Term
| Give 5 examples of primary infections. |
|
Definition
| superficial cellulitis, folliculitis, furunculosis, simple abscess, minor wound infection |
|
|
Term
| Name 4 examples of secondary infections. |
|
Definition
| complicated abscess, diabetic ulcers, infected burn wounds, deep space wound infections |
|
|
Term
|
Definition
| inflammation of a hair follicle |
|
|
Term
| Name 2 causative agents of folliculitis? |
|
Definition
| Staph. aureus and Pseudomonas aeruginosa |
|
|
Term
|
Definition
| folliculitis caused by Pseudomonas aeruginosa |
|
|
Term
| What oral antibiotic will resolve folliculitis? |
|
Definition
|
|
Term
| What type of infection is a stye? |
|
Definition
| folliculitis of the eyelash follicle |
|
|
Term
| What OTC topical agents are used to treat folliculitis? |
|
Definition
| bacitracin/neomycin/polymyxin B (Neosporin) and bacitracin zinc/polymyxin B sulfate (Betadine Brand) |
|
|
Term
| What Rx topical agents are used to treat folliculitis? |
|
Definition
| acne preparations such as benzoyl peroxide (Benzac), doxycycline (Doryx), and clindamycin/benzoyl peroxide (Benzaclin); or mupirocin (Bactroban, Centany) |
|
|
Term
| How do you treat extensive folliculitis? (hot tubitis?) |
|
Definition
| systemic antibiotic - cephalexin (Keflex) |
|
|
Term
| What generation of cephalosporins is cephalexin? |
|
Definition
|
|
Term
| What non-drug treatment is useful in folliculitis? |
|
Definition
|
|
Term
| What is benzoyl peroxide? |
|
Definition
| an antibacterial cleansing agent for acne |
|
|
Term
| How does benzoyl peroxide work to treat folliculitis? |
|
Definition
| it kills the bacteria and promotes the growth of new skin cells; it also dries the skin |
|
|
Term
| When should you use mupirocin (Bactroban, Bactroban nasal, Centany)? |
|
Definition
| Reserve for severe infections - has good MRSA coverage |
|
|
Term
| What is mupirocin (Bactroban nasal) used for? |
|
Definition
|
|
Term
| What is the mechanism of action of mupirocin (Bactroban)? |
|
Definition
| selective binding to bacterial isoleucyl-tRNA synthetase, which halts the incorporation of isoleucine into bacterial proteins |
|
|
Term
| What is dissecting cellulitis of the scalp? |
|
Definition
| a simple folliculitis that begins as clusters of pustules and progresses to absces and sinus formation with scarring alopecia. Lesions are resistant to treatment and are progressive. This is rare and typically occurs in black men between 18-40. Referral. |
|
|
Term
| What is Grover's disease? |
|
Definition
| pruritic papules on trunk (typically white, older men who have been hospitalized). Possibly occlusion of sweat ducts? Exacerbated by sunlight, excessive heat, or sweating. Lesions may last weeks to years. Treatment is avoidance and symptomatic for pruritis. |
|
|
Term
|
Definition
| An abscess, boil, walled-off mass of purulent material caused by a single pathogen; firm, red, and tender nodule - may drain spontaneously |
|
|
Term
| What is furuncle treatment for a closed lesion? |
|
Definition
| Broad spectrum abx for 7-10 days; RTC in 5-9 days for incision and drainage - remove the lesion as an intact mass |
|
|
Term
| How do you dress a incised and drained furuncle? |
|
Definition
| pack the wound with iodoform gauze as needed and perform daily dressing changes - use mupirocin ointment (to avoid MRSA infection) after opened, but oral abx before that (while closed); F/U in 1-3 days |
|
|
Term
| How do you treat an open furuncle? |
|
Definition
| Carefully remove all of the lesion - looking for a sac as well as caseated material. Pack with iodoform gauze, daily dressing changes, mupirocin (Bactroban), and maybe prescribe an oral abx; F/U in 1-3 days |
|
|
Term
|
Definition
| a broad, swollen, erythematous, deep, painful follicular mass |
|
|
Term
| What symptoms are usually associated with carbuncles? |
|
Definition
|
|
Term
| How do you treat a carbuncle? |
|
Definition
| clean the area daily with soap and water; sterile dressing if purulence; mupirocin to open wounds; wound culture; abx - fluoroquinolone, tetracycline, or amoxicillin/clavulanate |
|
|
Term
|
Definition
| tender red edematous plaque; often found on the face along the jaw line |
|
|
Term
| What is bullous erysipelas? |
|
Definition
| tender red edematous plaque with bullous formation; legs and face are primary sites |
|
|
Term
| What typically causes bullous erysipelas? |
|
Definition
|
|
Term
| What other symptoms are typically seen with bullous erysipelas? |
|
Definition
| lymphangitis, fever, chills |
|
|
Term
| What is the recurrence rate of bullous erysipelas and why? |
|
Definition
| 30% because of lymphatic obstruction |
|
|
Term
| What is the treatment for bullous erysipelas? |
|
Definition
rupture of bullae, debridement, and compression stockings
cephalexin |
|
|
Term
|
Definition
| red scaly patch with scattered crusted erosions; most common bacterial skin infection in children |
|
|
Term
| What season is impetigo most commonly seen in? |
|
Definition
|
|
Term
