NR511 Final Exam Study Guide See Midterm and Week 1 Study Guide for content covering weeks 1, 2 & 3

Common Infections 1. Impetigo Caused by Staph aureus Group Streptococcus (GAS) Occasional MRSA Most commonly seen in 2-5 years of age population. Easily spread in close environments. Risk Factors: Poverty, crowding, poor hygiene, and underlying scabies Nonbullous impetigo papulues that progress to vesicles and pustules rupture and become encrusted sores. Golden honey appearance. Involving face and extremities Bullous impetigo Vesicles enlarge to form a faccid bullae with clear yellow fluid, leaving a thin brown crust. Trunk is more frequently affected. If an adult w/ appropriate demographic risk factors should prompt an HIV investigation. Ecthyma Group A beta-hemolytic streptococci- GAS ulcerative form in which the lesions extend through the epidermis and deep into the dermis. "punched out" ulcers, with yellow crust. Poststreptococcal glomerulonephritis Nephritic syndrome that arises after group A beta-hemolytic streptococcal infection of the skin (impetigo) or pharynx. Edema, HTN, Fever, and Hematuria Must treat with oral antibiotic Treatment for Impetigo Limited skin involvement Mupirocin (Bactroban) TID Retapamulin BID Patient's with numerous affected areas (Tx: S.Aureus and GAS) Dicloxacillin seven days Cephalexin seven days if is only only GAS then Penicillin is preferred MRSA impetigo treatment mupirocin - inhibits bacterial protein synthesisDoxycycline, clindamycin, or tiimethoprim-sulfamethoxazole (Bactrim) 2. Staphylococcal Scalded Skin Syndrome Staphylococcus aureus, epidermal necrosis caused by bacterial exotoxins. Epithelial layer peeling off in large sheetlike pieces. Mimics scalded-skin thermal burn. More common in children. Found in places where skin rubs together. 3. Cellulitis an acute, diffuse inflammation of the skin and subcutaneous tissue characterized by local heat, redness, pain, and swelling. Typically unilateral common site is lower extremities. Middle aged and older adults. Erythema, edema, warmth, and pain. "peau d’orange" Cellulitis is caused by The most common are beta-hemolytic streptococci (A,B,C,G, and F) S. Aureus (gram +) Predisposing factors to cellulitis Tina pedis, lymphedema, and chronic venous insufficiency. Cellulitis treatment Beta-hemolytic streptococci and methicillin-susceptible staphylococcus areus (MSSA): tx: Cephalexin 500mg QID (alternative for mild PCN allergy) Clindamycin 300mg QID (severe PCN allergy) Not associated with Human or animal bites uncomplicated (Dicloxacillin or cephalexin 10-14 days. PCN allergy=Erythromycin If caused by human or animal bite Augmentin 2 weeks MRSA coverage cellulitis Add Amoxicillin to bactrim DS bid, doxycycline bid, minocycline 200 once and then 100 bid, Clindamycin No other coverage needed 4. Erysipelas -Involves upper dermis, superior lymphatics -raised above level of surrounding skin -fever and chills with acute onset -often affects ear (Milian's ear sign), face, and lower extremities -commonly caused by group a strep infection 5. Necrotizing fasciitis inflammation of fascia producing death of the tissue. Progressive infection measured in terms of hours instead of days. progressive destruction of the muscle fascia. Pressure on the skin reveals crepitus due to gas production is caused by clostridium perfringens 6. Mammalian bites amoxicillin-clavulanic acid + tetanus prophylaxis +/- rabies prophylaxis 3 to 5 days.Human=Staph aureus or strep. Do not suture hand wounds wait 3 to 5 days post treatment. Pasteurella multocida -Cellulitis, osteomyelitis -Animal bite, cats, dogs. Intense pain, erythema, and swelling. 12-24 hours post bite. Urology 1. Hematuria blood in the urine; if present in large enough quantities, urine may be bright red or reddish brown (myoglobin, hemoglobin, or porphyrins).Pyridium can cause reddish orange color Bladder cancer cardinal sign Gross pain less hematuria