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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
``` Eval of Skin Disorders Configuration > Grouped: Linear -1- > Confluent: Lesions that -2- > Linear: Scratch, streak, -3- (-4-) ```
1. clusters 2. run together 3. line, stripe 4. poison ivy
26
Eval of Skin Disorders Configuration > Annular: -1-, beginning in the center, and spreading to the periphery (-2-, -3-, -4-) > Polycyclic: -5-
1. circular 2. tinea 3. erythema migrans 4. Lyme disease 5. annular lesions merge
27
Eval of Skin Disorders Distribution > -1- the lesions -2- > -3-: following -4- (-5-)
1. Where 2. appear on the body 3. Dermatomal 4. nerve pathways 5. shingles
28
Acne | Def: A -1- skin disorder -2- by -3-, -4-, -5-
1. polymorphic 2. characterized 3. comedones 4. pustules 5. papules & cysts
29
Acne Causes/Incidence > Cause is unknown but appears to be activated by -1- in genetically predisposed individuals > Can be exacerbated by -2- and -3-
1. androgens 2. steroids 3. anticonvulsants
30
Acne Causes/Incidence | > -1- has -2- to be a(n) -3-
1. Food 2. not been demonstrated 3. contributing factor
31
Acne Causes/Incidence | During adolescence, acne is -1- and -2- in -3-
1. More common 2. severe 3. males
32
Acne S/S -1- > Open: -2- (-3-) > Closed: -4- (-5-)
1. Comedones 2. blackheads 3. black-hole/open 4. whiteheads 5. white-dwarf/closed
33
Acne S/S > -1- or hypertrophic -2- (-3-) > In -4-, may be exacerbated just -5-
1. depressed 2. scarring 3. cystic acne 4. women 5. prior to menses
34
``` Acne Labs/Dx > -1- to identify -2- in -3- Mgmt > -4- >> Use of oil-free, mild soaps, -5- and moisturizers ```
1. None indicated, except 2. causative organism 3. atypical folliculitis 4. Non-pharm 5. cleansers (cetaphil, Dove)
35
Acne Mgmt -1- > In mild acne, topical treatment w/ -2- (-3-) >> If unresponsive, -4- -5- (preg cat C)
1. Pharmacologic 2. benzoyl peroxide (2.5-10%) 3. start low, increase PRN 4. retinoic acid (.025% - .1%) 5. cream or gel
36
Acne Pharm Mgmt | -1- is -2- and -3- by -4-; this agent should only be -5- and not used concomitantly with -4-
1. Tetinoin 2. neutralized by UV light 3. oxidized 4. benzoyl peroxide 5. applied at night
37
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-
1. dryness 2. redness/irritation 3. decrease strength 4. duration
38
Acne Mgmt | -1- acne (or -2- acne) requires -3- (-4- should be tried followed by macrolides) along with topical treatments
1. moderate 2. severe pustular 3. systemic antibiotics 4. -cyclines
39
Moderate or Severe Pustular Acne Mgmt > -1-: 50-100 mg -2- or 100 -3- > -4-: 50-100 mg -2-
1. Doxy 2. BID 3. Qday 4. minocycline
40
Moderate or Severe Pustular Acne Mgmt > -1- >> Only for patients who -2- the -3- > Severe acne that doesn't -4- should be -5-
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)
41
Acne Mgmt | Consider -1- in patients -2- who also desire -3-
1. oral contraceptives 2. 14 yo + 3. pregnancy prevention
42
Oral Contraceptives for Acne Mgmt Age -1-: -2- 3 mg qd (on 24 off 4) Age -3-: -4- multidose regimen (on 21 off 7)
1. 14+ 2. Drospirenone 3. 15+ 4. Norgestimate
43
Fungal Infections | Def: There are a(n) -1- infections that are distinguished by the -2- of fungi and the -3-
1. variety of fungal 2. causal species 3. location they manifest
44
Fungal Infection Causes/Incidence > Fungal organisms -1- (-2-) or -3- cause the -4- > Pharm mgmt centers on -5- and the prevention of transmission
1. Trichophyton 2. most common 3. microsporum 4. dermatophyte infections 5. anti-fungal therapy (mostly topical)
45
Tinea capitis: a -1- of the -2- S/S > -2- > -3-
1. Fungal infection of the scalp 2. Annular balding 3. Black dots (broken shafts)
46
Tinea corporis (-1-) > -2- on the -3- > -4- (-5- & -6-) > -7-
1. Ringworm 2. Fungal infection 3. body 4. annular 5. raised borders 6. central clearing 7. pruritic
47
Tinea cruris | Def: -1-, aka -2-, characterized by -3- and -4-.
