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FNP ANCC > Integumentary > Flashcards

Integumentary Flashcards

1
Q

Anaphylaxis

A

S&S Angioedema and hives
flushing, hives, angioedema, dyspnea, wheezing, tachycardia or bradycardia, hypotension, hypoxia, or cardiac arrest

Cause: Food, insect sting, drugs
Immune globulin E

Onset: Acute onset
Minutes to several hours

Tx: Epinephrine IM 1 mg/mL 0.3mg to 0.5mg to mid-outer thigh
Repeat every 5 to 15 min

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2
Q

Rocky Mountain spotted fever (RMSF)

A

S&S: abrupt onset of high fever, chills, severe headache, nausea/vomiting, photophobia, myalgia, and arthralgia followed by a rash that erupts 2 to 5 days after onset of fever.

Rash: small red spots (petechiae) that start to erupt on the wrist, forearms, and ankles (sometimes the palms and soles). It rapidly progresses toward the trunk until it becomes generalized

10% have no rash

Tx: doxycycline

Prevention: DEET containing products

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3
Q

Brown recluse spider bites

A

Brown recluse spiders (Loxosceles reclusa) are found in midwestern and southeastern United States.

S&S fever, chills, nausea, and vomiting. Deaths are rare but more common in children (younger than 7). Any child with systemic signs should be hospitalized (the condition may cause hemolysis).

Most spider bites are located on the arms, upper legs, or trunk (underneath clothing). Bite may feel like a pinprick (or be painless). The bitten area becomes swollen, red, and tender, and blisters appear within 24 to 48 hours. Central area of bite becomes necrotic (purple-black eschar). When the eschar sloughs off, it leaves an ulcer, which takes several weeks to heal.

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4
Q

Erythema Migrans (Early Lyme Disease)

A

classic lesion: expanding red rash with central clearing that resembles a target. appears within 7 to 14 days and spontaneously resolves within a few weeks.
The rash feels hot to the touch and has a rough texture. Accompanied by flu-like symptoms.
Common locations: belt line, axillary area, behind the knees, and groin area.
northeastern regions.

Prevention: DEET-containing repellent on skin and permethrin on clothing and gear

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5
Q

Meningococcemia (Meningitis)

A

MEDICAL EMERGENCY
can progress very rapidly and cause death within several hours

C/b Neisseria meningitidis (gram neg)

S&S sudden onset of sore throat, cough, fever, headache, stiff neck, photophobia, and changes in level of consciousness. Rash in some cases

Risk factor: living in close quarters, asplenia, HIV

Vaccination for adolescents

Tx: Rifampin (twice a day for 2 days) and ceftriaxone 250 mg intramuscularly (one dose)

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6
Q

Shingles Infection of the Trigeminal Nerve (Herpes Zoster Ophthalmicus)

A

MEDICAL EMERGENCY

Cause: Reactivation of herpes zoster virus on trigeminal nerve

S&S: sudden eruption of multiple vesicular lesions on one side of scalp, forehead and sides and tip of the nose. If herpetic rash on nose, assume shingles. Eyelid can be swollen and red. C/o of photophobia, eye pain and blurred vision

Refer to ophthalmologist or ED

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7
Q

Melanoma

A

Dark-colored moles with uneven texture, variegated colors, and irregular borders with a diameter of 6 mm or larger

If in nail beds, may be very aggressive

Risk factors: fam hx, sunlight exposure, tanning beds, high nevus count, light skin/eyes.

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8
Q

Acral Lentiginous Melanoma

A

Sounds like “acra, ghana” and “Laos”

Most common melanoma in african americans and asains

Dark brown-to-black lesions on nail beds, palmar and plantar surfaces.

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9
Q

Basal cell carcinoma

A

Most common skin cancer

Pearly or waxy skin leasion w/ atrophic or ulcerated center that does not heal. Bleeds easily.

Risk factor: severe sun burn in childhood

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10
Q

Actinic keratosis

A

S&S: numerous dry, round, and red-colored lesions with a rough texture that do not heal. Slow growing.

Common locations: where sun hits, cheeks, nose, face arms, and back

High risk: light skin/hair/eyes

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11
Q

Subungual hematoma

A

Cause: Direct trauma to nail bed.

S&S: pain and bleeding trapped between nail bed and nail.

Complication: if 25% nail involved, risk of permanent ischemic damage.

