Derm

Question 1

Things that must be documented by ED in a derm complaint

Answer 1

distribution, pattern, arrangement, morphology, extent, evolutionary changes

Question 2

rash to flexor surfaces DDx

Answer 2

atopic dermatitis, candidiasis, eczema

Question 3

sun exposure pattern rash ddx

Answer 3

sunburn, photosensitive drug rxn, SLE, viral exanthem

Question 4

rash to distal extremities ddx

Answer 4

viral exanthema, atopic dermatitis, contact dermatitis, eczema, Rocky mountain spotted fever, gonnococemia,

Question 5

rash to front and back of chest ddx

Answer 5

pityriasis rosea, syphilis, drug eruption, psoriasis

Question 6

clothing covered distribution rash ddx

Answer 6

contact dermatitis, psoriasis, folliculitis

Question 7

aciniform rash ddx

Answer 7

acne is the main one

Question 8

Viral exanthems that start distal

Answer 8

erythema multiform, secondary syphillis, meningococcemia, dengue fever

Question 9

conditions that you want to consult derm BEFORE you start the pt on steroids

Answer 9

erythema multiform, toxic epidermal necrolyisis and vasculitis

Question 10

contraindications for PO steroids

Answer 10

DM, HTN, active PUD, psych disease, immunodef.

Question 11

Area where silver sulfadiazine cannot be applied

Answer 11

the face! it will stain the face.

Question 12

the least potent topical steroid

Answer 12

hydrocortisone. safe for face, finger, toes and no goes. and for kids.

Question 13

the most potent topical steroid

Answer 13

Clobetasol or Halobetasol

Question 14

medium potency topical steroids

Answer 14

Betamethasone, Triamcinalone, Fluticasone

Question 15

steroid formulation that cannot be used in pregnacny

Answer 15

fluorinated formulations

Question 16

conditions that require high potency steropid

Answer 16

psoriasis, severe eczema, severe poison ivy, severe atopic dermatitis

Question 17

conditions that require moderate potency steroid

Answer 17

atopic dermatitis, stasis dermatitis, Tinea, seborrheic dermatitis, scabies

Question 18

in genreal, 9 grams of topical steroid will cover

Answer 18

9% of body surface area for 1 day if applies 3x.day

Question 19

amount of topical steroid that should be Rx in the ED

Answer 19

only enough for 2-3 days worth because they need follow up with derm/PCP

Question 20

Wound and laceration things to worry about in the ED

Answer 20

1. cosmesis
2. Pain
3. Infection

Question 21

C/I for lidocaine with epi

Answer 21

fingers, toes, nose, and no-goes

Question 22

most common suture used in ER

Answer 22

Nylon or proline, monofilament

Question 23

suture in the face should be removed when?

Answer 23

3-4 d kids, 3-5 d adult

Question 24

suture in the neck should be removed when?

Answer 24

2-3d kid 3-4 d adult

Question 25

suture in the UE should be removed when?

Answer 25

7-10 d

Question 26

suture in the hand should be removed when?

Answer 26

10-14 d

Question 27

suture in the chest should be removed when?

Answer 27

7-10 d

Question 28

suture in the back should be removed when?

Answer 28

10-14 d

Question 29

suture in the legs should be removed when?

Answer 29

8-10d

Question 30

suture in the foot should be removed when?

Answer 30

10-14d

Question 31

suture over a joint should be removed when?

Answer 31

10-14d

Question 32

wound with the highest risk of infection

Answer 32

puncture wound and animal bites (cats > dogs)

Question 33

Tx for puncture/animal wound

Answer 33

IRRIGATION. allow for primary closure and do not give prophylactic abx if it is not a high risk plantar wound, but do give tetanus if indicated

Question 34

Abx prophylaxis for animal/human bites

Answer 34

Augmenting

Question 35

Utility of soaking wounds

Answer 35

NONE

Question 36

Utility of specific solutions to irrigate

Answer 36

NONE. water works just fine.

Question 37

Irrigation guidelines

Answer 37

35cc syringe with 19g needle. Be sure to use universal precautions and avoid splashing.

Question 38

If had primary tetanus series and have had last dose within 5-10 years and you have a major wound

Answer 38

you need vac. booster

Question 39

If had primary tetanus series and have had last dose within 5 years and you have a major wound

Answer 39

dont need anythign

Question 40

If had primary tetanus series and have had last dose >10 years and you have a major wound

Answer 40

you need vac booster

Question 41

if you have less than 3 tetanus series or are not sure and you have a minor wound

Answer 41

get tetanus vac. booster

Question 42

if you have less than 3 tetanus series or are not sure and you have a major wound

Answer 42

give tetanus immunoglobulin and vaccine

Question 43

S/Sx of black widow bite

Answer 43

redness and swelling (20-60min), pain and cramps (20-40min)

Question 44

Tx options for black widow bites

Answer 44

Lyovac antivenin, benzos, opiates

Question 45

S/Sx brown recluse bite

Answer 45

Bulls eye pattern, bluish discoloration, skin necrosis, pain (2-8 hrs)

Question 46

tx options for brown recluse bite

Answer 46

Dapsone to halt tissue necrosis

Question 47

Tx for urticaria

Answer 47

OTC cortrizine, ranitidine or cimetidine or steroids up to 1 week for severe

Question 48

Tx for Contact dermatitis

Answer 48

remove offending agents, topical baths, OTC antihistamines, Hydracortazone of kenalog cream.

Question 49

poison ivy steroid dose

Answer 49

can give 30-80mg/day of prednisone taper x 21 days for severe

Question 50

PUP tx

Answer 50

high potency steroid, oral antihistamine. Can consider PO steroid

Question 51

Tx for abscess

Answer 51

incision and drainage at bedside. Send home with bacterium X7-10 d if cellulitic or fever

Question 52

Tx for mild cellulitis

Answer 52

PO outpatient Clindamycin or Cephalexin

Question 53

Tx for cellulitis with systemic signs

Answer 53

admit to hospital for IV Ceftriaxone. If severe do IV vanco + Zosyn