1. Inguinal fungal infection 2. jock itch 3. Erythema 4. Pruritis
48
Tinea manuum/pedis > -1- fungal infection (-2-) > Also known as -3- > -4- is the chief symptom
1. Interdigital 2. hands/feet 3. "athletes' foot" 4. Pruritis
49
Tinea versicolor (2)
1. hypo/hyperpigmentation macules r/t fungal infection | 2. End of summer
50
Fungal Infections S/S > May be -1- (e.g. -2-) > Some forms present with -3- (tinea -4- and -5-)
1. asymptomatic 2. tinea capitis 3. severe itching 4. cruris 5. pedis
51
Fungal Infections S/S > -1- (tinea -2-) > -3- of -4- (-5-)
1. erythematous rings 2. corporis 3. solitary areas 4. hypo-/hyperpigmentation 5. tinea versicolor
52
Fungal Infections Labs/Dx | -1- -2- microscopically when treated w/ -3-
1. "Spaghetti & Meatballs" 2. hyphae 3. KOH
53
Fungal Infections Mgmt | Tinea capitis: -1- is -2- 20-25 mg/kg/day -3- for -4-
1. primary management 2. griseofulvin 3. PO (topical is ineffective r/t follicular permeation) 4. 6-8 weeks
54
Fungal Infections Mgmt | corporis: use of -1- is usually adequate (-2-); -3-
1. topical antifungals 2. mi-/ketoconazole 2% 3. BID
55
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-
1. terbinafine cream 2. > 80% 3. griseofulvin 4. severe cases
56
Fungal Infections Mgmt Tinea manuum/pedis > -1- stage: use -2- (-3-) to soak for -4- -5-
1. Macerated stage 2. aluminum subacetate solution 3. Domeboro (old & gold) 4. 20 min 5. BID
57
Fungal Infections Mgmt Tinea manuum/pedis > -1- stage: topical antifungals (e.g. -2-) > -3- in severe cases
1. Dry, scaly 2. terbinafine 3. oral antifungals
58
Fungal infections mgmt | Tinea versicolor: -1- applied for -2- daily for -3-; if -4-, -5- 200 mg PO every day for 5 days
1. Selenium sulfide shampoo 2. 5-15 minutes 3. 7 days 4. persistant or widespread 5. itraconazole (sporanox)
59
Varicella Zoster Virus (Chickenpox) | Def: Acute, -1- caused by -2-, transmitted by -3- w/ -4-
1. contagious disease 2. herpes virus 3. direct contact 4. lesions or airborne
60
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-
1. contagious for 48 hours 2. outbreak 3. crusted over 4. under 10 5. varicella vaccine
61
Varicella Zoster Virus (Chickenpox) - S/S > -1- > -2- > -3-: (-4-) Usually distributes initially on the -5-
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)
62
``` Varicella Zoster Virus (Chickenpox) S/S > Intense -1- > -2- > Generalized -3- Labs/Dx > -4-, typically a -5- ```
1. pruritis 2. low-grade fever 3. lymphadenopathy 4. None required 5. clinical dx
63
``` Varicella Zoster Virus (Chickenpox) - Mgmt -1- tx for -2- > -3- lotion > -4- > -5- ```
1. Supportive 2. pruritis 3. calamine/caladryl 4. antihistamine (benadryl) 5. acetaminophen for fever
64
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-
1. self-limiting disease 2. immunocomprimised: oral acyclovir 3. first 24 hours 4. magnitude 5. duration of symptoms (non-curative)
65
Molloscum Contagiosum | Def: A common, -1- infection, these lesions frequently -2- in -3- and are not easily treated
1. benign viral skin 2. disappear on their own 3. a few weeks to a few months
66
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-
