Bites

Question 1

in a patient with cellulitis + concern of NV integrity, action?

Answer 1

• orthopaedic emergency

- patient admitted for IV abx + debridement

Question 2

1st line management of cellulitis

Answer 2

flucloxacillin

Question 3

broad spec abx

Answer 3

co-amoxiclav + piperacillin with tazobactam

Question 4

if allergic to penicillin… what abx can be given for cellulitis

Answer 4

clindamycin

Question 5

what is associated with clostridium difficile associated diarrhoea + why

Answer 5

clindamycin… because it is active against most gut anaerobes (except c difficile)

Question 6

dog, cat + human bites

Answer 6

check tetanus immunisation up to date

Question 7

dog bite outside of UK

Answer 7

rabies vaccine +/or immunoglobulin

Question 8

which 1 mammal carries the rabies vaccine in the UK

Answer 8

bats

Question 9

abx for cellulitis from mammal bites

Answer 9

co-amoxiclav

Question 10

US showing thickening of subcutaneous tissue + fluid collection along fascial plane

Answer 10

necrotising fascitis

Question 11

clinical symptoms of necrotising fascitis

Answer 11

• pain disproportionate to lesion
• lesions spread rapidly
• area of necrosis developing in the centre

Question 12

management of necrotising fascitis

Answer 12

• surgical debridement of all necrotic tissue

- abx to cover gram +ve + neg and anaerobic bacteria

Question 13

most common 2 bacteria causative in skin + soft tissue infections

Answer 13

1) staphylococcus aureus

2) streptococcus pyogens/group A strep

Question 14

bacteria associated with hospital acquired infections and chronic wounds

Answer 14

Pseudomonas aeruginosa

Question 15

how can you monitor the progression of erythema to show how far it is spreading

Answer 15

by drawing a line along the edge of the erythema

Question 16

1st line abx for uncomplicated cellulitis

Answer 16

flucloxacillin

Question 17

abx very active against staph aureus

Answer 17

flucloxacillin

Question 18

topical trx for impetigo

Answer 18

fusidic acid

Question 19

why do dog, cat and human bites need to be treated slightly differently?

Answer 19

because infection is usually polymicrobial

Question 20

which anaerobes aditionally need to be covered for following a mammal bite

Answer 20

• fusobacterium spp

- pasteurella

Question 21

1st line abx for mammal bites

Answer 21

co-amoxiclav

Question 22

2 abx effective against MRSA

Answer 22

• vancomycin

- doxycycline

Question 23

worrying sign that suggests a deeper soft tissue infection

Answer 23

pain out of keeping with clinical signs

Question 24

standard sepsis lab tests

Answer 24

• FBC
• U +E
• LFT
• clotting
• lactate
• CRP

Question 25

blood tests for ? fascitis

Answer 25

- sepsis screen - blood cultures - ABG - CK - Plain x ray - USS - ECG - screening for blood borne viruses

Question 26

CK is a marker of

Answer 26

severe muscle damage

Question 27

blood borns viruses to screen for

Answer 27

hep b hep c hiv

Question 28

USS findings in Necrotising fasciitis

Answer 28

- thickening of subcutaneous tissues | - fluid collecting along fascial plane

Question 29

gas forming bacteria

Answer 29

clostridium perfringes

Question 30

Cellulitis is infection of ___-

Answer 30

dermis + subcutaneous fat

Question 31

which individuals are at higher risk fo cellulitis in legs

Answer 31

- pedal oedema secondary to congestive cardiac failure - obese with excess adipose tissue on limbs + trunk - diabetes

Question 32

what should all patients with cellulitis be examined for

Answer 32

athlete's foot | fungal nail infection

Question 33

typical appearance of staphylococcus aureus on gram stain

Answer 33

- gram positive cocci in clusters

Question 34

3 organisms that can cause both skin + soft tissue infections

Answer 34

- staphylococcus aureus - group a strep - pseudomonas aeruginosa

Question 35

differentials for bilateral lower limb swelling

Answer 35

- bilateral cellulitis - lymphedema - venous insufficiency - venous eczema - bilateral DVT

Question 36

abx for moderate to severe MRSA infection

Answer 36

Vancomycin

Question 37

3 abx used to treat MRSA infections

Answer 37

- vancomycin - teicoplanin - linezolid

Question 38

how does gas gangrene arise

Answer 38

wounds become contaminated with Clostridium perfingens spores