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Year 4: Dermatology > Skin + Soft Tissue Infections > Flashcards

Skin + Soft Tissue Infections Flashcards

1
Q

what is cellulitis

A

inflammation of dermis + subcutaneous tissue

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2
Q

most common organisms that cause cellulitis

A

staph aureus or group A strep through broken skin

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3
Q

signs + symptoms of cellulitis

A

painful, red, hot, swelling of site

- lower leg / cannula site / wound most common sites

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4
Q

non-dermal features of cellulitis

A

lymphadenopathy

fever

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5
Q

is bilateral leg cellulitis common?

A

NO - very rare, think venous eczema if bilateral erythema

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6
Q

risk factors for cellulitis

A 
previous cellulitis 
diabetes
CKD
liver disease 
cancer 
immunodeficiency 
venous insufficiency
age
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7
Q

management of staph aureus cellulitis

A

oral flucloxacillin 1-2 weeks

  • IV if severe
  • clindamycin/clarithromycin if penicillin allergic
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8
Q

management of step A cellulitis

A

oral phenoxymethylpenicillin

- IV benzylpenicillin if severe

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9
Q

treatment of cellulitis from human/animal bite wound

A

co-amoxiclav

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10
Q

what is erysipelas

A

superficial cellulitis

- affects dermis + upper subcutaneous tissue

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11
Q

what organism causes erysipelas

A

group A strep

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12
Q

presentation of erysipelas

A

raised, well defined erythema
systemic symptoms
usually affects legs
asymmetrical butterfly distribution on cheeks + nose if affecting face

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13
Q

treatment of erysipelas

A

phenoxymethylpenicillin or benzylpenicillin

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14
Q

what vein is most commonly affected by superficial thrombophlebitis

A

long saphenous

- usually non infectious cause + self limiting

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15
Q

treatment of superficial thrombophlebitis

A

topical anti-inflammatory

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16
Q

skin abscess presentation

what is the underlying pathology?

A

painful, fluctuant swelling of the skin

- localised collection of pus within dermis or epidermis

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17
Q

what organisms cause a skin abscess

A

usually staph aureus, including MRSA

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18
Q

management of skin abscess

A

incision + drainage under local anaesthesia

fluid culture

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19
Q

when are antibiotics used in the management of a skin abscess?

A

if abscess > 2cm
multiple abscesses
systemically unwell
immunocompromised

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20
Q

what antibiotic would be used to treat skin abscess if one was required

A

co-trimoxazole

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21
Q

what is folliculitis?

how does it present?

A

superficial infection of hair follicles causing itchy pustules
- usually staph aureus

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22
Q

what is hot tub folliculitis?

A

infection by pseudomonas aeruginosa

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23
Q

what are furuncles?

A

abscesses which result from deep infection of hair follicle

  • usually staph aureus
  • may rupture
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24
Q

what are carbuncles?

