Term
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Definition
| Superficial infection that causes honey-colored crusts. Only epidermis is involved, so no scarring once it heals. Does not causes "sick" patient. Can be caused by streptococcus or other bacteria. Can involve the hair follicle - which makes crust more difficult to remove. |
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Term
| How do you treat impetigo? Notes |
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Definition
| If small spot, use topical (bacitracin). If large or if topical won't be used, use systemic oral abx. |
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Term
| Describe cellulitis. Notes |
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Definition
| Skin infection that is deeper than impetigo. It is not an abscess; it is firm throughout. Cellulitis is not terribly demarcated. Signs of inflammation. |
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Term
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Definition
| Ecythema is like an impetigo infection that has gone deeper and now involves the dermis. This can cause scarring after healing. Impetigo may be the precursor. |
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Term
| Describe lymphangitis. Notes |
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Definition
| Inflammation of the lymph system proximal to a distal injury. Sometimes there is a breach in the skin. |
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Term
| How do you treat cellulitis? Notes |
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Definition
| Treat with antibiotics - penicillin. If suspect possibility of staph can treat with macrolide or sulfa drugs. |
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Term
| How do you treat lymphangitis? Notes |
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Definition
| Hot compresses make it feel better and resting the arm is good. Treat with abx - inpatient if septic. Follow up is key. |
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Term
T/F - Notes
Staph can cause lymphangitis. |
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Definition
| True - but Strep is a more common cause. |
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Term
| Describe folliculitis. Notes |
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Definition
| Infection of the hair follicle. Does not have the crusting that is seen with impetigo. May have pustules. Will not see white heads or black heads - cannot squeeze material from deeper. |
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Term
| How do you treat folliculitis? Notes |
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Definition
| If small, may not need abx. Antiseptic. Do not shave while treating! |
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Term
| Describe a furuncle. Notes |
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Definition
| Deep infection in which pus is coming out of a deeper abscess. Has a core of inspissated pus (drying). May scar. |
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Term
| How do you treat a furuncle during induration? Notes |
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Definition
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Term
| How do you treat a furuncle once it spontaneously breaks or is fluctuant and ready to be broken open? Notes |
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Definition
| Break open - no anesthetic needed and won't work well because of acidic wound. Remove the core. |
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Term
| Describe a carbuncle. Notes |
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Definition
| A collection of furuncles. These are typically found on the back of the legs or the back of the neck. |
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Term
| How do you treat a carbuncle? Notes |
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Definition
| Prescribe a pain med, abx, and hot compresses. Wait for furuncles to come to the surface. Cut out a 1 cm square, break up the inside, pack and leave open. |
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Term
| Describe erysipelas. Notes |
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Definition
| "Slapped face" rash. Fever. Firm. Septic!! Commonly on face, but can occur other places. |
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Term
| How do you treat erysipelas? Notes |
|
Definition
| Abx, may put on IV to get ahead of this. |
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Term
| What drugs should be used to treat pharyngitis and impetigo? Notes |
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Definition
| Penicillin or erythromycin (macrolide) |
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Term
| What drugs should be used to treat cellulitis and erysipelas? Notes |
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Definition
| Penicillin or dicloxacillin |
|
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Term
| What drugs do you use to treat necrotizing fasciitis or strep. toxic shock syndrome? Notes |
|
Definition
| Cindamycin (IV) and/or Penicillin |
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Term
| What are the 5 cardinal manifestations of rheumatic fever? Notes |
|
Definition
1. Carditis
2. Polyarthritis
3. Erythema marginatum
4. Subcutaneous nodules
5. chorea |
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Term
| How many major manifestations of rheumatic fever must you have for diagnosis? Notes |
|
Definition
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Term
| What are the 2 most common major manifestations of rheumatic fever? Notes |
|
Definition
| carditis and polyarthritis |
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Term
| If the patient presents with only 1 major manifestation of rheumatic fever, how many minor manifestations must the pt have? |
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Definition
| 1 major + 2 minor = diagnosis |
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Term
| What are the possible minor manifestations of rheumatic fever? Notes |
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Definition
| arthralgia, fever, inc. acute-phase reactants, inc. erythrocyte sed rate, ince. C-reactive protein, prolonged PR interval |
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Term
| How do you prevent recurrent attacks of rheumatic fever? Notes |
|
Definition
| 1 of the following: Penicillin, sulfadiazine, or erythromycin for allergic individuals |
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Term
| How long is secondary rheumatic fever prophylaxis continued? Notes |
|
Definition
| At least 10 years with carditis (maybe lifelong), and at least 5 years without carditis |
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Term
