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PNCB CPNP-PC > Derm > Flashcards

Derm Flashcards

1
Q

Categories of Burns
> First Degree: Dry, -1-, involves -2-
> Second Degree: -3-, extends -4-

A
  1. red, no blisters
  2. epidermis only (sunburn)
  3. Moist, blisters
  4. beyond epidermis
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2
Q

Categories of Burns

> Third degree: -1-, pearly, waxy; extends from -2- to underlying -3- and/or bone (-4-)

A
  1. dry, leathery, black
  2. epidermis to dermis
  3. tissues, fat, muscle
  4. no innervation
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3
Q

Measuring Extent of Burn Injury

> -1- used for quick estimates of -2- burned; for -3-

A
  1. Rule of nines
  2. total body surface area (TBSA)
  3. adolescents >13 yo, and adults
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4
Q

Measuring Extent of Burn Injury

Percent coverage of each body part for adolescents aged 14+:…

A

…9% - Head, chest, belly, upper back, lower back, both arms together, the front of either leg, the back of either leg
1% - groin

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5
Q

Measuring Extent of Burn Injury

Due to -1- by age, -2- by -3-

A
  1. TBSA growing
  2. different parameters
  3. age group
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6
Q

Measuring Extent of Burn Injury

Percent coverage of each body part for adolescents aged 13-:…

A 
...
6% - underwear region
20% - both arms
21% - HEENT
26% - entire torso
27% - both legs
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7
Q

Burns - Primary Mgmt
> Assess -1-. Will require prophylactic intubation if:
» Singed -2- or eyebrows
» Evaluate -3- for soot/mucous
> Drench the burn thoroughly with -4- to prevent further damage and -5-

A
  1. ABCs
  2. nares
  3. nares/mouth
  4. cool (not iced) water
  5. remove all burned clothing
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8
Q

Burns - Primary Mgmt

> -1- with -2-

A
  1. Do not cover

2. lotion, toothpaste, butter, etc.

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9
Q

Burns - Primary Mgmt
> If the burn area is -1-, immerse the site in -2- to reduce -3-; then, apply -4-
> If the area of the burn is large, after it has been doused with cool water, apply -4- about the burned area (or the whole patient) to -5-

A
  1. limited
  2. cold water for 30 minutes
  3. pain
  4. a clean, dry wrap
  5. prevent systemic hypothermia/heat loss
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10
Q

Burns - Primary Mgmt

The -1- the injury is/are -2-; transport a patient with severe burns to a -3-

A
  1. first 6 hours following
  2. critical
  3. hospital ASAP
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11
Q

The systematic approach to the evaluation of skin disorders concerns identifying the…

A

…morphology, configuration, and distribution

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12
Q

Skin Lesions

  • 1-: lesion that devleops on -2-
  • 3-: lesion that either changes -4- or occurs when a -5-; it may become infected, etc.
A
  1. Primary
  2. previously unaltered skin
  3. Secondary
  4. impression over time
  5. primary lesion is scratched (e.g. excoriation, impetigo being picked at)
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13
Q

Morphology
> Macule: A(n) -1-
» Example(s): -2-, petechiae, flat -3-

A
  1. flat discoloration
  2. ephelides (freckles)
  3. nevi (moles)
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14
Q

Patch: A(n) -1- that looks as though it is a collection of -2-; may be some sublte surface changes
> Example(s): -3-, -4- spot(s)

A
  1. flat discoloration
  2. multiple, tiny pigment changes
  3. mongolian spot
  4. cafe au lait
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15
Q

Nodule: a(n) -1- lesion -2-
> Examples -3-
Tumor: a(n) -4-
> Example(s): -5-

A
  1. elevated, firm
  2. > 1 cm
  3. Xanthoma, fibroma
  4. firm, elevated lump
  5. benign or malignant
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16
Q

Relation between Abscess, Bulla, Nodule, Papule, Pustule, and/or Vesicle:

A

Abscess vs Pustule
Bulla vs Vesicle
Nodule vs Papule

> 1cm vs < 1cm; otherwise same thing

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17
Q

Papule: a(n) -1-, -2- lesion

> examples: -3-, elevated nevus (mole), -4-

A
  1. small (< 1 cm)
  2. elevated, firm skin
  3. ant bite
  4. verruca (wart)
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18
Q

Plaque: a(n) -1- lesion
> Example(s): -2-
Vesicle: a(n) -3- lesion -4-
> Example(s): Herpes simplex, -5-

A
  1. scaly, elevated
  2. classic psoriasis lesion
  3. small (< 1 cm)
  4. filled with serous fluid
  5. Varicella (chicken pox), herpes zoster (shingles)
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19
Q

Bulla: -1-

Example(s): -2-, -3-, -4-

A
  1. serous fluid-filled vesicles > 1 cm
  2. Burns
  3. superficial blister
  4. contact dermatitis (poison ivy)
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20
Q

Wheal: a lesion -1- and extending a bit below the epdiermis; many times a(n) -2-
> Example(s): -3- and -4-

A
  1. raised above the surface
  2. allergic reaction (either contact or systemic)
  3. PPD test
  4. mosquito bites
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21
Q

Pustule: a(n) -1- -2- lesion

> Example(s): -3- and -4-

A
  1. small (< 1 cm)
  2. pus-filled
  3. Acne
  4. Impetigo
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22
Q

Abscess: a(n) -1- lesion -2-

A
  1. pus-filled

2. > 1 cm

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23
Q

Cyst: -1-, -2- lesions -3- with -4-, -5-

A
  1. Large
  2. raised
  3. filled
  4. serous fluid
  5. blood, and pus
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24
Q

Eval of Skin Disorders
Configuration: -1- the lesions -2- on the body
> Solitary or discrete
» individual or distinct lesions that remain separate (-3- rash, -4-)

