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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
Q

treatment of mild folliculitis

A

conservative management

topical antiseptics e.g. triclosan

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26
Q

treatment of moderate-severe folliculitis

A

topical antibiotics e.g. mupirocin or oral flucloxacillin

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27
Q

treatment of furuncles and carbuncles

A

incision + drainage, may also need oral flucloxacillin

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28
Q

what is pyomyositis

A

purulent muscle inflammation

- usually due to staph aureus

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29
Q

what muscles are most commonly affected by pyomyositis

A

pelvic + thigh muscles

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30
Q

presentation of pyomyositis

A

pain over muscle + fluctuant swelling
weakness
systemic symptoms

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31
Q

definitive diagnosis of pyomyositis

A

MRI

- bloods will show increased WBC + CRP

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32
Q

treatment pyomyositis

A

IV antibiotics until improvement then 2 weeks oral

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33
Q

what is necrotising fasciitis

A

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
Q

what are the two types of necrotising fasciitis

A

Type 1 - polymicrobial

Type 2 - monomicrobial

35
Q

when is type 1 necrotising fasciitis most commonly seen

A

post surgery

36
Q

what organism causes type 2 necrotising fasciitis

A

group A strep e.g. strep pyogenes

37
Q

presentation of necrotising fasciitis

A

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
Q

blood results in necrotising fasciitis

A

increased WBC, CK, lactate

39
Q

management necrotising fasciitis

A

urgent surgical debridement

IV antibiotics

40
Q

IV antibiotics given in necrotising fasciitis

A

IV Carbapenem + clindamycin +/- vancomycin for MRSA coverage

41
Q

what is Fourniers gangrene

A

polymicrobial (type 1) necrotiising fasciitis of male perineum

42
Q

what is gas gangrene

A

myonecrosis due to alpha toxin from clostridium perfrigens

43
Q

where are clostridia bacteria usually found?

how do they cause gas gangrene?

A

normal gut flora

major trauma or GI surgery

44
Q

signs + symptoms of gas gangrene

A

extreme pain
skin crepitus - crackly on palpation
swollen, dark purple skin + bullae

45
Q

treatment gas gangrene

A

surgical debridement

IV antibiotics - penicillin + clindamycin

46
Q

what causes shingles

A

herpes zoster

- reactivation of VZV in dorsal root ganglion

47
Q

presentation of shingles

A

dermatomal vesicular rash lasting 3-5 days

- pain may precede rash

48
Q

complication of shingles

A

post herpetic neuralgia

- persistence of pain once rash has gone

49
Q

what does multi-dermatomal shingles suggest?

A

immunosuppression

50
Q

what is Ramsay hunt syndrome?

A

reactivation of VSV in geniculate ganglion of CN7

- Herpes zoster oticus

51
Q

presentation of ramsay hunt syndrome

A

CN7 palsy
auricular pain
vesicular rash in ear

52
Q

what is Hutchisons sign?

what does it suggest?

A

vesicles on tip/side of nose - herpes zoster opthalmicus with ocular involvement
- VSV reactivation in ophthalmic division of CN5

53
Q

treatment of shingles

A

oral aciclovir 7-10 days

  • if presents within first 72 hours
  • > 50 years old
  • immunosuppressed
54
Q

management of post herpetic neuralgia

A

amitriptyline / gabapentin

55
Q

what is tinea pedis

A

athletes foot

  • cracked white skin between toes
  • moist skin key risk factor
56
Q

what is tinea cruris

A

itchy plaque with red raised edge in groin creases

57
Q

what is tinea corporis

A

ringworm

  • round, scaly plaques with red raised edge + central clearing
  • typically on trunk + limbs
58
Q

what is tinea capitis

A

itchy scaly scalp, sometimes yellow

59
Q

investigation of suspected fungal infection

A

skin scrapings

60
Q

management of tinea infections

A

keep affected areas clean + dry
topical clotrimazole/miconazole/ketoconazole/terbinafine
+ mild corticosteroid if very inflamed

61
Q

first line treament for tinea capitis

A

topical anti fungal + oral (terbinafine/itraconazole)

62
Q

what is onychomycosis

A

fungal nail infection

- dermatophyte infection most common

63
Q

presentation onychomycosis

A

yellow or white streaks
scaling/thickening - subungal hyperkeratosis
lifting of nail - onycholysis

64
Q

investigation of onychomycosis

A

microscopy + culture of nail clipping

65
Q

treatment onychomycosis

A 
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
Q

presentation of staphylococcal scalded skin syndrome (SSSS)

A

widespread fluid filled blisters
thin walled + nikolsky’s sign positive
painful erythroderma
- spares mucous membranes

67
Q

what is candida intertrigo

A

candida fungal infection seen in skin folds e.g. under breasts, groin areas

68
Q

treatment options for candida intertrigo

A

clotrimazole cream
nystatin
oral fluconazole

69
Q

diffuse scarlatiniform rash which later desquamates suggests what syndrome?

A

toxic shock syndrome

  • staph aureus
  • mostly seen palms + soles and skin folds
70
Q

how is infection by sarcoptes scabiei treated

A

benzyl benzoate

malathion lotion

71
Q

what toxin produced by staph aureus causes SSSS

A

SSST

72
Q

what toxin is associated with MRSA

A

panton valentine leukocidin

73
Q

what is the most common causative organism of tinea fungal infections

A

trichophyton rubrum

74
Q

what causes erythema infectiosum

A

paravirus B19

- red cheeks: slapped cheek disease

75
Q

what can paravirus B19 cause in early pregnancy

A

spontaneous abortion due to low RBC

76
Q

what virus causes hand foot mouth disease

A

cocksackie A16

77
Q

treatment of viral warts

A

topical salicylic acid - topical keratolytic

cryotherapy

78
Q

large warty lesion often affecting people in contact with farm animals

A

orf

79
Q

bullseye rash - well demarcated, expanding rash with clear inner ring at bite site
suggests what?

A

lyme disease

rash also known as erythema migrans

80
Q

organism responsible for Lyme disease

A

borrelia burgdorferi

- transmitted by ticks (must be attached for >24 hours for infection to occur)

81
Q

treatment Lyme disease

A

oral doxycycline 10-21 days

82
Q

fleshy, firm, umblicated pearlescent lesions

A

molluscum contagiosum

Year 4: Dermatology (17 decks)

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