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Dermatology > Skin infection > Flashcards

Skin infection Flashcards

1
Q

What is impetigo?

A

A superficial, contagious, blistering infection of the skin caused by the bacteria Staphylococcus aureus and Streptococcus pyogene

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3
Q

What are the different types of impetigo?

A
  • Bullous
  • Non-bullous
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4
Q

What layer of the skin does impetigo affect?

A

Epidermis

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5
Q

What is the most common form of impetigo?

A

Non-bullous impetigo - 70% of cases

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7
Q

What is bullous impetigo caused by?

A

Staphylococcus - produces exfoliative toxin

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8
Q

How do bullae form in impetigo?

A

Toxin that contains serine proteases acting on desmoglein 1. This process allows S. aureus to spread under the s.corneum in the space formed by the toxin, causing the epidermis to split just below the stratum granulosum.

Large blisters then form in the epidermis with neutrophil and, often, bacterial migration into the bullous cavity. In bullous impetigo, the bullae rupture quickly, causing superficial erosion and a yellow crust

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9
Q

What is the following?

A

Impetigo

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10
Q

What might you see on examination in someone with impetigo?

A

Erosions that have a yellowish to golden crust on an erythematous base, with patchy distribution, often in the peri-oral and peri-nasal area, although they can occur anywhere on the body.

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11
Q

What are the main causative agents of impetigo?

A
  • Staphylococcus
  • Group A B-haemolytic strep
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12
Q

What is erysipelas?

A

A distinct form of superficial cellulitis with notable lymphatic involvement and is raised, sharply demarcating it from uninvolved skin

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13
Q

What layer of the skin does erysipelas affect?

A

Dermis

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14
Q

What causes non-bullous impetigo?

A

Streptococcus pyogenes

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15
Q

What are features of erysipelas?

A
  • Painful, red area
  • Fever
  • Regional lymphadenopathy and lymphangitis
  • Distinct elevated borders
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16
Q

What is the following?

A

Erysipelas

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19
Q

How would you manage someone with impetigo?

A

Topical antibiotics

  • Flucloxacillin - 7-10 days
  • Fusidic acid

Hygeine advice

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20
Q

What layers does cellulitis affect?

A

Dermis and subcut tissue

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23
Q

What is the cause of erysipelas?

A

Strep. pyogenes

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24
Q

What is the following?

A

Ascending lymphangitis

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25
Q

What is the following?

A

Cellulitis

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26
Q

How would you treat a mild cellulitis empirically?

A

Oral Flucloxacillin or clarythromycin - 7-14 days

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27
Q

How would you treat moderate to severe cellulitis?

A

IV Flucloxacillin, switch to oral fluclox/doxycycline

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28
Q

What is folliculitis?

A

Pustular infection of a single hair follicle which can occur in clusters typically on head, back buttocks and extremities

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30
Q

What are the features of folliculitis?

A
  • Circumscribed, pustular infection of a hair follicle
  • Up to 5mm in diameter
  • Present as small red papules - Central area of purulence that may rupture and drain
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32
Q

Where does erysipelas most commonly affect?

A

The face

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33
Q

How would you treat erysipelas?

A

Benzylpenicillin + Flucloxacillin - consider IV if serious

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34
Q

What are features of furunculosis?

A
  • Single hair follicle-associated inflammatory nodule
  • Extending into dermis and subcutaneous tissue
  • May spontaneously drain purulent material
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35
Q

What is cellulitis?

A

An acute spreading infection of the skin with visually indistinct borders that principally involves the dermis and subcutaneous tissue

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36
Q

What are carbuncles?

A

Large abscess involving multiple adjacent hair follicles, which tend to by multiseptated. These may drain spontaneously

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37
Q

What are features of carbuncles?

A

Infection extends to involve multiple furuncles

  • Multiseptated abscesses
  • Purulent material expressed from multiple sites
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39
Q

What organisms are implicated in cellulitis?

A
  • B-haemolytic streps
  • Staph. aureus
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40
Q

What are signs of a cellulitis?

