Osteomyelitis, head&neck, and skin infections Flashcards Preview

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Flashcards in Osteomyelitis, head&neck, and skin infections Deck (16):
1

What are the findings on an x-ray for osteomyelitis

Raised periosteum (no association with fracture)

2

90% of patients with osteomyelitis have no fever and a normal white count. How do we determine if treatment is effective

Follow ESR rates

If elevated after 4-6 weeks, perhaps surgical debridement is necessary

3

What are the different organisms involved in osteomyelitis and what are the treatments for each

1.) Staphylococcus - must be IV medications
- Oxacillin or nafcillin
- Vanco/linezolid/daptomycin if MRSA

2.) Salmonella and Pseudomonas
- Confirm it is gram negative with biopsy
- Treat with oral antibiotics

4

What is the diagnostic test and treatment for otitis externa

Diagnostic test: None, don't need to do, will have itching and actual drainage coming from ear (remember this)

Therapy
1.) Neomycin/polymixin - antibiotics
2.) Topical hydrocortisone - steroid to reduce swelling
3.) Acetic acid/water solution to re-acidify ear

5

Malignant otitis externa has the same diagnostic tests as osteomyelitis (x-ray/MRI or biopsy). What is the treatment

Surgical debridement and abx against pseudomonas

6

What is the diagnosis and treatment of otitis media

Diagnosis: Clinical

Treatment
Step 1: Amoxicillin
Step 2: After 72 hour failure, Augmentin, cephalosporins
Step 3: If step 2 fails, tympanocentesis and culture

7

What is the initial and best diagnostic test and treatments for sinusitis

Initial test: Sinus x-ray
Best test: Sinus aspirate for culture (not radiology)

Treatment
- Otitis media (amoxicillin) + inhaled steroids

8

What are the symptoms, diagnostic testing, and treatment for influenza

Symptoms: Arthralgias, myalgias, cough, headache, fever, sore throat

Diagnosis: Viral antigen detection of nasopharyngeal swab

Treatment - Neuroaminidase inhibitors: Oseltamivir and zanamivir if within 48 hours, over 48 hours treat symptoms

9

The three skin infection levels are impetigo, erysipelas, and cellulitis. What is the pathology, presentation, and organisms for all three

1.) Impetigo: Most superficial, causing weeping, oozing, crusting and caused by staph aureus or strep pyogenes

2.) Erysipelas: Skin bright red due to capillary dilation, only caused by strep infection, usually on face

3.) Cellulitis: Warm, red, swollen and tender skin from both strep pyogenes and staph aereus (like impetigo).

10

The three skin infection levels are impetigo, erysipelas, and cellulitis. Compare and contrast the diagnostic studies for all three

1.) Impetigo: None
2.) Erysipelas: Blood cultures (may be positive)
3.) Cellulitis: If on leg, do DVT to rule out blood clot

11

What is the treatment for impetigo

First line: Topical mupirocin or retapamulin
Severe: Oral dicloxacillin or cephalexin
CA-MRSA: Bactrim

12

What is the treatment for erysipelas

Initial: Oral dicloxacillin or cephalexin
- Penicillin VK after strep confirmed (doesn't have staph so don't have to worry about it)

13

What is the treatment for cellulitis

Initial: Dicloxacillin or ccephalexin oral
Severe: Oxacillin, nafcillin, or cefazolin IV

14

Summarize treatment pearls for impetigo, erysipelas, and cellulitis

1.) Topical antibiotics are only useful for impetigo
2.) Severe impetigo, and first line for erysipelas and cellulitis is oral dicloxacillin or cephalexin

15

On the skin, you can also get infection of the hair follicles denoted by folliculitis>furuncles>carbuncles>boils>abscess. What is the treatment for these

1 Same treatments as cellulitis
2 Boil and above can be drained

16

Fungal infections on the skin vary in the sense that some require topical medications, while some require oral medications. What are these distinctions

Topical - if not on hair or nail - azoles

Oral - if tinea capitis (hair) or nail
1.) Terbinafine - causes increased liver function tests
2.) Itraconazole (only azole that is oral)
3.) Griseofulvin - something to do with microtubules