Week 8: cellulitis, sinusitis, OM

Question 1

What is acute, spreading pyogenic inflammation of there dermis and subcutaneous tissue

Answer 1

cellulitis

Question 2

What does cellulitis usually complicate? (2)

Answer 2

wound or ulcer

Question 3

What is the appearance of cellulitis?

Answer 3

warm, tender, swollen and erythematous

LACKS sharp demarcation from unaffected skin

Question 4

When does impetigo mostly occur?

Answer 4

in children during hot humid weather

Question 5

What is common with impetigo and what can that lead to?

Answer 5

pruritus is common, scratching resulting in secondary staph infection

Question 6

How do you treat impetigo?

Answer 6

treat with benzathine PCN, single IM injection

Question 7

What is a severe manifestation of s. aureus infection caused by exfoliative exotoxin?

Answer 7

staphylococcal scalded skin syndrome (SSSS)

Question 8

What is a complication of SSSS in neonatal?

Answer 8

may produce epidemics in neonatal nurseries

Question 9

What is the mortality rate of SSSS?

Answer 9

3%

Question 10

How do you treat SSSS?

Answer 10

penicilinase-resistant PCN

Nafcillin

Question 11

What is a pyoderma in the hair shafts?

Answer 11

folliculitis

Question 12

What is the etiology of folliculitis?

Answer 12

s. aureus
pseudomonas
candida

Question 13

What is the treatment for folliculitis?

Answer 13

local (topical) abx & antifungals

Question 14

What is a deep inflammatory nodule?

Answer 14

furuncle

Question 15

What is larger than a furuncle and extends into the subcutaneous fat (abscess)?

Answer 15

carbuncle

Question 16

What causes furuncles and carbuncles?

Answer 16

staph aureus

Question 17

What are predisposing factors of furuncles and carbuncles?

Answer 17

obesity
blood dycrasias
steroid treatment
diabetes

Question 18

What is the treatment for furuncle and carbuncles?

Answer 18

antistaphlococcal antibiotic

Dicloxacillin (Dycill) 250mg po q6h

Question 19

What is the treatment for furuncle and carbuncles if allergic to PCN?

Answer 19

clindamycin 150-300mg po q6h

Question 20

What is the treatment for furuncle and carbuncles if possible MRSA?

Answer 20

Vancomycin, Linezolid or Daptomycin

Question 21

What was previously associated with wool & animal hides?

Answer 21

chancriform lesion (Cutaneous Anthrax)

Question 22

What is caused by spores of Bacillus anthracis?

Answer 22

chancriform lesions

Question 23

With Chancriform lesions in 1-8 days, a _____ papule develops. As the lesion grows it becomes ______ & ______.

Answer 23

painless

hemorrhagic & necrotic

Question 24

What should be avoided with chancriform (cutaneous anthrax) lesions?

Answer 24

incision & debridement

Question 25

What is the treatment for chancriform (cutaneous anthrax) lesions?

Answer 25

cipro 500mg po q 12h for 7-10 days | 60 for bioterror

Question 26

What is a distinctive type of superficial cellulitis characterized by prominent lymphatic involvement?

Answer 26

erysipelas

Question 27

What is the presentation of erysipelas?

Answer 27

painful, red, edematous lesion w/ raised border and sharply demarcated

Question 28

What should be given to treat mild/early cases of erysipelas?

Answer 28

Pen V 250-500mg po q6h | Erythromycin 250-500mg po q6h

Question 29

What should be given for extensive or hospitalized cases of erysipelas?

Answer 29

Pen G 2000 units IV q6h OR | Nafcillin 2g IV q4h or Cefazolin 1-2g IV q8H

Question 30

What are the most common initializing sources of cellulitis from skin trauma?

Answer 30

staph or strep

Question 31

What are the most common initializing sources of cellulitis from bites?

Answer 31

dogs/cats: pasteurella | humans: bacteroides, Eikenella

Question 32

What are the most common initializing sources of cellulitis from wounds of body piercings?

Answer 32

staph, strep

Question 33

What are the most common initializing sources of cellulitis from hot tubs/pools?

Answer 33

pseudomonas

Question 34

What predisposes patients to cellulitis?

