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Flashcards in Infectious Derm II Deck (123):
1

What are the three major variants of impetigo?

-Non-bullous
-Bullous
-Ecthyma

2

What are the top two causes of impetigo in order?

S. aureus
S. Pyogenes

3

What is the age range that is generally affected with impetigo?

2-5 years

4

What is the treatment for impetigo?

Topical abx

5

What is ecthyma? What does it look like?

-Ulcerative form of impetigo--lesions extend into the dermis

-Appear as punched out ulcers surrounded by raised margins, covered with yellow crust

6

punched out ulcers surrounded by raised margins, covered with yellow crust = ?

Ecthyma

7

Where on the body does ecthyma usually occur?

Distal extremities, with regional LAD present

8

What are the preventative measures for impetigo?

Good handwashing

9

What is the oral treatment for impetigo? Topical?

oral abx like dicloxacillin or cephalexin

Topical mupirocin

10

Hot tub folliculitis = ?

Pseudomonas

11

What is the usual infectious agent that cause folliculitis?

Staph aureus

12

What is the treatment for folliculitis?

cleanse 3x/day and oral anti staph

13

What is a furuncle?

Staph infection of an obstructed hair follicle
-Presents as a red, TTP, inflamed nodule that becomes fluctuant with central suppuration

14

What is the treatment for a furuncle?

I and D

15

What are carbuncles?

Coalesced furuncles--large abscesses that are usually of staph orign

16

What is the treatment for a carbuncle?

I and D, maybe oral abx

17

What is hidradenitis suppurativa?

Chronic suppurative infection of apocrine sweat glands, most often d/t staph
-Leads to recurrent abscesses

18

What is the treatment for hidradenitis suppurativa?

Moist compresses and I and D

19

What, generally, is cellulitis?

-Infection of the dermis that often begins at a wound.
-Presents as a spreading, red, nonfluctuant, TTP, plaque, that has a *poorly defined border*

20

Where on the body is cellulitis usually found?

Legs

21

What are the associated signs of cellulitis?

Lymph streaking

22

What is characteristics of cellulitis if caused by strep?

Bullous lesions may form

23

spreading, red, nonfluctuant, TTP, plaque, that has a *poorly defined border* = ?

Cellulitis

24

What are the risk factors for cellulitis?

Preexisting skin infection or trauma

25

What usually causes cellulitis?

Gram positive organisms

26

What is the causative agent of animal bite and human bite cellulitis?

Animal = pasteurella multocida
Human = Eikenella Corrodens

27

What is the treatment for purulent vs nonpurulent cellulitis?

Purulent = treat for MRSA
Non-purulent = GAS

28

What are the causes of HA-MRSA? (3)

-Abx use
-Surgical site infection
-ICU

29

What are the causes of CA-MRSA? (3)

-proximity to others with MRSA
-Skin trauma
-Shaving

30

What causes erysipelas, and where does it tend to occur?

GAS
Legs or face

31

What, generally, is erysipelas?

Superficial cellulitis with marked dermal lymphatic involvement

32

What are the systemic symptoms of erysipelas?

Fevers
Leukocytosis
HA
Emesis

33

What is the major difference between cellulitis and erysipelas?

Erysipelas is sharply demarcated, while cellulitis is not

34

What causes the rash with scarlet fever?

Strep exotoxin

35

Where does the rash begin with scarlet fever? How does it progress?

-Face
-Neck
-Upper chest
-Progresses downward

36

What are the oral findings of scarlet fever? (2)

-Strawberry tongue
-Perioral pallor

37

What are the palpable characteristics of the rash with scarlet fever?

Feels like sandpaper

38

What are the pastia's lines that can be seen with scarlet fever?

a clinical sign in which pink or red lines formed of confluent petechiae are found in skin creases, particularly the crease in the antecubital fossa

39

Does the rash with scarlet fever blanch?

Yes

40

What areas are spared with scarlet fever?

