Derm part 2

Question 1

Organism of scabies

Answer 1

Sarcoptes scabiei

Question 2

What is the hallmark presentation of scabies?

Answer 2

Severe and paroxysmal itching

Question 3

Eruption of scabies in children

Answer 3

Eczematous eruption composed of red, excoriated papules and nodules

Question 4

Distribution of scabies

Answer 4

Axillae
Umbilicus
Groin
Penis
Instep of the foot
Web spaces of the fingers and toes

Question 5

Scabies in infants

Answer 5

Diffuse erythema, scaling and pinpoint papules

Question 6

How to confirm the dx of scabies

Answer 6

Microscopic visualization of the mite, eggs, larvae, or feces in scrapings of papules or burrows examined under oil immersion

Question 7

Tx of scabies

Answer 7

12-hr application of permethrin 5% cream applied to the entire body
Repeat 1 wk later
Treat all close contacts
Wash all bed linens, towels, and clothes worn for the previous 2 days before tx in hot water and high heat

Question 8

Transmission of lice

Answer 8

Direct contact with another infested individual
Indirect through:
-Contact with fomites
-Hairbrushes
-Combs
-Caps

Question 9

What is the primary symptom of lice?

Answer 9

Itching

Question 10

Location of pediculosis capitis itching

Answer 10

Behind the ears or on the nape of the neck, or a crawling sensation in the scalp

Question 11

Dx of head lice

Answer 11

Visualization of a live louse through wet combing

Question 12

Which type of nits suggests active infestation?

Answer 12

Brown nits located on the proximal hair shaft

Question 13

Tx of head lice

Answer 13

Over the counter permethrin and pyrethrin-based products

Second tx should be applied in 7-10 days

Question 14

Tx of resistant head lice

Answer 14

Malathion lotion

Question 15

Causative organism of warts

Answer 15

HPV

Question 16

How are common warts transmitted?

Answer 16

Direct contact or by fomites

Question 17

Description of common wart

Answer 17

Painless, well-circumscribed, 2-5 mm papule with a papillated or verrucous surface typically distributed on the fingers, toes, elbows, and knees.

Question 18

Filiform warts

Answer 18

Verrucous, exophytic, 2 mm papules that have a narrow or pedunculated base

Question 19

Flat warts

Answer 19

Multiple, flat-topped 2-4 mm papules clustered on the dorsal surface of the hands, soles of the feet (plantar warts), or on the face

Question 20

Tx of warts except genital

Answer 20

Typically self-limited and resolve spontaneously without tx
Salicylic acid
Liquid nitro
Laser therapy

Question 21

3 subclasses of urticaria

Answer 21

Acute
Chronic
Physical

Question 22

Acute urticaria

Answer 22

Hives that last <6 wks

Question 23

Chronic urticaria

Answer 23

Persistence of sx beyond 6 wks

Can be daily sx or intermittent or recurrent

Question 24

Physical urticaria

Answer 24

Characterized by known eliciting external factors that may include pressure, cold, heat, exercise, or exposure to sun or water

Question 25

What is the most common physical urticaria?

Answer 25

Dermatographism

Question 26

Dermatographism

Answer 26

Characterized by an urticarial reaction localized to the site of skin trauma

Question 27

Cholinergic urticaria

Answer 27

The appearance of 1-3 mm wheals surrounded by large erythematous flares after an increase in core body temp

Question 28

Causes of cholinergic urticaria

Answer 28

Strenuous exercise Hot bath Emotional stress

Question 29

Cold urticaria

Answer 29

Occurs with exposure to cold and may develop within minutes on areas directly exposed to cold or on rewarming of the affected parts

Question 30

PE of urticaria

Answer 30

Raised erythematous lesions with pale centers that are intensely pruritic Lesions vary in size and can occur anywhere on the body

Question 31

Timing of urticaria

Answer 31

Arises suddenly and may resolve within 1-2 hrs or may persist for 24 hrs.

Question 32

Tx of urticaria

Answer 32

Second generation H1 antihistamines Add sedating H1 antihistamines or H2 antihistamines at bedtime if needed TCAs for H1 and H2 activity Montelukast

Question 33

What are the four criteria upon which burns are classified?

Answer 33

Depth of injury Percent of body surface area involved Location of the burn Association with other injuries

Question 34

Superficial burns

Answer 34

Red, painful, and dry Commonly seen with seen with sun exposure or mild scald injuries Involve injury to the epidermis only Heal in 2-5 days without scarring Not included in burn surface area calculations

Question 35

Superficial partial-thickness burns PE

Answer 35

Involve the entire epidermis and superficial dermis | Have fluid-containing blisters.

Question 36

Tx and healing of superficial partial-thickness burns

Answer 36

Debridement | Healing usually occurs within about 2 wks without the need for skin grafting and without scarring.

Question 37

Deep partial-thickness burns PE

Answer 37

Involve the entire epidermis and deeper portions of the dermis

Question 38

Characteristics of superficial partial-thickness burns after tx

Answer 38

Underlying dermis appears erythematous and wet, will be painful, and will blanch under pressure

Question 39

Dermal base of deep partial-thickness burns

Answer 39

Less blanching Mottled pink or white Less painful than superficial partial-thickness burns

Question 40

Tx of deep partial-thickness burns

Answer 40

Excision and grafting

Question 41

Full-thickness burns PE

Answer 41

Involve all skin layers Dry, white, dark, red, brown, or black in color Do not blanch and are usually insensate

Question 42

Tx of full-thickness burns

Answer 42

Surgical management

Question 43

When to suspect inhalation injuries with burns

Answer 43

Facial burns Singed nasal hairs Carbonaceous sputum Hoarseness on vocalization

Question 44

Rule of 9s for children

Answer 44

Face: 18% Torso: 18% each for both front and back Arms: 9% Legs: 14%

Question 45

Labs for major burns

Answer 45

``` CBC Type and crossmatch Coagulation studies Basic chem profile ABG CXR ```

Question 46

Labs for suspected inhalation exposure for burns

Answer 46

Carboxyhemoglobin assessment

Question 47

Labs for children who sustain smoke inhalation and have AMS

Answer 47

Cyanide levels

Question 48

Burn center transfer criteria

Answer 48

Partial and full-thickness burns >10% total body surface area in pts <10 yrs old or >50 yo or >20% TBSA in other age groups Partial and full-thickness burns involving the face, hands, feet, genitalia, perineum, or major joints Electrical burns Chemical burns Inhalation injury Burn injury in pts with preexisting medical conditions that could complicate management, prolong recovery, or increase mortality rate Any burn with concomitant trauma Burn injury in children with ill-euqipped hospitals Children who required social, emotional, or rehabilitative support

Question 49

Tx of burns

Answer 49

``` ABCs Fluid management- children with a significant burn should get rapid bolus of 20 mL/kg LR solution Nutritional support Wound care Pain control ```

Question 50

Common topical agents for burns

Answer 50

``` Silver sulfadiazine Polymyxin B/bacitracin/neomycin Alternatives: Silver nitrate Mafenide acetate ```