A
  1. how
  2. present
  3. fungal diaper
  4. satellite lesions
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25
Q 
Eval of Skin Disorders
Configuration
> Grouped: Linear -1-
> Confluent: Lesions that -2-
> Linear: Scratch, streak, -3- (-4-)
A
  1. clusters
  2. run together
  3. line, stripe
  4. poison ivy
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26
Q

Eval of Skin Disorders
Configuration
> Annular: -1-, beginning in the center, and spreading to the periphery (-2-, -3-, -4-)
> Polycyclic: -5-

A
  1. circular
  2. tinea
  3. erythema migrans
  4. Lyme disease
  5. annular lesions merge
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27
Q

Eval of Skin Disorders
Distribution
> -1- the lesions -2-
> -3-: following -4- (-5-)

A
  1. Where
  2. appear on the body
  3. Dermatomal
  4. nerve pathways
  5. shingles
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28
Q

Acne

Def: A -1- skin disorder -2- by -3-, -4-, -5-

A
  1. polymorphic
  2. characterized
  3. comedones
  4. pustules
  5. papules & cysts
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29
Q

Acne Causes/Incidence
> Cause is unknown but appears to be activated by -1- in genetically predisposed individuals
> Can be exacerbated by -2- and -3-

A
  1. androgens
  2. steroids
  3. anticonvulsants
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30
Q

Acne Causes/Incidence

> -1- has -2- to be a(n) -3-

A
  1. Food
  2. not been demonstrated
  3. contributing factor
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31
Q

Acne Causes/Incidence

During adolescence, acne is -1- and -2- in -3-

A
  1. More common
  2. severe
  3. males
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32
Q

Acne S/S
-1-
> Open: -2- (-3-)
> Closed: -4- (-5-)

A
  1. Comedones
  2. blackheads
  3. black-hole/open
  4. whiteheads
  5. white-dwarf/closed
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33
Q

Acne S/S
> -1- or hypertrophic -2- (-3-)
> In -4-, may be exacerbated just -5-

A
  1. depressed
  2. scarring
  3. cystic acne
  4. women
  5. prior to menses
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34
Q 
Acne
Labs/Dx
> -1- to identify -2- in -3-
Mgmt
> -4-
>> Use of oil-free, mild soaps, -5- and moisturizers
A
  1. None indicated, except
  2. causative organism
  3. atypical folliculitis
  4. Non-pharm
  5. cleansers (cetaphil, Dove)
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35
Q

Acne Mgmt
-1-
> In mild acne, topical treatment w/ -2- (-3-)
» If unresponsive, -4- -5- (preg cat C)

A
  1. Pharmacologic
  2. benzoyl peroxide (2.5-10%)
  3. start low, increase PRN
  4. retinoic acid (.025% - .1%)
  5. cream or gel
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36
Q

Acne Pharm Mgmt

-1- is -2- and -3- by -4-; this agent should only be -5- and not used concomitantly with -4-

A
  1. Tetinoin
  2. neutralized by UV light
  3. oxidized
  4. benzoyl peroxide
  5. applied at night
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37
Q

Acne Pharm Mgmt
Most common side effects of mild topical acne creams are -1-, -2- of skin. May need to -3- or -4- of application for excess -2-

A
  1. dryness
  2. redness/irritation
  3. decrease strength
  4. duration
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38
Q

Acne Mgmt

-1- acne (or -2- acne) requires -3- (-4- should be tried followed by macrolides) along with topical treatments

A
  1. moderate
  2. severe pustular
  3. systemic antibiotics
  4. -cyclines
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39
Q

Moderate or Severe Pustular Acne Mgmt
> -1-: 50-100 mg -2- or 100 -3-
> -4-: 50-100 mg -2-

A
  1. Doxy
  2. BID
  3. Qday
  4. minocycline
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40
Q

Moderate or Severe Pustular Acne Mgmt
> -1-
» Only for patients who -2- the -3-
> Severe acne that doesn’t -4- should be -5-

A
  1. Erythromycin
  2. cannot use
  3. tetracyclines (i.e., pregnant patients or children < 8 years of age)
  4. respond to above
  5. referred to dermatology (for Accutane treatment)
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41
Q

Acne Mgmt

Consider -1- in patients -2- who also desire -3-

A
  1. oral contraceptives
  2. 14 yo +
  3. pregnancy prevention
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42
Q

Oral Contraceptives for Acne Mgmt
Age -1-: -2- 3 mg qd (on 24 off 4)
Age -3-: -4- multidose regimen (on 21 off 7)

A
  1. 14+
  2. Drospirenone
  3. 15+
  4. Norgestimate
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43
Q

Fungal Infections

Def: There are a(n) -1- infections that are distinguished by the -2- of fungi and the -3-

A
  1. variety of fungal
  2. causal species
  3. location they manifest
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44
Q

Fungal Infection Causes/Incidence
> Fungal organisms -1- (-2-) or -3- cause the -4-
> Pharm mgmt centers on -5- and the prevention of transmission

A
  1. Trichophyton
  2. most common
  3. microsporum
  4. dermatophyte infections
  5. anti-fungal therapy (mostly topical)
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45
Q

Tinea capitis: a -1- of the -2-
S/S
> -2-
> -3-

A
  1. Fungal infection of the scalp
  2. Annular balding
  3. Black dots (broken shafts)
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46
Q

Tinea corporis (-1-)
> -2- on the -3-
> -4- (-5- & -6-)
> -7-

A
  1. Ringworm
  2. Fungal infection
  3. body
  4. annular
  5. raised borders
  6. central clearing
  7. pruritic
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47
Q

Tinea cruris

Def: -1-, aka -2-, characterized by -3- and -4-.

