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N8720 acute & chronic illness > Module 1- DERM > Flashcards

Module 1- DERM Flashcards

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1
Q

Lice
- whats the name for it?
- how long do they live?
- how is it transmitted/ how long?
- what does it look like?
- What is the treatment?

A

Pediculosis
- transmitted by indirect and direct contact (backpacks, hairbrush etc.) THEY DO NOT JUMP
- 30 days on a single host
- nits: small white eggs that attach to the shaft of hair and cannot be wiped away.
- live lice are brown in color and crawl
- treatment: permethrin shampoo without conditioner for LIVE lice, comb for nits
soak brushes in pediculocide
clean carpet
clean everything in hot soapy water, if cannot: pastic bag for 2 weeks time

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2
Q

Scabies
- what are they
- what does it look like?
- when is it worse?
- where is it most common on the body?
- how do you test them?
- treatment?
- what are scabies-infected kids more susceptible to?

A
  • borrow in skin, and feed on human blood
  • s shaped vesiculopustular lesions.
  • after itching, secondary lesion is red-brown nodules
  • worse at night
  • folds of the skin is most common place
  • burrow ink stain test- the burrow sucks up the ink ( can just use a marker)
  • permethrin 5% neck down, then rinse after 8-14 hours
  • high incidence for secondary bacterial infections
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3
Q

spider bites that cause problems for us: 4

A

1) false black widows
2) recluse spiders
3) australian funnel web spiders
4) phoneutria spiders

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4
Q

black widow bites
- incidence?
- what do they look like?
- how does someone get bit by one?
- bite presentation
- symptoms of a bite
- treatment

A
  • leading cause of spider bite deaths in US
  • females are the only dangerous ones (has the red hourglass mark on the back)
  • not aggressive unless provoked or threatened
    -dull cramp like pain at site within 15-60 min of bite. tap test is painful at site
  • systemic pain/dizziness, headache, dyspnea, face swelling are common
  • treatment: wash w soap and water, give dose of tetnus, treat pain.
  • mild symptoms: monitor for 6 hours
    -small child less than 40 kg= latrodectus antivenom STAT
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5
Q

brown recluse:
- what do they look like
- symtoms?
- what does the bite look like? how does it change over time?
- treatment

A
  • brown, 1-2 cm, small violin shaped dark area on the back
  • pain appears 1-2 hours after bite.
  • white ring of tissue ischemia secondary to vasoconstriction, bulls eye appearance. over few days- darkens, necrosis, and increases to 10-15 cm. then drains and leaves a dark crater
  • treatment: if bite has a DUSKY CENTER or other sign of developing necrosis, give antivenom
  • antivenom has not been proven benificial to most recluse bites. keep in mind
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6
Q

Brown Recluse diff dx

A

N numerous (only one)
O occurrence (secluded)
T timing (not in Nov-March)

R red (recluse= white center)
E elevated (recluse= sunken)
C chronic
L large (recluse= < 10 cm)
U ulcerates too early (recluse= >7 days)
S swelling
E exudative

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7
Q

2 types of snake families that are venomous and which ones each include

A
  • crotalinae (pit vipers)
    includes: rattles, water moccasins (cotton mouths), and copperheads
  • elapidae (coral snakes)
    includes: found in southern states, names unidentified
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8
Q

crotalinae (pit vipers)
includes: rattles, water moccasins (cotton mouths), and copperheads:
- incidence?
- how many need hospitalized?
- site appearence?
- symtoms?
- rare effect?
- Treatment:

A
  • responsible for over 1/2 of annual snakebites. 1/2 of those need hospitalization
  • ecchymosis and progressive tissue swelling
  • non specific including N/v, diarrhea, weakness, lightheadedness, diaphoresis, chills, tachycardia, hypotension, neurotoxicity (oral paresthesia, unusual taste, seizures, change in mental status)
  • rare: coagulopathy, rhabdomyolysis and nephrotoxicity
  • treat: first assess for evidence of rhabdomyolysis (CBC and CMP, BUN creatinine, UA, D dimer, coags, EKC), then tetnus, and give antivenom
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9
Q

elapidae (coral snakes)
-incidence?
- who are victims?
- what does the site look like?
- symtoms? when do they start?
- treatment?