| Does long term secondary prophylaxis for rheumatic fever lead to drug resistance? Notes |
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Definition
| There is no evidence that it does at this time. |
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Term
| Where is staphylococcus carried? Notes |
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Definition
|
|
Term
T/F - Notes
Staphyloccocus in the nasopharynx can cause infection in the host or in others. |
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Definition
|
|
Term
T/F - Notes
Staph usually causes an invasive, disseminated infection as opposed to a local infection. |
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Definition
| False - usually local but can invade |
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Term
| Why does Staph tend to complicate inflamed/traumatized tissue (ex. wounds)? Notes |
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Definition
| surface receptors on Staph adhere to inflamed/traumatized tissue and thus complicate these areas |
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Term
| What types of infections are commonly caused by Staph? Notes |
|
Definition
furuncle or skin abscess
bullous impetigo
surgical wound infection
nosocomial bacteremia
acute or R sided bacterial endocarditis
hematogenous osteomyelitis
septic arthritis
pyomyositis
renal carbuncle
scalded skin syndrome
toxic shock syndrome
food-borne gastroenteritis
botryomycosis
paraspinous or epidural abscess |
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|
Term
| What types of infections are less commonly caused by Staph? Notes |
|
Definition
cellulitis
nosocomial pneumonia
brain abscess
empyema |
|
|
Term
| What types of infections are rarely caused by Staph? Notes |
|
Definition
CAP
ascending UTI
meningitis
enterocolitis |
|
|
Term
| What is Nikolsky's sign? Notes |
|
Definition
| Where the skin slips off - as in scalded skin syndrome |
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|
Term
| What are furuncles frequently mistaken for by patients? Notes |
|
Definition
|
|
Term
| What drug do we use to treat Staph and why? Notes |
|
Definition
Bactrim DS - sulfa drug
because Staph is getting more resistant to dicloxicillin and macrolides |
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Term
| When should you suspect a carrier state for Staph? Notes |
|
Definition
|
|
Term
| How do you treat the carrier state for Staph? Notes |
|
Definition
Mupirocin ointment intranasally bid
Rifampin plus dicloxacillin |
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Term
| When is the best time to treat osteomyelitis? Notes |
|
Definition
| the first time that it shows - be aggressive! Don't let it come back! |
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Term
| What are the 3 types of osteomyelitis? Notes |
|
Definition
| Hematogenous, vertebral, and focal |
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Term
| What would the WBC count be in a patient with osteomyelitis? Notes |
|
Definition
> 15,000
normal is about 5,000-10,000 |
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Term
| What lab tests would you run for suspected osteomyelitis? Notes |
|
Definition
| CBC/WBC, Chem profile, sed rate, C-reactive protein, bone/blood C&S, bone biopsy, plain film x-ray |
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Term
| What are the 3 treatment options for osteomyelitis? Notes |
|
Definition
1. Medical
2. Medical/ surgical debridement/ stabilization
3. Medical/ surgical amputation |
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Term
| Name 3 indications for surgery in an osteomyelitis case. Notes |
|
Definition
1. failure of medical treatment
2. soft tissue abscess
3. joint sepsis/ instability |
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Term
| Name 4 factors that influence treatment and prognosis. Notes |
|
Definition
1. degree of necrosis
2. condition of host
3. site and extent of involvement
4. disabling effects |
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Term
| How do we classify osteomyelitis cases? Notes |
|
Definition
Anatomic type 1-4 and physiologic class A-C
Anatomic type
1. medullary
2. superficial
3. localized
4. diffuse
?
A. healthy
B. immunocompromised
C. treatment worse than disease |
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Term
| What is the most common cause of osteomyelitis? Notes |
|
Definition
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|
Term
T/F - Notes
Staph. can cause GI infections. |
|
Definition
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|
Term
| What is the definition of acute diarrhea? Notes |
|
Definition
|
|
Term
| What are the possible causes of acute diarrhea? Notes |
|
Definition
| infection, drug-related (abx, laxatives, etc), or IBD (inflammatory bowel disease such as Crohn's or UC) |
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|
Term
| What is the definition of chronic diarrhea? Notes |
|
Definition
|
|
Term
| What are the possible causes of chronic diarrhea? Notes |
|
Definition
| drug-related, giardia, malabsorption, UC< tumors |
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|
Term
| What causes diarrhea pathophysiologically? Notes |
|
Definition
decreased fluid absorption
increased fluid secretion
motor changes
mucosal injury |
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|
Term
| What 10 things do you need to know when a patient complains of diarrhea? Notes |
|
Definition
1. Amount of water
2. blood
3. pus
4. time
5. cramps
6. travel
7. food history
8. contacts
9. fluid intake
10. temperature |
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Term
| When is Giardia especially likely? Notes |
|
Definition
1. hx of travel to mountainous areas of North America
2. travel to Russia (St. Petersburg)
3. travel to developing tropical/semitropical world
4. Contact with day care centers |
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Term
| What are the 5 key things to note during the physical exam of the patient with diarrhea? Notes |
|
Definition
1. hydration
2. overall appearance
3. age
4. vitals
5. abdominal exam |
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Term
| What lab tests should be run on a patient presenting with diarrhea? Notes |
|
Definition
Stool C&S, WBC, RBC, Ova and parasites, Rotavirus and Norwalk
abdominal x-ray |
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Term
| What are the possible causes of diarrhea that has lasted > 2 weeks? Notes |
|
Definition
| parasites, disaccharidase, bacterial, host deficiencies, or other |
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|
Term
| What is the treatment for diarrhea? Notes |
|
Definition
Fluid and electrolytes
abx - especially for travelers
Pepto bismol before eating and before bed
Lomotil - if necessary; don't use with food poisoning |
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