Derm part 2 Flashcards
Organism of scabies
Sarcoptes scabiei
What is the hallmark presentation of scabies?
Severe and paroxysmal itching
Eruption of scabies in children
Eczematous eruption composed of red, excoriated papules and nodules
Distribution of scabies
Axillae Umbilicus Groin Penis Instep of the foot Web spaces of the fingers and toes
Scabies in infants
Diffuse erythema, scaling and pinpoint papules
How to confirm the dx of scabies
Microscopic visualization of the mite, eggs, larvae, or feces in scrapings of papules or burrows examined under oil immersion
Tx of scabies
12-hr application of permethrin 5% cream applied to the entire body
Repeat 1 wk later
Treat all close contacts
Wash all bed linens, towels, and clothes worn for the previous 2 days before tx in hot water and high heat
Transmission of lice
Direct contact with another infested individual Indirect through: -Contact with fomites -Hairbrushes -Combs -Caps
What is the primary symptom of lice?
Itching
Location of pediculosis capitis itching
Behind the ears or on the nape of the neck, or a crawling sensation in the scalp
Dx of head lice
Visualization of a live louse through wet combing
Which type of nits suggests active infestation?
Brown nits located on the proximal hair shaft
Tx of head lice
Over the counter permethrin and pyrethrin-based products
Second tx should be applied in 7-10 days
Tx of resistant head lice
Malathion lotion
Causative organism of warts
HPV
How are common warts transmitted?
Direct contact or by fomites
Description of common wart
Painless, well-circumscribed, 2-5 mm papule with a papillated or verrucous surface typically distributed on the fingers, toes, elbows, and knees.
Filiform warts
Verrucous, exophytic, 2 mm papules that have a narrow or pedunculated base
Flat warts
Multiple, flat-topped 2-4 mm papules clustered on the dorsal surface of the hands, soles of the feet (plantar warts), or on the face
Tx of warts except genital
Typically self-limited and resolve spontaneously without tx
Salicylic acid
Liquid nitro
Laser therapy
3 subclasses of urticaria
Acute
Chronic
Physical
Acute urticaria
Hives that last <6 wks
Chronic urticaria
Persistence of sx beyond 6 wks
Can be daily sx or intermittent or recurrent
Physical urticaria
Characterized by known eliciting external factors that may include pressure, cold, heat, exercise, or exposure to sun or water
What is the most common physical urticaria?
Dermatographism
Dermatographism
Characterized by an urticarial reaction localized to the site of skin trauma
Cholinergic urticaria
The appearance of 1-3 mm wheals surrounded by large erythematous flares after an increase in core body temp
Causes of cholinergic urticaria
Strenuous exercise
Hot bath
Emotional stress
Cold urticaria
Occurs with exposure to cold and may develop within minutes on areas directly exposed to cold or on rewarming of the affected parts
PE of urticaria
Raised erythematous lesions with pale centers that are intensely pruritic
Lesions vary in size and can occur anywhere on the body
Timing of urticaria
Arises suddenly and may resolve within 1-2 hrs or may persist for 24 hrs.
Tx of urticaria
Second generation H1 antihistamines
Add sedating H1 antihistamines or H2 antihistamines at bedtime if needed
TCAs for H1 and H2 activity
Montelukast
What are the four criteria upon which burns are classified?
Depth of injury
Percent of body surface area involved
Location of the burn
Association with other injuries
Superficial burns
Red, painful, and dry
Commonly seen with seen with sun exposure or mild scald injuries
Involve injury to the epidermis only
Heal in 2-5 days without scarring
Not included in burn surface area calculations
Superficial partial-thickness burns PE
Involve the entire epidermis and superficial dermis
Have fluid-containing blisters.
Tx and healing of superficial partial-thickness burns
Debridement
Healing usually occurs within about 2 wks without the need for skin grafting and without scarring.
Deep partial-thickness burns PE
Involve the entire epidermis and deeper portions of the dermis
Characteristics of superficial partial-thickness burns after tx
Underlying dermis appears erythematous and wet, will be painful, and will blanch under pressure
Dermal base of deep partial-thickness burns
Less blanching
Mottled pink or white
Less painful than superficial partial-thickness burns
Tx of deep partial-thickness burns
Excision and grafting
Full-thickness burns PE
Involve all skin layers
Dry, white, dark, red, brown, or black in color
Do not blanch and are usually insensate
Tx of full-thickness burns
Surgical management
When to suspect inhalation injuries with burns
Facial burns
Singed nasal hairs
Carbonaceous sputum
Hoarseness on vocalization
Rule of 9s for children
Face: 18%
Torso: 18% each for both front and back
Arms: 9%
Legs: 14%
Labs for major burns
CBC Type and crossmatch Coagulation studies Basic chem profile ABG CXR
Labs for suspected inhalation exposure for burns
Carboxyhemoglobin assessment
Labs for children who sustain smoke inhalation and have AMS
Cyanide levels
Burn center transfer criteria
Partial and full-thickness burns >10% total body surface area in pts <10 yrs old or >50 yo or >20% TBSA in other age groups
Partial and full-thickness burns involving the face, hands, feet, genitalia, perineum, or major joints
Electrical burns
Chemical burns
Inhalation injury
Burn injury in pts with preexisting medical conditions that could complicate management, prolong recovery, or increase mortality rate
Any burn with concomitant trauma
Burn injury in children with ill-euqipped hospitals
Children who required social, emotional, or rehabilitative support
Tx of burns
ABCs Fluid management- children with a significant burn should get rapid bolus of 20 mL/kg LR solution Nutritional support Wound care Pain control
Common topical agents for burns
Silver sulfadiazine Polymyxin B/bacitracin/neomycin Alternatives: Silver nitrate Mafenide acetate