Tx: draining

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12
Q

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

A

Multiple lesions start erupting abruptly and can include hives, blisters (bullae), petechiae, purpura, and necrosis and sloughing of the epidermis. Look like target.
Mucousal surface involvement (eyes, nose, mouth, esophagus, bronchial tree).
Can have prodomal of fever and flue like symptoms a few days prior

Triggers: medications (allopurinol, anticonvulsants, sulfonamides, NSAIDs)

Risk factors: HIV

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13
Q

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis difference

A

SJS is less severe (involves <10% body skin) compared with TEN (involves >30% body skin)

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14
Q

Pseudofolliculitis barbae (barber’s itch)

A

Caused by inflammation from the curly hair growing back into the skin.

The “treatment” is to let the beard hair grow for 3 to 4 weeks. Avoid shaving beard hair too short and too close to the skin.

affects up to 60% of African American men.

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15
Q

Acral

A

Distal portions of the limbs (i.e., the hand or feet [acral melanoma])

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16
Q

Annular

A

Ring-shaped (ringworm, or tinea corporis)

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17
Q

Exanthem

A

Cutaneous rash

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18
Q

Extensor

A

The skin area that is outside of the joint (e.g., front of knee, back of elbow)

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19
Q

Flexor

A

The area of the skin on top of the joint with skin folds (e.g., back of knees, antecubital space)

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20
Q

Flexural

A

Skin flexures are body folds (eczema affects flexural folds)

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21
Q

Intertriginous

A

An area where two skin areas touch or rub each other (e.g., axilla, breast skin folds, anogenital area, between the fingers/digits)

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22
Q

Maculopapular rash

A

Rash with color (usually pink to red) with small bumps that are raised above the skin (viral rashes)

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23
Q

Morbilliform

A

Rash that resembles measles (pink rash with texture)

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24
Q

Nummular

A

Coin-shaped, round (nummular eczema)

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25
Q

Purpura

A

Bleeding into the skin; small bleeds are petechial (RMSF), and larger areas of bleeding are ecchymoses or purpura (meningococcemia)

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26
Q

Serpiginous

A

Shaped like a snake (larva migrans)

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27
Q

Verrucous

A

Wartlike

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28
Q

Xerosis

A

Dry skin

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29
Q

The “A, B, C, D, E” of melanoma

A

A: Asymmetry
B: Border irregular
C: Color varies in the same region
D: Diameter >6 mm
E: Enlargement or change in size

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30
Q

Macule

A

Flat nonpalpable lesion <1 cm in diameter
Example: Freckles (ephelis), lentigo or lentigines (plural)

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31
Q

Papule

A

Palpable solid lesion ≤0.5 cm in diameter
Example: Nevi (moles), acne, small cherry angiomas

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32
Q

Plaque

A

Flattened, elevated lesion with variable shape >1 cm in diameter
Example: Psoriatic lesions

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33
Q

Bulla

A

Elevated superficial blister filled with serous fluid and >1 cm in size
Example: Impetigo, second-degree burn with blisters, SJS lesions

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34
Q

Vesicle

A

Elevated superficial skin lesion <1 cm in diameter, filled with serous fluid
Example: Herpetic lesions

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35
Q

Pustule

A

Elevated superficial skin lesion <1 cm in diameter, filled with purulent fluid
Example: Acne pustules

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36
Q

Lichenification

A

Thickening of the epidermis with exaggeration of normal skin lines due to chronic itching (eczema)

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37
Q

Scale

A

Flaking skin (psoriasis)

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38
Q

Crust

A

Dried exudate, may be serous exudate (impetigo)

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39
Q

Ulceration

A

Full-thickness loss of skin (decubiti or pressure injury)

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40
Q

Scar

A

Permanent fi brotic changes following damage to the dermis (surgical scars)

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41
Q

Keloids/hypertrophic scar

A

Overgrowth of scar tissue; more common in Blacks, Asians

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42
Q

Urticaria (Hives)

A

Erythematous and raised skin lesions with discrete borders that are irregular, oval, or round
Can be the start of anaphylaxis

considered chronic if it lasts longer than 6 weeks. Most cases are self-limited

Multiple etiologies

Ts: Eliminate the cause

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43
Q

Seborrheic Keratoses

A

Soft, wartlike, fleshy growths in the trunk that are located mostly on the back. Painless. Can range from light tan to black.

They start to appear during middle age (or later) and become more numerous as patient gets older.

44
Q

Xanthelasma

A

Raised and yellow-colored soft plaques that are usually located under the brow or upper and/or lower lids of the eyes on the nasal side.

