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Dermatology > Skin and Soft Tissue Infection > Flashcards

Skin and Soft Tissue Infection Flashcards

1
Q

Which bacteria make up the normal skin flora?

A

Gram positives such as diptheroids, corynebacteria, anaerobes, staphylococci and streptococci

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2
Q

On what areas of the skin is s.aureus most commonly found?

A

Nose and moist areas of the skin

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3
Q

In which areas of the body is s.pyogenes commonly found as a commensal?

A

Respiratory or vaginal tract

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4
Q

What are general predisposing factors to cellulitis?

A

Pregnancy
Caucasian
Venous insufficiency
Lymphoedema

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5
Q

What are local factors which can predispose to cellulitis?

A

Trauma, animal/insect bites, tattoos, ulcers, eczema, athlete’s foot, burns and surgery

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6
Q

What factors are important to assess when classifying skin and soft tissue infection?

A

Severity
Anatomical site
Comorbidity
Hospital acquired infection

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7
Q

What classes of skin and soft tissue infection are admitted to hospital?

A 
Class two (if no outpatient parenteral antimicrobial therapy facilities are available)
Classes three and four
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8
Q

Which classes of skin and soft tissue infection require management with IV antibiotics?

A

Classes 2, 3 and 4

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9
Q

In addition to IV antibiotics, which classes of skin and soft tissue infection require surgical management?

A

Class 4

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10
Q

Describe class one skin and soft tissue infection

A

No signs of systemic toxicity
No comorbidities
Treated as outpatient with oral antibiotics

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11
Q

Describe class two skin and soft tissue infection

A

Possible signs of systemic illness
Possible comorbidities of: obesity, venous insufficiency and peripheral vascular disease
Treated as inpatient with IV antibiotics unless outpatient parenetaral antimicrobial therapy facilities are available.

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12
Q

Describe class three skin and soft tissue infection

A

Signs of significant systemic illness
Unstable
Treated as inpatient with IV antibiotics

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13
Q

Describe class four skin and soft tissue infection

A

Signs of sepsis or necrotising fasciitis
Unstable
Treated as inpatient with IV antibiotics and surgery

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14
Q

What specific groups of patients should always be admitted to hospital for treatment of skin and soft tissue infections?

A

Immuocompromised patients

Very young children (<1 year)

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15
Q

Cellulitis at which sites should always be admitted to hospital for treatment?

A

Facial cellulitis

Suspected orbital or periorbital cellulitis (referred to ophthalmology)

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16
Q

Typical cellulitis is caused by s.pyogenes. What antibiotics are used to treat this?

A

Amplicillin or flucloxacillin

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17
Q

Typical pus forming cellulitis is caused by which organisms?

A

S.aureus

MRSA

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18
Q

Typical pus forming cellulitis is caused by s.aureus (possibly MRSA). How is this treated?

A

Flucloxacillin

Vancomycin

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19
Q

How should skin and soft tissue infection be treated when there is a penicillin allergy?

A

Doxycycline
Clindamicin
Vancomycin

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20
Q

What organism commonly causes skin/soft tissue infection as a result of a dog or cat bite?

A

Pasturella multocida

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21
Q

Pasturella multocida commonly causes skin/soft tissue infection as a result of a dog or cat bite. How is this treated?

A

Co-amoxiclav

Doxycycline + metronidazole

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22
Q

What organism commonly causes skin/soft tissue infection as a result of a freshwater exposure?

A

Aeromonas hydrophila

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23
Q

Aeromonas hydrophila commonly causes skin/soft tissue infection as a result of a freshwater exposure. How is this treated?

A

Ciprofloxacin

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24
Q

What organism commonly causes skin/soft tissue infection as a result of a salt water exposure?

A

Vibrio vulnificus

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25
Q

Vibrio vulnificus commonly causes skin/soft tissue infection as a result of a salt water exposure. How is this treated?

A

Doxycycline

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26
Q

What organism commonly causes necrotising fasciitis?

A

Clostridium perfringes

S.pyogenes

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27
Q

Which antibiotics are commonly used to treat necrotising fasciitis?

A 
Penicillin
Flucloxacillin
Clindamycin
Gentamicin
Metronidazole
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28
Q

What organism commonly causes skin/soft tissue infection in butchers and fish handlers?

A

Erysipelothrix

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29
Q

Erysipelothrix commonly causes skin/soft tissue infection in butchers and fish handlers. How is this treated?

A

Ciprofloxacin

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30
Q

List differential diagnoses of skin and soft tissue infection?

A 
Stasis dermatitis
Acute arthritis
Pyoderma gangrenosum
Hypersensitivity or drug reaction
DVT
Necrotising fasciitis
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31
Q

Explain how stasis dermatitis can be distinguished from skin and soft tissue infection?

A

Absence of pain and fever
Circumferential
Bilateral

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32
Q

Explain how acute arthritis can be distinguished from skin and soft tissue infection?

A

Joint involvement

Pain on movement

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33
Q

Explain how pyoderma gangrenosum can be distinguished from skin and soft tissue infection?