A
  1. Inguinal fungal infection
  2. jock itch
  3. Erythema
  4. Pruritis
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48
Q

Tinea manuum/pedis
> -1- fungal infection (-2-)
> Also known as -3-
> -4- is the chief symptom

A
  1. Interdigital
  2. hands/feet
  3. “athletes’ foot”
  4. Pruritis
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49
Q

Tinea versicolor (2)

A
  1. hypo/hyperpigmentation macules r/t fungal infection

2. End of summer

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50
Q

Fungal Infections S/S
> May be -1- (e.g. -2-)
> Some forms present with -3- (tinea -4- and -5-)

A
  1. asymptomatic
  2. tinea capitis
  3. severe itching
  4. cruris
  5. pedis
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51
Q

Fungal Infections S/S
> -1- (tinea -2-)
> -3- of -4- (-5-)

A
  1. erythematous rings
  2. corporis
  3. solitary areas
  4. hypo-/hyperpigmentation
  5. tinea versicolor
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52
Q

Fungal Infections Labs/Dx

-1- -2- microscopically when treated w/ -3-

A
  1. “Spaghetti & Meatballs”
  2. hyphae
  3. KOH
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53
Q

Fungal Infections Mgmt

Tinea capitis: -1- is -2- 20-25 mg/kg/day -3- for -4-

A
  1. primary management
  2. griseofulvin
  3. PO (topical is ineffective r/t follicular permeation)
  4. 6-8 weeks
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54
Q

Fungal Infections Mgmt

corporis: use of -1- is usually adequate (-2-); -3-

A
  1. topical antifungals
  2. mi-/ketoconazole 2%
  3. BID
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55
Q

Fungal Infections Mgmt
cruris: same topical antifungals as corporis; -1- is curative in -2- of cases when used twice a day for 7 days; -3- for -4-

A
  1. terbinafine cream
  2. > 80%
  3. griseofulvin
  4. severe cases
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56
Q

Fungal Infections Mgmt
Tinea manuum/pedis
> -1- stage: use -2- (-3-) to soak for -4- -5-

A
  1. Macerated stage
  2. aluminum subacetate solution
  3. Domeboro (old & gold)
  4. 20 min
  5. BID
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57
Q

Fungal Infections Mgmt
Tinea manuum/pedis
> -1- stage: topical antifungals (e.g. -2-)
> -3- in severe cases

A
  1. Dry, scaly
  2. terbinafine
  3. oral antifungals
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58
Q

Fungal infections mgmt

Tinea versicolor: -1- applied for -2- daily for -3-; if -4-, -5- 200 mg PO every day for 5 days

A
  1. Selenium sulfide shampoo
  2. 5-15 minutes
  3. 7 days
  4. persistant or widespread
  5. itraconazole (sporanox)
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59
Q

Varicella Zoster Virus (Chickenpox)

Def: Acute, -1- caused by -2-, transmitted by -3- w/ -4-

A
  1. contagious disease
  2. herpes virus
  3. direct contact
  4. lesions or airborne
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60
Q

Varicella Zoster Virus (Chickenpox) - Causes/Incidence
> Infected ppl are -1- before -2- and until lesions have -3-
> Most common in children -4-
> risk greatly decreases w/ -5-

A
  1. contagious for 48 hours
  2. outbreak
  3. crusted over
  4. under 10
  5. varicella vaccine
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61
Q

Varicella Zoster Virus (Chickenpox) - S/S
> -1-
> -2-
> -3-: (-4-) Usually distributes initially on the -5-

A
  1. erythematous macules
  2. papules develop over macules
  3. vesicles erupt
  4. “dew on a rose petal”
  5. trunk, then scalp/face (mouth & ears too)
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62
Q 
Varicella Zoster Virus (Chickenpox)
S/S
> Intense -1-
> -2-
> Generalized -3-
Labs/Dx
> -4-, typically a -5-
A
  1. pruritis
  2. low-grade fever
  3. lymphadenopathy
  4. None required
  5. clinical dx
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63
Q 
Varicella Zoster Virus (Chickenpox) - Mgmt
-1- tx for -2-
> -3- lotion
> -4-
> -5-
A
  1. Supportive
  2. pruritis
  3. calamine/caladryl
  4. antihistamine (benadryl)
  5. acetaminophen for fever
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64
Q

Varicella Zoster Virus (Chickenpox) - Mgmt
> Healthy children < 12: -1-; antivirals likely unnecessary
> Patients at risk for complications/-2- 20 mg/kg 5x/day; given in the -3- to reduce the -4- and/or -5-

A
  1. self-limiting disease
  2. immunocomprimised: oral acyclovir
  3. first 24 hours
  4. magnitude
  5. duration of symptoms (non-curative)
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65
Q

Molloscum Contagiosum

Def: A common, -1- infection, these lesions frequently -2- in -3- and are not easily treated

A
  1. benign viral skin
  2. disappear on their own
  3. a few weeks to a few months
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66
Q

Molloscum Contagiosum - Causes/Incidence
Diagnositc criteria icnlude pruritis and the presence of very small, firm, -1- to -2- discrete -3-, which become -4- with a -5-

A
  1. pink-
  2. flesh-colored
  3. papules
  4. umbilicated
  5. cheese-like center
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67
Q

Molloscum Contagiosum - Causes/Incidence

Children who are -1- can have grouped lesions in the -2- area

A
  1. sexually active or abused

2. genital

68
Q

Molloscum Contagiosum - S/S

Lesions most commonly present on the -1-, -2-, -3- trunk, -4-, and extremities

A
  1. face
  2. axillae
  3. antecubital fossa
  4. crural fascia
69
Q

Molloscum Contagiosum - S/S

-1- at the site of infection –> -2-

A
  1. Itching/picking

2. secondary lesions

70
Q

Molloscum Contagiosum - Labs/Dx
> -1-
> -2- of -3- to -4-

A
  1. clinical presentation
  2. hx
  3. exposure
  4. MC
71
Q

Molloscum Contagiosum - Mgmt
-1- if left alone
> -2- of the -3- prevents spread and -4-
> -5-, after anesthetizing the area with prilocaine 2.5% and lidocaine 2.5% cream (i.e., EMLA cream), is a useful treatment of a few lesions, but should not be used in sensitive areas as it may scar