If younger than 40, rule out hyperlipidemia. If on fingers, may be familial hyperlipidemia

45
Q

Melasma (Mask of Pregnancy)

A

Bilateral brown- to tan-colored stains located on the upper cheeks, malar area (cheeks and nose), forehead, and chin.

Cause: pregnancy, oral contraceptives

Usually permanent, can lighten over time

46
Q

Vitiligo

A

Loss of epidermal melanocytes. White patches of skin

Develop and spread over time. Chronic and progressive. Can flare.

Risk factors: autoimmune disease

Refer to derm. Use sunscreen and avoid prolonged sun exposure.

47
Q

Cherry Angioma

A

Benign small and smooth round papules that are a bright cherry-red color. Always blanch with pressure

Patho: nest of malformed arterioles in the skin

No treatment needed

48
Q

Lipoma

A

Soft, fatty cystic tumors that are usually painless and are located in the subcutaneous layer of the skin. Asymptomatic unless irritated or ruptured

PE: feel smooth with a discrete edge

Can be surgically removed

49
Q

Nevi (Moles)

A

Round macules to papules (junctional nevi) in colors ranging from light tan to dark brown. Often found in trunk and lower extremeties.

Junctional nevi: macular or minimally raised with colors ranging from brown to black.

Compound nevi: pigmented papules and vary in color from tan to medium brown.

50
Q

Xerosis

A

Inherited skin disorder that results in extremely dry skin and may involve mucosal surfaces such as the mouth (xerostomia) or the conjunctiva of the eye (xerophthalmia).

51
Q

Acanthosis Nigricans

A

Diffuse velvety thickening of the skin that is usually located behind the neck and on the axilla

Associated with diabetes, metabolic syndrome, obesity, and cancer of the gastrointestinal (GI) tract.

52
Q

Acrochordon (Skin Tags)

A

Painless and pedunculated outgrowths of skin that are the same color as the patient’s skin

When twisted or traumatized (e.g., gets caught on a necklace), the outgrowth can become necrotic and drop off the skin.

More common with diabetes and obesity

53
Q

Topical steroids and classes

A

Halobetasol propionate 0.5% (Ultravate)
Class I (super-high) Daily–BID (max 2 weeks)

Halcinonide 0.1% (Halog)
Class II (high) BID–TID

Triamcinolone acetonide 0.1% (Kenalog)
Class III (medium-high) BID–TID

Mometasone furoate 0.1% (Elocon)
Class IV (medium) BID–QID

Desonide 0.05% (Desonate)
Class V (low-medium) BID–QID

Fluocinolone acetonide 0.01% (Synalar)
Class VI (low) BID–QID

Hydrocortisone 1% (OTC; no Rx needed)
Class VII (least potent) BID–QID

54
Q

Topical steroid treatment recommendations based on class

A

Super-high potency: Use for severe dermatoses (psoriasis, severe eczema) on nonfacial and nonintertriginous areas for up to 2 weeks. Works well on palms, scalp, and soles, which have “thicker” skin.

Medium-high potency: Use on mild-to-moderate nonfacial and nonintertriginous areas

Low-medium potency: Use on larger areas that need treatment

Low-potency: Use on eyelid and genital areas for limited duration. Ophthalmic form of topical steroid is used on eyelids.

(intertriginous: places that rub)

55
Q

Can you use steriods for fungal infections?

A

No, it may worsen the infection. Stay away if fungus suspected

56
Q

How long should you wait to apply steroid cream after bathing?

A

Within 3 minutes

57
Q

What steroids should you avoid with children and sensitive areas? What is the potential adverse effect?

A

Do not use fluorinated topical steroids. Use class 7 (least potent) topical steroids, such as 0.5% to 1% hydrocortisone.

Hypothalamic–pituitary–adrenal (HPA) axis suppression may occur with excessive or prolonged use (>2 weeks), especially in infants and children, or with use of potent to ultrapotent topical steroids. These agents can cause striae, skin atrophy, telangiectasia, acne, and hypopigmentation.

58
Q

Psoriasis

A

Inherited skin disorder in which squamous epithelial cells undergo rapid mitotic division and abnormal maturation. The rapid turnover of skin produces the classic psoriatic plaque.

S&S: pruritic erythematous plaques covered with fine silvery-white scales along with pitted fingernails and toenails. If psoriatic arthritis will c/o painful red, warm and swollen joints

Types of phenotypes: plaque (80%), guttate, inverse, erythrodermic, and pustular psoriasis.