A

larger than furuncles with multiple openings

  • due to infection of several adjacent hair follicles
  • usually staph aureus
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25
treatment of mild folliculitis
conservative management | topical antiseptics e.g. triclosan
26
treatment of moderate-severe folliculitis
topical antibiotics e.g. mupirocin or oral flucloxacillin
27
treatment of furuncles and carbuncles
incision + drainage, may also need oral flucloxacillin
28
what is pyomyositis
purulent muscle inflammation | - usually due to staph aureus
29
what muscles are most commonly affected by pyomyositis
pelvic + thigh muscles
30
presentation of pyomyositis
pain over muscle + fluctuant swelling weakness systemic symptoms
31
definitive diagnosis of pyomyositis
MRI | - bloods will show increased WBC + CRP
32
treatment pyomyositis
IV antibiotics until improvement then 2 weeks oral
33
what is necrotising fasciitis
rare but life threatening infection of soft tissue - bacteria enters through break in skin e.g. following surgery/trauma - infection spreads rapidly across fascial layer leading to tissue death
34
what are the two types of necrotising fasciitis
Type 1 - polymicrobial | Type 2 - monomicrobial
35
when is type 1 necrotising fasciitis most commonly seen
post surgery
36
what organism causes type 2 necrotising fasciitis
group A strep e.g. strep pyogenes
37
presentation of necrotising fasciitis
rapidly expanding inflamed area of skin may progress to bullae + purple discolouration severe pain skin crepitus- crackly on palpation. seen as gas bubbles on plain X ray
38
blood results in necrotising fasciitis
increased WBC, CK, lactate
39
management necrotising fasciitis
urgent surgical debridement | IV antibiotics
40
IV antibiotics given in necrotising fasciitis
IV Carbapenem + clindamycin +/- vancomycin for MRSA coverage
41
what is Fourniers gangrene
polymicrobial (type 1) necrotiising fasciitis of male perineum
42
what is gas gangrene
myonecrosis due to alpha toxin from clostridium perfrigens
43
where are clostridia bacteria usually found? | how do they cause gas gangrene?
normal gut flora | major trauma or GI surgery
44
signs + symptoms of gas gangrene
extreme pain skin crepitus - crackly on palpation swollen, dark purple skin + bullae
45
treatment gas gangrene
surgical debridement | IV antibiotics - penicillin + clindamycin
46
what causes shingles
herpes zoster | - reactivation of VZV in dorsal root ganglion
47
presentation of shingles
dermatomal vesicular rash lasting 3-5 days | - pain may precede rash
48
complication of shingles
post herpetic neuralgia | - persistence of pain once rash has gone
49
what does multi-dermatomal shingles suggest?
immunosuppression
50
what is Ramsay hunt syndrome?
reactivation of VSV in geniculate ganglion of CN7 | - Herpes zoster oticus
51
presentation of ramsay hunt syndrome
CN7 palsy auricular pain vesicular rash in ear
52
what is Hutchisons sign? | what does it suggest?
vesicles on tip/side of nose - herpes zoster opthalmicus with ocular involvement - VSV reactivation in ophthalmic division of CN5
53
treatment of shingles
oral aciclovir 7-10 days - if presents within first 72 hours - > 50 years old - immunosuppressed
54
management of post herpetic neuralgia
amitriptyline / gabapentin
55
what is tinea pedis
athletes foot - cracked white skin between toes - moist skin key risk factor
56
what is tinea cruris
itchy plaque with red raised edge in groin creases
57
what is tinea corporis
ringworm - round, scaly plaques with red raised edge + central clearing - typically on trunk + limbs
58
what is tinea capitis
itchy scaly scalp, sometimes yellow
59
investigation of suspected fungal infection
skin scrapings
60
management of tinea infections
keep affected areas clean + dry topical clotrimazole/miconazole/ketoconazole/terbinafine + mild corticosteroid if very inflamed
61
first line treament for tinea capitis
topical anti fungal + oral (terbinafine/itraconazole)
62
what is onychomycosis
fungal nail infection | - dermatophyte infection most common
63
presentation onychomycosis
yellow or white streaks scaling/thickening - subungal hyperkeratosis lifting of nail - onycholysis
64
investigation of onychomycosis
microscopy + culture of nail clipping
65
treatment onychomycosis
``` dermatophyte infection: oral terbinafine ( 3months for finger, 6 months for toe) ``` ``` candida infection: superficial - topical amorolfine 5% for - 6 months on fingers - 12 months on toes extensive- oral terbinafine or itraconazole ```
66
presentation of staphylococcal scalded skin syndrome (SSSS)
widespread fluid filled blisters thin walled + nikolsky's sign positive painful erythroderma - spares mucous membranes
67
what is candida intertrigo
candida fungal infection seen in skin folds e.g. under breasts, groin areas
68
treatment options for candida intertrigo
clotrimazole cream nystatin oral fluconazole
69
diffuse scarlatiniform rash which later desquamates suggests what syndrome?
toxic shock syndrome - staph aureus - mostly seen palms + soles and skin folds
70
how is infection by sarcoptes scabiei treated
benzyl benzoate | malathion lotion
71
what toxin produced by staph aureus causes SSSS
SSST
72
what toxin is associated with MRSA
panton valentine leukocidin
73
what is the most common causative organism of tinea fungal infections
trichophyton rubrum
74
what causes erythema infectiosum
paravirus B19 | - red cheeks: slapped cheek disease
75
what can paravirus B19 cause in early pregnancy
spontaneous abortion due to low RBC
76
what virus causes hand foot mouth disease
cocksackie A16
77
treatment of viral warts
topical salicylic acid - topical keratolytic | cryotherapy
78
large warty lesion often affecting people in contact with farm animals
orf
79
bullseye rash - well demarcated, expanding rash with clear inner ring at bite site suggests what?
lyme disease | rash also known as erythema migrans
80
organism responsible for Lyme disease
borrelia burgdorferi | - transmitted by ticks (must be attached for >24 hours for infection to occur)
81
treatment Lyme disease
oral doxycycline 10-21 days
82
fleshy, firm, umblicated pearlescent lesions
molluscum contagiosum

Year 4: Dermatology (17 decks)

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