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ACNP Exam > Derm disorders > Flashcards

Derm disorders Flashcards

1
Q

Cellulitis - patho, s/s, things to look for

A

diffuse infiltration of bacteria
red, warm skin
important to determine if lymphadenopathy or streaking is present

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2
Q

Erysipelas - what is it and treatment

A

Type of cellulitis on the face
gram + strep
usually occurs on the middle 3rd of the face and drains downwards into regional lymph nodes –> meningitis
need IV antibiotics - linezolid

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3
Q

Carbuncle - description, management

A

multiple deep seeded furuncles, does not have a central location for I & D
Management - needs OR I&D with washout and IV abx

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4
Q

Paronychia - description, management

A

abscess of the nail bed, requires I&D + oral abx

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5
Q

Treatment for minor skin infections

A

bacitracin or mupirocin

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6
Q

Treatment for severe skin infections (systemic s/s)

A

First-generation cephalosporins (FA/PHA) - cefazolin, cephalexin or beta-lactamase resistant PCNs (pipercillin)

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7
Q

Herpes Zoster (shingles) general information

A

c/b varicella-zoster virus –> acute vesicular eruptions along a dermatomal pattern
in immunocompromised adults, this can be life-threatening

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8
Q

Herpes Zoster Assessment

A

painful, grouped vesicular eruption across a dermatomal pattern
typically on the trunk, if it goes beyond midline consider immunocompromised
regional lymphadenopathy may be present
typically presents in steps - discomfort/tingling prodromal syndrome, vesicular eruption

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9
Q

Herpes Zoster labs/diagnostics

A

typically not indicated
you can consider Tznack smear, viral serology for viral IgM

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10
Q

Appropriate treatment for herpes zoster

A

oral valacyclovir for 7 days
start within 72hrs of presentation
- can use other -clovir drugs

immunocompromised patients - severe - acyclovir IV 7-14 days

ocular involvement - urgent referral to optho

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11
Q

Lyme disease - general information

A

spirochetal disease c/b Borrelia burgdorferi
most common vector-born disease in the US
c/b deer ticks - tick becomes infected with the bacteria after feeding on mice and/or birds.
Must attach to person > 24hrs

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12
Q

Lyme disease Assessment

A

Stage 1 (local) - erythema migrans rash, 50% of patients develop flu-like symptoms (bull’s eye rash)
Stage 2 (systemic) - HA, joint stiffness, migratory pain, complications - cardiac symptoms, aseptic meningitis, Bell’s palsy, and peripheral neuropathy
Stage 3 - joint and periarticular pain, sub-acute encephalopathy, acrodermatitis chornicum atrophicans (bluish/red discoloration of the distal extremity with edema)

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13
Q

Lyme disease lab/diagnostics

A

ELISA screening - detects B. Burgdorferi antibody
Western blot - for confirmation
can also consider PCR, ESR, LFTs

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14
Q

Lyme disease diagnostic criteria

A
  • exposure to tick habitat within the last 30 days with erythema migrans
  • exposure to tick habitat within the last 30 days with one late manifestation and laboratory confirmation
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15
Q

Lyme disease treatment

A

primary regimen - doxycycline 100mg PO bid 10 days
can also consider amoxicillin or cefuroxime
azithromycin 500mg PO 1x daily for 10 days (if unable to take doxy or beta-lactams)
if they have systemic complications - 30 days
neuro manifestations - PCN or cephalosporin IV

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16
Q

Actinic keratosis general information

A

small patches occurring on sun-exposed parts of the body
typical in individuals with a fair complexion
considered premalignant and can progress to SCC

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17
Q

AK Assessment

A

small (typically painless) patches
flesh colored, pink, or slight pigmentation
feel like sandpaper

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18
Q

AK labs and diagnostics

A

not typically needed, biopsy if unresponsive to treatment

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19
Q

AK treatment

A

LN
flouracin cream bid two weeks
Masoprocol 10% cream

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20
Q

Seborrheic keratosis general information & assessment

A

benign plaques, with a stuck-on appearance
3-30mm in diameter
no labs or diagnostic studies