Tx: Topical steroids, topical retinoids (tazarotene), tar preparations (psoralen drug class)
Severe disease: Methotrexate, cyclosporine, biologics (etanercept, adalimumab)

59
Q

Koebner phenomenon

A

New psoriatic plaques form over areas of skin trauma

60
Q

Auspitz sign

A

Pinpoint areas of bleeding in the skin when scales from a psoriatic plaque are removed

61
Q

Actinic Keratoses

A

Precancerous precursor to squamous cell carcinoma

S&S: Numerous dry, round, and pink-to-red lesions with a rough and scaly texture that do not heal. Slow growing. Common locations are sun-exposed areas.

TX: refer to derm for biopsy (GOLD STANDARD)

62
Q

Tinea Versicolor

A

Superficial skin infection caused by yeasts Pityrosporum orbiculare or P. ovale.

S&S: multiple hypopigmented round macules, “appear” after skin becomes tan, asymptomatic

DX: Potassium hydroxide (KOH) slide: Hyphae and spores (“spaghetti and meatballs”)

Tx: Topical selenium sulfide and topical azole antifungals such as ketoconazole (Nizoral) and terbinafine (Lamisil) cream twice a day × 2 week. May take several months for pigment to return

63
Q

Atopic Dermatitis (Eczema)

A

Infants up to 2 years of age have a larger area of rash distribution compared with teens and adults. The rashes are typically found on the cheeks, entire trunk, knees, and elbows.

Older children and adults have rashes on the hands, neck, and antecubital and popliteal space (flexural folds).

The classic rash starts as multiple small vesicles that rupture, leaving painful, bright-red, weepy lesions. The lesions become lichenified from chronic itching and can persist for months. Fissures form that can be secondarily infected with bacteria.

Associated with atopic disorders such as asthma, allergic rhinitis, and multiple allergies

Tx:
Topical steriods are first-line (hydrocortisone & triamcinolone acetonide)
Oral antihistamines for itching
Avoid drying the skin, will make itching worse

64
Q

Contact Dermatitis

A

Inflammatory skin reaction caused by direct contact with an irritating external substance

Types: Irritant and allergic

S&S: bright-red and pruritic lesions that evolve into bullous or vesicular lesions; easily rupture and can be painful. When rash dries, becomes crusted, pruritic and lichenfied.

Tx: remove irritant, topical steriods. Calamine lotion or oatmeal baths

65
Q

Superficial Candidiasis

A

Patho: yeast Candida albicans

S&S: bright-red shiny lesions that itch or burn, may have satellite lesions.
Thrush: severe sore throat with white adherent plaques with a red base that are hard to dislodge on the pharynx

Tx: Nystatin powder/cream
OTC topical antifungals are miconazole and clotrimazole
Systemic: Oral fluconazole
Keep skin dry and aerated.

66
Q

Cellulitis

A

Acute skin infection of the deep dermis and underlying tissue, usually caused by gram-positive bacteria.

Types:
-orbital and peritonsilar: refer to ER
-Purulent: S. aureus (gram+) or MRSA
-Nonpurulent: streptococci usually
-Cat bites: pasturella multocida (gram-)
-Dog bites: P.multocide, P. canis
-Puncture wounds foot: may be pseudomonas aeruginosa
-Vibrio vulnifuces: exposure to brackish water or salt water

S&S: acute onset, pink/red skin, poorly demarcated w/ advancing margins. Warm to touch, may have abscess or puss.

67
Q

Clenched fist injuries

A

These injuries have a high risk of infection to joints (e.g., knuckles), fascia, nerves, and bones (osteomyelitis; especially if punched in the mouth or bitten by a human).

Refer to ED for treatment.

There may be a foreign body embedded, such as a tooth (x-ray needed), and/or a fracture.

68
Q

Necrotizing Fasciitis (“Flesh-Eating” Bacteria)

A

Reddish to purple-colored lesion that increases rapidly in size. May have bullae. Infected area appears indurated (“woody” induration) with complaints of severe pain on affected site.

69
Q

Folliculitis

A

Infection of hair follicle(s). May involve several follicles.

Small (1-mm) round lesions filled with pus with erythema. Usually self-limiting.

Tx: Avoid shaving or scrubbing area.
Consider mupirocin (Bactroban) ointment or cream.