1. pink- 2. flesh-colored 3. papules 4. *umbilicated* 5. cheese-like center
67
Molloscum Contagiosum - Causes/Incidence | Children who are -1- can have grouped lesions in the -2- area
1. sexually active or abused | 2. genital
68
Molloscum Contagiosum - S/S | Lesions most commonly present on the -1-, -2-, -3- trunk, -4-, and extremities
1. face 2. axillae 3. antecubital fossa 4. crural fascia
69
Molloscum Contagiosum - S/S | -1- at the site of infection --> -2-
1. Itching/picking | 2. secondary lesions
70
Molloscum Contagiosum - Labs/Dx > -1- > -2- of -3- to -4-
1. clinical presentation 2. hx 3. exposure 4. MC
71
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
1. Self-limiting 2. Removal 3. cheese-like core 4. autoinoculation 5. Curettage
72
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-
1. Tretinoin 2. Salicylic acid 3. Podophyllotoxin cream 4. not recommended for pregnant women due to presumed toxicity to fetus
73
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)
1. liquid nitrogen 2. trichloroacetic acid peel 3. silver nitrate, iodine 4. Imiquimod
74
Molloscum Contagiosum - Mgmt > -1- and -2- lesions to stop from spreading. (-3-) > -4- may occur after -5- in some immunocompetent patients
1. Prevent touching 2. scratching 3. keep nails trim 4. spontaneous resolution 5. 6-9 months
75
``` Atopic Dermatitis (Eczema) Def: -1- characterize by -2- along a typical pattern of distribution with periods of -3- ```
1. chronic skin condition 2. intense itching 3. remission an exacerbation
76
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.
1. sensitive to low humidity 2. winter 3. air is dry 4. family history 5. Asthma, allergic rhinitis, or AD
77
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-
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
Atopic Dermatitis (Eczema) - Labs/Dx > -1- may suggest dust mite allergy (food allergy uncommon) > -2- may be -3- > -4- may be present
1. Radioallergosorbent Test (RAST) or skin tests 2. Serum IgE 3. Elevated 4. Eosinophilia
79
``` Atopic Dermatitis (Eczema) - Mgmt -1- mgmt: -2- lotion (-3-) -4-; must -5- ```
1. **Hallmark** Dry skin 2. moisturizing 3. thick (vaseline, eucerin, aquaphor) 4. immediately after bathing 5. blot dry
80
``` 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) ```
1. apply thin layer 2. seal w/ moisturizer 3. hydrocortisone 4. fluocinonide cream 5. desonide
81
``` Atopic Dermatitis (Eczema) - Mgmt >>Adverse effects of hydrocortisone: -1-, -2-, -3-/scarring ```
1. bladder dysfunction 2. hyperglycemia 3. *hypopigmentation*
82
``` Atopic Dermatitis (Eczema) - Mgmt > -1- ointment > Systemic steroids only in -2-: -3-, taper over 10-14 days ```
1. Crisaborole 2% 2. extremely severe cases 3. prednisone (avoid)
83
Atopic Dermatitis (Eczema) - Mgmt > In acute -1- >> use saline or -2- >> colloidal -3-
1. Weeping 2. Domeboro solution (AlSubacetate) 3. Oatmeal baths (Aveeno)
84
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.
1. Bleach baths 2. kill all the bacteria on the skin 3. 1/4 - 1/2 cup bleach 4. 40 gallon bathtub filled
85
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.