| What is the treatment for impetigo? |
|
Definition
| clean the area daily - not with topical disinfectant; mupirocin, retapamulin - ointments or cephalexin, dicloxacillin - oral abx |
|
|
Term
|
Definition
| linear, lymphagatic red edematous plaque |
|
|
Term
| What is the treatment for lymphangitis? |
|
Definition
| immobilizaion and elevation of the infected area; parenteral abx - penicillin, then after fever abates switch to oral penicillin for 10 days |
|
|
Term
| When is cellulitis a medical emergency? |
|
Definition
| When it involves the periorbital area |
|
|
Term
|
Definition
| history of a minor wound that begins an infection |
|
|
Term
| How do you treat cellulitis? |
|
Definition
| cephalexin (Keflex), amoxicillin/clavulanate (Augmentin), or tirmethoprim/sulfamethoxazole (Bactrim) |
|
|
Term
| How do you treat serious cellulitis? (orbital cellulitis or large areas of infection) |
|
Definition
|
|
Term
| What is necrotizing fasciitis? |
|
Definition
| rapidly progressive painful erythema and edema of an area following history of a minor wound |
|
|
Term
| What factors are included in calculating the risk that an infection is necrotizing fasciitis? |
|
Definition
| C-reactive protein, WBC count, Hemoglobin, Sodium level, Creatinine level, and Glucose level |
|
|
Term
| What is a diabetic foot ulcer? |
|
Definition
| a well demarcated necrotic ulcer found on the foot of a diabetic patient; ulcerated plaques over weight bearing areas |
|
|
Term
| Are diabetic ulcers polymicrobial? |
|
Definition
|
|
Term
| What is the % of diabetic patients that develop a foot ulcer during their lifetime? |
|
Definition
|
|
Term
| How many diabetics are there in the U.S.? |
|
Definition
|
|
Term
| Give 2 reasons diabetics get diabetic foot ulcers. |
|
Definition
1. Peripheral sensory neuropathy - prone to injury
2. Peripheral motor neuropathy - affects normal roll over process of joints leading to pressure points |
|
|
Term
| What is the treatment for diabetic foot ulcers? |
|
Definition
PREVENTION
Rule out osteomyelitis
Oral broad specrum antibiotic - fluoroquinolone, amoxicillin/clavulanate
Debridement of the wound to bleeding margins
Daily care |
|
|
Term
| How can you prevent diabetic foot ulcers? |
|
Definition
Keep sugars under control long term
Annual foot exams
Good socks and shoes - change shoes often
Inspect foot daily
Wash feet and dry between toes
Treat any break in the skin, rashes, or onychomychoses promptly |
|
|
Term
| How do you rule out osteomyelitis in a diabetic foot ulcer? |
|
Definition
|
|
Term
| How long do you dose an oral abx for a diabetic foot ulcer? |
|
Definition
| 10-14 days, if no S/S of infection, discontinue |
|
|
Term
| How long does treatment of a diabetic foot ulcer last? |
|
Definition
| minimum of 6 weeks - they heal slowly |
|
|
Term
| When do you use IV abx for diabetic foot ulcers? |
|
Definition
| if extensive area or if osteomyelitis is suspected |
|
|
Term
| How far do you debride the diabetic foot ulcer? |
|
Definition
|
|
Term
| Why should you not use Hydrogen peroxide and antiseptic cleaners when trying to get a wound to heal? |
|
Definition
| they retard wound healing by killing the new cells trying to reform |
|
|
Term
| What should daily care of a diabetic foot ulcer include? |
|
Definition
| washing with soap and water, mupirocin (Bactroban) ointment, and clean sterile dressing |
|
|
Term
| What is a more intense treatment for diabetic foot ulcers? |
|
Definition
| becaplermin (Regranex) 0.1% gel |
|
|
Term
| What is in becaplermin (Regranex) 0.1% gel? |
|
Definition
| platelet-derived growth factors (PDGFs); these recruit cells around the ulcer and initiate the second phase of healing - proliferation |
|
|
Term
| What is important to note about becaplermin (Regranex)? |
|
Definition
| It is a 12-hour topical treatment. Apply it in the AM and remove in the PM. Use an abx cream/ointment at night. |
|
|
Term
| What non-drug treatment is used as part of more intense treatment of diabetic foot ulcers? |
|
Definition
| relieving pressure by casting or using half shoes, boots and other devices |
|
|
Term
| How often do diabetic foot ulcers need to be debrided? |
|
Definition
|
|
Term
| What is the average time for a healing of a diabetic foot ulcer? |
|
Definition
|
|
Term
| How do you treat foot ulcers in those with peripheral vascular disease? (PVD) |
|
Definition
| debride, place a sterile dressing, then apply an Unna boot |
|
|
Term
|
Definition
| a gauze bandage impregnated with a zinc ointment; it relieves edema and promotes healing |
|
|
Term
| How often does an Unna boot need to be replaced? |
|
Definition
|
|
Term
| What % of melanomas appear on the plantar surface? |
|
Definition
|
|
Term
| In what ethnicity is the plantar surface of the foot the most common location of melanoma? |
|
Definition
|
|
Term
| What is a decubitus ulcer? |
|
Definition
| a pressure sore; usually induced by lying in one position for too long - which compromises the blood supply to the skin |
|
|