70
Q

Furuncles (Boils)

A

An infected hair follicle that fills with pus (abscess).

S&S: round red bump and is hot and tender to the touch, can rupture and drain purulent green-colored discharge

Tx: Apply antibiotic ointment twice a day and cover with dressing until healed.
For small boils, use warm compress twice a day. If abscess is >2 cm, incising and draining of abscess and/or empiric antibiotic treatment may be adequate.

If located over a joint, refer to ED. Rule out osteomylitis

71
Q

Carbuncles (Multiple Abscesses)

A

Carbuncles are several boils that coalesce to form a large boil or abscess.

Dx: C&S, CBC if fever. Suspect necrotizing fasciitis? Refer to ED

Tx: If rapid progression, diabetic, immunocompromised, joint involvement, refer to ED
Mild:
-Nonpurulent cellulitis (non-MRSA): Dicloxacillin
-Penicillin allergic: Azithromycin
-Suspect MRSA: Bactrim DS
-Td booster

Should improve in 24-48 hr

72
Q

Erysipelas

A

A subtype of cellulitis involving the upper dermis and superficial lymphatics that is usually caused by group A Streptococcus.
For facial erysipelas, assume it is MRSA

S&S: Sudden onset of one large hot and indurated red skin lesion that has clear demarcated margins. Usually on the lower legs (the shins) or the cheeks. W/ fever and chills. Hospitalization is recommended, since patient may be bacteremic.

73
Q

Dog and cat bites

A

P. multocida (gram negative) most common

Dogs also –> capnocytophaga canimorsus (gram negative).

Cat bites have a higher risk of infection than dog bites.

Signs of infection: redness, swelling, and pain, and systemic symptoms may develop within 12 to 24 hours.

Tx: Amoxicillin–clavulanate (Augmentin) 875 mg/125 mg orally twice a day × 10 days.
Penicillin allergy –> Doxycycline + Bactrim
Do not suture
Tetanus

74
Q

What animals are likely to have rabies?

A

Consider bats, raccoons, skunks, foxes, and coyotes
Check rabies vaccine on domestic animals
Rabies rarely seen in rodents such as mice, rats, squirrels, hamsters, guinea pigs, or rabbits.

75
Q

Hidradenitis Suppurativa

A

Chronic and recurrent
Inflammatory disorder of the apocrine glands Results in painful nodules, abscesses, and pustules in the axilla (most common location), mammary area, perianal area, and groin

Classified: Stage 1 –> 3 (severe)

S&S: recurrent episodes of painful, large, dark-red nodules, abscesses, and pustules. Pain resolves when the abscess drains and heals.

Risk factors: smoking & obesity

Tx: no cure
Stage 1: Either systemic or topical antibiotics (clindamycin) & oral abx (tetracycline)
Stage 2/3: Topical & oral abx (Clindamycin)
Avoid high-glycemic food
Smoking cessation, weight loss, sitz baths, warm compress. Derm referral

76
Q

Impetigo

A

Acute superficial skin infection caused by gram-positive bacteria (beta Streptococcus or Staphylococcus aureus)

Common with children ages 2 to 5 years

S&S: Acute onset, itchy pink-to-red lesions, evolve into vesiculopustules that rupture.

Bullous –> large blisters that rupture easily. After rupture, red, weeping, shallow ulcers appear. Have honey crusts

Dx: C&S

Tx: Cephalexin (Keflex), dicloxacillin
Penicillin allergy: azithromycin, clindamycin
No bullae –> topical mupirocin
Clean lesions with antibacteial soap

Children do not return to school until 48-72 hr after initiation of treatment

77
Q

Meningococcemia (Meningitis)

A

Spread by respiratory droplets
Bacterial = MEDICAL EMERGENCY

Risk factor: close quarters

S&S: sore throat, cough, fever, headache, stiff neck, photophobia, change in LOC. Petechial or hemmorrhagic rashes. Hypotension & shock

Tx: exposure - rifampin
Vaccination (MCV4 or Menactra) in first year of college
MPSV4 or Menomune for preteens and teens

DX: LP, blood cultures, CT/MRI

Tx: Ceftriaxone (Rocephin) 2 g IV every 12 hours plus vancomycin IV every 8 to 12 hours

78
Q

Early Lyme Disease
Erythema migrans

A

Caused by tick bite infected with borrelia burgdorferi

Can present with just rash or rash and flue like symptoms
Rash is target like in shape, warm to touch and rough texture. Appears 7-14 days after tick bite

Dx: two part testing
EIA first, if + cont, if - no lyme
IFA next, if + lyme, if - no lyme
Can have false negative antibody for 4-6 weeks

Tx: Doxycycline for early disease only

79
Q

Rocky Mountain Spotted Fever

A

Dog tick borne illness caused by Rickesttsia rickettsiii
More common in south east and central southern states

S&S: fever, chills, headache, N/V, photophobia, myalgia, arthralgia, followed by a rash 2-5 days after fever

Do not delay treatment! Treat empirically. Can result in death with delayed treatment

Dx:
Antibody titer, must collect acute and convalescent samples 2-4 wks apart. Cannot diagnose on one sample.

Tx: Doxycycline 100 mg orally or by IV twice a day × 7 days or for 2 days after temperature becomes normal

80
Q

Varicella-Zoster Virus Infections

A

Chickenpox (varicella) and herpes zoster (shingles) comes from the same varicella-zoster virus (VZV)

Chicken pox - first infection
Prodrome of fever, pharngitis, and malaise. Rash within 24 hr, pruritic vesicular lesions. Rash over 4 days. stars on head and spreads to body
Lasts 1-2 weeks
Infectious 1-2 days before symptoms until all lesions crust over

Shingles - reactivation
Acute onset of papules and vesiclues on a red base that rupture and become crusted. Follow dermatomes. Can be painful. Can last 2-4 weeks. Contagious from onset of rash until crusted over. Treat within 48-72 hours in immunocompromised and >50 yrs to avoid postherpetic neuralgia.

Dx: can be clincal diagnosis
Gold standard is PCR

Tx: Acyclovir (Zovirax) five times per day or valacyclovir (Valtrex) twice a day × 10 days for initial breakouts and 7 days for flare-ups.
Most effective when started 48 to 72 hours after the appearance of the rash.

81
Q

Herpetic Whitlow

A

Infection of the finger caused by herpes simplex 1 or 2

Transmitted through contact to cold sore or genital lesions

S&S: Acute onset, painful red bumps and lesions on fingers. Ask about other herpes symptoms.

Tx: NSAIDs for pain, acyclovir
Avoid sharing personal items, cover lesions until healed

82
Q

Paronychia

A

Bacterial infection of proximal or lateral nail (cuticle)

Causative agent: S. auerous, strep, pseudomonas
Chornic cases may be a/w onychomycosis

S&: acute onset pain in finger, eventually forming an abscess. Most common fingers thumb and index. May have h/o bitting nail, hang nail

Tx: warm soaks, mupirocin, I&D

83
Q

Pityriasis Rosea

A

Viral

S&S: oval lesions with fine scales. Follow skin folds. Can has a “christmas tree” pattern. Can be pruritic.
“herald patch” - the first lesion, appears 2 wks prior to break out. 2-5 cm in diameter, oval.

Tx: Self-limiting, resolves in 6-8 wk
If sexually active, rule out secondary syphilis.

84
Q

Scabies

A

Infestation of Sarcoptes scabiei mites, female lays eggs under skin

Can be asymptomatic for 4-8 weeks
Pruritis can last for 2-4 weeks after treatment due to sensitivity to feces
Spread through close contact

S&S: pruritic rash that is worse at night,
serpiginous (snakelike) or linear burrows
can be vesicular, papular or have crusts
Rash on webs of the hands, axillae, breasts, buttock folds, waist, scrotum, and penis

Dx: use wet mount to look for eggs

Tx: Permethrin 5% (Elimite): Apply cream from the neck to the sole of the feet after bathing or showering. Wash off after 8 to 14 hours. Repeat treatment in 7 days.

Treat all family memebrs at the same time
Bedding used 3 days prior and during treatment shouold be washed on high setting or placed in plastic bags for 72 hours

85
Q

Norwegian scabies

A

Severe form of scabies
Affects the elderly and immunocompromised.
Lesions are covered with fine scales (looks like white plaques) and crusts
Involves the nails (dystrophic nails), scalp, body; absent-to-mild pruritus; very contagious.
Treat with oral ivermectin combined with a topical agent (permethrin).

86
Q

Tinea infections

A

Infection of the superficial keratinized tissues by tinea organisms

Dx: fungal culture, KOH slide

Tx: Most cases of tinea can be treated with topical antifungal medication except for tinea capitis and moderate-to-severe onychomycosis or tinea unguium (toenails).
Topical azoles/imidazoles: Clotrimazole (Lotrimin Ultra), naftifine (Naftin) once a day or twice a day, miconazole (Monistat) twice a day, ketoconazole (Nizoral) shampoo/cream once a day
Avoid topical steriods unless severe, can reduce effectiveness of anti-fungal

87
Q

Tinea Capitis

A

(Ringworm of the Scalp)
Black dot tinea capitis (BDTC) is the most common

Spread by close contact and fomites (shared hats, combs).

Systemic treatment only (topicals are not effective).

Asymptomatic scaly patch that gradually enlarges. Hairs break off easily by the roots (looks like black dots), causing patchy alopecia.

“Black dot sign:” Broken hair shafts leave a dot-like pattern on scalp.

Gold standard: Administer griseofulvin (microsize/ultramicrosize) daily to twice a day × 6 to 12 weeks.
Avoid hepatotoxic substances (alcohol, statins, acetaminophen), monitor LFTS.
Avoid sharing combs, headgear, towels, pillows, and clothes with others.

Complications
Kerion: Inflammatory and indurated lesions that permanently damage hair follicles, causing patchy alopecia (permanent).

88
Q

Tinea Pedis

A

(Athlete’s foot)
Scaly/dry form: scales are present

Moist form: Moist lesions found in toes, strong odor

Can spread to fingernails from itching

Keep toes dry after showering/bathing

89
Q

Tinea Corporis or Tinea Circinata

A

(Ringworm of the Body)

Ringlike pruritic rashes, collarette of fine scales that slowly enlarge with some central clearing.

Topical azole antifungals (topical terbinafine 1%, butenafine 1%) for 2 to 3 weeks

90
Q

Tinea Cruris

A

(“Jock Itch”)
Perineal and groin area has pruritic red rashes with fine scales

May be mistaken for candidal infection (bright-red rashes with satellite lesions) or intertrigo (bright-red diffused rash due to bacterial infection).

91
Q

Tinea Manuum

A

(Hands)
Pruritic round rashes with fine scales found on the hands.

Check for scratching of foot (athlete’s foot).

92
Q

Tinea Barbae

A

(Beard Area)
Scaling occurs with pruritic red rashes.

93
Q

Tinea unguium
Onychomycosis

A

Tinea of fingers
Most common type: Distal subungual onychomycosis.
Most common location: Great toe

S&S: Opaque, yellow, thickening with scales under fingernail. Fingernail can fall off (onycholysis)

Dx: Fungal cultures or KOH slide

TX: Systemic unless mild
Continuous dosing - terbinafine x 12 weeks
Pulse dosing - need baseline LFTs. Intraconazole for one week per month, 3-4 cycles

Mild-to-moderate cases: Topical antifungals such as efinaconazole (Jublia) and ciclopirox (Penlac).

94
Q

Acne Vulgaris (Common Acne)
Mild

A

Found on face, chest, shoulders and back

Can be closed comedomes (noninflammatory), open comedomes (blackheadS), w/ or w/o papules

Tx: topical retinoids, clindamycin
start slow, may purge, photosensitivity. Should improve in 4-6 weeks

95
Q

Acne Vulgaris (Common Acne)
Moderate

A

papules & pustules w/ comedones

Tx: topical retinoid is first line
W/ inflammatory, add antibacteril (clindamycin, erythromycin)
Can do oral antibiotic if not effective (tetracycline, minocycline, doxycycline, erythromycin) for 3-4 weeks

**tetra okay if over 13 yr b/c teeth discoloration

Can use birth control (Desogen & Yaz)
Try to avoid dairy

96
Q

Acne Vulgaris (Common Acne)
Severe

A

S&S of mild/moderate plus painful, indurated cysts, nodules, abcesses, and pustules

Tx: isotretinoin (Acutane)
Category X - extremely teratogenic
Must be in iPLEDGE program to prescribe
Must have 2 forms of contraception, monthly pregnancy results to pharmacist, can only prescribe one month at a time

DC if severe depression, visual disturbance, hearing loss, tinnitus, GI pain, rectal bleeding, uncontrolled hypertriglyceridemia, pancreatitis, hepatitis.

97
Q

Rosacea (Acne Rosacea)

A

Chronic and relapsing
More likely with fair skin

chronic and small acne-like papules and pustules on nose, mouth and chin
Telangiectasias (spider veins) on nose and cheeks

Tx: symptom management and avoidance of triggers (spicy food, irritating skin care, sunlight, alcohol). Frequent moisturization
Can use topical antibiotic like metronidazole and azeleic acid gel. Low-dose oral tetracycline or minocycline given over several weeks.

Complications:
Rhinophyma: Hyperplasia of tissue at the tip of the nose from chronic severe disease
Ocular rosacea: Blepharitis, conjunctival injection, lid margin telangiectasia

98
Q

Molluscum Contagiosum

A

Caused by poxvirus
More common with children
Spread with direct skin-to-skin contact
Considered an STD if in genital area in sexually active adolescent

S&S: dome shaped papules with umbilication

TX: should resolve in 6-12 months

99
Q

Partial-thickness burns
(2nd degree)

A

Red-colored skin with superficial blisters (bullae); the burn is painful.

TX: Use water with mild soap or normal saline to clean broken skin (not hydrogen peroxide or full-strength Betadine). Do not rupture blisters. Treat with silver sulfadiazine cream (Silvadene) or triple antibiotic ointment such as Polysporin (bacitracin zinc and polymyxin B) and apply nonadherent dressings. Apply biologic dressings (e.g., DuoDERM), Tegaderm.
Alternative medicine: Use a topical application of honey or aloe vera.

Sulfadiazine can damage the eyes (do not use near the eyes). Pregnant or breastfeeding women should not use this agent.

100
Q

Full-thickness burns
(minor burn)

A

Rule out airway and breathing compromise.

Painless. Entire skin layer, subcutaneous area, and soft tissue fascia may be destroyed.

Smoke inhalation injury is a medical emergency.
Suspect inhalation injury if facial burns, electrical burns, or burns on cartilaginous areas such as the nose and ears (cartilage will not regenerate). Also suspect if burns are on >10% of body, are circumferential (risk of compartment syndrome), and cross major joints

101
Q

Superficial-Thickness Burns (First-Degree)

A

Erythema only (no blisters); painful (e.g., sunburns, mild scalds)

Cleanse with mild soap and water (or saline); cold packs for 24 to 48 hours
Intact skin does not require topical antibiotics; apply a topical OTC anesthetic such as benzocaine if desired or aloe vera gel

102
Q

Rule of nines

A

Child
Arms: 9% each
Legs: 14% each
Trunk: 18% anterior trunk, 18% posterior trunk

Adult
Arms/head: 9% each
Legs/trunk: 18% each leg, anterior trunk, and posterior trunk

103
Q

Cutaneous Anthrax

A

Caused by Bacillus anthracis (gram-positive rods).

S&S: papule that enlarges in 24 to 48 hours and develops eschar (necrosis) and ulceration. Arms, neck, and face.
Ask about history handing animal hides, hair or wool.

TX: Cutaneous anthrax (naturally acquired): Doxycycline twice a day, ciprofloxacin twice a day, levofloxacin twice a day for 7 to 10 days (if bioterrorism suspected, treat for 60 days).
Without treatment, 20% of people with cutaneous anthrax may die.

Postexposure prophylaxis (bioterrorism suspected): Doxycycline 100 mg orally twice a day × 60 days.

104
Q

Smallpox (Variola Virus)

A

“eliminated” in 1977

S&S: flu-like symptoms, numerous large nodules on face, arms and legs.

Tx: tecovirimat (Tpoxx)
If vaccinated within 2-3 days of exposure, can lessen symptoms.

105
Q

Phases of wound healing

A

Hemostasis: Constriction of local blood vessels, platelet aggregation, fibrin (clot) formation

Inflammation: Macrophages and lymphocytes proliferate, presence of inflammatory mediators such as cytokines and leukotrienes

Proliferation: Proliferation of basal and epithelial cells (angiogenesis)

Remodeling: Remodeling of collagen, scar formation (cicatrix)

106
Q

Categories of Wound Healing

A

Primary healing (primary closure): Wound is closed within 24 hours by suturing or applying tissue glue or butterfly strips (so that edges of wounds are well approximated). Causes the least amount of scarring.
Secondary intention: Wound is left open with formation of granulation tissue and scarring. Wound heals from the bottom of the wound up. Wound edges are not well approximated. Causes more scarring than primary closure.
Tertiary intention (delayed primary closure): Wounds with heavy contamination or poor vascularity (crush injuries) are best left open to heal by secondary intention (granulation) and wound contraction. Then the wound edges are approximated in 3 to 4 days. Produces the most scar tissue.

FNP ANCC (11 decks)

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