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STEP 2: Soft Tissue Infections Flashcards

(47 cards)

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1
Q
A
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2
Q

What is a necrotizing soft tissue infection (NSTI)?

A

An aggressive, life-threatening infection involving necrosis of the tissue, affecting superficial and/or deep tissue.

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3
Q

What is necrotizing fasciitis?

A

The most common NSTI, a rapidly progressive infection resulting in extensive necrosis of superficial and deep fascia and subcutaneous fat.

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4
Q

Define Fournier gangrene.

A

Necrotizing fasciitis of the external genitalia that can spread rapidly to the anterior abdominal wall and gluteal muscles.

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5
Q

What is clostridial myonecrosis?

A

A rapidly spreading necrotizing infection caused by Clostridium perfringens or Clostridium septicum.

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6
Q

What types of bacteria are commonly isolated in NSTIs?

A

Aerobic and anaerobic, gram-positive and gram-negative bacteria.

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7
Q

What are the common causes of polymicrobial NSTIs?

A
  • E. coli
  • Bacteroides spp.
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8
Q

What are the common monomicrobial pathogens associated with NSTIs?

A
  • Group A Streptococcus (S. pyogenes)
  • Peptostreptococcus spp.
  • S. aureus
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9
Q

What type of infection is Fournier gangrene typically?

A

Usually a mixed infection with facultative pathogens and anaerobic bacteria.

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10
Q

What is the only definitive method to establish the causative pathogen in NSTIs?

A

Obtaining a deep tissue culture during surgical exploration.

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11
Q

List some systemic symptoms of NSTIs.

A
  • Fever
  • Chills
  • Altered mental status
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12
Q

What cutaneous findings are associated with NSTIs?

A
  • Diffuse erythema
  • Extreme tenderness
  • Significant induration
  • Crepitus
  • Purple skin discoloration
  • Bullae
  • Loss of sensation
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13
Q

What are red flags indicating a necrotizing deep tissue infection?

A
  • Crepitus
  • Bullous lesions
  • Skin necrosis
  • Pain out of proportion to examination
  • Signs of systemic toxicity
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14
Q

How is a definitive diagnosis of NSTIs usually made?

A

During visualization of the tissue during surgery.

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15
Q

What laboratory studies are relevant in diagnosing NSTIs?

A
  • CBC: leukocytosis
  • BMP: possibly hyperglycemia
  • Inflammatory markers: elevated
  • CK: elevated
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16
Q

What imaging studies may be used for NSTIs?

A
  • CT/MRI with/without IV contrast
  • X-ray to detect gas in soft tissue
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17
Q

What is the management protocol for suspected NSTIs?

A

Admit to hospital, start immediate surgical and medical treatment, and perform surgical exploration with debridement.

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18
Q

What is the mainstay of treatment for NSTIs?

A

Surgical exploration with debridement.

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19
Q

What type of antibiotic therapy should be started for NSTIs?

Study These Flashcards
A

Systemic, broad-spectrum antibiotic therapy immediately after blood cultures.

20
Q

What are some possible complications of NSTIs?

Study These Flashcards
A
  • Severe necrosis requiring amputation
  • Sepsis
  • Disseminated intravascular coagulation
  • Organ dysfunction
  • Death with high mortality rate
21
Q

What condition is caused by C. perfringens and may be confused with NSTIs?

Study These Flashcards
A

Gas gangrene.

22
Q

True or False: Imaging studies should delay treatment for NSTIs.

23
Q

Fill in the blank: A definitive diagnosis of NSTI is usually made during _______.

24
Q

What is erysipelas?

Study These Flashcards
A

A superficial skin infection involving the upper dermis

Erysipelas is characterized by raised, sharply demarcated lesions.

25
What is cellulitis?
A local infection of the deep dermis and subcutaneous tissue ## Footnote Cellulitis presents with poorly defined lesions and induration.
26
What are common local signs of nonpurulent skin and soft tissue infections?
* Erythema * Edema * Warmth * Tenderness
27
What is a specific clinical feature of erysipelas?
Raised, sharply demarcated lesion
28
What is a specific clinical feature of cellulitis?
Poorly defined lesion with induration
29
Fill in the blank: Cutaneous lymphatic edema is historically referred to as _______.
peau d'orange
30
What are common locations for nonpurulent skin and soft tissue infections?
* Lower limbs * Face
31
What are possible additional features of nonpurulent skin and soft tissue infections?
* Lymphangitis * Lymphadenitis * Bullae * Purulent exudate
32
What systemic symptoms may occur in moderate/severe infections?
* Fever * Chills * Confusion * Nausea * Headache * Muscle and joint pain
33
True or False: Bilateral cellulitis is common.
False
34
What is the most common point of entry for pathogens in erysipelas and cellulitis?
A small skin lesion (e.g., interdigital tinea pedis)
35
What is the most common pathogen causing nonpurulent skin and soft tissue infections?
Beta-hemolytic streptococci, mostly group A Streptococcus (S. pyogenes)
36
Name two less common pathogens for cellulitis.
* S. aureus * Pasteurella multocida
37
What laboratory studies may be indicated for patients with systemic symptoms?
* CBC * BMP * Inflammatory markers (e.g., CRP, procalcitonin)
38
What imaging may be considered if there is concern for complications?
* Soft tissue ultrasound * CT/MRI with or without IV contrast
39
What is the mainstay of treatment for nonpurulent SSTIs?
Empiric antibiotic therapy active against streptococci and S. aureus
40
What supportive care should be included in the treatment of nonpurulent SSTIs?
* Elevation of the affected limbs * Rest * Acute pain management
41
What is perianal streptococcal dermatitis?
An infection of the perianal skin with group A Streptococcus characterized by pain, pruritus, and rash
42
What is the most common age group affected by perianal streptococcal dermatitis?
Children between 6 months and 10 years of age
43
What are clinical features of perianal streptococcal dermatitis?
* Pruritus * Rectal pain * Blood-streaked stools * Erythematous perianal rash with pseudoexudate
44
What is the preferred treatment for perianal streptococcal dermatitis?
Penicillin or amoxicillin (preferred in children)
45
List some complications of nonpurulent skin and soft tissue infections.
* Recurrent infections * Abscess * Infection of deeper tissues * Thrombophlebitis * Lymphedema * Systemic complications (e.g., sepsis)
46
What are systemic complications associated with nonpurulent skin and soft tissue infections?
* Sepsis * Endocarditis * Streptococcal toxic shock syndrome * Poststreptococcal glomerulonephritis * Acute rheumatic fever
47
What serious complications can arise from orbital cellulitis?
* Blindness * Cavernous sinus thrombosis * Intracranial abscess

STEP 2 (42 decks)

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