Soft Tissue Infections

Question 1

what causes impetigo?

Answer 1

> STAPH AUREUS

> strep pyogens

Question 2

what is impetigo?

Answer 2

a highly infective superficial skin infection that has multiple vascular lesions on erythematous base

Question 3

how does impetigo present?

Answer 3

> golden crust
on exposed body part (face, scalp, extremities)
children 2-5

Question 4

what are some predisposing factors to impetigo?

Answer 4

> abrasions
> burns
> eczema
> poor hygiene
> insect bites
> chicken pox
> atopic dermatitis

Question 5

how is impetigo treated?

Answer 5

> small areas with topical antibiotics

> large areas with topical and oral antibiotics

Question 6

what cause erysipelas?

Answer 6

strep. pyogens

Question 7

what is erysipelas?

Answer 7

infection of the epidermis

Question 8

how does erysipelas present?

Answer 8

> painful red area with a distinct border
fever
regional lymphadenopathy

Question 9

what risk factors are there for erysipelas?

Answer 9

> DM
obesity
paraparesis
venous stasis

Question 10

how is erysipelas treated?

Answer 10

combination of anti-staphylococcal and antistreptococcal antibiotics (extensive need rest and IV antibiotics)

Question 11

what causes cellulitis?

Answer 11

> strep pyogens

> staph aureus

Question 12

what is cellulitis?

Answer 12

diffuse skin infection involving the deep dermis and subcutaneous fat

Question 13

how does cellulitis present?

Answer 13

> fever
spreading erythematous area with no distinct border
regional lymphadenopathy

Question 14

how is cellulitis treated?

Answer 14

combination of anti-staphylococcal and anti-streptococcal antibiotics

Question 15

what are the predisposing factors for cellulitis?

Answer 15

> DM
tinea pedis
Lymphedema

Question 16

what are the predisposing factors for necrotising fasciitis?

Answer 16

> peripheral vascular disease
> skin popping
> trauma
> surgery
> DM

Question 17

what causes type 1 necrotising fasciitis?

Answer 17

mixture of aerobes and anaerobes
>enterococci
> staphylococci
> -ve bacilli
> streptococci
> clostridium

Question 18

what causes type 2 necrotising fasciitis?

Answer 18

> strep pyogens

Question 19

how does necrotising fasciitis present?

Answer 19

> rapid onset
> haemorrhagic bullae
> skin necrosis
> crepitus
> anaesthesia at site

Question 20

what are the systemic features of necrotising fasciitis?

Answer 20

>fever
> hypotension
> delirium
> multi-organ failure
> tachycardia

Question 21

what is the presentation of sequential development in necrotising fasciitis?

Answer 21

> severe pain
extensive oedema
erythema

Question 22

what is the management of necrotising fasciitis?

Answer 22

> surgical review

> broad spectrum antibiotics (flucloxacillin, gentamicin, clindamycin)

Question 23

what is polymyositis?

Answer 23

infection of deep striated muscle

Question 24

what causes polymyositis?

Answer 24

staph aureus

Question 25

what are the predisposing factors for polymyositis?

Answer 25

``` > liver cirrhosis > malignancy > DM > IV drug abuse > immunocompromised > rheumatological disease ```

Question 26

what investigations could you carry out for polymyositis?

Answer 26

> CT | > MRI

Question 27

how does polymyositis present?

Answer 27

> fever > pain > woody induration of the affected muscle

Question 28

where does polymyositis present?

Answer 28

``` > arm > thigh > psoas muscle > calf > gluteal region > chest wall ```

Question 29

how is polymyositis treated?

Answer 29

antibiotics and drainage

Question 30

what is infectious tenosynovitis?

Answer 30

infection of the synovial sheets surrounding the tendons

Question 31

what causes infectious tenosynovitis?

Answer 31

> penetrating trauma > STAPH AREUS > STREPTOCOCCI > chronic- fungi and microbacteria

Question 32

how does infectious synovitis present?

Answer 32

> tenderness > finger in semi-flexed position (extension painful) > erythematous pusiform swelling

Question 33

how is infectious synovitis treated?

Answer 33

> empirical antibiotics

Question 34

what is folliculitis?

Answer 34

pustular infection of hair follicle

Question 35

what causes folliculitis?

Answer 35

staph aureus

Question 36

how does folliculitis present?

Answer 36

> small red papules

Question 37

what are furunculosis?

Answer 37

single hair follicle associated inflammatory nodules, extended into the dermis and subcutaneous tissue

Question 38

what are the risk factors for furunculosis?

Answer 38

``` > obesity > CKD > DM > atopic dermatitis > corticosteroid use ```

Question 39

where does furunculosis present?

Answer 39

moist hairy friction prone areas

Question 40

what cause furunculosis?

Answer 40

staph. aureus

Question 41

what is a carbuncle?

Answer 41

infection involving multiple follicles ( a multi septated abscess)

Question 42

how does a carbuncle present?

Answer 42

high temperature

Question 43

how is a carbuncle treated?

Answer 43

surgery and IV antibiotics

Question 44

what are some predisposing factors to septic bursitis?

Answer 44

``` > rheumatoid arthritis > alcoholism > DM > IV drug abuse > immunosuppression > renal insufficiency ```

Question 45

how does septic bursitis present?

Answer 45

``` > peri-bursal cellulitis > warmth > swelling > fever > pain on movement ```

Question 46

how is septic bursitis diagnosed?

Answer 46

aspiration of fluid

Question 47

what causes septic bursitis caused?

Answer 47

staph aureus

Question 48

what causes toxin mediated syndromes?

Answer 48

super antigens of pyrogenic exotoxins activated the immune system by attaching directly to the T cell receptors causing a massive cytokine release

Question 49

how does staphylococcal TSS present?

Answer 49

> fever > hypotension > diffuse macular rash > 3 organ involvement (GI, renal, liver, MSK, CNS)

Question 50

how is streptococcal Toxin shock syndrome treated?

Answer 50

urgent surgical debridement of infected tissue

Question 51

how is toxic shock syndrome managed?

Answer 51

``` > IV fluids > removing the offending agent > inotropes > antibiotics > IV immunoglobulins ```

Question 52

how does staphylococcal scalded skin syndrome present?

Answer 52

> widespread bullae | > skin exfoliation

Question 53

what causes panton-valentine leucocidin toxin?

Answer 53

gamma haemoglobin

Question 54

what are the risk factors for IV catheter infections?

Answer 54

> cannula in situ for >72 hours > neurological problems > cannula in lower limb

Question 55

how are IV catheter infections prevented?

Answer 55

> do not leave in an unused catheter > change cannula every 72 hours > monitor for thrombophlebitis > use aseptic technique

Question 56

what are the risk factors for surgical site infections?

Answer 56

``` > diabetes > obesity > smoking > malnutrition > concurrent steroid use > staph aureus colonisation > procedural factors ```

Question 57

describe class 1 surgical site infection

Answer 57

clean wound | resp/GI /uro/genital systems not entered

Question 58

describe a class 2 surgical site infection

Answer 58

clean contaminated wound

Question 59

describe a class 3 surgical site infection

Answer 59

contaminated wound

Question 60

describe a class 4 surgical site infection

Answer 60

infected wound