A
  • less than 100 bites per year
  • most victims are male and intoxicated at time of bite
  • symptoms: pain at site, neuro sx start up to 12 hours after bite (salivation, drowsy, euphoria, descending muscle weakness, ophthalmoplegia, dysphagia)
  • treatment: observation for 12 hours, Q2 neuro exams, antivenom given, tetnus given, sx may progress even with antivenom given
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10
Q

lacerations- when to close?
face, contaminated, animal/human bites, severe

A

face: wait 24 hours
contaminated: close within 6 hours
animal and human bites: leave open to heal
severe: of any place, needs plastic and or ortho refferal

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11
Q

sutures vs staples vs surgical tape vs skin glue

A

sutures- uncomplicated lacerations
staples- scalp, trunk, extremities when rapid closure is needed
surgical tape- small, superficial wounds
skin glue- simple, clean edges

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12
Q

order considerations for wound

A
  • plain radiograph to ensure no forign body retention
  • abx with s/sx of infection
  • tetnus if patient is >5
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13
Q

wound management:
- skin prep
- wound cleaning

A
  • skin prep= DO NOT SHAVE, clip hair, use vaseline to put hair where you want it
  • wound cleaning- irrigate with 50-100 ml sterile water or saline with a LARGE syringe. use alcohol, CHG or iodine to clean AROUND the wound, not IN
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14
Q

ingrown toenails managment
cause?
treatment?

A
  • cause: ill fitting shoes
    tx: dotton packing under nail edge, warm foot soaks TID, EBX for signs of infections (cephalexin)
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15
Q

nail hematoma

A
  • radiograph to look for broken bones
  • nail trephination (hole puncture in nail to release pressure
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16
Q

bites
- what can cause the greatest risk for infection and join compromise?
- treatment?

A
  • clenched fist bites
  • tx: tetnus, rabies, ABX (3-5 days), suture VS delayed closure depends on the circumstances
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17
Q

burns
prevalence?
goals for care?
factors of a burn? (5)

A
  • leading cause of accidental injury in children!!
  • Prevent first!!
  • after the burn: protect against infection, skin healing, maintaining ROM
  • factors: temp, time of exposure, depth, extent, cause
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18
Q

1st degree burn characteristics (6)
also known as?

A

called superficial burn
superficial
painful
no blistering
pink/red
mild edema
blanches with pressure

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19
Q

2nd degree burn characteristics (5)
also known as?

A

partial thickness
- pink to red
- blisters
- moderate edema
- extremely painful
-weepy

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20
Q

3rd degree burns characteristics (6)

A

full thickness burn
- waxy-white to black
- dry leathery
- thrombosed vessels
-edema
-painless
does not blanch with pressure

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21
Q

treatments for burns (general) 6

A
  • topical dressing
  • nutrition
    -therapy
    -pain control
    -itching control
  • grafts
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22
Q

preventing scaring

A
  • compression (hypertrophic scarring)
  • sun exposure
  • silicone patches
  • lotion with massage
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24
Q

necrotizing fasciitis etiology
- what layers does this involve
- causative agents (4top)
- why does it happen
- how does it start and on who?

Study These Flashcards
A
  • involves muscle and fascia and sub Q (not bone and joint)
  • GAS, Staph aureus, klebsiella, E coli,
    -endo toxin load causes destruction of skin
  • starts from any puncture wound on any person including healthy person
25
necrotising fasciitis presentation - symptoms/presentation? - where on the body? - downstream symtoms (systemic?)
- erythema, warmth, induration, edema, increasing fever rapidly - anywhere on the body! - toxic appearing, tachycardia, hypotension as well as gangrene or crepetis
26
treatment for necrotising fasciitis - early intervention/labs? - wound management - meds -what compliation are we looking for?
-URGENT INTERVENTION! -fluids, vasoactive agents, oxygen, cbc /bc -surgical exploration (debridement to remove tissue- may need to be repeated after 24-48 hours) - bs ABX to narrow ABX (both anaerobic and aerobic) - compartment syndrome
27
Stevens Johnson Syndrome- what else has it been called in the past?
erythema multiform major
28
SJS etiology - what is the reaction that happens and what layers does it effect? - what causes SJS (there are three root causes) (which three classes of medications? & which bacteria?) - reaction time? - what is causing skin damage?
- hypersensitivity rxn on the skin and mucosa (VS EPIDERMIS IN TEN) - can be either environmental associated, medication associated (sulfonamides, anticonvulsants and rarely NSAIDS) and infection associated (mycoplasma pneumonia) - two weeks after medication administration - inflammatory infiltration of the epidermis that causes cell death and sloughing
29
SJS symptoms - t4 types of dermal reactions they form? - what other system is effected? - what other symptoms besides eyes and skin may they have?
1) rash (erythematous macules) **<10% of skin involved** 2) ulcerations in 2 mucosal surfaces 3) lesions= "target" lesions Bulla with fluid inside 4) Nikolsky Sign = mild friction/ dermal exfoliation - ophthalmic- keratitis and conjunctivitis - from mast cell take over: high fever, cough, rhinorrhea, pharyngitis, vomiting, diarrhea and headache
30
SJS management - what initial priority do we need to do? -what to do for support?
- eliminate the inciting agent (medication, environmental or infection) - supportive care: nutrition, hydration, resp support, wound care and eye care
31
Toxic Epidermal Necrolysis also referred to as...? - severity? - what type of reaction is it?
erythema multiform - worst form on continuum of erythema multiform - immune-mediated hypersensitivity - damages the epidermis (VS SKIN AND MUCOSA IN SJS)
32
TEN causes (2 major root causes)
- medications (sulfs, anticonvulsants, and NSAIDS) - infection (bacterial or viral)
33
TEN symptoms - initial symptoms? - look of rash and how it develops
- fever and then rash within 24 hours after fever- PAINFUL** - DUSKY macules (vs RED MACULES IN SJS) progresses to fluid filled bullae then full thickness necrosis >30% skin surface
34
key differences between TEN and SJS
1) no target lesion in TEN, target lesion and mucosal involvement in SJS 2) TEN includes >30% of skin, SJS includes <10% of skin 3) appearance of initial macule is DUSK in TEN and erythematous in SJS. 4) TEN is much more deadly and rare than SJS
35
treatment for TEN - supportive care? - May require...? - why is mortality rate so high?
-support: wound care, usually on burn unit, resp. support (25% have tracheal sloughing), exquisite pain control, wound care, fluid management - may require plasmapheresis or renal replacement - secondary infection and sepsis
36
what treatments are controversial in SJS and TEN?
- IVIG and Steroids
37
pressure ulcers stage 1 characteristic
- non blanchable - epidermis intact - painful area - may be either warm or cool or firm or soft compared to surrounding tissue. - hard to identify on dark complexions
38
pressure ulcers stage 2 characteristic
- involved in epidermis and or dermis - shallow open ulcer with red wound bed - once ruptured, serum filled or serosanguinous filled
39
pressure ulcers stage 3 characteristic
- full thickness skin loss - can see sub Q fat (NO BONE MUSCLE OR TENDON) - may have undermining or tunneling
40
pressure ulcers stage 4 characteristic
tissue loss - exposed bone, muscle, tendon, joints, may need to treat osteomylitis
41
unstageable ulcer characteristic
- full thickness loss with depth obscured by slough or eschar - slough- yellow tan or brown - eschar- tan brown black
42
treatment of ulcers
- balanced diet - mobility - skin care - offloading devices surgical management (for stage 3 and 4) - consider holding steroids before working with a wound (inhibits cell regeneration and healing)
43
perks of vacuum assisted closure (V.A.C.) therapy - 5 perks - what is the dressing made from?
- prepare the wound bed for closure -reduce edema -promotes granulation tissue -increases perfusion -removes exudate and infectious material made from: polyurethane or polyvinyl alcohol foam dressing
44
pressure setting for VAC closure by age birth- 2 years >2 years to 12 years 12 years- 21 years
birth- 2 years= 50-75 mmhg >2 years to 12 years= 75-100 mmhg 12 years- 21 years mmhg= 75-125 mmhg
45
contraindications to wound VAC (6)
1) necrotic tissue 2) direct placement over exposed vital structures (tendon, bone, blood vessels, organs, nerves) 3) untreated osteomyelitis 4)malignancy in wound 5) sensitivity to silver foam dressings 6) unexplored fistula
46
minimum time for wound vac
22-24 hrs
47
I & D procedure - what is it used for? where are these found? - how to look at it? - common pathogens?
-to drain dead neutrophils, primarily in buttox, axilla, or extremities - ultrasound helps look at it and know size - staph aureus, strep pyogens most common
48
steps of I&D - blade selection? - where to initiate incision? - to use ABX or not to use? - 4 indications to USe abx?
- 11 or 15 blade - direct incision on plane of skin folds to reduce the scarring - no sign of systemic involvement? no need for ABX. if involved, can use oral or IV with most likely pathogens being targeted. + get a culture to aid you in narrowing coverage (will take 48-72 hours to narrow) 1) life or limb threatening tissue infection 2) systemic illness 3) immunocompromised 4) infant/young children
49
rubeola/ measles - first symptom? - other associated symptoms? - hallmark spots? - how does it spread? - how long does it last?
- fever then rash - cough, red eyes (conjunctival injection) Koplicks spots: erythema "halo" - face first then chest and abdomen then extremities - lasts > 72 hours
50
Rubella: german measles - what does the rash look like? - where does the rash start/ spread? - other associated symtoms? - how long does it last?
- Rose-Pink Rash/ Maculopapular * Begins on face, Spreads to trunk & extremities Associated symptoms: Malaise, Joint pain, Lymphadenopathy o Lasts < 72 hours (3-day measles)
51
roseola Infantum: herpes virus 6 - how does the rash shart? - What else is this disease called?
- 3 days of HIGH fever and then rapid decline. - after fever is gone, diffuse, faint blanchable erythematous reticulated rash - SIXTH DISEASE
52
erythema infectiosum - what else is it called? - what is most likely to get it? - what is the appearance of the rash? - associated symptoms?
- fifths disease - school age kids mostly get it because it is very very contagious - rash appears on the cheeks (slapped cheek) and worsens with heat - associated symptoms: fever and pharyngitis
53
coxsackie virus 16 - what else is it called? - what does the rash look like and where is it?
- hand foot mouth - small grey-white vesicles on hard palate, buccal mucosa, and tongue gingiva, as well as small oval vesicles on the lateral aspects of the hands and feet/ palms soles.
54
varicella: chickenpox
- progressive rash (fluid filled lesions, erythematous macules, and crusted lesions)
55
pityriasis rosea - what is it caused from? - what does the rash look like? what about the secondary rash? - contagious? - symptoms? - treatment
- etiology unknown (possibly HSV #7) - 2-5 cm oval lesion (often mistaken for ringworm) THEN secondary rash: 2-24 days after primary, Christmas tree rash line on the ribs (rarely involved face and distal extremities) - not contagious - symptoms: really pruritic - tx: calamine lotion, antihistamines, erythromycin
56

N8720 acute & chronic illness (2 decks)

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