4/7 Skin & Soft Tissue + Ch 6 Flashcards Preview

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Flashcards in 4/7 Skin & Soft Tissue + Ch 6 Deck (28)
1

Focal infections like boils are usually from what? treatment should be what?

Usually from Staph aureus.

Treatment should cover MRSA (unless you have a culture cooking)

2

Spreading infections (like cellulitis) are usually from what? Sensitive to what?

Usually from GAS (strep pyogenes).

Sensitive to PCN

3

Cat bite: what bug?

Pasturella

4

Human bite: what bug?

Eikenella

5

Cellulitis after trauma: what bug?

Group A Strep or Staphylococci

6

Fresh water trauma: what bug?

Aeromonas

7

Salt water trauma: what bug?

Vibrio vulnificus

8

Rose gardener: think about what bug?

Sporotrichosis

9

Fish tank exposure: think about what?

Nodular skin lesions in someone with aquatic exposure including fish tanks can be from "fish tank granuloma"

bug = Mycobacterium marinum (cousin of TB)

10

A spreading infection like cellulitis usually is the result of what kind of event?

What organism again?

A microtrauma to the skin: a caught zipper, a toenail infection, surgery.

Likely group A strep (pyogenes)

11

Besides PCN, what is another antibiotic that is commonly used for Group A Strep? Is this appropriate?

Cephalexin (1st, PO )is commonly used for cellulitis - but it is overkill in most cases, since it covers much more than just Group A strep.

12

Focal infections like boils and other abscesses: at what point do they need to be drained?

What bug are we talking about again?

if bigger than 1cm in diameter, need to be drained.

Staph aureus.

13

Focal infections (boils, etc): what is a primary treatment? 

-Drain if larger than 1cm

-Moist heat for comfort and to aid healing

14

Focal infections: when we have to use abx, what should we use? what if the pt is in the hospital?

have to target MSSA as well as MRSA. 

Examples (in order of desirability):

-Trimethoprim-sulfamethoxazole (TMP/SMX)

-Doxycline

-Clindamycin

-Vancomycin (hospitalized pts)

15

If a pt has recurrent focal infections (staph), either due to recurrent exposure, due to close contact who sheds it, or due to chronic nasal carriage, what are preventative measures we can take?

Treat episodes as independent events

In between:

Treat contacts

Reduce nasal carriage via nasal mupirocin

16

What is the level of tissue involvement of the following:

  • Fasciitis
  • Erysipelas
  • Folliculitis, Furuncle, Carbuncle
  • Myositis
  • Cellulitis
  • Impetigo

sorry Jen - i mixed it up 

no worries!

Impetigo

Erysipelas

Cellulitis & Folliculitis/Furuncle/Carbuncle (hair follicle in this layer)

Fasciitis 

Myositis

17

Necrotizing Fasciitis: what is the bug? what can accompany the infection?

Bug: GAS or staph (OR, rarely, from gram negs)

involves the fascia, spreads quickly

If from GAS or staph, can be accompanied by shock from bacterial toxins.

18

Necrotizing Fasciitis: what is the appropriate response? tx?

-Hospital admission

-MRI for dx

-Rapid surgical debridement

-Start with wide abx coverage, narrow down once the pathogen is identified.

-Often use clindamycin to slow the elaboration of the toxin

19

Impetigo: bug? 

Tx for mild cases?

More severe cases?

Typically Strep

Mild: topical ointment like mupirocin

Severe: think of this as cellulitis, and use cephalexin (+ possibly TMP/SMX depending on likelihood of MRSA).

20

Erysipelas: bug? treatment?

Caused by GAS

commonly has systemic sx (fever)

Tx = systemic antibiotics like oral PCN

21

What is paronychia? tx?

usually due to staph aureus

Inflammation of the skin around a nail bed.

Tx: moist heat, possibly drainage, abx for systemic or large lesions

(MSSA -> dicloxacillin or cephalexin)

22

What is Folliculitis? tx?

Multiple red spots centered on hair follicles.

Usually from Staph

Topical therapy: Polymixin B or Mupirocin

23

Anthrax: caused by what? what is presentation?

Caused by Bacillus anthracis (gram + rod).

Painless eschar with surrounding tissue edema in someone with exposures either to animal hides or terrorists.

24

Common cause of secondary cellulitis?

infection of devitalized tissue: diabetic foot infections, decubitus ulcers (bedbound pts)

25

What is a rare but serious cause of cellulitis? what are risk factors? what are clues?

Clostridium perfringens

Risk fx: soil or stool contamination, devitalized tissue.

Clues: gas production (on exam or XR), foul odor, tissue necrosis, rapid stread, presence of Gram + rod.

26

Lyme Disease: bacterium? Tx? 

What are possible sx of Lyme besides rash?

Bacterium = Borrelia burgdorferi (tick-borne)

Tx = doxycycline

May have Bell's Palsy, septic monocular arthritis, meningitis, heart block.

27

 clostridium perferingens causes what?

how is it diagnosed?

bacterial infection of muscle -> myonecosis (gas gangrene)

xray - see bubbles

foul odor

tissue necrosis

28

2 scenarios that might make you think of Anthrax?

How does Anthrax stain? what shape?

-Someone who works with animal hides (a tanner)

-Terrorist scenario

Anthrax = Gram neg rods