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Pharmacology > Week 8: cellulitis, sinusitis, OM > Flashcards

Week 8: cellulitis, sinusitis, OM Flashcards

1
Q

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

A

cellulitis

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2
Q

What does cellulitis usually complicate? (2)

A

wound or ulcer

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3
Q

What is the appearance of cellulitis?

A

warm, tender, swollen and erythematous

LACKS sharp demarcation from unaffected skin

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4
Q

When does impetigo mostly occur?

A

in children during hot humid weather

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5
Q

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

A

pruritus is common, scratching resulting in secondary staph infection

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6
Q

How do you treat impetigo?

A

treat with benzathine PCN, single IM injection

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7
Q

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

A

staphylococcal scalded skin syndrome (SSSS)

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8
Q

What is a complication of SSSS in neonatal?

A

may produce epidemics in neonatal nurseries

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9
Q

What is the mortality rate of SSSS?

A

3%

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10
Q

How do you treat SSSS?

A

penicilinase-resistant PCN

Nafcillin

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11
Q

What is a pyoderma in the hair shafts?

A

folliculitis

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12
Q

What is the etiology of folliculitis?

A

s. aureus
pseudomonas
candida

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13
Q

What is the treatment for folliculitis?

A

local (topical) abx & antifungals

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14
Q

What is a deep inflammatory nodule?

A

furuncle

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15
Q

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

A

carbuncle

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16
Q

What causes furuncles and carbuncles?

A

staph aureus

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17
Q

What are predisposing factors of furuncles and carbuncles?

A

obesity
blood dycrasias
steroid treatment
diabetes

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18
Q

What is the treatment for furuncle and carbuncles?

A

antistaphlococcal antibiotic

Dicloxacillin (Dycill) 250mg po q6h

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19
Q

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

A

clindamycin 150-300mg po q6h

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20
Q

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

A

Vancomycin, Linezolid or Daptomycin

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21
Q

What was previously associated with wool & animal hides?

A

chancriform lesion (Cutaneous Anthrax)

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22
Q

What is caused by spores of Bacillus anthracis?

A

chancriform lesions

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23
Q

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

A

painless

hemorrhagic & necrotic

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24
Q

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

A

incision & debridement

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25
Q

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

A

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

60 for bioterror

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26
Q

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

A

erysipelas

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27
Q

What is the presentation of erysipelas?

A

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

28
Q

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

A

Pen V 250-500mg po q6h

Erythromycin 250-500mg po q6h

29
Q

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

A

Pen G 2000 units IV q6h OR

Nafcillin 2g IV q4h or Cefazolin 1-2g IV q8H

30
Q

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

A

staph or strep

31
Q

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

A

dogs/cats: pasteurella

humans: bacteroides, Eikenella

32
Q

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

A

staph, strep

33
Q

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

A

pseudomonas

34
Q

What predisposes patients to cellulitis?

35
Q

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

36
Q

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

A

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

37
Q

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

A

No- reveal typical skin flora

38
Q

When are cultures and bx reserved for?

A

special cases (blisters)

39
Q

Empiric treatment should focus on gram _____.

40
Q

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

41
Q

Necrotizing Fasciitis usually affects what areas?

A

extremities, abdominal wall, perianal and groin

42
Q

What is Fournier’s Gangrene?

A

necrotizing fasciitis of the genitalia

43
Q

What is the presentation of NF?

A

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

44
Q

What is the result of thromboses of subQ vessels?

45
Q

What may precede necrosis?

A

anesthesia

46
Q

What is an important clue of NF?

A

disproportionate pain

47
Q

What is the mortality of NF?

A

20-50% (10-20% for Fournier’s Gangrene)

Prompt diagnosis is crucial!

48
Q

What are the empiric abx for NF?

A

ampicillin, gentamicin and clindamycin or metronidazole

49
Q

What is the MOA of clindamycin and metronidazole?

A

inhibits exotoxin production

50
Q

What is sinusitis usually secondary to?

A

cold (viral rhinosinusitis= VRS)

51
Q

What percentage of viral rhino sinusitis progress to bacterial sinusitis?

52
Q

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

A

secondary obstruction

53
Q

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

A

s. pneumoniae & H. influenza

54
Q

When do VRS symptoms improve?

55
Q

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

A

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

56
Q

In general what are the current recommendations for ABS?

A 
amoxicillin-clavulanate
cefdinir
cefpodoxime proxetil
cefuroxime axetil
levofloxacin
moxifloxacin

10 days

57
Q

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

58
Q

What is the most common reason for abx in children?

A

otitis media

59
Q

What are the common etiologies for acute otitis media?

A

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

60
Q

What is significant about M. catarrhalis causing AOM?

A

most produce beta lactamase

61
Q

What is required to diagnose AOM?

A

signs or symptoms AND

  1. inflammation (red tympanic membrane)
  2. fluid in the middle ear (bulging membrane)
62
Q

Is a retracted eardrum AOM?

A

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

63
Q

Is a red membrane WITHOUT middle ear fluid AOM?

64
Q

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

A

otoscope (visual)

65
Q

When are tympanocentesis indicated? (3)

A

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

66
Q

What is the drug of choice for AOM?

A

High dose of amoxicillin

80mg/kg/d

67
Q

What are the alternative treatment in failed pts with amoxicillin?

A

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

Pharmacology (17 decks)

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