skin infections & wounds

Question 1

given in tetanus prone wounds when the patient’s immune status is unknown or partial

Answer 1

tetanus immune globulin

Question 2

given in traumatic wounds if tetanus immune status is unknown

Answer 2

tetanus toxoid

Question 3

what are tetanus prone wounds?

Answer 3

gross devitalized tissue, obvious contamination, frostbite, missile injuries, and injuries >6hrs old

Question 4

best antibiotic choice for an MRSA infection resistant to vancomycin

Answer 4

linezolid

Question 5

treatment for severe hidradenitis suppurativa

Answer 5

wide excision with healing by secondary intention

Question 6

recurrent chronic inflammatory skin condition due to follicular occlusion:

Answer 6

hidradenitis suppurativa

Question 7

acute purulent infection of the fingertip pad (pulp)

Answer 7

felon

Question 8

most common organism of infection in felon

Answer 8

staph aureus

Question 9

what does full thickness skin graft include

Answer 9

epidermis and complete dermis; no subcutaneous tissue

Question 10

what is primary graft contraction?

Answer 10

degree to which a graft shrinks in surface area after harvesting but before grafting

Question 11

what is secondary graft contraction?

Answer 11

degree to which a graft shrinks during healing

Question 12

which has less primary contraction - full thickness or STSG?

Answer 12

STSG

Question 13

which has less secondary contraction - full thickness or STSG?

Answer 13

full thickness

Question 14

which has greater rates of engraftment (graft survival)?

Answer 14

STSG

Question 15

infection spreading along lymphatic channels that presents with red linear streaking proximal to the site of infection and travels toward the regional lymph nodes which may also be enlarged and tender

Answer 15

acute lymphangitis

Question 16

most common organism and treatment of acute lymphangitis

Answer 16

group A strep; tx with penicillin

Question 17

mupirocin is indicated for treatment of ___ wound infections

Answer 17

MRSA

Question 18

how is a full thickness skin graft harvested and repaired?

Answer 18

excised sharply with knife, defatted to encourage uptake; wound is closed primarily

Question 19

most common pathogen of paronychia

Answer 19

staph aureus

Question 20

order and stages of healing for skin grafts:

Answer 20

imbibition, inosculation, revascularization

Question 21

treatment of paronychia (nailbed infection):

Answer 21

incision and drainage of nailbed to evacuate purulence + abx; incision made longitudinally and laterally, parallel to nail bed

Question 22

characteristics of Hurley I hidradenitis suppurativa:

Answer 22

localized abscesses without sinus tracts or scarring; first line treatment is clindamycin gel

Question 23

characteristics of Hurley II hidradenitis:

Answer 23

multiple abscesses and sinus tracts separated by normal appearing skin

Question 24

characteristics of Hurley III hidradenitis:

Answer 24

diffuse disease with multiple interconnected sinus tracts and abscesses involving the entire anatomic area with scarring

Question 25

form of cellulitis caused by group A strep that causes raised lesions with sharply demarcated borders between infected and normal skin:

Answer 25

erysipelas

Question 26

skin and soft tissue infection confined to the epidermis that usually involves the face or extremities; consists of discrete vesicular lesions and crusted plaques; usually caused by beta hemolytic strep or staph aureus

Answer 26

impetigo

Question 27

deep ulcerated form of impetigo

Answer 27

ecthyma

Question 28

pressure ulcer stage: intact skin that is reddened

Answer 28

stage 1

Question 29

pressure ulcer stage: blisters or breaks in dermis or partial thickness loss of dermis

Answer 29

stage 2

Question 30

pressure ulcer stage: full thickness tissue loss with visible subcutaneous fat but no exposed bone, tendon or muscle

Answer 30

stage 3

Question 31

pressure ulcer stage: exposed bone, joint, muscle, or tendon

Answer 31

stage 4

Question 32

pressure ulcer stage: covered by slough or eschar, true depth can't be determined without debridement

Answer 32

unstageable

Question 33

subcutaneous abscess of the fingertip pulp

Answer 33

felon; treat with I&D and abx

Question 34

nodular cellulitis that is often mistaken for fungal infection; due to innoculation of bacteria (usually S. aureus) in the wound of immunocompromised patient

Answer 34

botryomycosis

Question 35

TNF alpha inhibitor shown to have benefits for patients with moderate to severe hidradenitis

Answer 35

adalimumab

Question 36

clindamycin mechanism of benefit in NSTI

Answer 36

provides coverage for panton-valentine leucocidin toxin (PVL)

Question 37

histologic features of hidradenitis

Answer 37

follicular hyperkeratosis, plugging, and dilation; lymphocytic perifolliculitis; in chronic phase can demonstrate psoriasform hyperplasia of the interfollicular epithelium or inflammatory infiltrate of dermis and subcutis

Question 38

medical treatments for hidradenitis:

Answer 38

``` smoking cessaion zinc gluconate resorcinol sulfur topical methylprednisolone 1 week taper IV ceftriaxone followed by rifampin, moxifloxacin, and metronidazole dapsone or cyclosporine TNF blocker adalimumab ```

Question 39

Initial treatment of paronychia:

Answer 39

warm compresses and antibiotics

Question 40

Surgical treatment of hidradenitis:

Answer 40

total excision of all hair bearing skin with STSG

Question 41

First line therapy for Hurley stage 1 hidradenitis:

Answer 41

clindamycin gel