Peri-oral area

41

Where is the rash accentuated with scarlet fever?

Antecubital areas
Axillary folds

42

What happens to the scarlet fever rash?

After 4 days, there is extensive desquamation of the skin

43

What is the treatment for scarlet fever?

PCN

44

What is Ritter's disease?

SSSS

45

What causes SSSS?

Exfoliative exotoxin of staph aureus

46

What is SSSS called in neonates?

Pemphigus neonatorum

47

What is the progression of the rash with SSSS?

Within 24 hours, large clear bullae develop which gradually shed, leaving a red, denuded base

48

What causes toxic shock syndrome?

one or more exotoxins of staph aureus

49

What are the s/sx of toxic shock syndrome?

-n/v
-Hyperemia of the oral
-Kidney failure
-Hepatitis

50

True or false: bacteremia is not a feature of toxic shock syndrome

True

51

What is the treatment for toxic shock syndrome?

Abx, but more so aggressive supportive therapy

52

What part of the skin is affected with necrotizing fasciitis?

Fascia just above the muscle

53

What is the appearance of the skin with necrotizing fasciitis?

Rapidly expanding dusky, edematous, red plaques with blue discoloration.

54

Expanding dusky, edematous, red plaques with blue discoloration. = ?

Necrotizing fasciitis

55

What are the symptoms of nec fash?

Anesthesia of the skin

56

What is the treatment for nec fash?

WIdespread debridement and broad spectrum abx

57

What are types I - III of Necrotizing fasciitis?

Type I = poly microbial
Type II = GAS
Type III = Gas gangrene or Clostridial

58

What is Fournier's gangrene?

Necrotizing fasciitis of the perineum and scrotum

59

What are the x-ray findings that may be present with Necrotizing fasciitis?

gas

60

What area of the body is particularly bad for Necrotizing fasciitis?

Abdomen

61

Over what age is a bad prognostic factor for Necrotizing fasciitis?

50

62

What diseases are bad prognostic signs for Necrotizing fasciitis? (2)

-Atherosclerosis
-DM

63

Which neisseria meningitidis strain is there no vaccine available for?

B

64

What is the rash that is seen with meningococcemia?

Erythematous macules, with brown stained appearance. Later lesions become purpuric with an irregular edge

65

True or false: the petechia with meningococcemia always spares the conjunctiva?

False-it can

66

What is the treatment for meningococcemia?

PCN

67

True or false: there is meningococcus in the rash with meningococcemia

True--don't touch it

68

What are the three types of fungi, based on their location/source?

Geophilic
Zoophilic
Anthrophilic

69

What are the three major genera of fungi that infect humans?

-Epidermophyton
-Microsporum
-Trichophyton

70

What area of the body do dermatophytes infect? What allow them to infect this area?

-Keratinized tissue
-Have keratinase that allows them to live there

71

Yeasts are more likely to infect what parts of the body?

Deep skin or mucous membranes

72

What is the cause of tinea versicolor? What is the appearance with KOH prep?

Malassezia furfur

Spaghetti and meatballs

73

What is the causative agent of tinea pedis?

Trichophyton rubrum or mentagrophytes

74

What are the three major clinical patterns of tinea pedis? Which is most common?

-**Interdigital**
-Moccasin
-Vesiculobullous

75

What is the moccasin type of tinea associated with?

Onychomycosis

76

What are the findings of tinea manus?

Whiteness in the creases of the hand

77

What are the characteristics of the vesiculobullous type of tinea?

Grouped, 2-3 mm vesicles, often on the arch of the instep of the foot

78

What are the topical agents for tinea?

Azoles
Terbinafine

79

What is the best way to diagnose tinea?

KOH prep

80

What are the characteristics of tinea corporis?

Sharply marginated annular plaque with central clearing and scaling at the edges

81

Sharply marginated annular plaque with central clearing and scaling at the edges

Tinea corporis

82

Where in the lesion of tinea corporis is the fungi most active, and thus where you should take a sample from for dx?