A
  • Pain
  • Swelling
  • Warmth
  • Erythema - no distinct borders
  • Systemic upset plus fever
  • Lymphadenopathy/lymphangitis
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41
Q

Where does cellulitis most commonly affect?

A

Lower legs

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47
Q

What is the cause of folliclitis?

A

S. Aureus

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48
Q

What are signs of necrotising fasciiitis?

A
  • Crepitus
  • Haemorrhagic bullae
  • Skin necrosis
  • Anaesthesia at site of infection
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50
Q

How would you manage someone with necrotizing fasciitis?

A
  • ABx - Fluclox + benpen + Gentamicin + Clindamycin
  • Urgent surgical debridement +/- amputation
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51
Q

Where is folliculitis typically found?

A

Head, back, buttocks and extremities

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52
Q

What is furunculosis?

A

An inflammatory infection of a single hair follicle that extends deep into dermis and subcutaneous tissue. Usually affecting moist hairy areas of body

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53
Q

What is the most common cause of furunculosis?

A

S. aureus

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55
Q

What are risk factors for folliculitis?

A
  • Obesity
  • Diabetes mellitus
  • Atopic dermatitis
  • Chronic kidney disease
  • Corticosteroid use
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58
Q

Where are carbuncles most commonly found?

A
  • Back of neck
  • Posterior trunk
  • Thigh
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59
Q

Where are features of septic bursitis?

A
  • Fever
  • Pain on movement
  • Peribursal cellulitis
  • Swelling
  • Warmth
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60
Q

How would you treat folliculitis?

A

Topical antibiotics

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61
Q

How would you treat a furuncle?

A

Topical/oral antibiotics

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62
Q

How would you manage someone with a carbuncle?

A

Hospital admission, surgery and IV Abx

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63
Q

What are features of infective tenosynovitis?

A
  • Erythematous fusiform swelling of finger
  • Pain with extension of finger
  • Held in a semiflexed position
  • Tenderness over the length of the tendon sheath
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64
Q

What is necrotising fasciitis?

A

A life-threatening subcutaneous soft-tissue infection that may extend to the deep fascia, but not into the underlying muscle. The causal organisms may be aerobic, anaerobic, or mixed flora

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65
Q

What is staphylococcal scalded sking syndrome?

A

An illness characterised by red blistering skin that looks like a burn or scald, hence its name staphylococcal scalded skin syndrome.

The scalded skin syndrome is caused by a toxin-secreting strain of S. aureus.

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66
Q

What are the main clinical forms of necrotising fasciitis?

A
  • Type I - polymicrobial
  • Type II - monomicrobial infection with Streptococcus pyogenes (group A streptococci)
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67
Q

What organisms are commonly involved in type I necrotising fasciititis?

A

An aerobe and a facultative anaerobe

  • Streptococci
  • Staphylococci
  • Enterococci
  • Gram negative bacilli
  • Clostridium
68
Q

What are the majority of superificial skin infections caused by?

A
  • S. aureus
  • S. pyogenes
69
Q

What layers are involved in necrotizing fasciitis?

A

Infection extends through the fascia but not into the underlying muscle, and tracks along fascial planes extending beyond the area of overlying cellulitis

70
Q

What are symptoms of necrotizing fasciitis?

A

Rapid onset, sequential development of:

  • Severe, unremitting pain around site
  • Fever
  • Delerium
72
Q

How would you diagnose necrotising fasciitis?

A

Clinical diagnosis

74
Q

What is the overall mortality associated with necrotising fasciitis?

75
Q

What would you trat GAS necrotizing fasciitis?

A

Benzylpenicillin and clindamycin

76
Q

What is pyomyositis?

A

A bacterial infection of the skeletal muscles which results in a pus-filled abscess. Pyomyositis is most common in tropical areas but can also occur in temperate zones.

77
Q

Where does pyomyositis most commonly occur?

A
  • Thigh
  • Calf
  • Arms
  • Gluteal region
  • Chest wall
  • Psoas muscle
78
Q

What are predisposing factors to the development of pyomyositis?