A
  1. Self-limiting
  2. Removal
  3. cheese-like core
  4. autoinoculation
  5. Curettage
72
Q

Molloscum Contagiosum - Mgmt
> Pharm agents
» -1- 0.025% gel or 0.1% cream at bedtime
» -2- daily at bedtime
» -3- (0.5%); treat each lesion individually; -4-

A
  1. Tretinoin
  2. Salicylic acid
  3. Podophyllotoxin cream
  4. not recommended for pregnant women due to presumed toxicity to fetus
73
Q

Molloscum Contagiosum - Mgmt
> Pharm agents
» -1- applied for 2-3 seconds
» -2- 25%-50% applied by dropper to the center of the lesion, followed by alcohol, repeated q 2 wks
» -3- 7-9% applied to individual lesions and covered with clear tape; blistering within 24 hours and posible clearing without scarring; shouldb e avoided on facial esoins
» -4- (T cell modifier)

A
  1. liquid nitrogen
  2. trichloroacetic acid peel
  3. silver nitrate, iodine
  4. Imiquimod
74
Q

Molloscum Contagiosum - Mgmt
> -1- and -2- lesions to stop from spreading. (-3-)
> -4- may occur after -5- in some immunocompetent patients

A
  1. Prevent touching
  2. scratching
  3. keep nails trim
  4. spontaneous resolution
  5. 6-9 months
75
Q 
Atopic Dermatitis (Eczema)
Def: -1- characterize by -2- along a typical pattern of distribution with periods of -3-
A
  1. chronic skin condition
  2. intense itching
  3. remission an exacerbation
76
Q

Atopic Dermatitis (Eczema) - Causes/Incidence
> Particularly -1- and often worsens in the -2- when the -3-
> A personal or -4- of -5-, elevated IgE levels, and a tendency for skin infections is helpful to the Dx.

A
  1. sensitive to low humidity
  2. winter
  3. air is dry
  4. family history
  5. Asthma, allergic rhinitis, or AD
77
Q

Atopic Dermatitis (Eczema) - S/S
> -1- along face, neck, trunk, wrists, hands, antecubital and popliteal folds
> -2-
» -3- may show -4-, shiny, or thickened patches
» Dry, -5-

A
  1. Intense pruritis
  2. Dry scaly skin
  3. Acute flare-ups
  4. red
  5. leathery, and lichenified skin (in severe or poorly managed cases)
78
Q

Atopic Dermatitis (Eczema) - Labs/Dx
> -1- may suggest dust mite allergy (food allergy uncommon)
> -2- may be -3-
> -4- may be present

A
  1. Radioallergosorbent Test (RAST) or skin tests
  2. Serum IgE
  3. Elevated
  4. Eosinophilia
79
Q 
Atopic Dermatitis (Eczema) - Mgmt
-1- mgmt: -2- lotion (-3-) -4-; must -5-
A
  1. Hallmark Dry skin
  2. moisturizing
  3. thick (vaseline, eucerin, aquaphor)
  4. immediately after bathing
  5. blot dry
80
Q 
Atopic Dermatitis (Eczema) - Mgmt
> Topical steroids; -1- and rub in well (then -2-); begin with -3- or other steroids (-4- 0.05% BID-QID, or 0.1% daily, -5-, triamcinolone 0.1% daily-BID)
A
  1. apply thin layer
  2. seal w/ moisturizer
  3. hydrocortisone
  4. fluocinonide cream
  5. desonide
81
Q 
Atopic Dermatitis (Eczema) - Mgmt
>>Adverse effects of hydrocortisone: -1-, -2-, -3-/scarring
A
  1. bladder dysfunction
  2. hyperglycemia
  3. hypopigmentation
82
Q 
Atopic Dermatitis (Eczema) - Mgmt
> -1- ointment
> Systemic steroids only in -2-: -3-, taper over 10-14 days
A
  1. Crisaborole 2%
  2. extremely severe cases
  3. prednisone (avoid)
83
Q

Atopic Dermatitis (Eczema) - Mgmt
> In acute -1-
» use saline or -2-
» colloidal -3-

A
  1. Weeping
  2. Domeboro solution (AlSubacetate)
  3. Oatmeal baths (Aveeno)
84
Q

Atopic Dermatitis (Eczema) - Mgmt
> Acute Weeping
» -1- 1-3 times per week (for about 10 minutes) can -2-, reducing itching, redness, and scaling; most effective when combined with other treatments. Add -3- to -4- with warm water. Apply moisturizer afterward.

A
  1. Bleach baths
  2. kill all the bacteria on the skin
  3. 1/4 - 1/2 cup bleach
  4. 40 gallon bathtub filled
85
Q

Atopic Dermatitis (Eczema) - Mgmt
> -1- may be considererd for moderate to severe symptoms (-2-)
> Two immunomodulating agents, -3-, have also been approved as second-line agents for treatment of moderate-to-severe AD in children -4-.
» The most common adverse effects of -3- are -5-. These effects tend to -6- applications.

A
  1. Dupilumab
  2. Dermatologist
  3. tacrolimus (Protopic) and pimecrolimus (Elidel)
  4. 2+ yo
  5. local burning/stinging sensations
  6. lessen after several
86
Q

Allergic Contact Dermatitis

Def: an acute or chronic dermatitis that -1- from -2- with chemicals or -3-

A
  1. results
  2. direct skin contact
  3. allergens
87
Q

Allergic Contact Dermatitis - S/S
> -1-, -2-, scabbing
> Tiny -3- and -4-, encrusted lesions in acute phases

A
  1. Redness
  2. pruritis
  3. vesicles
  4. weeping
88
Q

Allergic Contact Dermatitis - S/S
> -1- will -2-
> Affected areas -3- (worse w/ -4-)

A
  1. location
  2. suggest cause
  3. hot and swollen
  4. heat (like after a bath)
89
Q 
Allergic Contact Dermatitis
> Labs/Dx
>> -1-
> Mgmt
>> Depends on severity; -2-, avoid scrubbing with soap and water
>> High potency -3-
>> If -4-: -5-
A
  1. None indicated
  2. if compresses locally
  3. topical steroids locally
  4. severe/systemic
  5. prednisone taper
90
Q

Irritant (Diaper) Dermatitis
Def: Common skin irritation of the -1-
> Causes/Incidence
» Most common type of diaper rash, typically due to exposure to chemical irritants and -2-
» Occurs at some time in 95% of infants; peaks at -3-

A
  1. genital/perianal region
  2. urine, feces (prolonged contact)
  3. 9-12 months (ambulating with soiled diapers)
91
Q

Irritant (Diaper) Dermatitis - Labs/Dx:

A

None indicated

92
Q

Irritant (Diaper) Dermatitis - Mgmt
> In mild cases, -1-
> When erythema/papules present, -2-
> Use Burow’s (-3-) compresses for severe erythema and -4-

A
  1. barrier emollients (desitin, etc.)
  2. use Hydrocortisone 1%
  3. Domeboro’s
  4. vesicles
93
Q

Irritant (Diaper) Dermatitis - Mgmt
> Secondary -1- may need -2-
> Secondary -3- may need -4-
> Allow -5- several times daily

A
  1. bacterial infection
  2. topical antibiotics
  3. fungal infection
  4. topical antifungals
  5. diaper area to air dry (as much as possible)
94
Q 
Psoriasis
Def; a common -1- skin disorder (acute or chronic) based on genetic predisposition (affecting ~ -2-)
> Causes/Incidence
>> The -3- is reduced from -4-
>> May be -5-
A
  1. benign hyperproliferative inflammatory
  2. 2-3% of the population
  3. epidermal turnover time
  4. 14 days to 2 days
  5. immunologically mediated
95
Q

Psoriasis - S/S
> Often -1-; -2- may occur
> Lesions are red, sharptly defined plaques with -3-
> -4-, -5- are common sites

A
  1. asymptomatic
  2. itching
  3. silvery scales
  4. scalp, joints
  5. palms & soles, nails
96
Q

Psoriasis - S/S
> Fine -1- is strongly suggestive of psoriasis, as is separation of the nail -2-
> -3-: -4- when -5-

A
  1. pitting of the nails
  2. plate and bed
  3. Auspitz sign
  4. droplets of blood
  5. scales are removed
97
Q

Psoriasis - Labs/Dx:

A

None indicated

98
Q

Psoriasis - Mgmt
> Topicals for the -1-
» -2- (-3-)
» Medium potency topical -4-

A
  1. scalp
  2. tar/salicylic acid shampoo
  3. T-gel
  4. steroid oil
99
Q

Psoriasis - Mgmt
> Topical -1- for the skin
» Topical -1- -2- for 2-3 wks; resume w/ -3-, a synthetic vit D3 derivative
» -4-
» Triamcinolone acetonide -5- (aristocort)

A
  1. steroids
  2. BID
  3. calcipotriene (Dovonex)
  4. betamethasone dipropionate 0.05% (Diprolene AF)
  5. 0.5%
100
Q

Psoriasis - Mgmt
> -1- if -2- is involved
> -3- (-4-)

A
  1. UVB light
  2. > 30% TBSA
  3. Moisturizers
  4. fragrance-free emolient creams
101
Q

Pityriasis Rosea

Def: A -1-, acute -2-; usually -3-, lasting -4-

A
  1. mild
  2. inflammatory
  3. self-limiting
  4. 3-8 wks
102
Q

Pityriasis Rosea - Causes/Incidence
> More common in the -1- seasons, and patients frequenly report a(n) -2-
> More common in -3-

A
  1. fall and spring (christmas is in between)
  2. recent URI
  3. females than males
103
Q

Pityriasis Rosea - S/S
> May be -1-
> -2- (2-10 cm) known as -3-
» Usually -4-, and -5- with a crinkled appearance and collarette scale

A
  1. asymptomatic
  2. Initial lesion
  3. (hark the) “herald patch”
  4. macular, oval
  5. fawn/salmon-colored
104
Q

Pityriasis Rosea - S/S

-1- in a -2- (usually -3-) may be found on the -4- w/in 1-2 weeks

A
  1. pruritic rash
  2. christmas tree-pattern
  3. mild
  4. trunk and proximal extremities
105
Q 
Pityriasis Rosea - Labs/Dx
-1- should be performed
> If the rash -2-
> -3-, or mucous membreanes are involved
> If a(n) -4- are -5-
A
  1. Serologic test for syphillis
  2. does not itch
  3. If palmar surfaces, genitalia
  4. few typically perfect lesions
  5. not present
106
Q 
Pityriasis Rosea - Mgmt
Pruritis
> -1-
> -2-
> -3-
> Cool compresses, -4-
> Medium strength -5-
A
  1. Hydroxyzine (atarax)
  2. Antihistamines (zyrtec, claritin, allegra)
  3. topical anti-pruritic (cetaphil, etc.)
  4. baths (with or w/o colloidal oatmeal)
  5. topical steroids (triamcinolone 0.1%)
107
Q

Pityriasis Rosea - Mgmt
> -1- exposure will hasten healing; most effectively -2- x 3-5 days
> -3- (2-wk course) is -4- of pts

A
  1. Daily sunlight
  2. UVB
  3. oral erythromycin
  4. effective in the majority
108
Q

Scarlet Fever
Def: generally mild infection caused by -1-. Contracted through contact witih infected -2- or skin exudate, as a complicatoin of -1- in the throat, or as a result of food-borne -1-. Most common in -3-

A
  1. GABHS
  2. repiratory droplets
  3. children aged 5-15 years
109
Q

Scarlet Fever - S/S - Initial presentation (1-2 days)
> -1- or higher
> -2-

A
  1. Fever of 101 (38.3)

2. exudate pharyngitis

110
Q

Scarlet Fever - S/S - Initial presentation (1-2 days)
> -1- with -2- and/or -3-
> Young children: -4-, -5-, Sz

A
  1. swollen tongue
  2. white exudate
  3. red papillae (beefy) (1-3 = “strawberry” tongue)
  4. abdominal upset
  5. vomiting
111
Q

Scarlet Fever - S/S - Rash presentation (12-48 hours after fever)
> Confined, -1- that progress into widespread -2-
> Initially presents on -3-, and progresses to the -4- before spreading across the trunk & extremities
> Reddened -5-

A
  1. bright red, flat blotches
  2. sandpaper-like papillae
  3. face, neck, armpits
  4. groin
  5. cheeks w/ circumoral pallor
112
Q

Scarlet Fever - Diagnostics
> Primarily diagnosed through a -1-
> -2- may also be used

A
  1. Physical exam

2. throat culture (for GABHS)

113
Q

Scarlet Fever - Mgmt
> -1- course of -2-; should see improvement -3-
> Emollients or oral -4- for desquamating rash

A
  1. 10- to 14-day
  2. PCN or amoxicillin
  3. in 24-48 hours
  4. antihistamines
114
Q

Scarlet Fever - Mgmt

Consider taking a -1- after completion of -2- for red blood cells, which may suggest secondary -3-

A
  1. UA 14 days
  2. abx regimen
  3. glomerulonephritis
115
Q

Impetigo

Def: A -1- of the -2- typically caused by gram+ -3- or -4-

A
  1. bacterial infection
  2. skin
  3. strep
  4. staph (aureus)
116
Q

Impetigo - Causes/Incidence
> Predominantly involves the -1- but can occur anywhere on the body
> Occurs most often in -2-
> -3- and autoinoculable

A
  1. face
  2. summer and fall
  3. highly contagious
117
Q 
Impetigo - S/S
> signs of -1-
> -2-, swelling, -3-
> Regional -4-
> classic -5- lesions
A
  1. inflammation
  2. pain
  3. warmth (pruritic)
  4. lymphadenopathy
  5. honey-crusting
118
Q

Impetigo - Labs/Dx
> -1-, -2-
> -3- to -4- if desired

A
  1. none indicated
  2. clinical diagnosis
  3. culture
  4. confirm causative organism
119
Q 
Impetigo - Mgmt
> Use topical antimicrobials for -1-
>> -2-
> -3-, only when indicated due to severity, should be directed at the offending organism
>> -4- first, then consider -5-
A
  1. mild infections
  2. mupirocin
  3. Systemic antibiotic treatment
  4. Augmentin (amox-clav)
  5. dicloxacillin, cephalexin, or erythromycin (if PCN- or cephalosporin-sensitive)
120
Q

Impetigo - Mgmt
Based on -1-: use the oral beta lactamase resistant abx when oral route is preferred
> If -2- in pts >8yo: -3-, -4-, doxycycline

A
  1. organism
  2. MRSA is suspected
  3. clinda
  4. bactrim (trimeth-sulfameth)
121
Q

Impetigo - Mgmt
> -1- and other community events until -2- of tx
> -3- to -4-

A
  1. abstain from school
  2. 48 hours
  3. apply burow’s (domeboro’s) solution
  4. clean lesions
122
Q

Impetigo - Mgmt
> Advise patient and family members to -1-, clothing , kitchen utensils, or communal surfaces
> -2- to avoid transmission to others

A
  1. avoid sharing towels/co-bathing

2. keep nails trim

123
Q

Scabies
Def: -1- infestation caused by a -2- that -3- into stratum corneum
> Causes/Incidence
» Incubation of -4-
» Spread through the -5- with personal items

A
  1. Highly contagious skin
  2. parasitic mite
  3. burrows
  4. 4-6 weeks
  5. direct or inderect contact (bed-sharing is a major vector)
124
Q

Scabies - S/S
> -1-
> -2-
> -3-: -4- lesoins on -5-

A
  1. intense itching
  2. linear or curved burrows
  3. infants
  4. red-brown vesiculopapular
  5. head, neck, palms, soles
125
Q

Scabies - S/S
> -1- children: red papules on -2-
>-3-

A
  1. older
  2. skin folds, umbilicus, abdomen (warm and tucked away)
  3. interdigital lesions
126
Q

Scabies - Lab/Dx

-1- show -2-

A
  1. skin scrapings

2. mites, ova, and/or feces (but are rarely necessary)

127
Q

Scabies - Mgmt

-1- 5% rinse (-2-: leave on for -3-), -4- in -5-

A
  1. Permethrin (Nix)
  2. 1st tx
  3. 8-14 hours
  4. repeat
  5. one week
128
Q

Scabies - Mgmt
> -1- (not to be used if mother is -2-, or for children -3-)
> -4- for 1 week (-5-)

A
  1. Ivermectin
  2. pregnant, lactating
  3. under 15 kg (33.1 lb)
  4. Rash may persist
  5. after extermination
129
Q

Scabies - Mgmt
> -1- items
> -2- items for -3-
> Antihistamines for -4- (-5-)

A
  1. wash all washable
  2. store all unwashable
  3. one week in air-tight containers
  4. pruritis
  5. also may outlast the mites alongside rash
130
Q

Pinworms

Def: -1- that live in the -2- of humans; occurs most commonly among school-1agd children and younger; spread by -3-

A
  1. Parasitic roundworms, white, thin
  2. colon & rectum
  3. fecal-oral route (kitty litter/sandboxes)
131
Q

Pinworms - S/S
> -1- in the -2-
> Pinworms appear -3- around the anus and may be observed visually

A
  1. itching
  2. perianal area
  3. nocturnally
132
Q

Pinworms - Labs/Dx

-1-: press -2- to skin around anus, -3- and look at -4-

A
  1. “Tape Test”
  2. clear tape
  3. place on slide
  4. under microscope
133
Q 
Pinworms - Mgmt
> -1-
> anthelmintics to -2-
>> -3-
>> -4-: require(s) -5-
A
  1. Symptomatic treatment (benadryl for pruritis
  2. eradicate infection
  3. Pyrantel (pin-x): OTC
  4. Mebendazole or albendazole
  5. prescriptions
134
Q

Lyme Disease

Def: a -1-, and th emost common -2- in the US

A
  1. spirochetal disease

2. vector-borne disease

135
Q

Lyme Disease - Causes/Incidence
Most cases occur in the -1-, and -2-
-3- and -4- are the major animal reservoirs, but -5- may also be a source

A
  1. NE, upper midwest
  2. pacific coast
  3. Mice
  4. deer ticks
  5. birds
136
Q

Lyme Disease - Etiology/Incidence

  • 1-
  • 2- must feed for -3- to -4-
A
  1. borrelia burgdorferi (spirochete)
  2. Ticks
  3. > 36 hours
  4. Transmit the spirochete
137
Q

Lyme Disease - S/S - Stage 1
-1-: a -2- or slightly raised -3- that expands over several days but has -4-; commonly appears in areas of tight clothing

A
  1. erythema migrans
  2. flat
  3. red lesion
  4. central clearing in that time (target-shaped)
138
Q

Lyme Disease - S/S - Stage 1
> -1- have -2-
> -3-; usually resolves

A
  1. 50% of patients
  2. flu-like symptoms
  3. Joint pain
139
Q

Lyme Disease - S/S - Stage 2
> -1- (-2-)
> -3-
> -4-

A
  1. headache, stiff joints
  2. flu-like symptoms worsen
  3. Bell’s palsy
  4. peripheral neruopathy
140
Q

Lyme Disease - S/S - Stage 3
> -1- and -2-
> -3- (-4-)

A
  1. joint
  2. periarticular pain
  3. subacute encephalopathy
  4. “Lyme meningitis”
141
Q

Lyme Disease - S/S - Stage 3

-1-: -2- of the -3- with -4-

A
  1. acrodermatitis chronicum atrophicans
  2. Bluish red discoloration
  3. distal extremity
  4. edema
142
Q

Lyme Disease - Lab/Dx
> Detection of antibody to B. burgdorferi via -1-
> -2- assay is -3-

A
  1. ELISA screening
  2. Western blot
  3. confirmatory
143
Q 
Lyme Disease - Dx criteria
Exposure to -1- w/in the last -2-:
> -3- or
> -4- and
> -5-
A
  1. tick habitat
  2. 30 days with
  3. erythema migrans
  4. one late manifestation
  5. laboratory confirmation
144
Q 
Lyme Disease - Mgmt
> Infection confined to the skin
>> -1- of age: -2- axetil
>> -3- of age: -4-
> referral for -5- disease
A
  1. < 8 years
  2. amoxicillin or cefuroxime
  3. > 8 years
  4. doxycycline
  5. stage 2/3
145
Q 
Measles & Associated Conditions
Name: Rubeola
AKA: -2-; -3-
Age: -4-
Pathogen: virus
S/S: Fever, runny nose, cough, red eyes, -5-, -6-
A
  1. ordinary measles
  2. red measles
  3. any age
  4. Koplik’s spots (white, buccal membrane)
  5. spreading skin rash
146
Q 
Measles & Associated Conditions
Name: Rubella
AKA: -2- measles
Age: -3-
Pathogen: -4-
S/S: Erythematous maculopapular rash; Starts on -6-; gone in -2-; postauricular and suboccipital -8-
Considerations: teratogenicity
A
  1. 3 day(s)
  2. any age
  3. virus
  4. face, spreads to extremities, trunk
  5. lymphadenopathy
147
Q

Measles & Associated Conditions
Name: Erythema infectiosum
AKA: 5th disease
Age: 5-15 yo
Pathogen: human -4-
S/S: -5- appearance, lacy reticular exanthema
Considerations: Fetal -7- (-8-); not contagious after -10-

A
  1. parvovirus B19
  2. “slapped cheek”
  3. aplastic crisis
  4. hydrops fetalis
  5. fever breaks
148
Q 
Measles & Associated Conditions
Name: -1- infantum
AKA: 6th disease
Age: -2-
Pathogen: -3-
S/S: -4- when -5-
A
  1. roseola
  2. 6 mo - 2 years
  3. herpesvirus 6
  4. high fever, abrupt end
  5. rash develops
149
Q 
Coxsackie Virus (HFM Disease)
Def: A -1- viral illness resulting in ulceration and -2- the  -3- and -4- on the -5-
A
  1. highly contagious
  2. inflammation of
  3. soft palate
  4. papulovesicular exanthem
  5. hands/feet
150
Q

Coxsackie Virus (HFM Disease) - Causes/Incidence
> Affects children -1- of age
> -2- in -3-