1. Dupilumab 2. Dermatologist 3. tacrolimus (Protopic) and pimecrolimus (Elidel) 4. 2+ yo 5. local burning/stinging sensations 6. lessen after several
86
Allergic Contact Dermatitis | Def: an acute or chronic dermatitis that -1- from -2- with chemicals or -3-
1. results 2. direct skin contact 3. *allergens*
87
Allergic Contact Dermatitis - S/S > -1-, -2-, scabbing > Tiny -3- and -4-, encrusted lesions in acute phases
1. Redness 2. pruritis 3. vesicles 4. weeping
88
Allergic Contact Dermatitis - S/S > -1- will -2- > Affected areas -3- (worse w/ -4-)
1. location 2. suggest cause 3. hot and swollen 4. heat (like after a bath)
89
``` Allergic Contact Dermatitis > Labs/Dx >> -1- > Mgmt >> Depends on severity; -2-, avoid scrubbing with soap and water >> High potency -3- >> If -4-: -5- ```
1. None indicated 2. if compresses locally 3. topical steroids locally 4. severe/systemic 5. prednisone taper
90
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-
1. genital/perianal region 2. urine, feces (prolonged contact) 3. 9-12 months (ambulating with soiled diapers)
91
Irritant (Diaper) Dermatitis - Labs/Dx:
None indicated
92
Irritant (Diaper) Dermatitis - Mgmt > In mild cases, -1- > When erythema/papules present, -2- > Use Burow's (-3-) compresses for severe erythema and -4-
1. barrier emollients (desitin, etc.) 2. use Hydrocortisone 1% 3. Domeboro's 4. vesicles
93
Irritant (Diaper) Dermatitis - Mgmt > Secondary -1- may need -2- > Secondary -3- may need -4- > Allow -5- several times daily
1. bacterial infection 2. topical antibiotics 3. fungal infection 4. topical antifungals 5. diaper area to air dry (as much as possible)
94
``` 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- ```
1. benign hyperproliferative inflammatory 2. 2-3% of the population 3. epidermal turnover time 4. 14 days to 2 days 5. immunologically mediated
95
Psoriasis - S/S > Often -1-; -2- may occur > Lesions are red, sharptly defined plaques with -3- > -4-, -5- are common sites
1. asymptomatic 2. itching 3. silvery scales 4. scalp, joints 5. palms & soles, nails
96
Psoriasis - S/S > Fine -1- is strongly suggestive of psoriasis, as is separation of the nail -2- > -3-: -4- when -5-
1. pitting of the nails 2. plate and bed 3. *Auspitz sign* 4. droplets of blood 5. scales are removed
97
Psoriasis - Labs/Dx:
None indicated
98
Psoriasis - Mgmt > Topicals for the -1- >> -2- (-3-) >> Medium potency topical -4-
1. scalp 2. tar/salicylic acid shampoo 3. T-gel 4. steroid oil
99
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)
1. steroids 2. BID 3. calcipotriene (Dovonex) 4. betamethasone dipropionate 0.05% (Diprolene AF) 5. 0.5%
100
Psoriasis - Mgmt > -1- if -2- is involved > -3- (-4-)
1. UVB light 2. > 30% TBSA 3. Moisturizers 4. fragrance-free emolient creams
101
Pityriasis Rosea | Def: A -1-, acute -2-; usually -3-, lasting -4-
1. mild 2. inflammatory 3. self-limiting 4. 3-8 wks
102
Pityriasis Rosea - Causes/Incidence > More common in the -1- seasons, and patients frequenly report a(n) -2- > More common in -3-
1. fall and spring (christmas is in between) 2. recent URI 3. females than males
103
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
1. asymptomatic 2. Initial lesion 3. (hark the) "herald patch" 4. macular, oval 5. fawn/salmon-colored
104
Pityriasis Rosea - S/S | -1- in a -2- (usually -3-) may be found on the -4- w/in 1-2 weeks
1. pruritic rash 2. christmas tree-pattern 3. mild 4. trunk and proximal extremities
105
``` Pityriasis Rosea - Labs/Dx -1- should be performed > If the rash -2- > -3-, or mucous membreanes are involved > If a(n) -4- are -5- ```
