Skin, Bone, Healthcare Infections

Question 1

most skin and soft tissue infections are caused by?

Answer 1

staph aureus

strep pyogenes

Question 2

cellulitis is?

Answer 2

acute inflammatory process involving skin and soft tissues causing erythema, tenderness, warmth, swelling, lymphangitis
mostly lower limb

Question 3

lymphangitis vs lymphadenitis

Answer 3

lymphangitis is inflammation of lymph tracks, red lines running up the legs
lymphadenitis is painful swollen nodes

Question 4

risk factors for cellulitis

Answer 4

peripheral edema
lymph stasis
ulcers/wounds/trauma
dermatophytic infections (tinea)

Question 5

mycobacterium marinum causes

Answer 5

fish tank granuloma

Question 6

management of cellulitis

Answer 6

flucloxacillin

or cephalexin or cephazolin if allergic to penicillins

Question 7

what is chronic venous insufficiency

Answer 7

disruption of the valves in veins which overwhelms the lymphatics.
get blood in the interstitial space that isnt cleared, breaks down leaving hemosiderin stains.
get swelling of legs
not as painful as cellulitis

Question 8

how to differentiate acute contact dermatitis with cellulitis

Answer 8

usually have an exposure to irritant

and isnt as tender as cellulitis

Question 9

differentials for cellulitis

Answer 9

septic arthritis
septic bursitis
contact dermatitis
chronic lymphodema
necrotising fasciitis 
pyomyositis 
DVT
gout
thrombophlebitis

Question 10

markers for deeper infection (necrotising fasciitis/gas gangrene)

Answer 10

severe pain
systemic toxicity (high HR, low BP)
gas
clinical deterioiration despite antibiotics
skin necrosis
bullae
elevated CK (due to muscle destruction)

Question 11

typical pathogen post-burn

Answer 11

pseudamonus aerigonosa

Question 12

treatment for cellulitis (suspected staph or strep)

Answer 12

flucloxacillin or cephalexin if allergic

if strep pyogenes likely can use penicillin

Question 13

treatment of severe cellulitis

Answer 13

IV fluclox 2g/6 hourly

or IV cephazolin if allergic

Question 14

what is gout? what joint is most common? treat with?

Answer 14

urate crystal deposition in joints, usually metatarsophalyngeal
diagnosed by urate aspirate
treat with NSAIDS

Question 15

what is thrombophlebitis

Answer 15

inflammation and thrombus within a vein

Question 16

septic arthritis mostly occurs via

Answer 16

blood borne infection

but oculd be direct innoculation

Question 17

what is a fomite

Answer 17

contaminated object

Question 18

what is MRSA, what is it resistant to?

treat with?

Answer 18

methicillin resistant staph aureus
resistant to all penicillins, most cephalosporins
treat with vancomycin

Question 19

does culture of klebsiella in sputum mean a patient has pneumonia?
what about staph aureus in blood?

Answer 19

for pneumonia look at the patient and assess them for actual symptoms of pneumonia.
staph aureus in blood is ALWAYS significant

Question 20

what is VRE

Answer 20

vancomycin resistant enterococcus

Question 21

what is CPE

Answer 21

carbapenemase producing enterobacteriaceae

Question 22

difference between gram positive and gram negative

Answer 22

gram positive = 1 membrane and surrounding peptidoglycan wall
gram negative = inner and outer membrane (LPS) with a thin peptidoglycan wall in between

Question 23

examples of beta lactam drugs and how they work

Answer 23

penicillins
cephalosporins
carbapenems

they inhibit cell wall synthesis by blocking transpeptidase so only work on dividing bacteria

Question 24

antibiotics that inhibit protein synthesis by blocking ribosomal subunits

Answer 24

aminogycosides (gentmicin)
tetracyclines (doxycycline)
macrolides (azithromycin)
lincosamides (clindamycin)

Question 25

antibiotics that inhibit nucleic acid synthesis

Answer 25

trimethoprim sulphonamides fluoroquinolones (ciprofloxacin) metranidazole

Question 26

normal white cell count range

Answer 26

4-11

Question 27

normal CRP levels

Answer 27

below 5

Question 28

gram positive diplococci present on sputum culture would indicate?

Answer 28

pneumococcal infection

Question 29

treatment for pneumoccal pneumonia

Answer 29

typically penicillins penicillin G (IV) and penicillin V (oral)

Question 30

a broad specturm penicillin with activity against pseudamonus aeriginosa

Answer 30

piperacillin | commonly prescrribed with beta-lactamase inhibitor tazobactam

Question 31

if patient with pneumococcal pneumonia developed rash from penicillin what would you give?

Answer 31

cephtriaxone (a cephalosporin) | cephtriaxone doesnt work well for staph aureus

Question 32

the kind of organisms that cause atypical pneumonia? | treatment?

Answer 32

intracellular legionalla chlamydia coxiella ``` treatment: doxycycline (a tetracycline) or azithromycin (a macrolide) with intracellular activity ```

Question 33

what causes rigors?

Answer 33

other than influenza it is mostly bacterial infections

Question 34

when should you treat asymptomatic bacteriuria

Answer 34

only in pregnancy or before urology procedures

Question 35

causes of postoperative fever?

Answer 35

``` usually a result of the procedure itself wind (pneumonia) water (UTI) wound walking (PE) ```