Bacterial Skin

Question 1

What are the localized infections?

Answer 1

Folliculitis
Cellulitis
Erysipelas
Abscess
Impetigo

Question 2

What are potentially lethal infections?

Answer 2

Necrotizing fasciitis
Clostridial myonecrosis (gas gangrene)

Question 3

What is the treatment for impetigo?

Answer 3

may resolve on it own or progress to cellultitis or glomerulonephritis

Question 4

What is the systemic abx for impetigo?

Answer 4

Dicloxacillin 250-500 mg po q4-6h x 5-10d

Question 5

What is the topical meds for impetigo?

Answer 5

Mupirocin (Bactroban) – apply tid x 5-10d

Question 6

What pt education do you need for give for impetigo?

Answer 6

hand washing, don’t share towels, bed linens, wash lesions 2-3x a day or warm soaks

Question 7

What are the general features of cellutitis and erysipelas?

Answer 7

varying degrees of skin or soft-tissue erythema, warmth, edema, and pain
associated fever and leukocytosis
history of trauma, abrasion, or skin ulceration (not reported by every patient)

Question 8

How is celluitis on PE?

Answer 8

ill-defined border that merge smoothly with adjacent skin; usually pinkish to redish

Question 9

What is erysipelas on PE?

Answer 9

elevated and sharply demarcated border with a fiery-red appearance

Question 10

How do you dx celluitis and erysipelas?

Answer 10

clinically

Question 11

What is the management of cellutitis and erysipelas?

Answer 11

local care - immoblize, elevate to reduce swelling
2 weeks of abx
-penicillin and dicloxacillin for most pt

Question 12

What is the admission criteria for cellulitis?

Answer 12

Animal bite on patient’s face or hand
Area of skin involvement >50% of limb or torso, or >10% of body surface
Coexisting morbidity
(diabetes, heart failure, renal failure, generalized edema)
Edge of cellulitis advancing at rate >5cm/2 in, per hour
History of saphenous venectomy, pelvic surgery, pelvic irradiation, or neoplastic pelvic lymph nodes
(with lower extremity cellulitis)
Immunosuppression
Intolerance of oral or IM antibiotic therapy
Lack of response after 72 hours of oral therapy
Noncompliance with medication and follow-up visits
Purpuric or petechial rash, numbness at skin surface, or impaired tendon or nerve function
shock or disseminated intravascular coagulation
Signs and symptoms suggestive of bacteremia
Total WBC

Question 13

What do you give for erysipleas most common?

Answer 13

pencillin V 500 mg po q6h

Question 14

What do you give most common for cellulitis?

Answer 14

dicloxacillin 500 mg po q6h

Question 15

What is inflammation of hair follicle that occurs as a result of various infections, or it can seconday to follicular trauma or occlusion?

Answer 15

Infectious folliculitis

Question 16

What does infectious folliculitis looks like?

Answer 16

follicular based pustules, multiple small papules and pustules on an erythematous base that are pierced by a ccentral hair

Question 17

What do deeper infectious folliculitis look like?

Answer 17

erythematous, often fluctuant, nodules

Question 18

What orangism cause infectious folliculitis?

Answer 18

staphylococcus aureus

Question 19

What is the topical treatment of infectious follicultis?

Answer 19

topical bactroban, dicloxacillin or cephalosporin first choice

Question 20

What is chronic pustular staph infection of the beard?

Answer 20

pseudofolliculitis barbae

Question 21

Who is pseudofollicuilits barbae more common in?

Answer 21

african americans

Question 22

What is the treatment for pseudofollicultitis barbae?

Answer 22

skin cleanse, bacitracin, bactroban, erythro, diclox

Question 23

What do you do for formed abscess?

Answer 23

I and D, give abx to immunocompromised (in real world give to all)

Question 24

Streptococcal/Staph skin infection confined to epidermis

Answer 24

impetigo

Question 25

infection of the skin and subcutaneous tissue. Flat lesions and edges are indistinct. Cause GAS

Answer 25

cellulitis

Question 26

a type of cellulitis that is bright red, raised, with sharp borders.

Answer 26

erysipelas

Question 27

What causes skin abscess?

Answer 27

s. aureus

Question 28

What causes impetigo?

Answer 28

s. aureus, GAS

Question 29

What are features of impetigo?

Answer 29

honey crusted lesions, kids get it, exposed areas, contagious

Question 30

What are predisposing factors to impetigo?

