Skin and soft tissue

Question 1

How does impetigo present?

Answer 1

Superficial skin infection
Multiple vesicular lesions on an erythematous base
Golden crust is highly suggestive of impetigo diagnosis

Question 2

What organism causes impetigo?

Answer 2

Most commonly staph aureus

Less commonly strep pyogenes

Question 3

What are some pre-disposing factors for impetigo?

Answer 3

Skin abrasions
Minor trauma
Burns
Poor hygiene
Insect bites
Eczema
Atopic dermatitis

Question 4

How are small areas of impetigo treated?

Answer 4

Topical antibiotics

Question 5

How are large areas of impetigo treated?

Answer 5

Topical treatment and oral antibiotics (flucloxacilin)

Question 6

What is erysipelas?

Answer 6

Infection of upper dermis

Painful red area with no central clearing

Question 7

How does erysipelas present?

Answer 7

Painful red area
Fever
Lymphadenopathy
Lymphangitis
Typically has distinct elevated borders

Question 8

What organism causes erysipelas?

Answer 8

Most commonly strep pyogenes

Question 9

What is cellulitis?

Answer 9

Diffuse skin infection involving deep dermis and subcutaneous fat

Question 10

How does cellulitis present?

Answer 10

Spreading erythematous area with no distinct borders
Fever is common
Lymphadenopathy
Lymphangitis

Question 11

What are some predisposing factors for cellulitis?

Answer 11

DM
Tinea pedis
Lymphoedema

Question 12

What is folliculitis?

Answer 12

Circumscribed pustular infection of a hair follicle

Question 13

How is folliculitis caused?

Answer 13

Typically staph aureus

Question 14

What is a common name for furuncles?

Answer 14

Boils

Question 15

What is the most common causative organism for furuncles?

Answer 15

Staph aureus

Question 16

What are some risk factors for furuncles?

Answer 16

Obesity
DM
Atopic dermatitis
Chronic kidney disease
Corticosteroid use

Question 17

What is a carbuncle?

Answer 17

When an infection extends to involve multiple furuncles

Question 18

Is necrotising fasciitis a medical emergency?

Answer 18

Yes

Question 19

What are some predisposing conditions for necrotising fasciitis?

Answer 19

DM
Surgery
Trauma
Peripheral vascular disease
Skin popping

Question 20

Describe the onset of necrotising fasciitis.

Answer 20

Rapid
Erythema
Extensive oedema
Unremitting pain
Haemorrhagic bullae
Skin necrosis

Question 21

What are some systemic features of necrotising fasciitis?

Answer 21

Fever
Hypotension
Tachycardia
Delirium
Multiorgan failure

Question 22

How is necrotising fasciitis managed?

Answer 22

Surgical review
Imaging may help but could delay treatment
Broad spectrum antibiotics (Flucloxacilin, gentamycin, clindamycin)

Question 23

What is pyomyolitis?

Answer 23

Purulent infection deep within striated muscle, often manifesting as an abscess

Question 24

How does pyomyositis present?

Answer 24

Fever
Pain
Woody induration of affected muscle

Question 25

How is pyomyositis managed?

Answer 25

CT/MRI Drainage with antibiotic cover depending on gram stain and culture results

Question 26

What are bursae?

Answer 26

Small sac-like cavities that contain fluid and are lined by synovial membrane Facilitate movement with reduced friction

Question 27

What is septic bursitis?

Answer 27

Infection of bursae often from adjacent skin infection

Question 28

What are some predisposing factors for septic bursitis?

Answer 28

``` Rheumatoid arthritis Alcoholism DM IV drug use Immunosuppression Renal insufficiency ```

Question 29

How does septic bursitis present?

Answer 29

Fever Pain on movement Swelling Warmth

Question 30

What is infectious tenosynovitis?

Answer 30

Infection of the synovial sheaths that surround tendons

Question 31

How does infectious tenosynovitis present?

Answer 31

Erythematous fusiform swelling of finger Held in semi-flexed position Tender Pain with extension

Question 32

What are the criteria for diagnosis of staphylococcal TSS?

Answer 32

Fever Hypotension Diffuse macular rash Three of liver, blood, renal, GI, CNS or muscular involved Isolation of staph aureus from mucosal or normally sterile sites Production of TSST1 from isolate Development of antibody to toxin during convalesence

Question 33

How is toxic shock syndrome treated?

Answer 33

``` Remove offending agent IV fluids Inotropes Antibiotics IV immunoglobulins ```

Question 34

What is the usual progression of an IV-catheter associated infection?

Answer 34

Nosocomial infection Starts as local SST inflammation Progresses to cellulitis Sometimes even tissue necrosis

Question 35

What is a common association of IV-catheter associated infection?

Answer 35

Bacteraemia