A
  1. under 10 years
  2. resolves spontaneously
  3. less than a week
151
Q

Coxsackie Virus (HFM Disease) - Causes/Incidence
> -1- of nails is -2-
> -3- by contact with unwashed hands or contaminated surfaces as well as -4-

A
  1. peeling/loss
  2. common
  3. spread
  4. respiratory droplets
152
Q 
Coxsackie Virus (HFM Disease) - S/S
> -1-
> -2-
> -3-
> -4-
> poor oral intake (-5-)
A
  1. fever
  2. malaise
  3. papulovesicular rash
  4. drooling
  5. oral pain
153
Q 
Coxsackie Virus (HFM Disease)
> Lab/Dx
>> -1-
> Mgmt
>> -2- (-3-)
>> -4- for -5-
A
  1. none indicated
  2. acetaminophen
  3. fever
  4. topical applications
  5. comfort
154
Q

Mumps
Def: a -1- viral infection primarily affecting the -2-; resolves within 2 weeks; may occasionally cause -3- such as -4-, encephalitis, meningitis, and deafness

A
  1. highly contagious
  2. salivary glands
  3. complications
  4. oophoritis, mastitis, pancreatitis
155
Q 
Mumps - S/S
> -1- causing puffy cheeks and a tender, swollen jaw
> -2-
> -3- (-4-)
> -5-
A
  1. swollen salivary glands (parotitis; CHIPMUMPS)
  2. fever
  3. HA, muscle aches, weakness/fatigue
  4. flu-like symptoms
  5. loss of appetite
156
Q 
Mumps
> Lab/Dx
>> -1-
> Mgmt
>> -2- and isolation
>> -3-
>> May use -4- to -5-
A
  1. mumps IgM (usually self-limiting, however)
  2. Rest
  3. NSAIDs
  4. sugar-free lemon drops
  5. increase the flow of saliva
157
Q

Initial management of puncture wounds -1- with sterile saline and -2- of foreign matter to prevent tattooing of debris into the -3-. High pressure wound irrigation as well as -4- may damage the tissue and -5- deeper into the wound.

A
  1. includes superficial irrigation
  2. cleansing the area
  3. dermal layers
  4. surgical debridement/wound probing
  5. push foreign objects/bacteria
158
Q

Prophylactic antibiotics are -1- for puncture wounds unless the -2- is especially high such as with cat bites, puncture wounds of the face, and -3-. A tetanus booster is indicated if it has been -4- years since the patient’s last dose of a tetanus-containing vaccine or if -5- doses have ever been received.

A
  1. not indicated
  2. risk of infection
  3. human bite wounds
  4. more than 10
  5. less than 3
159
Q

The therapeutic objectives in the management of acne vulgaris are to -1-, prevent formation of -2-, suppress -3-, and reduce inflammation to prevent scarring. Topical retinoids, -4- that bind to retinoid receptors in the skin, are -5- of primary acne management.

A
  1. reduce sebum production
  2. microcomedones
  3. Cutibacterium acnes (formerly Propionibacterium acnes)
  4. vitamin A derivatives
  5. a key component
160
Q

Topical retinoids normalize -1- to prevent new formation of microcomedones, the precursors of both -2- lesions. Additionally, -3- of existing microcomedones and work within the nucleus to -4- that affect inflammatory pathways.

A
  1. follicular epithelial desquamation
  2. comedonal and inflammatory
  3. retinoids promote clearing
  4. alter downstream signals
161
Q

The -1- for the diagnosis and treatment of pediatric acne (last published in 2013) -2- of topical retinoids -3- for -4- in children and adolescents.

A
  1. evidence-based recommendations
  2. support the use
  3. as/in mono-/combination therapy
  4. all acne types/severities
162
Q

Perianal streptococcal infection
Common symptoms include erythema, -1-, local itching, and -2-. While presentation with -3- can occur, many cases do not involve -4-. The infection is usually a result of from a -5-.

A
  1. pain
  2. blood-streaked stools
  3. fever (low-grade)
  4. systemic symptoms
  5. GABHS autoinoculation
163
Q

Perianal streptococcal infection
On physical exam, the perianal area is -1- with distinct margins that can extend up -2- from the anus. The most important history question is whether there is history of a -3- which could suggest a -4-. -5- of a perianal swab assists in confirming the diagnosis.

A
  1. erythematous
  2. to 2 cm
  3. recent sore throat
  4. streptococcal autoinoculation
  5. Rapid strep test
164
Q

Perianal streptococcal infection

Treatment for perianal infection is the same as for -1- with -2- being the most appropriate -3-.

A
  1. streptococcal pharyngitis
  2. penicillin V/amoxicillin
  3. antibiotics
165
Q

Perianal streptococcal infection - DDx
-1- is also seen with pinworm infections. However, these children typically present with -2-. Pinworm infections are not -3- and do not present with -4-. On exam during the nighttime, -5- can be seen at the anus.

A
  1. Perianal pruritis
  2. neurobehavioral symptoms (irritability, hyperactivity, and insomnia)
  3. painful
  4. systemic symptoms
  5. white threadlike worms
166
Q

Exam findings in a school-age child of dry, intensely pruritic papules and plaques affecting the flexural surfaces, as well as cracking, dryness, and scaling on his hands and feet are most likely due to -1-.

As a result of the patient constantly scratching the -1- eruptions, the skin on the hands and feet has lichenified. -2- usually present with severe itching, but, missing from the above findings, -2- would also present with erythematous rings, and hypopigmentation or hyperpigmentation.

-3- causes a rash as well, but would also cause irritability in this age group. -4- usually affects -5- and presents with flaky skin.

A
  1. atopic dermatitis (skin disease characterized by areas of severe itching and scaling)
  2. Fungal infections/tinea
  3. Candidiasis (yeast infection)
  4. Seborrheic dermatitis
  5. only the ears

PNCB CPNP-PC (19 decks)

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