Answer 30

poor hygiene, anemia, malnutrition, warm climates

Question 31

What causes most cellulitis?

Answer 31

GAS and staph

Question 32

How does cellulitis present?

Answer 32

boarders blend, redness, tender, deeper injury

Question 33

Who can cellulitis be life threatening in?

Answer 33

immunocomp, DM, PV

Question 34

What causes periorbital cellulitis in kids?

Answer 34

HIB

Question 35

What does erysipelas require?

Answer 35

prompt tx

Question 36

How does erysipelas spread?

Answer 36

superficial lymphatics

Question 37

How does erysipelas appear?

Answer 37

confluent rash, sharply demarcated | abrupt with - fever chills pain

Question 38

What is the tx for erysipelas?

Answer 38

pen or erythromycin, rest, elevation, warm compress

Question 39

What does GAS cellulitis look like?

Answer 39

follow unnoticed injury, diffuse inflammation, spread on tissue planes

Question 40

What does s. aureus cellulitis look like?

Answer 40

wound or pentrating trauma, local abscess becomes surrounded with cellulitis

Question 41

What causes erysipelas?

Answer 41

GAS

Question 42

What do you get when symptoms of toxicity or temp >102?

Answer 42

blood cultures

Question 43

What do you give for penicillin resistant pt with cellulitis?

Answer 43

cephalexin 500 mg po qh6 clindamycin 450mg po qh6 cefazolin 1mg iv q8h

Question 44

Where do you get hot tub folliculitis?

Answer 44

axillae, butt, trunk

Question 45

How do you treat hot tub folliculitis?

Answer 45

self limiting

Question 46

What does hot tube folliculitis look like?

Answer 46

follicular vesicular/pustular lesions

Question 47

cluster of boils

Answer 47

carbuncle

Question 48

What causes skin abscesses?

Answer 48

autoinoculation, immunosuppression, etoh, malnutrition

Question 49

How do you tx skin abscess?

Answer 49

Dicloxacillin 250-500mg po q4-6h x 7-10d, erythromycin, cephalexin 500-1000 mg po qid 7-10d

Question 50

Gangrenous cellulitis of the genitals

Answer 50

fournier's gangrene

Question 51

What causes ecthyma gangrenosum?

Answer 51

pseudomonas

Question 52

What causes toxic shock syndrome?

Answer 52

s. aureus, GAS

Question 53

a clopolymicrobial infection, commonly caused by a mixture of anaerobic and aerobic bacteria stridium species, enterobacteriaceae (E. coli, Enterobacter, Klebsiella, and Proteus species), and “flesh-eating” streptococci

Answer 53

necrotizing fasciitis

Question 54

Where does necrotizing fasciitis start?

Answer 54

site on nonpenetrating trauma (a bruise)

Question 55

Who are more prone to necrotizing fasciitis?

Answer 55

DM, PV, ETOH, IV drug use, immunosuppression

Question 56

What does the infected area look like in necrotizing fasciitis?

Answer 56

swollen, erythematous, painful, warm, tender rapidly advancing boarders discoloration

Question 57

How do you treat necrotizing fasciitis?

Answer 57

``` surgical debridement emergent metronidazole+clindamycin+ceftriaxone vancomycin+ piperacillin tazobactam/imipenem/meropenem/clinda Ampicilin sulbactam + clinda + cipro antibiotics for a minimum of 3 wks ```

Question 58

What causes myonecrosis (gas gangrene)?

Answer 58

clostridium perfringens

Question 59

What does myonecrosis look like?

Answer 59

gas, local edema, pain, fever

Question 60

What is the incubation period for myonecrosis?

Answer 60

hr to days

Question 61

What is the discharge like for myonecrosis?

Answer 61

serosanguinous, dirty, foul smelling

Question 62

How do you treat myonecrosis?

Answer 62

IV vanco + zosyn/meropenem/clinda | surgical debridement of infected muscles

Question 63

A Necrotizing Soft Tissue Infection caused by Pseudomonas in immunocompromised patients

Answer 63

ecthyma gangrenosum

Question 64

How do you treat ecthyma gangrenosum?

Answer 64

``` antipseudomonal penicillin (piperacillin) should be used in conjunction with an aminoglycoside (gentamicin) fluoroquinolones, third-generation cephalosporins, or aztreonam also effective ```

Question 65

Mupirocin

Answer 65

Bactroban