Chapter 3-Physical Factors

Question 1

What type of heat injury does the following characterize: -Erythema due to congestion of vessels +/- desquamation

Answer 1

First degree thermal burn

Question 2

What type of heat injury does the following characterize: -Edema of superficial tissues due to transudation of serum from capillaries -Vesicles and blebs -Recover without scars

Answer 2

Second degree superficial burn

Question 3

What type of heat injury does the following characterize: -Pale and anesthetic skin -Injury to reticular dermis -Takes > 1 month to heal with scars

Answer 3

Second degree deep burn

Question 4

What type of heat injury does the following characterize: -Loss of full thickness of dermis +/- subq -Ulcerating wound, once healed leaves scar

Answer 4

Third degree thermal burn Note: Ulcer is due to fact that skin appendages are completely destroyed, thus no epithelium is available for skin to regenerate

Question 5

What type of heat injury does the following characterize: -Destruction of skin + subq + underlying tendons

Answer 5

Fourth degree thermal burn

Question 6

Which types of burns require grafting for closure

Answer 6

3rd and 4th

Question 7

True or False: 2nd degree deep burns, 3rd degree, and 4th degree are followed by constitutional symptoms of varying severity

Answer 7

FALSE (only 3rd and 4th)

Question 8

Name 3 complications of burns

Answer 8

1. Excessive scarring (keloid or flat) 2. Contractures (cause deformity or joint dysfunction) 3. Chronic ulceration

Question 9

4 reasons to excise full thickness and deep dermal wounds

Answer 9

1. Reduces infection 2. Shortens hospital stay 3. Improves survival 4. Mitigates contractors and functional impairment

Question 10

List burn cases that should be managed by burn center

Answer 10

1. Partial thickness wounds covering >10% BSA 2. Partial thinkness burns involving face, hands, feet, genitalia, or joints 3. Secondary to electrical, chemical, or inhalation injury 4. Patients with special needs 5. Any full-thickness burn

Question 11

Answer 11

Hot oil burn

? Superficial second degree ?

Question 12

Answer 12

Electrical Burn from biting cord

Question 13

Answer 13

Burn scars

Question 14

Answer 14

Thermal burn from child abuse (the person who did this should go kill themselves)

Question 15

Answer 15

Hot water burn

Question 16

Name 2 categories of electrical burns:

Answer 16

1. Contact burn: small but deep, some necrosis (low voltage at home vs. high voltage in work place)
2. Flash burns: cover larger area (Ex-Lightening)

Question 17

Signs of indirect lightening strike:

Answer 17

1. Linear burns on which sweat was present
2. Burns in feathery or arborescent pattern
3. Punctate burns with multiple, deep, circular lesions
4. Thermal burns from clothing or heated metal

Question 18

Mother brings newborn in due to intermittent rash. She states her daughter’s rash comes and goes and describes the eruption as small, clear bumps but they do not seem to bother the pt. On exam, eruption no longer present. Based on history, what is your diagnosis?

Answer 18

Miliaria Crystallina (Sudamina)

• Rash not present because lesions rupture at slightest trauma
• MC patients are: bedridden pts with fever or when clothing prevents dissipation of heat/moisture (as in bundled children)

Lesions are self-limited, no txt required

Question 19

Name 3 medications that can induce sudamina

Answer 19

1. ISTN
2. Bethanechol
3. Doxorubicin

Question 20

True or False: Staph aureus produces an extracellular polysaccharid that induces miliaria

Answer 20

False

Correct anser is staph epidermidis

Question 21

Which form of miliaria is accompanied by a sensation of prickling, burning, or tingling?

Answer 21

M. Rubra

Question 22

True or False: Site of injury and sweat escape in Miliaria Rubra is the stratum granulosum

Answer 22

False

Site of injury is the prickle cell layer aka stratum spinosum

Question 23

Name disorder based on morphology

Distinct, superficial, and pruritic pustules independent of hair follicle

Answer 23

Miliairia Pustulosa

Question 24

Name disease commonly associated with miliaria pustulosa

Answer 24

1. Contact Derm
2. LSC
3. Intertrigo

Note: Eruption may occur several weeks after these diseases have subsided. Miliairia pustulosa is always preceded by another dermatitis that has produced injury, destruction, or blockage of sweat duct

Question 25

If patient presents with recurrent episodes of miliaria pustulosa what should you be concerned about

Answer 25

Type 1 hypoaldosteronism (salt losing crisis)

-Also if recurrent miliaria rubra

Question 26

Pt presents to urgent care due to skin eruption. States he was playing basketball when he noticed bumps on his stomach and arms. The lesions do not cause him any symptoms.

On exam, multiple flesh-colored to whitish papules. Hyperhydrosis of hands and face noted.

What is your diagnosis?

Answer 26

Miliaria Profunda

• Usually follows severe episode of m. rubra
• Upper dermis occluded
• sweat glands are non-functional except for compensatory sweating of hands, face, and feet

Question 27

List treatments for Miliaria

Answer 27

1. Cool enviorment
2. Anhydrous lanolin (Resolves occlusion of pores and may help to restore normal sweat secretions)
3. Hydrophilic ointment (Disolves keratin pluf and facilitates normal flow of sweat)
4. Soothing/cooling baths with oatmeal or cornstarch
5. Dusting powders

Question 28

Answer 28

M. Pustulosa

Question 29

Answer 29

M. Rubra

Fun Fact: Exercise induced itching or itching in AD may be caused by M. Rubra

Question 30

Answer 30

M. Rubra

Question 31

Answer 31

M. crystallina

Question 32

Answer 32

M. Rubra

Question 33

Answer 33

M. pustulosa

Question 34

Answer 34

M crystallina

Question 35

Answer 35

Erythema Ab Igne