21
Q

SK treatment

A

no treatment necessary
can be frozen with LN or surgically removed
cosmetic

22
Q

BCC general information

A

slow-growing carcinoma starting as a papule or nodule - central scab or erosion
commonly presents on the face, occurs mostly in fair-skinned individuals in 20-30s
no mets, can lead to deformity

23
Q

BCC assessment

A

papule or nodule with central scab or erosion
waxy or pearly appearance can also present shiny red

24
Q

BCC labs & diagnostics

A

shave or punch bx
if left untreated it can really cause deformity

25
Q

BCC treatment

A

surgical incision, cryo, radiotherapy
derm referral

26
Q

SCC general information

A

arise from AK and rapidly growing - limited risk of met
common in sun-exposed parts of the body, oral cavity, and genital area

27
Q

SCC Assessment

A

small, red, conical, hard nodules
occasionally nodules can lead to ulceration

28
Q

SCC labs/diagnostics

A

biopsy

29
Q

SCC treatment

A

surgical excision
consider chemo and radiation

30
Q

Malignant melanoma general information

A

leading cause of CA death r/t skin CA
high rate of mets - in most cases if it mets the prognosis is poor
most common in caucasian populations

31
Q

Malignant melanoma assessment

A

ABCs of malignant melanoma
- asymmetry
- borders are irregular
- color (multiple) or changing lesion
- diameter > 6mm (pencil eraser)
- elevated or evolving lesion

32
Q

Malignant melanoma labs/diagnostics

A

biopsy
could need met screening - commonly goes to the lungs

33
Q

Malignant melanoma treatment

A

referral to derm and/or oncology
excision with possible LN dissection
chemo

34
Q

Would hemostasis

A

direct pressure (gold standard)
lido + epi (no epi on fingers, ears, nose, penis, or toes)
gel foam
cautery

35
Q

primary closure

A

suture, staple, adhesive, or tape
performed on recently sustained lacerations < 12hrs and < 24h on face

36
Q

When to refer

A

tarsal plate or lacrimal duct
open fracture or joint space
extensive facial wounds
associated with amputation
associated with loss of function
involves tendons, nerves, or vessels
significant loss of epidermis
or if you are uncertain

37
Q

Pressure ulcer staging

A

stage 1 - non-blanching erythema of intact skin; induration may be present
stage 2 -epidermal or dermal loss; can appear as intact blister
stage 3 - full-thickness skin loss; deep crater w/o undermining
stage 4 - full-thickness skin and tissue loss; though fascia, muscle, bone, or supporting tissue visible
unstageable - full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, grey, green, or brown) and/or eschar (tan, brown, or black) in the wound bed

38
Q

Macule

A

flat discoloration of the epidermis
< 1cm

39
Q

Patch

A

flat, discoloration of the epidermis
> 1cm

40
Q

Papule

A

Elevated firm skin lesion, < 0.5cm

41
Q

Nodule

A

elevated, firm skin lesion > 0.5cm

42
Q

Tumor

A

Elevated firm skin lesion >1cm
can be benign or malignant
usually not filled with anything

43
Q

Wheal

A

raised skin lesion above the surface of the skin that extends below the epidermis
ex: allergic rhinitis, usually IgE mediated reaction, contact dermatitis or hives

44
Q

Vesicle

A

small lesion filled with serous fluid, <0.5cm
ex: herpes, chicken pox, contact dermatitis

45
Q

Bulla

A

larger lesion filled with serous fluids, > 0.5cm
ex: blister

46
Q

Pustule

A

small lesion filled with pus, < 0.5cm
some form of bacterial infection
ex: acne, folliculititis, impetigo

47
Q

Abscess

A

Large lesion filled with pus, > 0.5cm

48
Q

cyst

A

non-infectious fluid filled lesion

ACNP Exam (6 decks)

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