1. Serologic test for syphillis 2. does not itch 3. If palmar surfaces, genitalia 4. few typically perfect lesions 5. not present
106
``` Pityriasis Rosea - Mgmt Pruritis > -1- > -2- > -3- > Cool compresses, -4- > Medium strength -5- ```
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
Pityriasis Rosea - Mgmt > -1- exposure will hasten healing; most effectively -2- x 3-5 days > -3- (2-wk course) is -4- of pts
1. Daily sunlight 2. UVB 3. oral erythromycin 4. effective in the majority
108
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-
1. GABHS 2. repiratory droplets 3. children aged 5-15 years
109
Scarlet Fever - S/S - Initial presentation (1-2 days) > -1- or higher > -2-
1. Fever of 101 (38.3) | 2. exudate pharyngitis
110
Scarlet Fever - S/S - Initial presentation (1-2 days) > -1- with -2- and/or -3- > Young children: -4-, -5-, Sz
1. swollen tongue 2. white exudate 3. red papillae (beefy) (1-3 = "strawberry" tongue) 4. abdominal upset 5. vomiting
111
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-
1. bright red, flat blotches 2. sandpaper-like papillae 3. face, neck, armpits 4. groin 5. cheeks w/ circumoral pallor
112
Scarlet Fever - Diagnostics > Primarily diagnosed through a -1- > -2- may also be used
1. Physical exam | 2. throat culture (for GABHS)
113
Scarlet Fever - Mgmt > -1- course of -2-; should see improvement -3- > Emollients or oral -4- for desquamating rash
1. 10- to 14-day 2. PCN or amoxicillin 3. in 24-48 hours 4. antihistamines
114
Scarlet Fever - Mgmt | Consider taking a -1- after completion of -2- for red blood cells, which may suggest secondary -3-
1. UA 14 days 2. abx regimen 3. glomerulonephritis
115
Impetigo | Def: A -1- of the -2- typically caused by gram+ -3- or -4-
1. bacterial infection 2. skin 3. strep 4. staph (aureus)
116
Impetigo - Causes/Incidence > Predominantly involves the -1- but can occur anywhere on the body > Occurs most often in -2- > -3- and autoinoculable
1. face 2. summer and fall 3. highly contagious
117
``` Impetigo - S/S > signs of -1- > -2-, swelling, -3- > Regional -4- > classic -5- lesions ```
1. inflammation 2. pain 3. warmth (pruritic) 4. lymphadenopathy 5. *honey-crusting*
118
Impetigo - Labs/Dx > -1-, -2- > -3- to -4- if desired
1. none indicated 2. clinical diagnosis 3. culture 4. confirm causative organism
119
``` 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- ```
1. mild infections 2. mupirocin 3. Systemic antibiotic treatment 4. Augmentin (amox-clav) 5. dicloxacillin, cephalexin, or erythromycin (if PCN- or cephalosporin-sensitive)
120
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
1. organism 2. MRSA is suspected 3. clinda 4. bactrim (trimeth-sulfameth)
121
Impetigo - Mgmt > -1- and other community events until -2- of tx > -3- to -4-
1. abstain from school 2. 48 hours 3. apply burow's (domeboro's) solution 4. clean lesions
122
Impetigo - Mgmt > Advise patient and family members to -1-, clothing , kitchen utensils, or communal surfaces > -2- to avoid transmission to others
1. avoid sharing towels/co-bathing | 2. keep nails trim
123
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
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
Scabies - S/S > -1- > -2- > -3-: -4- lesoins on -5-
1. intense itching 2. linear or curved burrows 3. infants 4. red-brown vesiculopapular 5. head, neck, palms, soles
125
Scabies - S/S > -1- children: red papules on -2- >-3-
1. older 2. skin folds, umbilicus, abdomen (warm and tucked away) 3. interdigital lesions
126
Scabies - Lab/Dx | -1- show -2-