Margins

83

What should always be assessed for with tinea corporis?

Tinea pedis

84

What is the usual fungi involved with tinea corporis?

Trichophyton rubrum

85

What are the usual fungi involved with tinea cruris? (2)

Epidermophyton floccosum
Trichophyton rubrum

86

What is the treatment for tinea corporis? When is systemic therapy indicated?

Topical antifungals
-systematic if poor response to topical, or large surface area

87

What are the two types of tinea on the face? How does each appear?

-Tinea faciei = corporis on the face
-Tinea barbae = multiple pustules around hair follicles

88

What is the fungus usually responsible for tinea barbae?

Trichophyton mentagrophytes

89

What is the usual presentation of tinea capitis?

Patch of alopecia with black dots, which are hairs that have broken off at the skin

90

What are the fungi that cause tinea capitis?

Microsporum canis, audouninii

91

Who usually gets tinea capitis?

School aged children

92

What is a kerion?

Pustules of the hair shaft with tinea capitis develop, forming an inflammatory nodule

93

What is the treatment for tinea capitis?

Topical agents not effective--oral griseofulvin

94

What is the treatment for onychomycosis?

Oral terbinafine x 12 weeks

95

What is the usual presentation of tinea versicolor?

Well demarcated hyper and hypopigmentation

96

What is the treatment for tinea versicolor?

Selenium shampoos, ketoconazole

97

What is the appearance of intertrigo?

Sharply defined red plaques involving skin folds with surrounding satellite macules

98

What is the usual cause of diaper dermatitis, and what does it look like?

-Beefy red plaques with white scales
-Candida

99

Is a diaper rash does not improve with barrier creams like Zn oxide, what pathogen should be suspected?

candida

100

What is the treatment for candidal diaper rashes?

Nystatin

101

Cradle cap in infants = ?

Seborrheic dermatitis

102

What causes seborrheic dermatitis?

Increased sebaceous gland activity causes an inflammatory reaction to malassezia species

103

What does seborrheic dermatitis look like?

Ranges from fine white scale to erythematous patches and plaques with greasy yellow scales

104

What is the fungal infection commonly seen with PD?

Seborrheic dermatitis

105

What is the treatment for seborrheic dermatitis?

Ketoconazole

106

What are the symptoms of candidal vulvovaginitis?

Creamy white d/c with pruritis

107

What is candidal paronychia? What is the risk that this presents?

Fungal infection of the nail folds

secondary infection with bacteria

108

What is the lepromatous form of TB?

Infiltrative cutaneous lesions will ill-defined borders

109

What is the tuberculoid leprosy?

Benign course, but with cutaneous lesions that are frequently erythematous with elevated border

110

What is the treatment for lepromatous and tuberculoid leprosy?

-lepromatous = Dapsone, RIPE
-tuberculoid = excise +systemic therapy

111

What is the parasite that causes pediculosis (lice)?

Pediculus humanus

112

Where is the most common place to find head lice on the head?

retroauricular and occipital scalp

113

What is the treatment for head lice?

Permethrin or malathion

114

What is the usual presentation of scabies?

Multiple erythematous papules on trunk, extremities, and genitals

Burrows are pathognomonic

115

What is the best way to diagnose scabies?

skin scrapings and microscopy

116

What is the treatment for scabies?

Oral ivermectin

117

What is Norwegian scabies?

Scabies + hyperkeratosis

118

What is pediculosis pubis? Treatment?

Pubic lice
Ivermectin

119

What is the usual presentation of bed bugs?

Clusters of Pruritic, erythematous and edematous papules

120

What is the parasite that causes bed bugs?

Cimex lectuularis

121

What is the treatment for bed bugs?

Topical steroids and antihistamines

Burn everything

122

What causes rocky mountain spotted fever? Presentation?

Rickettsia rickettsii
ILI + centipedal rash

123

What are the lab abnormalities that may be seen with RMSF?

Hyponatremia and thrombocytopenia