Dermatology/Burns Review Flashcards by Alexis B

When is antibiotics recommended for dog bites?

Moderate to severe bite wounds and punctures
Facial bites, hand/foot, or genital area wounds
Immunocompromised or asplenic host

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What is typical of the workup for a dog and human bite?1

X-ray for suspected fracture, penetrating wound over bone/joint, foreign body
Wound culture

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What antibiotics is recommended for dog bites?

Amoxicillin-clavulanate PO

Consider vancomycin for MRSA coverage if severe

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What are signs of systemic toxicity for a snake bite?

Tachycardia, hypotension
Swelling of airways
Altered mental status

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What are the common labs after a snake bite?

Hemoglobin and Hematocrit
Platelet
Creatinine
ALT/AST
Coagulation studies
CK

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How do you dose anti-venom for snake bites?

Based on severity!

NOT based on weight/age

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A snake bite that causes inflammation, redness, and joint pain along with tissue necrosis?

Brown recluse

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A snake bite that causes intense pain with tachycardia, flushed appearance, and altered mental status

Black widow

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Snake bite that causes ring of white tissue ischemia then blisters then has a bull’s eye effect

Brown recluse

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Snake bite with acute pain, swelling, muscle spasms, tachycardia, hypertension, and agitation

Black widow

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What is the “tap test” for a snake bite?

You tap the bite area and it causes severe pain

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What is the best way to treat a jellyfish sting?

Double glove and remove adherent tentacles

Baking soda slurry (baking soda and water)

Topical steroids

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Epidermal erythema and superficial necrosis with consistent pattern of progression with prodrome of URI and purulent conjunctivitis

Staph Scalded Skin Syndrome

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Presents with erythema (redness around mouth and spreads with Nikolsky’s sign) and in the next 24-48 hours, there is exfoliation; then the next couple of days there is desquamation and then 5-7 days later there is new skin

Staph Scalded Skin Syndrome

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What is the treatment for staph scalded skin syndrome?

Vancomycin IV/Clindamycin IV

Fluid and electrolyte management

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What are the most common venomous snake species?

Rattlesnakes, cottonmouth moccasins, copperheads, and coral snakes

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What are the diagnostic tests for brown recluse?

No specific lab tests

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What are the diagnostic tests for black widow?

CBC, metabolic panel, coagulation studies, ECG, and urinalysis

What is the treatment for brown recluse bites?

Local debridement, elevation, loose immobilization, and cool compresses

Avoid strenuous activity

What is the treatment for black widow bites?

Local wound care, tetanous prophylaxis, pain control, cool compresses/ice packs

Treat infection with broad-spectrum antibiotics

Monitor for 6 hours in mild cases

How do you treat muscle cramps associated with black widow bites?

Benzodiazepines, opioids, or dantrolene

How do you treat bee and wasp stings?

Remove the stringer

Treat local reactions symptomatically

How do you treat anaphylaxis reaction to bee and wasp stings?

Epinephrine, corticosteroids, inhaled beta-adrenergic agonists, and H1 and H2 antihistamines

What is a rapidly progressing deep tissue involving fascial and muscle layers, skin, and subcutaneous tissue

Necrotizing fasciitis

Erythema, warmth, induration, and edema of skin at local inflammatory site; rapidly progressing; fever >39C Associated with limited mobility of nearest joint May progress to gangrene and tissue sloughing

Necrotizing fasciitis

What are the signs of compartment syndrome?

Edema, pain, loss of sensation, decreased/absent pulses on associated extremity

What are the common antibiotic types for necrotizing fasciitis?

Aerobic (penicillin G, ampicillin-sulbactam, clindamycin) Anaerobic coverage (metronidazole, 3rd generation cephalosporin)

What is a hypersensitivity reaction affecting skin and mucous membranes that is commonly attributed to medication, infection, and environmental causes?

Stevens-Johnson Syndrome

What medications are associated with Stevens-Johnson Syndrome?

Antibiotics (sulfonamides), anticonvulsant medications (phenobarbital, lamotrigine, carbamazepine), nonsteroidal anti-inflammatory medications

A patient has high fevers, cough, rhinorrhea, pharyngitis, vomiting, diarrhea, headache, myalgia, and arthralgia. What disease are these symptoms related to?

Stevens-Johnson Syndrome

What is hypersensitivity reaction resulting in damage to epidermis?

Toxic epidermal necrolysis

A child presents with fevers, malaise, localized skin tenderness and diffuse erythema, painful, burning, erythematous, or dusky macule rash after 24 hours

Toxic epidermal necrolysis

Widespread blister formation or confluent erythema with skin tenderness Absence of target lesions Sudden onset within 24-48 hours Full thickness epidermal necrosis

Toxic epidermal necrolysis

Localized injury to skin and/or underlying tissue usually over a bony prominence

Pressure ulcer

What is a non-blanchable erythema of intact skin that doesn't resolve within 30 minutes of pressure relief?

Stage I pressure ulcer

What involves epidermis, dermis, or both presenting as shallow open ulcer with red pink wound bed without slough?

Partial thickness (Stage II) pressure ulcer

What is it when there is a full-thickness tissue loss with subcutaneous fat may be visible but bone, tendon or muscle is not exposed?

Full-thickness skin loss (Stage III) pressure ulcer

What is it when there is full-thickness tissue loss with exposed bone, tendon or muscle?

Full-thickness tissue loss (Stage IV) pressure ulcer

A 3-year-old girl presents to the ED for a progressive erythematous rash to her torso and bilateral lower extremities. She has had a fever for 1 day and has been receiving ibuprofen for the past 24 hours. What is the likely diagnosis? A. Stevens-Johnsons syndrome B. TEN C. Necrotizing fasciitis D. Kawasaki disease

TEN

Which of the following is a contraindication for NPWT in the pediatric patient? A. Placing NPWT dressing over nerves B. Using NPWT in a clean wound bed C. Using a NPWT pressure setting appropriate for the child's age D. Using NPWT on a pediatric patient after flap surgery

A. Placing NPWT dressing over nerves

Which of the following is an advantage of using NPWT? A. Decreases perfusion B. Increases edema C. Inhibits granulation tissue formation D. Prepares wound bed for closure

D. Prepares wound bed for closure

When examining a patient with a confluent, erythematous sloughing rash. TEN is suspected. Which of the following physical examination supports diagnosis of TEN? A. Target lesions B. Crusted lesions C. Petechiae D. Skin tenderness

D. Skin tenderness

When evaluating a child with a prolonged hospitalization, it is noted that he has a blister on his sacrum. This lesion is categorized as which of the following pressure ulcer stages? A. Stage I B. Stage II C. Stage III D. Stage IV

B. Stage II

Which combination is the best choice for empiric antibiotic treatment of suspected necrotizing fasciitis? A. Ampicillin and Flagyl B. Vancomycin and ciprofloxacin C. Bactrim and fluconazole D. Rocephin and gentamycin

B. Vancomycin and ciprofloxacin