Answer 34

edema

Question 35

What percentage of needle aspiration cultures and biopsies are gram (+) organisms?

Answer 35

80%

Question 36

What are some of the Gram (+) organisms found with culture and bx?

Answer 36

staph aureus group A or B streptococci Viridans streptococci E. faecalis (rarely)

Question 37

Are cultures, and biopsies typical helpful? (esp swabs)

Answer 37

No- reveal typical skin flora

Question 38

When are cultures and bx reserved for?

Answer 38

special cases (blisters)

Question 39

Empiric treatment should focus on gram _____.

Answer 39

positive

Question 40

What is the exception when empiric therapy should include anaerobic coverage?

Answer 40

diabetics

Question 41

Necrotizing Fasciitis usually affects what areas?

Answer 41

extremities, abdominal wall, perianal and groin

Question 42

What is Fournier's Gangrene?

Answer 42

necrotizing fasciitis of the genitalia

Question 43

What is the presentation of NF?

Answer 43

affected area is swollen, hot, and VERY PAINFUL that rapidly progresses over several days

Question 44

What is the result of thromboses of subQ vessels?

Answer 44

necrosis

Question 45

What may precede necrosis?

Answer 45

anesthesia

Question 46

What is an important clue of NF?

Answer 46

disproportionate pain

Question 47

What is the mortality of NF?

Answer 47

20-50% (10-20% for Fournier's Gangrene) | Prompt diagnosis is crucial!

Question 48

What are the empiric abx for NF?

Answer 48

ampicillin, gentamicin and clindamycin or metronidazole

Question 49

What is the MOA of clindamycin and metronidazole?

Answer 49

inhibits exotoxin production

Question 50

What is sinusitis usually secondary to?

Answer 50

cold (viral rhinosinusitis= VRS)

Question 51

What percentage of viral rhino sinusitis progress to bacterial sinusitis?

Answer 51

1-2%

Question 52

What favors bacterial overgrowth, resulting in Acute Bacterial Sinusitis (ABS)?

Answer 52

secondary obstruction

Question 53

What are the most common(50%) organisms of acute bacterial sinusitis?

Answer 53

s. pneumoniae & H. influenza

Question 54

When do VRS symptoms improve?

Answer 54

7-10 days

Question 55

What are the clinical diagnosis findings to differentiate ABS (compared to VRS)?

Answer 55

symptom persistence >10 days worsening symptoms after 5-7 days OR (+) transillumination of the maxillary sinus

Question 56

In general what are the current recommendations for ABS?

Answer 56

``` amoxicillin-clavulanate cefdinir cefpodoxime proxetil cefuroxime axetil levofloxacin moxifloxacin ``` 10 days

Question 57

What is the cure rate of ABS with 10 days of abx?

Answer 57

90%

Question 58

What is the most common reason for abx in children?

Answer 58

otitis media

Question 59

What are the common etiologies for acute otitis media?

Answer 59

S. pneumoniae 38% (pneumococcal vaccine) H. influenza 27% (Hib vaccine) M. catarrhalis 10%

Question 60

What is significant about M. catarrhalis causing AOM?

Answer 60

most produce beta lactamase

Question 61

What is required to diagnose AOM?

Answer 61

signs or symptoms AND 1. inflammation (red tympanic membrane) 2. fluid in the middle ear (bulging membrane)

Question 62

Is a retracted eardrum AOM?

Answer 62

NO- It is painful but caused by negative middle ear pressure

Question 63

Is a red membrane WITHOUT middle ear fluid AOM?

Answer 63

NO

Question 64

What is a method of detecting middle ear fluid (effusion)?

Answer 64

otoscope (visual)

Question 65

When are tympanocentesis indicated? (3)

Answer 65

patients critically ill at symptoms onset toxic patients not responding in 48-72 hours patients with altered host defenses (immune defect, newborn)

Question 66

What is the drug of choice for AOM?

Answer 66

High dose of amoxicillin | 80mg/kg/d

Question 67

What are the alternative treatment in failed pts with amoxicillin?

Answer 67

amox/clav 80-90mg/kg/d BID cefuroxime axetil (Ceftin) or cefdinir (Omnicef) ceftriaxone (Rocephin )IM