INESSS Cellulitis

Question 1

Potential portal of entry for cellulitis (5)

Answer 1

1- injury
2- skin problem (Atopic dermatitis)
3- Toe web abnormalities (Tinea pedis)
4- Hygiene or neglect issues
5- Uncorrected dental problem

Question 2

Comorbidities putting people more at risk of cellulitis. (5)

Answer 2

1- Venous or arterial insufficiency
2- Lymphedema
3- Uncontrolled Diabetes
4- Immunosuppression
5- History of cellulitis

Question 3

Signs & symptoms of cellulitis (3)

Answer 3

1- Continuous erythematous skin, warm, painful, edematous. (Orange peel texture) (Observe and palpate)
2- Systemic symptoms (fever, nausea, vomiting, chills, malaise, lack of appetite) (History and VS)
3- No epidermal changes. Presence would suggest different pathology or related (Observe)

Question 4

Clinical assessment cellulitis (5)

Answer 4

1- Assess General condition
2- Palpate affected area for : Sensitivity, depth of infection, tissue firmness and presence fluctuant area (abcesses) +lymphadenopathy
3- Determine source of infection.
4- Look for special circumstances suggesting different pathogens (History)
5- Mark outline or photograph to follow evolution

Question 5

Name special circumstances that would suggest a different pathogen than strep or staph in cellulitis. (7)

Answer 5

1- Animal bite
2- Human bite,
3- Cellulitis of dental origin
4- Periorbital/orbital cellulitis of sinusal origin
5- Injury while immersed in water
6- Neutropenic patient
7- Diabetic foot syndrome

Question 6

Ddx for facial cellulitis (2)

Answer 6

1- Conjuctivitis
2- Dacryocuystitis

Question 7

Community-associate MRSA should be suspected in which situations? (4)

Answer 7

1- Recurrent furunculosis or abscess
2- Aboriginal community
3- Previous infection/colonization (pt or family)
4- Recent trip high prevalence area

Question 8

Red flags cellulitis (general) (12)

Answer 8

1- Impairment of general condition/persistent fever
2- Hemodynamic impairment
3- Pain disproportionate to clinical signs (necrotizing fasciitis)
4- Rapid progression
5- Gas in tissue
6- Vesicles with hemorrhagic content
7- Dyspnea or dysphagia
8- Centrofacial region involvement
9- Significant edema/erythema or external auditory canal and auricle
10- Suspected joint involvement
11- Suspected osteomyelitis
12- ATB failure after 72 hours

Question 9

Red flags cellulitis w suspected orbital involvement (8)

Answer 9

1- Fever
2- Severe pain
3- Limited or painful extraocular movements
4- Difficulty or inability to open eye
5- Chemosis
6- Proptosis
7- Impaired vision
8- Recent history of dental treatment

Question 10

Supportive tx for cellulitis. (3)
And when to FU with pt (1)

Answer 10

1- Elevate limb
2- analgesic/antipyretic
3- Check immunization status (td)
4- 24 to 72 hours

Question 11

1st line cellulitis tx (PO) for
1- Adultd
2- Peds

Answer 11

1- Cefadroxil 500-1000 mg PO BID x 5 to 10 days
2- Cephalexin 50-100mg/kg/day divided TID x 7-10 days. OR Cefadroxil 30mg/kg/day PO divided BID x 7-10 days

Question 12

1st line IV tx for cellulitis for
1-adults
2-peds

Answer 12

1- Cefazolin 1000-2000 mg IV TID x 5 to 10 days
2- Cefazolin 50-100 mg/kg/day IV divided TID

Question 13

1st line ATB PO tx for cellulitis with a bite and of sinusal origin.
Can also be used 2nd line for dental origin. (1st line for peds)
1- adult dose
2- peds dose

Actually it’s best because digested better

Answer 13

1- Amoxicillin/clavulanate 875/125mg PO BID x 7-10 days.
2- Amoxicillin/clavulanate 45-60mg/kg/day PO divided TID x 7 to 10 days.

Question 14

PO Tx for cellulitis with suspicion of MRSA
1- adults

Answer 14

1- Doxycycline 100 mg PO BID x 5 to 10 days