1. skin scrapings | 2. mites, ova, and/or feces (but are rarely necessary)
127
Scabies - Mgmt | -1- 5% rinse (-2-: leave on for -3-), -4- in -5-
1. Permethrin (Nix) 2. 1st tx 3. 8-14 hours 4. repeat 5. one week
128
Scabies - Mgmt > -1- (not to be used if mother is -2-, or for children -3-) > -4- for 1 week (-5-)
1. Ivermectin 2. pregnant, lactating 3. under 15 kg (33.1 lb) 4. Rash may persist 5. after extermination
129
Scabies - Mgmt > -1- items > -2- items for -3- > Antihistamines for -4- (-5-)
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
Pinworms | Def: -1- that live in the -2- of humans; occurs most commonly among school-1agd children and younger; spread by -3-
1. Parasitic roundworms, white, thin 2. colon & rectum 3. fecal-oral route (kitty litter/sandboxes)
131
Pinworms - S/S > -1- in the -2- > Pinworms appear -3- around the anus and may be observed visually
1. itching 2. perianal area 3. nocturnally
132
Pinworms - Labs/Dx | -1-: press -2- to skin around anus, -3- and look at -4-
1. "Tape Test" 2. clear tape 3. place on slide 4. under microscope
133
``` Pinworms - Mgmt > -1- > anthelmintics to -2- >> -3- >> -4-: require(s) -5- ```
1. Symptomatic treatment (benadryl for pruritis 2. eradicate infection 3. Pyrantel (pin-x): OTC 4. Mebendazole or albendazole 5. prescriptions
134
Lyme Disease | Def: a -1-, and th emost common -2- in the US
1. spirochetal disease | 2. vector-borne disease
135
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
1. NE, upper midwest 2. pacific coast 3. Mice 4. deer ticks 5. birds
136
Lyme Disease - Etiology/Incidence - 1- - 2- must feed for -3- to -4-
1. borrelia burgdorferi (spirochete) 2. Ticks 3. **> 36 hours** 4. Transmit the spirochete
137
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
1. **erythema migrans** 2. flat 3. red lesion 4. central clearing in that time (target-shaped)
138
Lyme Disease - S/S - Stage 1 > -1- have -2- > -3-; usually resolves
1. 50% of patients 2. flu-like symptoms 3. Joint pain
139
Lyme Disease - S/S - Stage 2 > -1- (-2-) > -3- > -4-
1. headache, stiff joints 2. flu-like symptoms worsen 3. Bell's palsy 4. peripheral neruopathy
140
Lyme Disease - S/S - Stage 3 > -1- and -2- > -3- (-4-)
1. joint 2. periarticular pain 3. subacute encephalopathy 4. "Lyme meningitis"
141
Lyme Disease - S/S - Stage 3 | -1-: -2- of the -3- with -4-
1. acrodermatitis chronicum atrophicans 2. Bluish red discoloration 3. distal extremity 4. edema
142
Lyme Disease - Lab/Dx > Detection of antibody to B. burgdorferi via -1- > -2- assay is -3-
1. ELISA screening 2. Western blot 3. confirmatory
143
``` Lyme Disease - Dx criteria Exposure to -1- w/in the last -2-: > -3- or > -4- and > -5- ```
1. tick habitat 2. 30 days with 3. erythema migrans 4. one late manifestation 5. laboratory confirmation
144
``` Lyme Disease - Mgmt > Infection confined to the skin >> -1- of age: -2- axetil >> -3- of age: -4- > referral for -5- disease ```
1. < 8 years 2. amoxicillin or cefuroxime 3. > 8 years 4. doxycycline 5. stage 2/3
145
``` Measles & Associated Conditions Name: Rubeola AKA: -2-; -3- Age: -4- Pathogen: virus S/S: Fever, runny nose, cough, red eyes, -5-, -6- ```
2. ordinary measles 3. red measles 4. any age 5. Koplik's spots (white, buccal membrane) 6. spreading skin rash
146
``` 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 ```
2. 3 day(s) 3. any age 4. virus 6. face, spreads to extremities, trunk 8. lymphadenopathy
147
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-
4. parvovirus B19 5. "slapped cheek" 7. aplastic crisis 8. hydrops fetalis 10. fever breaks
