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Clinical Pathology (RIP) > T10 - L4 Clinical infections: Orthopaedic, skin and soft tissue > Flashcards

T10 - L4 Clinical infections: Orthopaedic, skin and soft tissue Flashcards

1
Q

what are the layers of the epidermis?

A

stratum corneum

stratum granulosum

stratum spinosum

stratum basale

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2
Q

what are the functions of the skin?

A
  • physical barrier - homeostasis (thermoregulation, prevention of desiccation electrolyte loss) - immunological function (Ag presentation and phagocytosis)
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3
Q

the skin is heavily colonised with which bacteria?

A

Coagulase-negative staphylococci, Staph. aureus, Propionibacterium, Corynebacterium spp.

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4
Q

what is inoculation?

A

Penetration of skin with a contaminated object or Contamination of pre-existing breach in the skin surface

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5
Q

give examples of accidental inoculation

A

tooth, rusty nail, knife etc.

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6
Q

give examples of deliberate inoculation

A

surgical procedure, therapeutic injection, injection drug use etc.

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7
Q

what are viral warts?

A

Small asymptomatic growths of skin (hands, genitals, feet, around nails, throat) Causative agent: Human Papilloma Virus (HPV)

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8
Q

what is the Causative agent of viral warts?

A

Human Papilloma Virus (HPV)

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9
Q

what is the pathogenesis of viral warts?

A

Human Papilloma Virus (HPV) - causes proliferation and thickening of stratum corneum, granulosum and spinosum

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10
Q

what is the treatment of viral warts?

A

Topical: - salicylic acid, - silver nitrate, - cryosurgery

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11
Q

what is cryosurgery?

A

the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation

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12
Q

how can you prevent genital viral warts?

A

condoms

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13
Q

how can you prevent viral warts?

A

Gardasil (types 16, 18, 6 and 11); (16 and 18 cause 70% cancer) Genital: Barrier protection

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14
Q

what are Pilonidal Cyst or Abscess?

A

Cysts or abscesses in natal cleft - contain hair and debris - recurrent

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15
Q

what are Pilonidal Cyst/abscesses caused by?

A

ingrown hair

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16
Q

how do Pilonidal Cyst or Abscess present?

A
  • Discharge to form sinus - pain - swelling - pus
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17
Q

what is the treatment for Pilonidal Cyst or Abscesses?

A
  • Hot compress - analgesia - antibiotics - Surgical excision
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18
Q

what is impetigo?

A

Crusting, around nares or corners of mouth

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19
Q

what is the causative organism for impetigo?

A

Staph aureus

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20
Q

how is impetigo transmitted?

A

Impetigo is easily spread from person to person by direct contact with the lesions and/or indirectly by touching items (clothing, sheets, or toys) that have been used by individuals with this skin disease. Indirect transmission is less frequent than direct person-to-person transmission.

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21
Q

what is the treatment for impetigo?

A

Topical antiseptics Oral antibiotics

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22
Q

what is Erysipelas?

A
  • Rash over face, raised, demarcated - Upper dermis - Can involve lymphatics- systemic - recurrent - transmissible
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23
Q

what is the causative organism of Erysipelas?

A

Strep pyogenes

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24
Q

what is the treatment of Erysipelas?

A

oral antibiotics

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25
Q

what is Cellulitis?

A

Infection affecting the inner layers of the skin - Dermis and subcutaneous fat, into lymphatics

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26
Q

what is the causative agent of cellulitis?

A

Causative agent: Bacterial – Staph aureus, Group A Streptococci (Strep pyogenese), other B-haemolytic Streptococci

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27
Q

what is the pathogenesis of cellulitis?

A

Pathogens enter through breaks in skin - wound, insect bite - pre-existing condition e.g. eczema, athletes foot, shingles (zoster)

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28
Q

what is the clinical presentation of cellulitis?

A

– Rubor (red), calor (heat), dolor (pain), tumor (swelling) – Loss of skin creases, blistering, pus/exudate, fever

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29
Q

how do you diagnose cellulitis?

A

– Clinical, unless septic cultures rarely helpful – Exclude other causes of red hot swollen leg (eg. DVT)

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30
Q

what is a clinical diagnosis?