A

Ulcerations on legs

History of inflammatory bowel disease

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34
Q

Explain how hypersensitivity/drug reactions can be distinguished from skin and soft tissue infection?

A

Exposure to allergens/drug
Pruritis
Absence of fever and pain

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35
Q

Explain how DVT can be distinguished from skin and soft tissue infection?

A

Absence of skin changes or fever

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36
Q

Explain how necrotising fasciitis can be distinguished from skin and soft tissue infection?

A 
Severe pain out of proportion
Swelling
Fever
Rapid progression
Systemic toxicity
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37
Q

What is necrotising fasciitis?

A

Rapidly spreading infection of the subcutaneous fascia

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38
Q

Necrotising fasciitis is toxin mediated. T/F?

A

True

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39
Q

Describe the clinical manifestation of necrotising fasciitis?

A

Remarkably rapid progression
Most common on extremities e.g. legs
Initially erythema and swelling without sharp mergins
Exquisite pain and tenderness
Lymphatic involvement is rare
Colour changes from red-purple to blue-grey
Skin breakdown and bullae with development of anaesthesia
Probing of lesion reveals easy passage through tissues

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40
Q

How is necrotising fasciitis treated?

A

Surgical debridement

IV antibiotics: penicillin, flucloxacillin, clindamycin, gentamicin and metronidazole

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41
Q

Which organisms cause erysipelas?

A

Group A strep

Rarely group B, S and G s.aureus

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42
Q

Describe the appearance of erysipelas?

A

Skin/soft tissue infection
Raised lesion with a clear line of demarcation
Classical butterfly involvement

43
Q

What age groups are particularly susceptible to erysipelas?

A

Infants

Elderly

44
Q

What is impetigo?

A

Staphylococcal infection of the epidermis which forms a honey coloured crust and is often peri oral

45
Q

What groups of people are most commonly affected by impetigo?

A

Children

Sports persons

46
Q

How is impetigo managed?

A

Gently removing crust
Flucloxacillin
Management of secondary infection

47
Q

S.aureus strains produce an exfoliative exotoxin which causes widespread bullae and exfoliation. What is this known as in the neonate?

A

Ritter’s disease or Pemphigus neonatorum

48
Q

S.aureus strains produce an exfoliative exotoxin which causes widespread bullae and exfoliation. What are the symptoms of this?

A

Fever
Tenderness
Scarlatiniform rash

49
Q

S.aureus can produce the toxin PVL. What is the action of this toxin?

A

Destroys white blood cells

50
Q

What conditions is PVL producing s.aureus associated with?

A

Necrotising pyogenic skin infections
Septic arthritis
Fulminant pneumonia

51
Q

Community isolates of s.aureus are more likely to carry to PVL toxin than hospital isolates. T/F?

A

True

52
Q

When should PVL producing s.aureus be suspected?

A

Patients with recurrent or multiple boils especially those in close contact situations

53
Q

How is PVL producing s.aureus skin/soft tissue infection managed?

A

Drainage
Treatment according to sensitivity patterns
Nose, throat, axilla, perineum and skin lesions screened for carriage

54
Q

What is scarlet fever caused by?

A

Infection with a streptococcal strain which has pyrogenic exotoxins or erythrogenic toxins

55
Q

Scarlet fever usually occurs post pharyngitis. T/F?

A

True

56
Q

Scarlet fever can complicate wound infections and post partum infections. T/F?

A

True

57
Q

Describe the appearance of scarlet fever?

A

Diffuse red blush which appears on the second day of infection with a point of deeper rich blanche on pressure
Starts on upper chest the spreads to trunk, neck and extremities
Occlusion of sweat glands gives skin a sandpapery touch

58
Q

Which sites are usually spared in scarlet fever?

A

Palms
Soles
Face

59
Q

Describe the appearance of the tongue in scarlet fever?

A

White strawberry tongue then ed strawberry tongue

60
Q

When is prophylaxis following a bite recommended?

A

Deep bites
Hand bites
Splenectomised or immunocompromised patients
Crush injuries

61
Q

How are infected bones treated?

A

Aggressive debridement
Abscess drainagae
Antibiotics

62
Q

Cat bites are more likely to become infected than dog bites. T/F?

A

True

63
Q

Which pathogen is most commonly isolated from bites?

A

Pasturella

64
Q

How is pasturella infection as a result of a bite treated?

A 
Penicllins
Cephalosporins
Tetrayclines
Quinolones
Macrolides
65
Q

Which organism can commonly infect puncture wounds from crabs?

A

Erysipelothrix rhusiopathiae

66
Q

Aeromonas infection from fresh water exposure results in skin/soft tissue infection with the following features…?

A

Rapidly developing infection associated with fever and sepsis

67
Q

Edwardsiella trade infection from fresh water exposure results in skin/soft tissue infection with the following features…?

A

Cellulitis

Occasionally fulminant infection with bacteraemia

68
Q

Describe the clinical syndrome which results from erysipelothrix rhusiopathiae infection of puncture wounds from crabs?