A
  • Diabetes mellitus
  • HIV/immunocompromised
  • Intravenous drug use
  • Rheumatological diseases
  • Malignancy
  • Liver cirrhosis
79
Q

What are features of pyomyositis?

A
  • Fever
  • Pain
  • Woody induration of affected muscle
80
Q

How would you investigate suspectedd pyomyositis?

A
  • Clinical diagnosis
  • Imaging - CT/MRI
81
Q

How would you manage someone with pyomyositis?

A
  • Drainage
  • Antibiotics
82
Q

What antibiotics would you use for MRSA infection?

A
  • Vancomycin
  • Linezolid
  • Teicoplanin
  • Daptomycin
84
Q

How would you investigate someone with septic arthritis?

A
  • Clinical diagnosis
  • Fluid aspiration
85
Q

What is infective tenosynovitis?

A

Infection of the synovial sheats that surround tendons

86
Q

What are organisms implicated in infective tenosynovitis?

A
  • S. aureus
  • Strep
  • Mycobacteria
  • Fungi
88
Q

How would you manage someone with infective tenosynovitis?

A
  • Abx
  • Hand surgeon referral
90
Q

What toxin is implicated in SSSS?

A

Exfoliatin - causes intra-epidermal cleavage at the level of the stratum corneum leading to the formation of large flaccid blisters that shear readily.

91
Q

Who does SSSS most commonly affect?

A

Children under the age of 5

92
Q

How would you treat staph scalded skin syndrome?

A

IV fluids and flucloxacillin

93
Q

What is toxic shock syndrome?

A

A condition of shock caused by bacterial super antigens

94
Q

What organisms cause toxic shock syndrome?

A
  • Staphylococcus
  • Streptococcus
95
Q

What toxin is implicated in TSS?

A

TSST-1 - causes cytokine release with abrupt onset of fever and shock, with a diffuse macular rash and desquamation of the palms and soles

96
Q

What are features of TSS?

A
  • Shock
  • Confusion
  • Fever
  • Rash
  • Diarrhoea
  • Myalgia
  • Desquamation of hands and feet
97
Q

What can be a cause of TSS in females?

A

Indwelling tampon

98
Q

What is a class I surgical wound?

A

Clean wound (respiratory, alimentary, genital or infected urinary systems not entered)

99
Q

What is a class II surgical wound?

A

Clean-contaminated wound (above tracts entered but no unusual contamination)

100
Q

What is a class III surgical wound?

A

Contaminated wound (Open, fresh accidental wounds or gross spillage from the gastrointestinal tract)

101
Q

What is a class IV surgical wound?

A

Infected wound (existing clinical infection, infection present before the operation)

102
Q

What is MRSA?

A

Methicillin-resistnat staphylococcus aureus

103
Q

Where is MRSA most commonly acquired?

A

Hospital acquired infection

104
Q

What is MRSA resistant to?

A

Resistant to penicillin and isolated resistance to other β-lactam antibiotics such as meticillin (now rarely used) and flucloxacillin

105
Q

What is MRSA most commonly found in?

A

Surgical wounds

106
Q

What type of rash do dermatophytes cause?

A

Ringworm rash

107
Q

What is the following?

A

Tinea pedis

108
Q

What is the following?

A

Tinea cruris

109
Q

What are the 3 main types of dermatophytes which cause skin infection?

A
  • Epidermophyton
  • Trichophyton
  • Microsporum
110
Q

How would you treat dermatophyte infection?

A
  • Skin - terbanifine, imidazole (cream)
  • Scalp - Griseofulvin, terbinafine PO
  • Nails - Terbinafine PO
111
Q

How would you treat candida infection of the mouth?

A

Nystatin (oral suspension)

112
Q

How would you treat vaginal candidiasis?

A

Imidazole cream +/- pessiary

113
Q

What is the following?

114
Q

What is the following caused by?

A

Sarcoptes scabiei - causes itchy red papules in webspaces of finger and toes, palms/soles of feet, around wrist and axilla, male genitalia

115
Q

What is the following?

A

Viral wart

116
Q

What is the most common cause of the following?