148
``` Measles & Associated Conditions Name: -1- infantum AKA: 6th disease Age: -2- Pathogen: -3- S/S: -4- when -5- ```
1. roseola 2. 6 mo - 2 years 3. herpesvirus 6 4. high fever, abrupt end 5. rash develops
149
``` Coxsackie Virus (HFM Disease) Def: A -1- viral illness resulting in ulceration and -2- the -3- and -4- on the -5- ```
1. highly contagious 2. inflammation of 3. soft palate 4. papulovesicular exanthem 5. hands/feet
150
Coxsackie Virus (HFM Disease) - Causes/Incidence > Affects children -1- of age > -2- in -3-
1. under 10 years 2. resolves spontaneously 3. less than a week
151
Coxsackie Virus (HFM Disease) - Causes/Incidence > -1- of nails is -2- > -3- by contact with unwashed hands or contaminated surfaces as well as -4-
1. peeling/loss 2. common 3. spread 4. respiratory droplets
152
``` Coxsackie Virus (HFM Disease) - S/S > -1- > -2- > -3- > -4- > poor oral intake (-5-) ```
1. fever 2. malaise 3. papulovesicular rash 4. drooling 5. oral pain
153
``` Coxsackie Virus (HFM Disease) > Lab/Dx >> -1- > Mgmt >> -2- (-3-) >> -4- for -5- ```
1. none indicated 2. acetaminophen 3. fever 4. topical applications 5. comfort
154
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
1. highly contagious 2. salivary glands 3. complications 4. oophoritis, mastitis, pancreatitis
155
``` Mumps - S/S > -1- causing puffy cheeks and a tender, swollen jaw > -2- > -3- (-4-) > -5- ```
1. swollen salivary glands (parotitis; CHIPMUMPS) 2. fever 3. HA, muscle aches, weakness/fatigue 4. flu-like symptoms 5. loss of appetite
156
``` Mumps > Lab/Dx >> -1- > Mgmt >> -2- and isolation >> -3- >> May use -4- to -5- ```
1. mumps IgM (usually self-limiting, however) 2. Rest 3. NSAIDs 4. sugar-free lemon drops 5. increase the flow of saliva
157
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.
1. includes superficial irrigation 2. cleansing the area 3. dermal layers 4. surgical debridement/wound probing 5. push foreign objects/bacteria
158
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.
1. not indicated 2. risk of infection 3. human bite wounds 4. more than 10 5. less than 3
159
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.
1. reduce sebum production 2. microcomedones 3. Cutibacterium acnes (formerly Propionibacterium acnes) 4. vitamin A derivatives 5. a key component
160
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.
1. follicular epithelial desquamation 2. comedonal and inflammatory 3. retinoids promote clearing 4. alter downstream signals
161
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.
1. evidence-based recommendations 2. support the use 3. as/in mono-/combination therapy 4. all acne types/severities
162
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-.
1. pain 2. blood-streaked stools 3. fever (low-grade) 4. systemic symptoms 5. GABHS autoinoculation
163
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.
1. erythematous 2. to 2 cm 3. recent sore throat 4. streptococcal autoinoculation 5. Rapid strep test
164
Perianal streptococcal infection | Treatment for perianal infection is the same as for -1- with -2- being the most appropriate -3-.
1. streptococcal pharyngitis 2. penicillin V/amoxicillin 3. antibiotics
165
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.
1. Perianal pruritis 2. neurobehavioral symptoms (irritability, hyperactivity, and insomnia) 3. painful 4. systemic symptoms 5. white threadlike worms
166
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.
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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