Skin & Soft Tissue Infection (SSTI)

Question 1

Which layer(s) of the skin does cellulitis extend into?

Answer 1

Epidermis

Dermis

Question 2

Which layer(s) of the skin does erysipelas extend into?

Answer 2

Epidermis

Superficial dermis

Question 3

Which layer(s) of the skin does necrotising fasciitis extend into?

Answer 3

Epidermis
Dermis
Hypodermis

Question 4

Which layer(s) of the skin does impetigo extend into?

Answer 4

Epidermis

Question 5

What is a major cause of deep SSTI?

Answer 5

Animal bites

Question 6

In the case of a bacterial infection, what re the most abundant leukocytes?

Answer 6

Neutrophils

Question 7

What is the most common bacterial film appearance causing SSTI?

Answer 7

GRAM POSITIVE COCCI

only rarely is SSTI caused by gram negative cocci

Question 8

Name a gram negative coccus bacterium which is penicillin sensitive and is present in cases of zoonosis, septic arthritis, septicaemia and meningitis.

Answer 8

Pasteurella multocida

Question 9

What percentage of A&E visits does animal bites account for?

Answer 9

3%

Question 10

What is the most common location of an animal bite on a child?

Answer 10

Facial/Cervical

Question 11

What is the most common location of an animal bite on an adult?

Answer 11

Extremities

Question 12

How does dog bite differ from a cat bite?

Answer 12

Cat = deep puncture wound, little superficial damage
Dog = extensive superficial injury, crush injury

Question 13

What are some potential dangers regarding human bites?

Answer 13

Can lead to clenched fist due to tendon damage in the hand
Common deep infection
Blood-bourne viruses

Question 14

List the four steps of animal bite wound management.

Answer 14

Full History
Radiology
Wound Management
Antibiotic Therapy

Question 15

Why are antibiotics administered?

Answer 15

Prevents disease/reduces risk of infection
Prolonged use usually selects for drug resistance
High risk patients benefit most from use of antibiotics

Question 16

When are antibiotics generally administered and how long is the average course?

Answer 16

Prior to surgery

7 day course

Question 17

What should NEVER be used as treatment/prophylaxis of an animal bite?

Answer 17

CLINDAMYCIN MONOTHERAPY

ERYTHROMYCIN MONOTHERAPY

Question 18

What is meant by ‘mono therapy’?

Answer 18

Use of the drug on its own

Question 19

Name the antibiotics used for mild-moderate cases of animal bites.

Answer 19

Co-amoxyclav
Doxycycline & Metronidazole
Clindamycin & Ciprofloxacin

Question 20

Name the antibiotics used for sever cases of animal bites.

Answer 20

Co-amoxyclav
Ben pen, Ciprofloxacin & Mtz
Meropenem & Clindamycin

Question 21

How long should the course of antibiotics be for treatment of cellulitis?

Answer 21

7-10 days

Question 22

How long should the course of antibiotics be for treatment of tenosynovitis?

Answer 22

21 days

Question 23

How long should the course of antibiotics be for treatment of septic arthritis?

Answer 23

28 days

Question 24

How long should the course of antibiotics be for treatment of osteomyelitis?

Answer 24

42 days

Question 25

Why are antibiotic courses for septic arthritis, tenosynovitis and osteomyelitis longer than, say, cellulitis?

Answer 25

Due to the avascular nature of the structures they affect

Question 26

Why is the antibiotic course for osteomyelitis in particular so long?

Answer 26

Formation of sequestre (dead bone)

Turnover of new bone takes about 6 weeks (42 days)