Skin, soft tissue, bone, joint infxns

Question 1

infxn at the jxn of the cutaneous and subcutaneous

Answer 1

erysipelas

Question 2

infxn at the subcutaneous fat

Answer 2

cellulitis

Question 3

infxn at the level of the arteries and veins

Answer 3

necrotizing fasciitis

Question 4

common agents of impetigo

Answer 4

strep pyogenes, staph aureus

Question 5

common agents of erysipelas

Answer 5

strep pyogenes

Question 6

common agents of folliculitis, furuncles

Answer 6

Staph aureus

Question 7

common agents of cellulitis

Answer 7

strep pyogenes, staph aureus

Question 8

slightly tender, pruritic, papular rash, caused by pseudomonas

Answer 8

hot tub folliculitis

Question 9

hot tub folliculitis caused by

Answer 9

pseudomonas aeruginosa

Question 10

initially tender 1 cm erythematous nodule, now larger with dark center, spider bite 4 months prior

Answer 10

furuncle (skin abscess)

Question 11

tx of furuncle (2)

Answer 11

1. I & D

2. antimicrobials if cellulitis

Question 12

tx of non-purulent cellulitis (2 topsions)

Answer 12

1. 1st gen cephalosporin (cefazolin, cephalxin)

2. anti-stphylococcal PDN (nafcillin, dicloxacillin)

Question 13

tx of purulent SSTI - MRSA possible (4 options)

Answer 13

1. vancomycin
2. TMP-SMX
3. clindamycin
4. minocycline

Question 14

tx of hot tub folliculitis

Answer 14

NO antimicrobials

Question 15

organisms that can cause necrotizing fasciitis (4)

Answer 15

1. clostridium perfringens
2. GAS
3. polymicrobial (gr- rods + gram+cocci)
4. MRSA

Question 16

patient presents with severe constant pain, systemic toxicity, gas in soft tissues

Answer 16

necrotizing fasciitis

Question 17

most common source of clostridium fasciitis

Answer 17

tissue trauma

Question 18

Fungal infxn in a patient who gardens, presents with chancriform/nodular lesions

Answer 18

sporotrichosis

Question 19

what sort of lesion does bacillis anthracis present with?

Answer 19

presents with chancriform/nodular lesions

Question 20

causative agent of tularemia

Answer 20

francisella tularenis

Question 21

other organisms that can cause chronic nodular lesions

Answer 21

nocardia
leishmania
blastomycosis dermatitis

Question 22

woman presents w/ h/o RA on prednisne, with acute onset of pain & swelling in knee; incr warmth, decr ROM, WBC 80K

Answer 22

septic arthritis

Question 23

risk factors for septic arthritis (3)

Answer 23

1. RA
2. steroids
3. DM

Question 24

most common etiology of septic arthritis

Answer 24

staph aureus

Question 25

common etiology of septic arthritis if prosthetic joint

Answer 25

coagulase negative staph (S. epidermis or S saprophyticus)

Question 26

other than staph, what else can cause septic arthritis?

Answer 26

streptococci grp A & B

Question 27

typical white count of synovial fluid in septic arthritis

Answer 27

purulent, >60K (>75%)

Question 28

young female, sexually active, febrile, wrist w/ swelling, erythema, pain on motion, painless skin lesions on extremities

Answer 28

disseminated gonococcal infxn

Question 29

disseminated gonococcal infxn presents with what syndromes (2)

Answer 29

1. gonococcal arthritis | 2. tenosynovitis, dermatitis, polyarthralgia w/o purulent joint infxn

Question 30

tx of N. gonorrhea in septic arthritis?

Answer 30

1. 3rd gen cephalosporin OR | 2. fluroquinolone

Question 31

tx of S. aureus in septic arthritis?

Answer 31

1. Nafcillin 2. 1st gen ceph OR 3. vancomycin

Question 32

tx of GAS in septic arthritis?

Answer 32

1. PCN | 2. ceph

Question 33

tx of gram neg in septic arthritis?

Answer 33

1. ceph 2. fluoroquinolone 3. carbapenems

Question 34

how long to tx gonococcal arthritis

Answer 34

2 weeks

Question 35

how long to tx S. aureus or gram neg arthritis

Answer 35

4 weeks

Question 36

in a diabetic, what type of osteomyelitis should you be thinking?

Answer 36

contiguous osteomyelitis

Question 37

S/S of acute osteomyelitis are ____month, vs chronic is ____

Answer 37

under 1 month; >1 mont

Question 38

acute osteomyelitis most commonly occurs under what circumstances?

Answer 38

IVDU, bacteremia

Question 39

chronic osteomyelitis most commonly occurs under what circumstances?

Answer 39

trauma, surgery, contigous foci

Question 40

what is the most common causative agent of osteomyelitis?

Answer 40

staph aureus

Question 41

preferred modality for imaging osteomyelitis?

Answer 41

MRI

Question 42

in puncture wound osteomyelitis with sinus tracking, suspect what sort of microb?

Answer 42

pseudomonas aeruginosa

Question 43

probe to the bone test in patients with osteomyelitis & h/o DM: positive predictive value ___, negative predictive value____

Answer 43

89%; 56%

Question 44

how to tx osteomyelitis in DM patients?

Answer 44

empiric Abx

Question 45

how to tx acute osteomyelitis

Answer 45

1. anti-staphylococcal Abx | 2. gr - tx if suggested by hx

Question 46

how to tx chronic osteomyelitis

Answer 46

broad spectrum pending cultures, then pathogen directed tx

Question 47

use of debridement in acute vs chronic osteomyelitis

Answer 47

acute - occasionally need | chronic - always need