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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

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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
what is Cellulitis?
Infection affecting the inner layers of the skin - Dermis and subcutaneous fat, into lymphatics
26
what is the causative agent of cellulitis?
Causative agent: Bacterial – Staph aureus, Group A Streptococci (Strep pyogenese), other B-haemolytic Streptococci
27
what is the pathogenesis of cellulitis?
Pathogens enter through breaks in skin - wound, insect bite - pre-existing condition e.g. eczema, athletes foot, shingles (zoster)
28
what is the clinical presentation of cellulitis?
– Rubor (red), calor (heat), dolor (pain), tumor (swelling) – Loss of skin creases, blistering, pus/exudate, fever
29
how do you diagnose cellulitis?
– Clinical, unless septic cultures rarely helpful – Exclude other causes of red hot swollen leg (eg. DVT)
30
what is a clinical diagnosis?
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.
31
what is the treatment of cellulitis?
Elevation, rest, antibiotics, source control (drainage of pus)
32
what is orbital cellulitis?
Infection of soft tissues around and behind eye
33
what is the pathogenesis of orbital cellulitis?
– from skin or sinuses or haematogenous or trauma
34
what is the clinical presentation of orbital cellulitis?
- Erythema - swelling with induration - pain on eye mov - bulging
35
what are the causative organisms of orbital cellulitis?
S. aureus, S. pyogenes but also S. pneumoniae and H. influenzae
36
what is the treatment of orbital cellulitis?
IV antibiotics
37
what is Necrotising Fasciitis?
“flesh-eating bug”, rapidly progressive, life threatening Tracking along fascia, cutting off blood supply- necrosis
38
what are the 4 types of Necrotising Fasciitis?
Type 1: Synergistic/poly-microbial Type 2: Group A Strep (S. pyogenese) mediated Type 3: Vibrio vulnificus- sea water, coral Type 4: fungal
39
what type of Necrotising Fasciitis does a fungus cause?
type 4
40
what type of Necrotising Fasciitis does Vibrio vulnificus cause?
type 3
41
what type of Necrotising Fasciitis does Group A Strep cause?
type 2
42
what type of Necrotising Fasciitis does Synergistic organisms cause?
type 1
43
what is the pathogenesis of type 1 Necrotising Fasciitis?
ischaemic tissue, colonisation then infection resulting in further ischaemia and necrosis Eg. diverticulitis, Fournier
44
what is the pathogenesis of type 2 Necrotising Fasciitis?
infection, toxin release- disruption in blood supply- necrosis
45
what is the clinical presentation of Necrotising Fasciitis?
– Swelling, erythema (non confluent), pain (out of context) – Crepatus, sepsis/toxaemia, necrosis, “dish water” exudate
46
what is the treatment of Necrotising Fasciitis?
– Surgical emergency- debridement, antibiotics
47
what is gangrene?
Necrosis caused by inadequate of blood supply
48
what are the 3 types of gangrene?
wet dry gas
49
what is the pathogenesis of gangrene?
– Poor blood flow- tissue necrosis- colonisation- infection- synergistic infection- further necrosis
50
what is the clinical presentation of gangrene?
dry: “mummified”, auto-amputate wet: boggy, swollen “dactylitis”, exudate, surrounding erythema gas as above but with gas in tissue- crepitus
51
what are the causative agents of gangrene?
Skin (Staphs, Streps); Enteric (GNB, Anaerobes inc. Clostridium)
52
what is the treatment for gangrene?
Surgical: source control, revascularisation; Antibiotics
53
what is diabetic foot infection?
Spectrum of disease from superficial through to deep bone infection in patients with Diabetes
54
what is the pathogenesis of diabetic foot infection?
- 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
what are causative organisms for superficial diabetic foot infections?
skin flora: Staph aureus, Streps, Corynebacterium
56
what are causative organisms for deep diabetic foot infections?
skin and enteric flora: above + GNB, anerobes
57
what is the treatment for diabetic foot infection?
– Surgical debridement – revascularisation – Antibiotics – off-loading – Diabetic control
58
what is osteomyelitis?
infection of bone
59
what is the pathogenesis of osteomyelitis?
• Contiguous: eg. Diabetic foot infection • Haematogenous: bugs in bloodstream • Penetrating: peri-prosthetic, traumatic
60
what is sequestrum?
bone death
61
what is involucrum?
new bone formatio
62
what are causative agents of osteomyelitis in children?
S. aureus, Strep, Kingella, Haemophilus
63
what are causative agents of contagious osteomyelitis?
Skin (Staph, Streps) enteric (GNB, anaerobes)
64
what are causative agents of penetrating osteomyelitis?
surgical - skin flora, open fracture - skin, environment
65
what are causative agents of sickle cell osteomyelitis?
Salmonella sp.
66
what is the clinical presentation of osteomyelitis?
– Acute pain, swelling, erythema, sinus, pathological fracture – Imaging, microbiology (blood, tissue/bone)
67
what is the treatment for osteomyelitis?
– Antibiotics (4-6 weeks) alone (haematogenous) – Surgical debridement and stabilisation (if dead bone present)
68
what is Septic (or Pyogenic) Arthritis?
Infection of the joint (usually bacterial but can also be cause by viruses, mycobacterium and fungi)
69
what is the pathogenesis of Septic (or Pyogenic) Arthritis?
Haematogenous: blood stream infection Local spread: soft tissue, bone, bursitis Penetrating: joint injections, surgery, trauma
70
what are the causative organisms of Septic (or Pyogenic) Arthritis?
S. aureus, Streps, Haemphilus, N. gonorrhoeae, E.coli
71
what is the clinical presentation of Septic (or Pyogenic) Arthritis?
Pain, swelling, erythema, reduced range of movement (unable to weightbear), Sepsis
72
how do you diagnose Septic (or Pyogenic) Arthritis?
Clinical, confirmed by joint aspiration (MCS)
73
what is the treatment for Septic (or Pyogenic) Arthritis?
– Antibiotics (guided by cultures)- 4 to 6 weeks – Surgical source control: Joint washout
74
what is Prosthetic Joint Infection?
“PERI-prosthetic joint infection”- infection of tissue and bone surrounding a prosthetic joint
75
what is the pathogenesis of Prosthetic Joint Infection?
– 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
what are causative organisms of Prosthetic Joint Infection?
– Early: Staph aureus, Staph epidermidis, Propionibacterium – Late: Above and E. coli, B Haem Streps, Viridans Streps
77
what is the clinical presentation of Prosthetic Joint Infection?
Pain, instability, swelling/erythema, sinus formation- pus
78
what is the treatment for Prosthetic Joint Infection?
– 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
what is single-stage revision treatment of a Prosthetic Joint Infection?
remove infected joint and replace with new one at same operation
80
what is two-stage revision treatment of a Prosthetic Joint Infection?
Remove old joint, given 6 weeks of antibiotics, insert new joint when sure all infection settled
81
what is syphilis?
Sexually Transmitted Infection (STI) or congenital
82
what are causative agents of syphilis?
spirochete, Treponema pallidum
83
what is the treatment of syphilis?
Antibiotics- Penicillin
84
how does primary syphilis present?
painless, firm non-itchy ulcer at the point of contact Usually solitary Lasts 3-6 weeks Lymphadenopathy
85
how does secondary syphilis present?
– 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
how does Tertiary (Late) Syphilis present?
– 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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