question 16

diagnosis of cellulitis

Answer 16

clinical appearance
- blood culture
- biopsy (only done if treatment failure)
- ASO (anti-streptolysin O) if culture negative

*Swabs have no effect if there is no presence of infected

Question 17

Treatment for cellulitis

Answer 17

Antistaphylococcal - flucloxacillin
+
Antistreptococcal - penicillin

Question 18

what is the type of cellulitis that occurs on the head and neck only
generate more superficial than cellulitis

Answer 18

Erysipelas

cause by Group A strep
(sometimes group G but rare cases)

Question 19

Where is the site of infection that happens the most for necrotising fasciitis?

Answer 19

Connective tissue
fat
muscle

Question 20

the complication of necrotising fasciitis

Answer 20

extensive tissue destruction with loss of function
risk of overwhelming infection septicaemia and death

Question 21

organisms cause necrotising fasciitis

Answer 21

streptococci group ABCDF
staphylococcus aureuss
anaerobic Gram + clostridial species
anaerobic Gram - Bacteroides species

Question 22

What is the causation of necrotising fasciitis

Answer 22

pathogenes encounter ischaemic tissue
lytic toxins and toxin that promote spreads

Question 23

the predisposition of necrotising fasciitis

Answer 23

old age (weaker immunity)
diabetes (plenty of nutrients in sugar and cultivation)
poor peripheral circulation
immunosuppression

Question 24

diagnosis for Necrotising fasciitis

Answer 24

microscopy of fluids and tissue samples
aerobic and anaerobic culture of samples
blood culture

Question 25

sort of treatment can be used on necrotising fasciitis

Answer 25

surgical excision of affected tissue
antibiotics
- cidal
- protein inhibitors

Question 26

What are the characteristics of puncture wounds

Answer 26

small or closed surface
deep cuts or wounds
can get contamination from
soil: tetanus risk
inorganic foreign body

Question 27

Why puncture wounds are listed as a severe condition, and what are their complication to further condition?

Answer 27

cellulitis
abscess formation
tetanus - infection that cause muscle spasm and tension
osteomyelitis - inflammation of bone infection

Question 28

What to do to prevent the future worsening of puncture wounds?

Answer 28

clean
remove damaged tissue and foreign body
vaccinate again tetanus
antibiotic cover

Question 29

What is the difference between animal bites in a puncture wound

Answer 29

same risk as the puncture wound

Capnocytophagia canimorsus for Dogs
Pasteurella multocida –> Cats
*Both are pyogenic organisms

+ streptococci, staphylococci and anaerobes common to most mammalian oral flora

Question 30

diagnosis and management for animal bites

Answer 30

culture of a swab of the site
microscopy and culture of any subsequent abscess

clean, remove and antibiotics and anaerobic cover

Question 31

a condition that has skin ulcerates due to prolonged pressure

Answer 31

Pressure sores

Question 32

risk factors that can cause pressure sores

Answer 32

faecal urinary incontinence

underlying fracture

malnutrition

Question 33

What organisms favour the colonisation in pressure sores

Answer 33

S.aureus
Group G streptococci
Pseudomonas

Question 34

factors that can increase the rate of surgical wound infection

Answer 34

length of operation
subsequent haematoma
the general health of the patient
wound classification

Question 35

how would you deal with if a surgical wound infection is found?

Answer 35

do laboratory investigations
microscopy + culture
* infected tissues and infected fluids

do a blood culture if systemically unwell