Final Exam NR 511|170 Complete
Questions with Answers
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 (PSGN) - -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 tx - -mupirocin - inhibits bacterial protein synthesis
Doxycycline, clindamycin, or tiimethoprim-sulfamethoxazole (Bactrim)
-Staphylococcal Scalded Skin Syndrome (SSSS) - -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.
-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 caused by - -The most common are beta-hemolytic streptococci
(A,B,C,G, and F)
S. Aureus (gram +)
-Predisposing factor 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
-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
-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
-Human or animal bite - -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.
-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
-Stress incontinence - -Cause:
Failure to store due to hypermobility of bladder neck, intrinsic sphincter
deficiency, neurogenic sphincter deficiency medications: sedatives,
hypnotics, antispasmodics.
Sx:
Leakage during a cough or sneeze
Tx:
Management: Kegels, weight loss and estrogen
-Urge incontinence AKA (Overactive Bladder) OAB - -Cause:
failure to store due to uti, vaginitis; bladder stones, tumors, cortical,
subcortical, and suprsacral lesions; CVA accident, dementia, multple
sclerosis: Detrusor instability
Sx:
Questions with Answers
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 (PSGN) - -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 tx - -mupirocin - inhibits bacterial protein synthesis
Doxycycline, clindamycin, or tiimethoprim-sulfamethoxazole (Bactrim)
-Staphylococcal Scalded Skin Syndrome (SSSS) - -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.
-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 caused by - -The most common are beta-hemolytic streptococci
(A,B,C,G, and F)
S. Aureus (gram +)
-Predisposing factor 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
-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
-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
-Human or animal bite - -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.
-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
-Stress incontinence - -Cause:
Failure to store due to hypermobility of bladder neck, intrinsic sphincter
deficiency, neurogenic sphincter deficiency medications: sedatives,
hypnotics, antispasmodics.
Sx:
Leakage during a cough or sneeze
Tx:
Management: Kegels, weight loss and estrogen
-Urge incontinence AKA (Overactive Bladder) OAB - -Cause:
failure to store due to uti, vaginitis; bladder stones, tumors, cortical,
subcortical, and suprsacral lesions; CVA accident, dementia, multple
sclerosis: Detrusor instability
Sx:
