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Semester 2 Year 1 > Skin and Sot Tissue Infections > Flashcards

Skin and Sot Tissue Infections Flashcards

1
Q

Discuss the skin as a defensive barrier

A 
• Epidermis – hard horny layer of dead cells
• Surface is dry
• Constant sloughing
• Acidic pH
• Sweat secretion
• Rich blood and lymphatic supply
• Produces antimicrobial substances e.g.
– fatty acids 
– sebum
– defensins
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2
Q

What is an abscess?

A

collection of pus; pustule

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3
Q

What is a (cutaneous) vesicle?

A

blister; bullae (plural); fluid filled sac

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4
Q

What is pyoderma?

A

pus-forming skin infection; cutaneous abscess

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5
Q

What is impetigo?

A

vesicles developing into rupturing pustules then forming dried crusts

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6
Q

What is ecthyma?

A

rupturing vesicles leading to erythematous lesions and dried crusts

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7
Q

What is folliculitis?

A

inflammation at hair follicle

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8
Q

What is a furuncle?

A

boil; deep folliculitis

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9
Q

What is a carbuncle?

A

collection of boils

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10
Q

What is erysipelas?

A

erythema and inflammation of superficial dermis

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11
Q

What is cellulitis?

A

erythematous inflammation affecting deeper dermis and subcutaneous fat

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12
Q

What is ACNE?

A

infection of sebaceous follicles

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13
Q

What is necrotising fasciitis?

A

cellulitis with necrosis affecting skin, deeper fascia and sometimes muscle

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14
Q

What is dehiscence?

A

wound rupture along surgical suture

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15
Q

What are some normal skin microbiota?

A 
• Coagulase-negative Staphylococci 
– Staphylococcus epidermidis
– Staphylococcus aureus
• Streptococcus pyogenes 
• Propionibacterium acnes 
• Corynebacterium sp.
• Candida sp.
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16
Q

What are the routes of infection in the skin?

A 
• Skin
– Pores
– Hair follicles
• Wounds
– Scratches
– Cuts
– Burns
• Bites
– Insects
– Animals
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17
Q

List 4 skin infections in order of superficiality

A

Impetigo
Erysipelas
Cellulitis
Necrotising fasciitis

18
Q

When taking a history about skin infection what should you ask abt?

A

• The onset, evolution, duration and location of lesions.
• Contacts with a similar rash.
• Past medical history noting skin conditions such
as eczema or immunosuppression.
• Skin trauma or abrasions or insect bites.
• Previous treatment including antimicrobial therapy.
• Systemic features such as fever

19
Q

Discuss management of skin infections in primary care

A
  • Class I cellulitis – draw a line around the lesion, prescribe high-dose oral antibiotics according to local guidelines
  • Pain relief and elevation
  • Deal with concomitant skin lesions

• Provide patient information on cellulitis. For example:
– Cellulitis or erysipelas published by the British Association of
Dermatologists (BAD, www.bad.org.uk).
– About cellulitis published by the Lymphoedema Support
Network (www.lymphoedema.org).
– Cellulitis published by NHS (www.nhs.uk).

– Refer patients with recurrent cellulitis
– Review in 48 hours

20
Q

Discuss general management of skin infection

A

• Referral rarely needed unless - part of an outbreak
- diagnostic uncertainty
- resistant to maximal treatment
- complications e.g., acute glomerulonephritis
• Advise hygiene measures help to aid healing and stop infection spreading:
– Wash affected areas with soap and water.
– Wash their hands regularly, in particular after touching a patch
of impetigo.
– Avoids scratching affected areas.
– Avoids sharing towels etc.,

21
Q

Are blood cultures necessary in skin infections?

A

Not always necessary but will take 24-48 to return so empiric therapy is usually required.

22
Q

What are some comorbidities of skin infections

A

Diabetes mellitus

Cathater related infection

23
Q

Name some fungal infections in the skin

A 
• Dermatophytes 
– Tinea spp.
– e.g. Tinea pedis
– e.g. Tinea corporis 
– e.g. Tinea cruris
• Yeasts
– Candida albicans 
– Malassezia furfur
24
Q

Name a parasite that can cause an infection?

A

Ringworm

25
Q

How may ringworm present?

A

As ringworm of the skin and ringworm of the groin

26
Q

What is a famous skin infection of the foot?

A

Athlete’s foot

27
Q

Name some viral infections of the skin

A
  • Human papilloma viruses (HPV) - Warts
  • Herpes simplex virus 1 (HSV1) - Cold sores
  • Herpes simplex virus 2 (HSV2) - Genital warts
  • Varicella zoster virus (VZV) - Chicken pox, shingles
  • Coxsackie A virus – Hand, foot and mouth disease
28
Q

What is the impact of sarcoptes scabei (mite)

A 
– Causes scabies
– Mite burrows into skin 
– Female lays eggs
– Infection is asymptomatic 
– Hypersensitivity may occur
– May lead to superinfection
29
Q

Discuss the epidemiology of animal bites

A 
– 250 000 cases A+E UK / yr 
• 3% visits
– Dogs 80-90% > cat > human
– Children > adults
– Site
• Children – facial / cervical 
• Adults – extremities
30
Q

What should be considered in an animal bite?

A

What structures have been affected?
What part of the body is affected?
What (if any) infection is going to result? Any expected complications? Management?

31
Q

Discuss cat bites

A

Small deep wound (2-5 cm)
Usually periphery (small mouths) (hand, foot) Pasteurella spp.
Cellulitis
Assess!

32
Q

Discuss pasteurella multocida

A

• Animal commensal + pathogen
– Fowl cholera, swine atrophic rhinitis, RTI rabbits,
bovine septicaemia

I
V

• Zoonosis
– Bites, septic arthritis, septicaemia, meningitis, osteomyelitis

33
Q

Discuss dog bites

A

Large wound: tearing, crushing
Usually periphery but can occur anywhere
Secondary infections: large area damaged, high chance of contamination (dog, environment)
Crush damage comes with its own complications
Surgery – extensive superficial damage and crushing

34
Q

Discuss human bites

A

Wide shallow wound
Anywhere…
Highly polymicrobial
Deep infection is common, viral infection Drastically different- Assess

35
Q

What is the animal bite ‘mantra’?

A

“The Solution to Pollution is Dilution”

36
Q

Discuss the microbiology of bites?

A 
• Polymicrobial!
• Human
– average 5 microorganisms will infect 
– 60% anaerobes
– Eikenella corrodens 1⁄4 hand bites
– Group A Strep (S. pyogenes)
• Viral aetiology (risk assess) 
– rabies (remember bats!)
– Simian herpes virus,
– Hep B, HIV, Hep C
37
Q

What are the important points of management of bites?

A 
• Full history
– immunodeficiency, country of exposure 
• Radiology
– clenched fist, scalp bites (children)
• Wound exploration
– irrigate / debride = SOURCE CONTROL – delayed closure
• Antibiotic therapy 
– prophylaxis
– treatment
38
Q

What length antibiotic course should be given for cellulitis?

A

7- 10 days

39
Q

What length antibiotic course should be given for tenosynovitis?

A

21 days

40
Q

What length antibiotic course should be given for septic arthritis?

A

28 days

41
Q

What length antibiotic course should be given for osteomyelitis?

A

42 days

Semester 2 Year 1 (82 decks)

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