A

The estimated identification of the disease underlying a patient’s complaints based merely on signs, symptoms and medical history of the patient rather than on laboratory examination or medical imaging.

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31
Q

what is the treatment of cellulitis?

A

Elevation, rest, antibiotics, source control (drainage of pus)

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32
Q

what is orbital cellulitis?

A

Infection of soft tissues around and behind eye

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33
Q

what is the pathogenesis of orbital cellulitis?

A

– from skin or sinuses or haematogenous or trauma

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34
Q

what is the clinical presentation of orbital cellulitis?

A
  • Erythema - swelling with induration - pain on eye mov - bulging
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35
Q

what are the causative organisms of orbital cellulitis?

A

S. aureus, S. pyogenes but also S. pneumoniae and H. influenzae

36
Q

what is the treatment of orbital cellulitis?

A

IV antibiotics

37
Q

what is Necrotising Fasciitis?

A

“flesh-eating bug”, rapidly progressive, life threatening Tracking along fascia, cutting off blood supply- necrosis

38
Q

what are the 4 types of Necrotising Fasciitis?

A

Type 1: Synergistic/poly-microbial Type 2: Group A Strep (S. pyogenese) mediated Type 3: Vibrio vulnificus- sea water, coral Type 4: fungal

39
Q

what type of Necrotising Fasciitis does a fungus cause?

A

type 4

40
Q

what type of Necrotising Fasciitis does Vibrio vulnificus cause?

A

type 3

41
Q

what type of Necrotising Fasciitis does Group A Strep cause?

A

type 2

42
Q

what type of Necrotising Fasciitis does Synergistic organisms cause?

A

type 1

43
Q

what is the pathogenesis of type 1 Necrotising Fasciitis?

A

ischaemic tissue, colonisation then infection resulting in further ischaemia and necrosis Eg. diverticulitis, Fournier

44
Q

what is the pathogenesis of type 2 Necrotising Fasciitis?

A

infection, toxin release- disruption in blood supply- necrosis

45
Q

what is the clinical presentation of Necrotising Fasciitis?

A

– Swelling, erythema (non confluent), pain (out of context) – Crepatus, sepsis/toxaemia, necrosis, “dish water” exudate

46
Q

what is the treatment of Necrotising Fasciitis?

A

– Surgical emergency- debridement, antibiotics

47
Q

what is gangrene?

A

Necrosis caused by inadequate of blood supply

48
Q

what are the 3 types of gangrene?

A

wet dry gas

49
Q

what is the pathogenesis of gangrene?

A

– Poor blood flow- tissue necrosis- colonisation- infection- synergistic infection- further necrosis

50
Q

what is the clinical presentation of gangrene?

A

dry: “mummified”, auto-amputate wet: boggy, swollen “dactylitis”, exudate, surrounding erythema gas as above but with gas in tissue- crepitus

51
Q

what are the causative agents of gangrene?

A

Skin (Staphs, Streps); Enteric (GNB, Anaerobes inc. Clostridium)

52
Q

what is the treatment for gangrene?

A

Surgical: source control, revascularisation; Antibiotics

53
Q

what is diabetic foot infection?

A

Spectrum of disease from superficial through to deep bone infection in patients with Diabetes

54
Q

what is the pathogenesis of diabetic foot infection?

A
  • damage to blood vessels (e.g. Ischaemia, impaired immunity and poor wound healing) - damage to nerves (e.g. Neuropathy, trauma) - high blood sugars (prone to bacterial infection)
55
Q

what are causative organisms for superficial diabetic foot infections?

A

skin flora: Staph aureus, Streps, Corynebacterium

56
Q

what are causative organisms for deep diabetic foot infections?

A

skin and enteric flora: above + GNB, anerobes

57
Q

what is the treatment for diabetic foot infection?

A

– Surgical debridement – revascularisation – Antibiotics – off-loading – Diabetic control

58
Q

what is osteomyelitis?

A

infection of bone

59
Q

what is the pathogenesis of osteomyelitis?

A

• Contiguous: eg. Diabetic foot infection • Haematogenous: bugs in bloodstream • Penetrating: peri-prosthetic, traumatic

60
Q

what is sequestrum?

A

bone death

61
Q

what is involucrum?

A

new bone formatio

62
Q

what are causative agents of osteomyelitis in children?

