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Clinical Pathology > Skin and Soft Tissue Pathology > Flashcards

Skin and Soft Tissue Pathology Flashcards

1
Q

4 commensal skin flora

A

Coagulase -ve staphylococci
Staph A
Proprionibacterium-acne
Corynebacterium

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2
Q

5 common commensal skin viruses

A 
Herpes viruses (HSV, VZV)
Moluscum contagiosum
HPV
Orf
Cowpox
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3
Q

Which virus is transmitted from sheep and results in ulcerative skin lesions

A

Orf

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4
Q

HZV pathogenesis

A

Vesicle forms which grows to form an ulcer. When it ruptures, it releases vesicle fluid containing infectious particles. Virus gains entry via sensory nerve endings and migrates along the nerve to the DRG where it remains latent and the immune response is not stimulated. When reactivated, the virus migrates outwards to sensory nerve endings and causes the clinical manifestations of infection- preceded by tingling

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5
Q

Triggers of reactivation of HSV

A

Infection or stress

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6
Q

Primary infections of HSV

A

Extensive, painful lesion, occurs only once. Rare. Normally HSV1. HSV2 is usually genital herpes.

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7
Q

Secondary infections fo HSV

A

All ages, recurrent infection. Peri-oral. Weeping, vesicular

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8
Q

Diagnosis of HSV

A

Clinical

Vesicle fluid contains virus-PCR

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9
Q

Treatment for HSV

A

Cold sores- topical aciclovir

Genical herpes/immunocompromised- oral aciclovir

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10
Q

Another name for strep pyogenes

A

Beta haemolytic streptococci

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11
Q

Usual causative organisms for bacterial skin infections

A

Staph A
Strep P
H. Influenzae
Pasteurella mulficida (grow in cat and dog’s mouths)

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12
Q

Gram +ve cocci in clusters. Catalase +ve. Normal nasal flora in 30% population

A

Staph A

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13
Q

Name some virulence factors of Staph A

A

DNAase
Coagulase
Teichoic acid
Exotoxin production e.g. epidemolytic toxins A & B, toxic shock syndrome toxin, PVL-boils

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14
Q

Really nasty bacteria, gram +ve cocci in chains. Catalase -ve.

A

Strep Pyogenes

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15
Q

Name some virulence factors of strep P

A 
Adhesins
M. proteins (antiphagocytic)
Streptolysins O and S
Hyaluronic capsule (antiphagocytic)
Hyaluronidase (facilitates intestinal spread)
C5a peptidase (anticomplementary)
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16
Q

Describe the rash in VZV

A

Weepeing, vesicular rash

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17
Q

Treatment for VZV

A

Oral aciclovir//valaciclovir

IV aciclovir if older, lower immune system or increased susceptibility to shingles

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18
Q

Causative organism for molluscum contagiosum

A

Molluscum contagiosum virus-poxvirus

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19
Q

Describe the appearance of molluscum contagiosum

A

Raised pearly lesions, umbilicated (central depressions) No sequelae.

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20
Q

Treatment of molluscum contagiosum

A

None. Usually disappear within 6-18 months. Physical treatments some times appropriate if disfiguring.

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21
Q

Causative organism for Impetigo

A

S. Aureus/S.Pyogenes

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22
Q

Often occurs at site of skin damage, superficial, thick scabs-‘honey crusted lesions’, with yellow exudate. often around the nose.

A

Impetigo

23
Q

Local manifestation of impetigo

A

Bullous impetigo

24
Q

Generalised manifestation of impetigo

A

Staph scalded skin syndrome

25
Q

Pathogenesis of impetigo

A

Desmosermal glycoprotein desmoglein-1 which is requied for cell to cell adhesion in the superficial epidermis is inactivated by ETA and ETB (epidermolytic toxin)

26
Q

Causative organism for erysipelas

A

S. pyogenes

27
Q

Erysipelas

A

Infection of dermis
Ocurs at site of skin damag, often face or shin. Preceded by pain and tenderness, well demarcated inflamed lesions-red, swollen, painful or hot. Fever, malaise and local lyphadenopathy.

28
Q

Cellulitis

A

Infection of skin and subcutanous tissues, not bilateral.

29
Q

Causative organisms of cellulitis

A

S. aureus
S. pyogenes
Pasteurella multicida (animal bites)
H. influenza

30
Q

What bacteria might give rise to peri-orbital cellulitis?

A

H. influenza

31
Q

Causative organism for anthrax

A

Bacillus anthracis-spore forming aerobic gram +ve bacillus, acquired from imported animal hides or wool.

32
Q

Describe the skin lesions in anthrax

A

Malignant pustular-eschar- dry dark scab

may develop into septicaemia

33
Q

Risk factors for anthrax

A

Drum skin exposure

Injecting drug users

34
Q

Describe the different types of anthrax

A

Cutaneous anthrax-readily treated

Inhalation/septicaemic antrhax-high mortality

35
Q

Necrotising fasciitis

A

Infection of the skin and SC tissue. Spontaneous or at site of skin penetration. Any part of the body. Dark, rapidly spreading, necrotic lesion. Fever and malaise.

36
Q

Describe the 2 types of Necrotising fasciitis

A

Type 1: polymicrobial - enteric gram -ve bacilli and anaerobes i.e. normal bowel flora.
Type 2: strep pyogenes- acquired.

37
Q

Another word for perineal necrotising fasciitis

A

Fournier’s or syndergistic gangrene

38
Q

Diagnosis of necrotising fasciitis

A

Blood or debrided material

39
Q

Treatment for necrotising fasciitis

A

IV-antibiotics

or surgical debridement

40
Q

Anaerobic Infections

A

Uncommon-ready availibility of O2.

Gas gangrene- similar to NF but with a palpable SC gas. Usually post operative at the site of surgery.

41
Q

Common causative organism of gas gangrene

A

Clostridium perfringens

42
Q

Treatment of gas gangrene

A

IV antibiotics

Surgical debridement

43
Q

Treatment for impetigo (causative organism staph A)

A

Fusidic acid or mopirocen

44
Q

Empiric bacterial skin infection treatment for those with a penicillin allergy

A

Erythromycin/clarithromycin/vancomycin/linezolid

45
Q

Treatment for NF

A

Need to cover anaerobic bacteria so meropenem and clindamycin. Metronidazole is an anti-anaerobic agent.

46
Q

Dermatophyte

A

Superficial fungal infection

47
Q

Skin fungal infection

A

Tinea corporis, tinea pedis (athlete’s foot)

48
Q

Nail fungal infections

A

Onychomycosis

49
Q

Scalp infections

A

Tinea capitis (scalp ringworm)

50
Q

Describe Pityriasis Versicolour

A

What I have on my back- hypopigmented patches that come out in the summer- fungal infection

51
Q

Causative organsims for dermatophyte infections

A

Tricophytum e.g T. rubum- circulates among humans

Microsporum- e.g. M.canis- circulates among animals

52
Q

What level of the skin do you usually get dermatophyte infections?

A

Usually restricted to stratum corneum- rarely penetrate the lining cells of the epidermis. Use keratin as a nutritional substrate

53
Q

Topical antifungal therapy

A

Clotrimazole

Terbinafine

54
Q

Scalp and nale infections- systemic antifungal therapy

A

Terbinafine, itraconazole, friseofluin

Clinical Pathology (53 decks)

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