NUR 611 1 - EXAM 1 - REVIEWER QUESTIONS & VERIFIED ANSWERS

Dermatology

Skin and Soft Tissue Infections: (SSTI)
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● 2 most common bacteria that cause skin infections: S. Aureus & S. pyogenes
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○ Gram (+) - Staph - most common - can cause MRSA
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○ Gram (-) - present in wound infections caused by:
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■ animal bites rs


■ trauma or surgery rs rs



■ exposed to infected water (E.coli, pseudomonas aeruginosa, proteus rs rs rs rs rs rs rs rs


mirabilis)
● Skin infections can be non-purulent or purulent
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Folliculitis, Furuncle, Carbuncle
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● Most commonly caused by S. Aureus - MRSA
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● Common in athletes, shaving, waxing, hot tubs
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● Occurs in areas with coarse hair
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➔ Presentation:
◆ Pustules in hair shaft rs rs rs


◆ Tenderness and redness rs rs


◆ If recurrent - ask if pt has DM
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◆ No diagnostics/labs needed - usually
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● If recurrent furuncles and carbuncles rs rs rs rs


○ Culture
● If MRSA suspected rs rs



○ Culture nares and axilla rs rs rs



➔ Treatments:
◆ Hygiene
◆ Warm, moist compress rs rs


◆ Betadine/Hibiclens wash (Antiseptic wash) rs rs rs




➔ Treatment for Folliculitis rs rs


◆ Benzoyl Peroxide 5%, Bactroban TID rs rs rs rs


◆ Clindamycin gel rs




➔ Treatment for Purulent SSTI rs rs rs


◆ 1st line - Incision & Drainage (I&D)
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◆ C&S

, ➔ Treatments for Furuncle and Carbuncle (PO)
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◆ Keflex 500mg (Cephalosporin 1st Gen) q12 x 10-14 days
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◆ MRSA
● Bactrim DS OD (Sulfonamide) x 10 -14 days rs rs rs rs rs rs rs



● Clindamycin 300 mg q6h x 14 days rs rs rs rs rs rs




Cellulitis
● Most caused by MRSA, Strep, H. Flu
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● Differential DX:
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○ Gout
○ Dermatitis
○ Herpes Zoster rs




➔ Presentation:
◆ Erythema
◆ Warmth
◆ Pain
◆ Lymphedema
◆ Fissuring
◆ Abscess

➔ Diagnostic test/Labs:
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◆ C&S
◆ CBC (Leukocytosis)
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◆ Blood CX, ESR rs rs


◆ Imaging to r/o OM rs rs rs




➔ Management:
◆ Hygiene, elevation, moist heat rs rs rs


◆ Pharma:
● Uncomplicated/nonsystematic:
○ PCN 500 mg q6 rs rs rs



○ Keflex 500 mg q12 x 10-14 days rs rs rs rs rs rs



◆ IDSA - rx min 5 days, extend if no improvement rs rs rs rs rs rs rs rs rs


○ MRSA:
◆ Bactrim DS OD x 10-14 days rs rs rs rs rs


◆ Clindamycin 300 mg q6h rs rs rs

, ◆ Pt w/ comorbidity: DM/HF
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● Non-ulcer
○ Amoxicillin/Clavulanate 500 mg q12h x 7-10 days rs rs rs rs rs rs



○ Quinolone - Cipro 500-750 mg q12h x 7-14 days rs rs rs rs rs rs rs rs



◆ Gram (-) and anaerobic coverage rs rs rs rs


● Mild ulcer rs


○ Cipro + Clindamycin rs rs




◆ Follow up: 48 HOURS!!! rs rs rs




➔ Refer to ID /Hospitalize pts if:
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◆ Immunocompromised pt = HOSPITAL ALWAYS! rs rs rs rs


◆ S/s of toxicity rs rs


● T >100.5 rs



● Hypotension
● Sustained tachycardia rs


◆ Rapid progression of erythema rs rs rs


◆ Rapid progression of clinical findings after 48hrs of antibx tx
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◆ Inability to tolerate oral therapy rs rs rs rs


◆ Proximity of the lesion to an indwelling medical device (prostethic jt or
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vascular graft)
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◆ Periorbital cellulitis = INPATIENT TX/ REFER ALWAYS! rs rs rs rs rs rs


◆ Refer to ID: hand infection, infection from bites (consider admission)
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Dermatitis:
● Contact Dermatitis
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○ Allergic
■ Causes: Nickel (jewelry), medications (topical cream/ointments), poison rs rs rs rs rs rs rs


oaks, personal products rs rs



■ Location: exposed areas, usually hands rs rs rs rs



■ Symptoms: predominantly pruritus rs rs


■ Surface appearance: vesicles and bullae rs rs rs rs



■ Lesion borders: distinct angles, line, and borders rs rs rs rs rs rs



○ Irritant
■ Causes: solvents, bleach, alcohol, chemicals in personal products rs rs rs rs rs rs rs



■ Location: usually hands rs rs



■ Symptoms: burning, pruritus, pain rs rs rs



■ Surface appearance: dry fissured skin rs rs rs rs


Lesion borders: less distinct rs rs rs

, ➔ Diagnostics:
◆ Thorough H&P rs


◆ diagnostic/labs - usually not necessary unless infection is suspected
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● KOH
● Culture
● Patch testing to identify contact allergen - dermatologist
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➔ Management:
◆ Symptom management rs


◆ Identify causative agents and avoid
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◆ Prevent infection rs


◆ Pharma:
● Calamine lotion, cool colloidal oatmeal bath to reduce pruritus rs rs rs rs rs rs rs rs



● Benadryl 25-50 mg PO PRN rs rs rs rs



● Mild cases rs



○ Hydrocortisone cream in a non-rx strength eg: 0.1% rs rs rs rs rs rs rs



○ Mid - high potency topical steroids BID: rs rs rs rs rs rs



◆ Triamcinolone 0.1% - Kenalog, Aristocort rs rs rs rs


◆ Clobetasol 0.05% - Temovate rs rs rs


● Barrier cream - Zinc oxide - moisture and protect skin
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◆ Use of RX corticosteroid:
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● No improvement in rash or cont to spread 2-3 days of self-care
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● Itching and/or pain is SEVERE. rs rs rs rs



◆ Use PO or IM systemic therapy:
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● Large portion of skin (20%) rs rs rs rs



● Genital or periorbital area rs rs rs



● If very severe rs rs



● Prednisone 0.5 - 1 mg per kg/day rs rs rs rs rs rs



○ s/s should subside in 12-24 hrs rs rs rs rs rs



○ If tx is effective after initial therapy, dose reduce by 50% x 5-
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7 days rs



◆ Antihistamines - can help w/ pruritus but side effects can help
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➔ Education: NO scratching, identify and avoid causative agent, MOISTURIZE
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● Atopic Dermatitis
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○ Most common in Asian and AA
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➔ Presentation:
◆ Dry skinrs


◆ Flexural surface rs


◆ Lichenification and scaling - chronic rs rs rs rs


➔ Diagnostic criteria:
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