A

S. aureus, Strep, Kingella, Haemophilus

63
Q

what are causative agents of contagious osteomyelitis?

A

Skin (Staph, Streps) enteric (GNB, anaerobes)

64
Q

what are causative agents of penetrating osteomyelitis?

A

surgical - skin flora, open fracture - skin, environment

65
Q

what are causative agents of sickle cell osteomyelitis?

A

Salmonella sp.

66
Q

what is the clinical presentation of osteomyelitis?

A

– Acute pain, swelling, erythema, sinus, pathological fracture – Imaging, microbiology (blood, tissue/bone)

67
Q

what is the treatment for osteomyelitis?

A

– Antibiotics (4-6 weeks) alone (haematogenous) – Surgical debridement and stabilisation (if dead bone present)

68
Q

what is Septic (or Pyogenic) Arthritis?

A

Infection of the joint (usually bacterial but can also be cause by viruses, mycobacterium and fungi)

69
Q

what is the pathogenesis of Septic (or Pyogenic) Arthritis?

A

Haematogenous: blood stream infection Local spread: soft tissue, bone, bursitis Penetrating: joint injections, surgery, trauma

70
Q

what are the causative organisms of Septic (or Pyogenic) Arthritis?

A

S. aureus, Streps, Haemphilus, N. gonorrhoeae, E.coli

71
Q

what is the clinical presentation of Septic (or Pyogenic) Arthritis?

A

Pain, swelling, erythema, reduced range of movement (unable to weightbear), Sepsis

72
Q

how do you diagnose Septic (or Pyogenic) Arthritis?

A

Clinical, confirmed by joint aspiration (MCS)

73
Q

what is the treatment for Septic (or Pyogenic) Arthritis?

A

– Antibiotics (guided by cultures)- 4 to 6 weeks – Surgical source control: Joint washout

74
Q

what is Prosthetic Joint Infection?

A

“PERI-prosthetic joint infection”- infection of tissue and bone surrounding a prosthetic joint

75
Q

what is the pathogenesis of Prosthetic Joint Infection?

A

– Bugs get onto surface of foreign body- immune system cannot reach- establish biofilm (slime) – Early: Implanted at time of surgery or shortly after (via wound) – Late: Haematogenous but can be late presenting Early infections

76
Q

what are causative organisms of Prosthetic Joint Infection?

A

– Early: Staph aureus, Staph epidermidis, Propionibacterium – Late: Above and E. coli, B Haem Streps, Viridans Streps

77
Q

what is the clinical presentation of Prosthetic Joint Infection?

A

Pain, instability, swelling/erythema, sinus formation- pus

78
Q

what is the treatment for Prosthetic Joint Infection?

A

– Antibiotics alone – Antibiotics with debridement – Single-stage revision • remove infected joint and replace with new one at same operation – Two- Stage revision • Remove old joint, given 6 weeks of antibiotics, insert new joint when sure all infection settled

79
Q

what is single-stage revision treatment of a Prosthetic Joint Infection?

A

remove infected joint and replace with new one at same operation

80
Q

what is two-stage revision treatment of a Prosthetic Joint Infection?

A

Remove old joint, given 6 weeks of antibiotics, insert new joint when sure all infection settled

81
Q

what is syphilis?

A

Sexually Transmitted Infection (STI) or congenital

82
Q

what are causative agents of syphilis?

A

spirochete, Treponema pallidum

83
Q

what is the treatment of syphilis?

A

Antibiotics- Penicillin

84
Q

how does primary syphilis present?

A

painless, firm non-itchy ulcer at the point of contact Usually solitary Lasts 3-6 weeks Lymphadenopathy

85
Q

how does secondary syphilis present?

A

– 4 -10 weeks after chancre – Rash- symmetrical, red/pink, non-itchy – Everywhere, inc. soles/palms/mucous membs. – Maculo-papular or pustular – Rash contains Treponema

86
Q

how does Tertiary (Late) Syphilis present?

A

– 3 to 15 years after initial infection – 3 forms: Gummatous, Neuro, Cardiovascular – Gummatous (Late Benign): Chronic Gummas (large inflammatory swellings of skin, bone and liver)

Clinical Pathology (RIP) (49 decks)

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