117
Q

What is the following caused by?

118
Q

What is the cause of the following?

A

Herpes simplex

119
Q

Where are the most common places for individuals to get viral warts?

A
  • Fingers
  • Toes
  • Plantar surface
  • Genital
120
Q

How would you treat an individual with a herptic rash?

A
  • Cold Sores - Aciclovir cream shortens attacks
  • Genital wart - Oral aciclovir
121
Q

What is the following caused by?

A

Herpes simplex

122
Q

How would you manage the following?

A

Admit and IV aciclovir

123
Q

What is the cause of shingles?

A

Reactivation of VZV

124
Q

What can precede an attack of shingles?

A

Prodromal phase of tingling or pain, which is followed by a painful and tender blistering eruption

125
Q

How are shingles lesions distributed?

A

Dermatomal distribution

126
Q

How long does a shingles rash last?

127
Q

What are complications of shingles?

A
  • Post-herpetic neuralgia
  • Ocular disease
  • Motor neuropathy
128
Q

What is the following?

A

Shingles rash in opthalmic nerve distribution

129
Q

How would you manage someone with acute shingles?

A
  • Pain relief
  • Protective ointment for rash
  • If severe
    • Aciclovir for 1 week, or
    • Famciclovir for 1 week
  • Oral abx to protect against secondary infection
130
Q

How would you manage viral warts?

A
  • Leave them - resolve spontaneously (and rapidly) within months/years
  • If troubleseome:
    • Regular keratolytic therapy
    • ​Cryotherapy + imiquimod
    • Topical 5FU
131
Q

What are features of a common viral wart?

A
  • Papules with a rough, papillomatous and hyperkeratotic surface - from 1 mm to larger than 1 cm.
  • Arise most often on the backs of fingers or toes, around the nails—where they can distort nail growth—and on the knees.
132
Q

What are features of plantar warts?

A

Verrucas

Tender inwardly growing and painful ‘myrmecia’ on the sole of the foot, and clusters of less painful mosaic warts.

133
Q

What are features of a plane wart?

A

Plane warts have a flat surface. The most common sites are the face, hands and shins.

134
Q

What is the following?

A

Molluscum contagiosum - lesions are multiple small (1–3 mm) translucent papules which often look like fluid-filled vesicles but are in fact solid. Individual lesions may have a central depression called a punctum. They exhibit the Köbner phenomenon

135
Q

What is the following caused by?

136
Q

How would you manage the following?

A

Consider:

  • Selenium sulphide shampoo
  • Imidazole cream
  • Oral intraconazole - resistant cases
137
Q

What is the following?

A

Pityriasis versicolour - presents most commonly on the trunk with reddish brown scaly macules, which are asymptomatic. In black-skinned individuals (or in whites who are sun-tanned) it more commonly presents as macular areas of hypopigmentation

138
Q

What is norwegian scabies?

A

Clinical variant of scabies occuring in immunocompromised individuals where huge numbers of mites are carried in the skin - EXTREMELY INFECITOUS

139
Q

How does norwegian scabies present?

A
  • Not always itchy
  • Hyperkeratotic crusted lesions, especially on the hands and feet
  • Can progress such that the patient has a widespread erythema with irregular crusted plaques
140
Q

How wouldyou manage scabies?

A
  • 1st line - Permethrin dermal cream
  • 2nd line - Malthoin
141
Q

What is the pathogenesis of scabies?

A

The female mite digs burrows and lays eggs which hatch larvae. The itching and red rash is thought to be caused by the mites and their products

142
Q

What is the following?

A

Headlice eggs

143
Q

What are complications of headlice?

A
  • Dermatitis
  • Impetigo
  • Tender swollen lymph nodes
144
Q

How would you manage headlice?

A

At least 2 applications of chemical insecticide and/or physical methods:

  • Neurotoxic agents - Malathion, Carbaryl, phenothrin
  • Non-irritant options - Dimeticone
  • Hot air
  • Meticulous combing
145
Q

What is the species of lice implicated in head lice?

A

Pediculus humanus/capitis

Dermatology (13 decks)

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