A

Indolent localised cutaneous eruption

Erypsipeloid

69
Q

Describe the clinical syndrome which results from vibrio velnificus skin/soft tissue infection from salt or brackish waters?

A

Rapidly progressive necrotising infection, bullies cellulitis, sepsis

70
Q

Describe the clinical syndrome which results from mycobacterium marine skin/soft tissue infection from fresh or salt water exposure?

A

Indolent infection
Papules to ulcers
Ascending lesions may resemble sporotrichosis

71
Q

Define ‘burns’

A

Damage to the skin caused bay heat/chemicals/radiation which results in protein denaturing

72
Q

Describe the classification of a superficial (1st degree) burn

A

Dry, red, glances on pressure, painful, heals in a week

73
Q

Describe the classification of a partial thickness (2nd degree) burn

A 
Superficial or deep
Blisters
Pain
Heals in less than 3 weeks
Treated with antibiotics,  surgery and grafting
74
Q

Describe the classification of a full thickness (3rd degree) burn

A

Painless
Non-blanching
Treated with surgery

75
Q

What are the possible complications of burns?

A

Infection
Hypothermia
Acid-base abnormalities
Dehydration

76
Q

How are infected burns managed?

A 
Cleaning
Dressings
Topical antimicrobials (silver salfadiazine, bismuth compounds, chlorhexidine)
Topical antibiotics
Systemic antibiotics
77
Q

What are the major features of cutaneous anthrax?

A

Extensive oedema
Painless
Non-tender

78
Q

What are the minor features of cutaneous anthrax?

A 
Black eschar
Progresses over 2-6 days through papular, vesicular and ulcerated stages before eschar appears
Affects hands, forearms, face and neck
Discharge of serous fluid
Local erythema and induration
Local lymphadenopathy
Systemic malaise - headache, chills, sort throat
Afebrile
79
Q

What are the risk factors for cutaneous anthrax?

A

Working with animals or animal hides
Making/owning or playing animal hide drums
Drug use (heroin)
Travel
Working in postal sorting offices
Handling large volumes of mail
Receiving threatening letters or packages containing white powder

80
Q

How is cutaneous anthrax treated?

A 
Penicllin
Flucloxacillin
Clindamycin
Ciprofloxacin
Metronidazole
81
Q

What is tinea?

A

A superficial dermatophyte infection characterised by scaly, inflammatory or non-inflammatory patches

82
Q

How is tinea spread?

A

Direct skin to skin contact

83
Q

In what pattern does tinea expand?

A

Centrifugal pattern

84
Q

What is the common name for tinea pedis?

A

Athlete’s foot

85
Q

What pathogens most commonly cause tinea?

A

Trichophyton
Microsporum
Epidermophyton

86
Q

How is tinea diagnosed?

A

Potassium hydroxide preparation form a skin scraping

87
Q

What causes erythema infectiosum?

A

Human parvovirus virus B19

88
Q

How is human parvovirus B19 (causing erythema infectiosum) spread?

A

Blood or blood products

89
Q

What are the symptoms fo erythema infectiosum?

A

Fever
Headache
Runny nose
Pruritic rash on the face, torso and extremities

90
Q

Erythema infectiosum is self limiting and reoslves without complications. T/F?

A

It is self limiting and IN CHILDREN resolves without complications

91
Q

Erythema infectiosum can cause an acute cessation of red blood cell production. What problems can this cause?

A

Transient aplastic crisis
Chronic red cell aplasia
Hydrops foetals
Congenital anaemia

92
Q

What virus causes hand foot and mouth disease?

A

Coxsackle virus A16

93
Q

What age groups are commonly affected by hand foot and mouth disease?

A

Children and infants

94
Q

What are the symptoms of hand foot and mouth disease?

A 
Fever
Rash
Headache
Sore throat
Oropharyngeal ulcers
Loss of appetite
95
Q

What are the symptoms of measles?

A 
Fever
Cough
Coryza
Conjunctivitis 
Koplik spots
Maculoppaular red rash on face and hairline then spreading to the neck, trunk, arms and legs
96
Q

What are the possible complications of measles?

A

Hospitalisation
Pneumonia
Encephalitis (can cause deafness and intellectual disability)
Death due to respiratory and neurological complications

97
Q

At what site can herpes simplex virus lie latent?

A

Sensory nerve ganglia

98
Q

How is herpes simplex virus treated?

A

Topical/oral/IV acyclovir

99
Q

At what days in infection is varicella zoster virus contagious?

A

days 8-21

100
Q

Varicella zoster virus can cause congenital abnormalities if it is acquired during pregnancy. T/F?

A

True

101
Q

High risk adults with varicella. zoster virus infection should be. treatment with acyclovir. Which adults are classified as high risk?

A

Pregnant
Immunocompromised
Pneumonitis

102
Q

Reactivation of format varicella zoster virus in what site causes shingles?

A

Dorsal root ganglia

103
Q

What is the typical distribution of shingles?

A

Dermatomal distribution

104
Q

How is shingles treated?

A

Pain management with NSAIDs and gabapentin

High risk patients treated with acyclovir

Dermatology (8 decks)

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