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Flashcards in FNP-Integument Deck (33)
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1

Rocky Mountain Spotted Fever (RMSF)

(Rickettsia rickettsii parasite)

>60% occur in south eastern to south central states, NC, OK, AK, TN, MO

caused by an infected wood tick bite

Most cases btw April to Sept. (Spring to Summer)

Highest incidence in >40 yo, Native Americans, and males.

  • Aburpt onset of fever, chills, severe HA, n/v, photophobia, myalgia, arthralgia.
  • followed by a rash 2-5 days later.
    • petechiae, starts on wrists, forearms and soles. Progessses towards trunk and then becomes generalized.
  • Labs: antibody R. rickettsii antibodies 
    • CBC, LFTs, CSF
  • 1st line tx=doxycycline BID, for 7-14 days
    • effective if within 5 days.
  • Complications=death, neurological sequelae (hearing loss, paraparesis, neuropathy, etc.)

2

Erythema Migrans (Early Lyme Dz)

(Borrelia burgdorferi)

  • Most common in North-eastern US
  • Classic lesion is a "target lesion"
  • appears ~7-14 days after a deer tick bite
  • hot to touch, with rough texture.
  • Commonly in belt area, axillary line, behind the knees, and groin
  • Rash spontaneously resolves in a few weeks
  • Flu-like symptoms
  • Labs (two step/two tier testing recommended:
    • enzyme immunoassay (EIA), if neg. no further testing necessary
    • If pos., "western blot" test (indirect immunofluorescence assay)
  • Tx (early Lyme only):
    • Doxy BID, x10 days (first line for kids and adults)
    • Alternative=amox. 500mg, TID or Ceftin 500mg BID, x14 day
  • Complications:
    • Neuropathy
    • Lyme arthritis, chronic fatigue

3

Impetiago

"Honey colored" crusts

fragile bullae

pruritic

4

Measles

Koplik's spots

  • small, white, round spots on red base on buccal mucosa by rear molars

5

Scabies

(Sarcoptes scabiei mite)

  • Caused by burrowing mites
  • Transmitted by close contact
  • itchiness may last or 2-6 weeks post tx d/t rxn to mites and their feces
  • Extremely pruritic, esp. at NIGHT
  • serpiginous rash on interdigit webs, waist, axilla and genitals
  • Treatment:
    • Elimite (permethrin 5%) from neck to feet for 8-14 hours
    • treat entire household
    • Itching may be treated with benadryl and topical steroids

6

Scarlet Fever

classic "sand paper" rash with fever

 

7

Tinea Versicolor

  • Hyperpigmented round to oval macular rashes on upper shoulders and back
  • not pruritic

8

Pityrisasis rosea

Classic "Christmas Tree" pattern (rash on cleavage lines)

starts with herald patch (looks like regular ringworm) is the largest lesion

9

Molluscum contagiosum

Smooth papules, 2-5 mm in size

Dome shaped with central umbilication ("white plug")

Caused by poxvirus

Spread by direct skin to skin contact

Be concerned if on genitals of kids

CDC considers a STI if on sexually active adolescents and adults

  • no need to treat, will clear in 6-12 months

10

Meningococcemia

(Meningitis)

  • caused by Neisseria meningitidis.
  • Aerosol droplet precautions
  • high risk in 1st year college student in dorms and people with no spleen
  • rapid progression to DEATH within 48 hours in fulminant form
  • Sudden sore throat, cough fever, HA, stiff neck (nuca rigidity), photophobia, and changes in LOC
  • petechial to hemorrhagic rashes in axillae, flanks, wrists and ankles (50-80% of cases)
  • Refer to ED
  • Prophylactic treatment for close contacts:  Rifampin BID for 2 days

 

11

Shingles

(Secondary Varicella-Zoster Virus Infection)

  • reactivation of varicella-zoster virus(primary infection=chickenpox)virus that was latent in a dermatome
  • Contagious with onset of rash until lesions have crusted over
  • Affects the elderly or older adults more often
  • Acute onset of groups of papules and vesicles on a red base that rupture and become crusted
  • lesions follow a dermatome on one side of body
  • severe pain/burning at site prior to breakout
  • May last 2-4 weeks
  • Gold standard labs: viral culture, PCR for VZV
  • Treat with acyclovir 5x daily or valcyclovir BID, 10 days
  • Refer to opthalmology or ED if eye affected

12

Melanoma

ABCDE screening 

A=asymmetry

B=border irregularity

C=color varies in same region

D=diameter >6mm

E=enlargement or chnage in size

13

Basal Cell Carcinoma

(BCC)

Pearly or waxy appearance

Atropic or ulcerated center that does not heal

Color: white, light pink, brown or flesh-colored.

Telangeictasias present

 

14

Actinic Keratosis

Precancerous (squamous cell carcinoma) lesion

Hx chronic sun exposure, past hx blistering sun burns as a child

Most common on cheeks, nose, face, neck, arms and back (high sun exposure)

  • Numerous dry, round pink to red lesions with rough, scaly texture that do not heal
  • Slow growing
  • Refer to derm for biopsy (gold standard)
  • Treatment=cryotherapy to 5 FU cream

 

15

Subungual hematoma

Blood blister under a nail

Treat by draining blood (trephination). Basically, creating a hole in the nail with a heated, sterile needle or paperclip

16

Seborrheic keratosis

17

Xanthelasma

18

Lipoma

19

Acanthus nigrans

Associated with: Diabetes, metabolic syndome, obesity, GI tract CA (rare)

20

Psoriasis

21

Atopic dermatitis (Eczema)

22

Clenched Fist Injuries

23

Erysipelas

24

Bites: Human, dog, cat

25

Hidradentitis suppurtiva

26

Tinea (ringworm) Infxns

types, treatment

Capitis=scalp

Pedis=foot

Corporis or Circinata=body

Cruris=groin (jock itch)

Manuum=hands

Barbae=beard area

27

Acne Vulgaris

mild and moderate treatment

mild

moderate

 

28

Severe Custic Acne

29

Burns

1st, 2nd, 3rd degree descriptions

30

Burns

Total Percentage Body Surface Area (TBSA)

Rule of Nines for Chiuldren & Adults

 

 

TBSA "Rule of Nines"

Children

  • Body surface=9% for each arm
  • Body surface=14% for each leg
  • Body surface=18% for ant. truck and post. trunk

Adults

  • Body surface=9% for each arm, head
  • Body surface=18% for each whole leg, ant. truck or post. trunk

example:

adult with bright red skin on right arm and right thigh. Chest and abdominal area are bright red with several bullae.

Superficial thickness (1st deg) on arm=9%, right thigh= 9% (only helf of whole leg), and partical thickness (2nd deg.) on chest and abdomin (ant. trunk). TBSA=36%